MRI of Hip Arthroplasties: Comparison of Isotropic Multiacquisition Variable-Resonance Image Combination Selective (MAVRIC SL) Acquisitions With a Conventional MAVRIC SL Acquisition.

OBJECTIVE. The objective of our study was to compare the quality and diagnostic utility of the following three metal artifact reduction sequences in evaluating hip arthroplasties: conventional multiacquisition variable-resonance image combination selective (MAVRIC SL), isotropic MAVRIC SL, and reduced-TR isotropic MAVRIC SL. SUBJECTS AND METHODS. Ninety-three hip arthroplasties (85 total hip replacements and eight hip resurfacings [nine bilateral hips]) in 84 patients (38 men and 46 women; mean age ± SD, 69.1 ± 9.7 years old) were imaged and evaluated. A calibration scan determined the number of spectral bins needed for each implant, and isotropic and conventional MAVRIC SL images were acquired. Reduced-TR isotropic MAVRIC SL scans were acquired for 40 arthroplasties. Two board-certified radiologists blinded to MRI acquisition evaluated images for clinical and image quality features and compared images using a mixed-effects ordinal logistic regression model and odds ratios. Rater agreement was assessed with Gwet agreement coefficients. Scanning times were compared using mixed-effects linear regression. Significance was set at p < 0.05. RESULTS. Calibration scans decreased the number of bins needed (median, 12 bins; interquartile range, 10-16 bins). Isotropic MAVRIC SL (mean scanning time, 7 minutes 16 seconds; 95% CI, 7 minutes 7 seconds-7 minutes 25 seconds) acquisitions had the longest scanning time, and conventional (mean, 5 minutes 46 seconds; 95% CI, 5 minutes 37 seconds-5 minutes 55 seconds) and reduced-TR isotropic (5 minutes 28 seconds; 95% CI, 5 minutes 15 seconds-5 minutes 41 seconds) MAVRIC SL acquisitions had scanning times that were similar. Both isotropic and reduced-TR isotropic MAVRIC SL images showed decreased blurring and improved visualization of the synovium and periprosthetic bone compared with conventional MAVRIC SL images (p < 0.001). Isotropic MAVRIC SL acquisitions more effectively improved signal-to-noise ratio (SNR), visualization of the synovium and periprosthetic bone, and lesion conspicuity and decreased blurring compared with reduced-TR isotropic MAVRIC SL acquisitions (p < 0.032). CONCLUSION. Isotropic MAVRIC SL acquisitions improve SNR, conspicuity of lesions, and visualization of synovium and periprosthetic bone and decrease blurring compared with conventional MAVRIC SL acquisitions.

MRI of THA Correlates With Implant Wear and Tissue Reactions: A Cross-sectional Study.

BACKGROUND: MRI is predictive of adverse local tissue reactions (ALTRs) after THA but how MRI directly relates to implant surface wear, fretting, and trunnion corrosion at different articulations between implant components remains unclear. MRI generates high-contrast images to display soft tissues around arthroplasty and may provide a surgeon the means to distinguish and differentiate host-related synovial patterns as a response to either polyethylene wear or metal wear and corrosion products. QUESTIONS/PURPOSES: The purposes of this study were (1) to correlate findings from MRI in patients who have undergone THA with direct assessment of implant wear, corrosion, and fretting from retrieved components; and (2) to distinguish the unique synovial responses on MRI in patients who have undergone THA based on bearing materials. METHODS: In this prospective study, patients undergoing THA (181 patients, 187 hips) with metal-on-metal (MoM), hip resurfacing (HRA), metal-on-polyethylene (MoP), ceramic-on-polyethylene, ceramic-on-ceramic, or modular neck designs having revision surgery (between October 2013 and June 2017) underwent preoperative MRI. A single reader blinded to the bearing surface made an assessment of the synovial response (Gwet's AC1, 0.65-0.97); these data were compared with semiquantitative histology of tissue samples by a single reader (Gwet's AC1, 0.92) and semiquantitative wear, corrosion, and fretting analysis of retrieved components using Goldberg scoring (Gwet's AC1, 0.60-0.79). Direct noncontact measurements of implant wear were also made. Correlations and analyses of variance were used to assess associations between metrics and differences by implant type, respectively. RESULTS: Correlations were found between MRI synovial thickness with severity of fretting and corrosion damage of the female head-neck trunnion of femoral stems in modular designs (ρ = 0.26 [95% confidence interval {CI}, 0.12-0.39]; p = 0.015, n = 185) and ALTR grade and volumetric wear in MoM bearings (ρ = 0.93 [95% CI, 0.72-0.98]; p < 0.001, n = 10). MRI synovial thickness was highest in patients identified with aseptic lymphocyte-dominated vasculitis-associated lesions and diffuse tissue necrosis. On MRI, MoP hips demonstrated a distinct polymeric synovial response, whereas HRA, MoM, and modular hips more commonly demonstrated ALTR. Hips classified as having a polymeric synovial response on MRI had a greater number of particles present in tissue samples. CONCLUSIONS: In this study, we demonstrated that MRI of THA can distinguish synovial responses that reflect the bearing type of the implanted THA and correlate to direct measurements of implant wear, corrosion, and fretting and histologic assessment of wear particles in periprosthetic tissues. MRI provides a means of direct, noninvasive visualization of the host-generated synovial response. Patients presenting with painful arthroplasties may be evaluated for the cause of their discomfort, specifically highlighting any concerning synovial reactions that would warrant more prompt surgical intervention. Future studies would benefit from a prospective evaluation of different implants to assess the natural longitudinal history of arthroplasty complications, including the development and prevalence of ALTR across bearing constructs. LEVEL OF EVIDENCE: Level III, diagnostic study.

Influence of custom adaptation on the characteristics of fiber posts.

In this in vitro study, 3 experiments were conducted to evaluate the influence of customizing the apical portion on the characteristics of fiber posts. In the first experiment, 4 fiber posts were submitted to different custom adaptations (no customization, industrial shaping tool, diamond bur, or paper disc) and were observed with a scanning electron microscope to evaluate the micromorphologic changes. In the second experiment, 60 posts of different sizes were divided into 6 groups (n = 10): 0 (No. 0.5), 1 (No. 1), 2 (No. 2), 3 (No. 3), 4 (No. 4), and 5 (paper disc-remodeled No. 4). The posts were submitted to a 3-point bending test. In the third experiment, the crowns of 20 extracted, healthy permanent human canines were removed, and the teeth were endodontically treated, embedded in acrylic resin, and divided into 2 groups (n = 10): I (control), No. 4 posts cemented into post spaces prepared with a No. 4 drill; and II (test), remodeled No. 4 posts cemented into root spaces prepared with No. 2 and 4 drills. The posts were cemented with self-adhesive dual resin cement, and the specimens received direct resin crowns. Fracture strength was measured with a universal testing machine at 45 degrees until fracture. Results were submitted to analysis of variance (P ≤ 0.05). Customization of fiber posts with diamond burs or paper discs produced acceptable micromorphologic changes. Custom adaptation of fiber posts reduced their flexural strength, which remained at acceptable values. Teeth restored with customized fiber posts had greater fracture strength than those restored with intact posts. The results of this study indicated that post remodeling is a safe means to facilitate adaptation to root walls and preserve tooth structure.

Corrosion in artificial saliva of a Ni-Cr-based dental alloy joined by TIG welding and conventional brazing.

STATEMENT OF THE PROBLEM: Fixed prosthesis and partial dental prosthesis frameworks are usually made from welded Ni-Cr-based alloys. These structures can corrode in saliva and have to be investigated to establish their safety. PURPOSE: The purpose of this study was to evaluate the corrosion behavior of joints joined by tungsten inert gas (TIG) welding and conventional brazing in specimens made of commercial Ni-Cr alloy in Fusayama artificial saliva at 37°C (pH 2.5 and 5.5). MATERIAL AND METHODS: Eighteen Ni-Cr base metal specimens were cast and welded by brazing or tungsten inert gas methods. The specimens were divided into 3 groups (base metal, 2 welded specimens), and the composition and microstructure were qualitatively evaluated. The results of potential corrosion and corrosion current density were analyzed with a 1-way analysis of variance and the Tukey test for pairwise comparisons (α=.05). RESULTS: Base metal and tungsten inert gas welded material showed equivalent results in electrochemical corrosion tests, while the air-torched specimens exhibited low corrosion resistance. The performance was worst at pH 2.5. CONCLUSIONS: These results suggest that tungsten inert gas is a suitable welding process for use in dentistry, because the final microstructure does not reduce the corrosion resistance in artificial saliva at 37°C, even in a corrosion-testing medium that facilitates galvanic corrosion processes. Moreover, the corrosion current density of brazed Ni-Cr alloy joints was significantly higher (P<.001) than the base metal and tungsten inert gas welded joints.

Influence of surface sealants on the quality of posterior restorations with bulk-fill composites: A 4-year randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate the clinical performance of surface sealants associated with a bulk-fill composite in posterior restorations after 4 years. METHODS: A total of 174 posterior restorations were performed on 57 participants using a self-etch adhesive system and a bulk-fill composite. The groups were then divided into the following categories: 1) without surface sealant (NoS), 2) with surface sealant Biscover (Bisco, SBi), and 3) with surface sealant Permaseal (Ultradent, SPe). Restorations were evaluated using FDI criteria at baseline and after 1 and 4 years. Statistical analysis was conducted using Kaplan-Meier survival analysis and the Chi-square test (α = 0.05). RESULTS: After 4 years, only one restoration was lost (1 in the NoS group). The fracture/retention rate (with 95% confidence interval) was 98% for NoS and 100% for both SBi and SPe (p = 0.76). The majority of secondary outcomes showed minor defects, with no significant differences among the groups (p > 0.05). However, significant differences were observed among the groups in terms of marginal staining and marginal adaptation (p = 0.03). In both items, twelve restorations (nine in NoS, one in SBi, and two in SPe) showed minor marginal discrepancies favoring the sealant groups (SBi and SPe). SIGNIFICANCE: Regardless of the use of surface sealants, the bulk-fill composite restorations showed excellent clinical performance after 4 years. However, the groups that received sealants showed better marginal adaptation and less marginal discoloration compared to those that did not receive sealants.

COVID-19 in non-hospitalised adults caused by either SARS-CoV-2 sub-variants Omicron BA.1, BA.2, BA.4/5 or Delta associates with similar illness duration, symptom severity and viral kinetics, irrespective of vaccination history.

BACKGROUND: SARS-CoV-2 variant Omicron rapidly evolved over 2022, causing three waves of infection due to sub-variants BA.1, BA.2 and BA.4/5. We sought to characterise symptoms and viral loads over the course of COVID-19 infection with these sub-variants in otherwise-healthy, vaccinated, non-hospitalised adults, and compared data to infections with the preceding Delta variant of concern (VOC). METHODS: In a prospective, observational cohort study, healthy vaccinated UK adults who reported a positive polymerase chain reaction (PCR) or lateral flow test, self-swabbed on alternate weekdays until day 10. We compared participant-reported symptoms and viral load trajectories between infections caused by VOCs Delta and Omicron (sub-variants BA.1, BA.2 or BA.4/5), and tested for relationships between vaccine dose, symptoms and PCR cycle threshold (Ct) as a proxy for viral load using Chi-squared (χ2) and Wilcoxon tests. RESULTS: 563 infection episodes were reported among 491 participants. Across infection episodes, there was little variation in symptom burden (4 [IQR 3-5] symptoms) and duration (8 [IQR 6-11] days). Whilst symptom profiles differed among infections caused by Delta compared to Omicron sub-variants, symptom profiles were similar between Omicron sub-variants. Anosmia was reported more frequently in Delta infections after 2 doses compared with Omicron sub-variant infections after 3 doses, for example: 42% (25/60) of participants with Delta infection compared to 9% (6/67) with Omicron BA.4/5 (χ2 P < 0.001; OR 7.3 [95% CI 2.7-19.4]). Fever was less common with Delta (20/60 participants; 33%) than Omicron BA.4/5 (39/67; 58%; χ2 P = 0.008; OR 0.4 [CI 0.2-0.7]). Amongst infections with an Omicron sub-variants, symptoms of coryza, fatigue, cough and myalgia predominated. Viral load trajectories and peaks did not differ between Delta, and Omicron, irrespective of symptom severity (including asymptomatic participants), VOC or vaccination status. PCR Ct values were negatively associated with time since vaccination in participants infected with BA.1 (ß = -0.05 (CI -0.10-0.01); P = 0.031); however, this trend was not observed in BA.2 or BA.4/5 infections. CONCLUSION: Our study emphasises both the changing symptom profile of COVID-19 infections in the Omicron era, and ongoing transmission risk of Omicron sub-variants in vaccinated adults. TRIAL REGISTRATION: NCT04750356.

Hybrid layer thickness and morphology: Influence of cavity preparation with air abrasion.

Dentinal surfaces prepared with air abrasion have considerably different characteristics from those prepared with conventional instruments. Different hybrid layer morphology and thickness occur, which can result in differences in the quality of restorations placed on dentinal surfaces prepared with a diamond bur compared to surfaces prepared using air abrasion. The objective of this study was to compare the hybrid layer thickness and morphology formed utilizing Scotchbond Multi-Purpose Plus (SBMP) on dentin prepared with a diamond bur in a high-speed handpiece and on dentin prepared using air abrasion. Flat dentin surfaces obtained from five human teeth were prepared using each method, then treated with the dentin adhesive system according to manufacturer's instructions. After a layer of composite was applied, specimens were sectioned, flattened, polished, and prepared for scanning electron microscopy. Ten different measurements of hybrid layer thickness were obtained along the bonded surface in each specimen. SBMP produced a 3.43 ± 0.75 µm hybrid layer in dentin prepared with diamond bur. This hybrid layer was regular and found consistently. In the air abrasion group, SBMP produced a 4.94 ± 1.28 µm hybrid layer, which was regular and found consistently. Statistical ANOVA (P = 0.05) indicated that there was a statistically significant difference between the groups. These data indicate that the air abrasion, within the parameters used in this study, provides a thick hybrid layer formation.

Effect of a glaze/composite sealant on the 3-D surface roughness of esthetic restorative materials.

The main goal of the current study was to evaluate the surface roughness of tooth-colored restorative materials after different finishing/polishing protocols, including a liquid polisher (BisCover, BISCO, Schaumburg, IL, USA). The restorative materials tested included two nanofilled resin composites (Filtek Supreme, 3M Dental Products, St Paul, MN, USA and Grandio, Voco, Cuxhaven, Germany), one resin-modified glass ionomer cement (Vitremer, 3M Dental Products) and one conventional glass ionomer cement (Meron Molar ART, Voco). The finishing/polishing methods were divided into five groups: G1 (compression with Mylar matrix), G2 (finishing with diamond burs), G3 (Sof-Lex, 3M Dental Products), G4 (BisCover, BISCO, after diamond burs) and G5 (BisCover after Sof-Lex). Five cylindrical specimens of each material were prepared for each group according to the manufacturer's instructions. The finishing/polishing methods were performed by a single operator in one direction to avoid variations at low speed (15,000 RPM). The surface roughness was evaluated using a 3-D scanning instrument with two parameters considered (Ra and Rz). The data was analyzed using one-way ANOVA followed by a multiple comparison Tukey's test. The results showed that BisCover (BISCO) was capable of reducing surface roughness and provided polished surfaces for all materials, enhancing smoothness over already polished surfaces (Sof-Lex, 3M Dental Products) and achieving polishing after finishing with diamond burs.

Influence of activation mode, fatigue, and ceramic interposition on resin cements' diametral tensile strength.

This study evaluated the influence of activation modes, on Diametral Tensile Strength (DTS) of dual cured resin cements subjected to a Mechanical Fatigue test (MF). Four dual-cured resin cements (RelyX UNICEM [U], RelyX ARC [A], ENFORCE [E] and Nexus 2 [N]) were activated by three different curing modes as follows: Self-Curing (SC), Dual Cure activation with photoactivation executed directly (DC) and Dual Cure activation with Photoactivation Through Porcelain (DCTP). After 24 hours, half of the sample was subjected to 30.000 fatigue cycles at 1 Hz frequency and 12 N load. Then, all specimens were subjected to DTS test in Instron Universal Testing Machine and data were analyzed by three-way ANOVA and Tukey's Test (5%). The results of DTS test means (MPa) and standard deviation, for each cement factor activated by SC, DC and DCTP was respectively: U (28.12 ± 5.29; 37.44 ± 6.49 and 40.10 ± 4.39), A (49.68 ± 8.42; 55.12 ± 5.16 and 63.43 ± 6.92), E (49.12 ± 3.89; 56.42 ± 8.88 and 56.96 ± 6.45) and N (61.89 ± 11.21; 59.26 ± 9.47 and 62.56 ± 10.93). Turkey's test indicated that DC is related to the highest DTS values; Nexus 2 DTS remained the same independently of activation mode and that the Porcelain disk interposition enhanced DTS only for RelyX ARC the ANOVA statistical test indicated that MF didn't alter the DTS values for all experimental groups. MF results clinical implication is that all cements tested exhibited, in an immediate loading, good cross linked bonds quality.

Analysis of the Chemical Modification of Dental Enamel Submitted to 35% Hydrogen Peroxide "In-Office" Whitening, with or without Calcium.

PURPOSE: The purpose of this study was to evaluate changes in calcium and phosphorus content in dental enamel when subjected to "in-office" whitening for an extended time by using a 35% hydrogen peroxide solution, with and without calcium. MATERIALS AND METHODS: 10 human teeth, from which the roots had been removed, were embedded in epoxy resin, and their surfaces were smoothed. The specimens were divided into two groups; in group 1, a whitening solution without calcium was used, while in group 2, the solution included calcium. Each specimen was evaluated at 6 different points before the bleaching treatment, and these points were reassessed after each session. A total of five sessions were carried out. Concentrations of calcium and phosphorus were measured by using the technique of X-ray fluorescence. RESULTS: After performing a statistical analysis, it was found that there was no statistically significant loss of calcium and phosphorus during the whitening treatment, and the groups showed no statistical differences. CONCLUSION: Excessive use of hydrogen peroxide, with or without calcium, causes no loss of calcium and phosphorus.

SEM evaluation of a non-rinse conditioner and a self-etching adhesive regarding enamel penetration.

This study evaluated the effect of a non-rinse conditioner (NRC) associated with two adhesive systems, Prime & Bond NT and Prime & Bond 2.1. The study also evaluated a self-etching adhesive, comparing it with the 37% phosphoric acid effects related to the regularity and infiltration depth of adhesives in human tooth enamel via observation using Scanning Electronic Microscopy (SEM). Fifteen third molars were longitudinally sectioned into four parts by means of a mesio-distal cut and facio-lingual cut. All pieces were flattened with silicon carbide paper, randomly separated and divided into five groups where the enamel surfaces were treated with different materials according to the manufacturers' instructions as follows: Group 1-Prime & Bond NT (Dentsply); Group 2-37% phosphoric acid + Prime & Bond NT; Group 3-Non-Rinse Conditioner (Dentsply) + Prime & Bond NT; Group 4-NRC + Prime & Bond 2.1 (Dentsply); Group 5-Prompt L-Pop (3M ESPE). All teeth were covered with Dyract AP (Dentsply). Specimens were decalcified, metalized and the inner portions of Dyract were observed in SEM and evaluated by calibrated examiners to evaluate resin penetration on enamel. Resin penetration was ranked from 0 = no penetration, to 3 = maximum penetration. The Kruskal-Wallis and Mann-Whitney U tests (p<0.05) showed only three statistically homogeneous groups: {1}, {2,3} and {4,5}. The authors concluded that Prime & Bond NT showed the lowest penetration, NRC showed similar effects compared to phosphoric acid when associated with Prime & Bond NT, and concluded that Prompt L-Pop showed similar effects to NRC, which was associated with Prime & Bond 2.1.

Influence of the Cement Film Thickness on the Push-Out Bond Strength of Glass Fiber Posts Cemented in Human Root Canals.

The present study evaluated the influence of the cement film thickness on the push-out bond strength of glass fiber posts in the cervical, medium, and apical thirds of root canal spaces. Thirty roots were randomly divided into three groups, according to the fiber post system's drills: (G1) #2; (G2) #3; (G3) #4. The posts were cemented using a self-adhesive cement, and a small amount of powdered Rhodamine B was used as a stain. Images of both sides of each slice were obtained before and after the push-out test. To determine the cement thickness, a macro routine was developed using the software KS 400. The data were analyzed statistically using Kruskal-Wallis and Dunn's test. G2 (14.62 ± 5.15 MPa) showed statistically higher bond strength values than G1 (10.04 ± 5.13 MPa) and G3 (7.68 ± 6.14 MPa). All groups presented higher bond strength values in the apical third. The bur diameter significantly influenced the results of the shear bond strength for the push-out test. The slight increase in the cement thickness allowed an increase in the values of shear bond strength when compared to very thin or very thick cement films.

Immediate Desensitization in Teeth Affected by Amelogenesis Imperfecta.

The aim of this paper was to describe a clinical case of immediate dental desensitization using a self-etch adhesive system in an adolescent patient diagnosed with amelogenesis imperfecta (AI). AI was associated with severe tooth sensitivity, treated by the application of a universal adhesive system for desensitization of the teeth affected by AI. Reduction of tooth sensitivity was assessed using a visual analog scale during all reevaluations. The technique was effective for reducing tooth sensitivity. It was concluded that the adhesive system for tooth desensitization had an immediate effect and maintained its effectiveness during a 12-month follow-up period.

Hybrid layer thickness and morphology: the influence of cavity preparation with Er:YAG laser.

Dentinal surfaces prepared with Er:YAG laser have significantly different characteristics from those prepared with conventional instruments. Different hybrid layer morphologies and thicknesses occur, which may result in differences in the quality of restorations placed on dentinal surfaces prepared with a diamond bur when compared with using an Er:YAG Laser. This study compared the hybrid layer thickness and morphology formed utilizing Scotchbond Multipurpose Plus (SBMP) on dentin prepared with a diamond bur in a high speed handpiece and dentin prepared with an Er:YAG laser. Flat dentin surfaces obtained from five human teeth were treated with the two methods and then with the dentin adhesive system according to the manufacturer's instructions. After a layer of composite was applied, the specimens were sectioned, flattened, polished and prepared for SEM observation. Ten different measurements of hybrid layer thickness were obtained along the bonded surface in each specimen. Results showed that SBMP produced a 3.43 +/- 0.75 microm hybrid layer in dentin prepared with a diamond bur. This hybrid layer was regular and constantly found. In the laser group, the dentin adhesive system produced a 1.54 +/- 0.35 microm hybrid layer that was very irregular and not found constantly. Statistical analysis of variance (p < 0.05) showed that there was a statistically significant difference between the groups. These data indicate that the Er:YAG laser, with parameters used in the experiment, is not a preparation method that allows for a thick hybrid layer formation, which is in opposition to using a diamond bur in a high speed turbine.

Shear bond strength of porcelain laminate veneer bonded with flowable composite.

This study evaluated the "in vitro" shear bond strength of two materials to bovine enamel when used as porcelain laminate veneer bonding systems. The authors used the dual-cured resin cement Variolink II (Vivadent) and the light-cured flowable composite Natural-Flow (DFL). Porcelain cylinders were bonded to bovine enamel following manufacturers' directions. After 24 hours of storage in distilled water and thermocycling, the specimens were tested on a universal testing machine to determine the shear bond strengths. Mean strengths found in Groups 1 (resin cement) and 2 (flowable composite) were not statistically different (p < or = 0.05). The authors concluded that the shear bond strength of Natural-Flow is not different from Variolink II and that flowable composites can be a suitable alternative when used as porcelain laminate veneer bonding systems.

The effect of disk type and cutting speed on the micro-tensile bond strength of ceramic specimens to resin cement.

The bond strength of dental materials has been evaluated by tensile testing of micro-specimens. The cutting process used to obtain specimens may influence the results. The objective of this study was to investigate the influence of different types of diamond disks and cutting speeds on the bond strength of ceramic specimens and on specimen integrity. Lithium disilicate-based ceramic cubes were bonded with resin cement to composite resin cubes, according to the manufacturers' instructions. The ceramic/cement/resin blocks thus obtained were divided into two groups to be cut with Buehler(®) or Extec(®) disks and then sectioned at cutting speeds of 200 rpm and 400 rpm. The results showed that the bond strength values were affected by the cutting speed and disk/speed interaction (p<0.05). SEM analysis revealed better specimen properties when the blocks were cut at 200 rpm. It was concluded that ceramic specimens must be cut at low speeds.

Aesthetic solution for ceramic restoration on cast metal core

Introduction: In order to satisfy the aesthetic desires of the population, by masking the restorations was the search for the evolution of restorative materials enabling the introduction of metal-free materials. But previous studies that have been made with metal structures often cannot be removed and therefore require devices that can be masked, because there is no desire for a total passage of light avoiding dim reflection of these funds. For these situations, you must opt for a ceramic system to provide a degree of opacity, without losing its characteristics of light transmission, reflectance and saturation. Case report: In case the patient had clinical a metal ceramic crown on the molten core element 21, it was confirmed radiographically the core could not be removed because it would fracture risk to the tooth. We chose to use an opaquer ceramic framework to prevent the passage of light over dark metal. The material of choice was zirconia ceramic by high flexural strength, allowing it to function as a framework for crowns. Conclusion: With the correct application of ceramic coverage on Caquetá noted that it is possible to mask the gray color of the metal through the knowledge of the optical material, the correct use of these properties, opacity and translucidus, and a close contact between dentists and prosthetic.

Introdução: A fim de satisfazer os anseios estéticos, da população, por mascarar as restaurações houve a busca pela evolução dos materiais restauradores possibilitando a introdução de materiais livres de metais. Porém trabalhos prévios que foram confeccionados com estruturas metálicas muitas vezes não podem ser removidos e, portanto, necessitam de artifícios para que possam ser mascarados, pois não há o desejo de uma total passagem de luz evitando a reflexão desses fundos escurecidos. Para estas situações, é necessário optar por um sistema cerâmico que apresente um grau de opacidade, sem perda de suas características de translucidez, refletância e saturação. Relato do caso: A paciente possuía uma coroa metalo-cerâmica sobre núcleo fundido no elemento 21, constatou-se radiograficamente que o núcleo não podia ser retirado, pois traria risco de fratura ao dente. Optou-se por utilizar uma cerâmica mais opaca de arcabouço para evitar a passagem de luz sobre o metal escurecido. O material de escolha foi à cerâmica de zircônia por apresentar alta resistência à flexão, permitindo que funcione como arcabouço para coroas unitárias. Conclusão: Com a correta aplicação de cerâmicas de cobertura sobre o casquete observou- se que é possível mascarar a cor acinzentada do metal através dos conhecimentos ópticos do material, a correta utilização dessas propriedades, opacidade e translucides, e um estreito contato entre dentista e protético.

Influence of activation mode, fatigue, and ceramic interposition on resin cements' diametral tensile strength

Abstract This study evaluated the influence of activation modes, on Diametral Tensile Strength (DTS) of dual cured resin cements subjected to a Mechanical Fatigue test (MF). Four dual-cured resin cements (RelyX UNICEM [U], RelyX ARC [A], ENFORCE [E] and Nexus 2 [N]) were activated by three different curing modes as follows: Self-Curing (SC), Dual Cure activation with photoactivation executed directly (DC) and Dual Cure activation with Photoactivation Through Porcelain (DCTP). After 24 hours, half of the sample was subjected to 30.000 fatigue cycles at 1 Hz frequency and 12 N load. Then, all specimens were subjected to DTS test in Instron Universal Testing Machine and data were analyzed by three-way ANOVA and Tukey's Test (5%). The results of DTS test means (MPa) and standard deviation, for each cement factor activated by SC, DC and DCTP was respectively: U (28.12 ± 5.29; 37.44 ± 6.49 and 40.10 ± 4.39), A (49.68 ± 8.42; 55.12 ± 5.16 and 63.43 ± 6.92), E (49.12 ± 3.89; 56.42 ± 8.88 and 56.96 ± 6.45) and N (61.89 ± 11.21; 59.26 ± 9.47 and 62.56 ± 10.93). Turkey's test indicated that DC is related to the highest DTS values; Nexus 2 DTS remained the same independently of activation mode and that the Porcelain disk interposition enhanced DTS only for RelyX ARC the ANOVA statistical test indicated that MF didn't alter the DTS values for all experimental groups. MF results clinical implication is that all cements tested exhibited, in an immediate loading, good cross linked bonds quality.