The challenge of ceramic restorations on dark substrate: a case report.

The use of dental ceramics on anterior teeth is associated with predictable and long-lasting esthetic results. However, treatment on darkened substrates is challenging. Various conservative options, including ceramic veneers, are available to change the shape and color of anterior teeth. The aim of this case report is to describe the esthetic rehabilitation of a darkened central incisor in a maxillary anterior region that had irregular gingival contours, multiple composite resin restorations, and unsatisfactory tooth shapes. Harmony was restored through periodontal recontouring surgery, placement of a lithium disilicate crown (consisting of a veneer cemented to a coping) on the darkened central incisor, and placement of lithium disilicate veneers on the other maxillary anterior teeth.

Effect of surface treatment on the retention of zirconia crowns to tooth structure after aging.

OBJECTIVE: To evaluate the effect of different surface treatments on the retention between zirconia crowns and tooth structure after in vitro aging. MATERIALS AND METHODS: Human third molars (n = 44) received crown preparations and CAD/CAM zirconia crowns were manufactured. Specimens were divided into two groups: no aging, control (NAC, n = 11) or aging (A, n = 33). NAC were bonded with universal adhesive (UA). Aged specimens were divided into three subgroups (n = 11) according to surface treatment: Control: no abrasion + UA; Alumina: alumina abrasion + UA; Silica: tribochemical silica coating + UA. The crowns were cemented with dual-cure resin cement. Specimens in group A were aged by a combination of mechanical, thermal, and pH cycling. Retention strength values were obtained by tensile tests and results were analyzed by one-way analysis of variance (ANOVA) and Tukey test (P < .05). RESULTS: Aging decreased the retention strength in control specimens (P < .001). Surface treatment improved the retention strength of aged specimens (P < .001), with similar results between alumina and tribochemical silica coating. CONCLUSION: The chemical interaction between the universal bonding system and zirconia's surface was not sufficient to withstand artificial aging. Tribochemical silica coating did not promote additional retention in comparison to alumina blasting. CLINICAL SIGNIFICANCE: The long-term retention of translucent zirconia crowns to tooth structure using phosphate-based materials is improved by means of mechanical surface treatments such as alumina blasting and tribochemical silica coating.

Effectiveness of combined internal-external bleaching for nonvital teeth: case reports.

In general, patients' dissatisfaction with the appearance of their smile is mainly influenced by the color of their teeth. Darkening of a single anterior tooth negatively impacts the appearance of the smile. Tooth bleaching is considered a conservative treatment option for darkened nonvital teeth, and, whenever possible, must be considered the first choice of treatment. This article describes the successful use of the internal-external home bleaching technique in 2 patients, each of whom had a single darkened nonvital tooth. In this technique, the bleaching agent is applied simultaneously to both the internal and external surfaces of the tooth. The bleaching agent of choice is 10% carbamide peroxide. This technique is simple, low cost, and conservative and provides excellent esthetic results.

Randomized clinical trial of 2 nonvital tooth bleaching techniques: A 1-year follow-up.

STATEMENT OF PROBLEM: Controlled clinical trials comparing the effectiveness of the walking bleaching (WB) technique and the inside-outside (I-O) technique used in a short daily regimen are lacking. PURPOSE: The purpose of this randomized clinical trial was to investigate the effectiveness of WB with that of the I-O technique conducted over 4 weeks and to compare color changes after 1 year. MATERIAL AND METHODS: Discolored and endodontically treated anterior teeth received a cervical seal and were randomly divided into groups according to the technique. In the WB group (n=9), a mixture of sodium perborate and 20% hydrogen peroxide was applied in the pulp chambers and replaced weekly up to 4 weeks. For the I-O group (n=8), participants applied 10% carbamide peroxide in the pulp chambers and wore custom-fitted trays for 1 hour per day over 4 weeks. CIELab parameters were obtained using a spectrophotometer at baseline, during bleaching (1, 2, 3, and 4 weeks) and after 1 year. Changes in color (ΔE), lightness (ΔL*), green-red axis (Δa*), blue-yellow axis (Δb*), and absolute color parameters (L*, b*, and a*) for each evaluation time were calculated and analyzed by repeated measures analysis of variance (ANOVA) and post hoc Bonferroni test (α=.05). RESULTS: No significant differences between WB and I-O techniques were observed for ΔE, ΔL*, Δa*, Δb*, L*, a*, or b* values (P>.05); however, significant differences were observed among the evaluation times (P<.05). Color changes observed after 2 weeks were stable after 1 year; ΔL* and Δa* values after 1 year were not significantly different from the 1-week evaluation, and significant changes in Δb* after 3 weeks were maintained at the 1-year follow-up. The same trend was observed for the absolute CIELab color parameters. CONCLUSIONS: Both WB and I-O regimens were similarly effective as shown by significant ΔE after 2 weeks and no color regression after 1 year.

Evaluation of a technique for color correction in restoring anterior teeth.

OBJECTIVE: This study aimed to evaluate the ability of the proposed technique in producing restorations that exhibit mimesis with tooth structure and to define a restorative clinical protocol. MATERIALS AND METHODS: For this study a typodont was used. The right upper central incisor with Class IV lesion was restored with the layering technique (reference tooth, RT). For the left upper central incisor with Class IV lesion, six teeth were restored monochromatically (test teeth, TT), using DA3.5 (n = 3) and DA4 (n = 3) composite resins-resulting in six unsatisfactory color restorations. TT were divided into six groups depending on the color of unsatisfactory restoration and preparation depth. First, a preparation was realized on the labial surface with 0.5 mm, 0.7 mm or 1.0 mm of depth. A second preparation was then performed to reproduce the dentinal mamelons. Next, adhesive procedures were performed and the teeth restored. Opaque halo, opalescent halo and vestibular enamel were then reproduced by the addition of different composite resins. The RT and TT were photographed side by side in typodont to obtain six photographic prints. The photographs of the groups were subjected to visual evaluation by 120 volunteers via a questionnaire. Data were analyzed by the prevalence of answers, and Chi-square test was used to investigate the association between variables at .05 significance. Furthermore, ΔE of groups was evaluated in comparison RT. RESULTS: The results demonstrated that the moderate intensity restorations (DA3.5) with depths of 0.5 mm and 0.7 mm had the highest prevalence of acceptance. For severe intensity restorations (DA4), the preparation depth of 1.0 mm obtained better acceptance. CONCLUSIONS: The technique was able to modify the final color of Class IV restorations, producing satisfactory color restorations. CLINICAL SIGNIFICANCE: This technique can be used for color correction in cases of Class IV restorations, in situations where there is no time for immediate layered restoration, and as a restorative technique.

Clinical evaluation of different desensitizing agents in home-bleaching gels.

STATEMENT OF PROBLEM: The influence of different compositions of desensitizing agents in whitening gels should be evaluated. PURPOSE: The purpose of this clinical trial was to compare the effectiveness of 4 carbamide peroxide (CP)-based bleaching gels containing desensitizing agents regarding the degree of bleaching, tooth sensitivity, degree of participant satisfaction, and gingival irritation. MATERIAL AND METHODS: The maxillary arch of the 50 participants was bleached using a split mouth, home-bleaching technique. The participants were divided into 2 groups: G1, 10% CP (Opalescence PF; Ultradent Products, Inc) (right) and 10% CP (Power Bleaching 10%; BM4) (left); and G2, 15% CP (Opalescence PF) (right) and 16% CP (Power Bleaching 16%) (left). Each gel was used in a 2-hour daily regimen for 45 days. The shade of the 6 maxillary anterior teeth was recorded with a shade guide and spectrophotometer at baseline, and after 15, 30, 45, and 180 days of treatment. Statistical differences were analyzed with ANOVA for repeated measures followed by the Bonferroni and Student t tests (α=.05). Tooth sensitivity was evaluated with a visual analog scale (rated on a 0 to 10 scale). Participant satisfaction was evaluated by using participant reports of their personal satisfaction or dissatisfaction with the shade. Gingival irritation was evaluated using the Löe index scores. RESULTS: Color change was found to be statistically significant for all treatment periods evaluated, both by the objective and the subjective analyses, regardless of the composition and the concentration of the bleaching agent (P<.001). After 45 days, all participants were satisfied with the shade obtained. No clinically diagnosed gingival irritation was noted. Neither of the 10% CP products caused sensitivity during treatment, and 16% CP containing 3% potassium oxalate showed lower sensitivity than 15% CP containing potassium nitrate. CONCLUSION: The association of 3% potassium oxalate with fluoride was effective in reducing tooth sensitivity during and after bleaching, particularly with the 16% CP product, and did not compromise the effectiveness of treatment.

Enamel hypoplasia: challenges of esthetic restorative treatment.

Enamel defects, such as white or yellow-brown spots, usually cause problems that are more esthetic than functional. Enamel hypoplasia may be the result of hereditary, systemic, or local factors. Dental trauma is a local etiologic factor. It is relatively common in the primary dentition and can cause defects on the surface of permanent successors. Treatment for such defects can differ, depending on the depth of the spots. For deeper white-spot lesions, a composite resin restoration may be necessary. This is an excellent mode of treatment, due to both its low cost and its conservation of healthy tooth structure. The objective of this case report is to describe composite resin restoration of a maxillary central incisor affected by enamel hypoplasia.

Comparison of treatment time versus patient satisfaction in at-home and in-office tooth bleaching therapy.

STATEMENT OF THE PROBLEM: There are different approaches and treatment times to achieve tooth whitening. PURPOSE: The purpose of this study was to evaluate the efficacy of different agents and the treatment time required to achieve participant satisfaction with at-home and in-office tooth whitening. MATERIAL AND METHODS: Thirty participants were selected based on the shade of the anterior teeth (between A2 and A3.5; Vita Classic Shade Guide). Each participant received both in-office and at-home bleaching agents in a split-mouth design at both arches. In-office bleaching was performed in the maxillary quadrants, applying 35% hydrogen peroxide (HP35%) (right) and 35% HP with calcium (HP35%Ca) (left) for 40 minutes/week. Home bleaching was performed in mandibular quadrants using carbamide peroxide 10% (CP10%) (right) and CP22% (left) for 2 hours/day. Bleaching treatments were performed until participant satisfaction was achieved (maximum 6 sessions [S] in the dental office or 6 weeks [W] in the home). The shade was measured with a spectrophotometer before treatment, then at 2 and 4 weeks, and at the last week for at-home bleaching; and 1 week after the second, fourth, and last sessions for in-office bleaching. Student t and Tukey-Kramer tests were used (α=.05). RESULTS: All bleaching agents were effective for vital tooth whitening. No significant differences were observed for color changes between CP10% and CP22% or between HP35% and HP35%Ca for all periods. Treatment times required to achieve patient satisfaction for the in-office bleaching technique were 4S (12 participants), 5S (10 participants), and 6S (8 participants); and 4W (6 participants), 5W (8 participants), and 6W (16 participants) for the at-home bleaching technique. CONCLUSIONS: Treatment time to participant satisfaction ranged from 4 to 6 weeks regardless of the bleaching agent used in at-home and in-office therapy.

Effect of immediate dentin sealing on load-bearing capacity under accelerated fatigue of thin occlusal veneers made of CAD-CAM glass-ceramic and resin composite material.

OBJECTIVE: The objective of this study was to assess the influence of immediate dentin sealing (IDS) on the fatigue behavior of laminate occlusal veneers fabricated with CAD/CAM lithium disilicate ceramic and resin composite. METHODS: Forty sound human molars were prepared and randomly divided into 4 groups (n = 10): RC-IDS+ (IDS and resin composite occlusal laminate veneer); RC-IDS- (resin composite occlusal laminate veneer without IDS); LD-IDS+ (IDS and lithium disilicate laminate veneer); LD-IDS- (lithium disilicate occlusal laminate veneer without IDS). The restorations were obtained using a digital workflow. After surface conditioning and bonding, thermocycling and accelerated fatigue tests (20 Hz, 5000 cycles with an initial load of 300 N, step-size of 100 N for 10,000 cycles, up to 1000 N, and then a step-size of 50 N until failure) were conducted. Fatigue data were recorded for both outcomes (crack or fracture) and statistically analyzed. Fractographic and adhesive interface analysis were conducted. RESULTS: The indirect resin composite groups showed better fatigue behavior compared to lithium disilicate. IDS only had a positive effect for the survival of resin composite restorations for the 'fracture' outcome. Evident presence of micro-gaps at the adhesive interface in the LD-IDS- group could be noted. SIGNIFICANCE: Immediate dentin sealing improved fatigue resistance behavior of resin composite occlusal veneers. However, this effect was not observed in lithium disilicate veneers.

Effect of Universal Adhesives on Long-term Bond Strength to Zirconia.

PURPOSE: To evaluate the effect of universal adhesives on the long-term bond strength to yttria-stabilized tetragonal zirconia polycrystal (Y-TZP). MATERIALS AND METHODS: Polyethylene tubes filled with composite cement containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) were adhesively luted to 60 fully sintered Y-TZP slabs (7 x 7 x 2 mm) with or without (control) previous application of a 10-MDP-based adhesive (All Bond Universal, Bisco) - ABU; Clearfil Universal Bond Quick, Kuraray Noritake - CUB; Scotchbond Universal Adhesive, 3M Oral Care - SUA) on the zirconia surface. The bonded specimens were stored in water for 24 h, 6 months, or 1 year and subjected to microshear bond strength testing. The data were analyzed by one-way ANOVA and Tukey's test (p < 0.05). The contact angle was measured after adhesive application to evaluate surface wettability. The adhesive-treated specimens were analyzed with x-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectrometry (ToF-SIMS) for chemical characterization. RESULTS: The application of a 10-MDP-based adhesive significantly improved bond strength of composite cement to zirconia when compared to the control group (no adhesive application) (p < 0.05). One-year water storage significantly decreased bond strength for ABU- and CUB-bonded specimens, but not for SUA-bonded specimens. The analysis by XPS and ToF-SIMS showed peaks of carbon, phosphorus, and silicon in all adhesive-treated specimens. CONCLUSIONS: One-year water storage affected the bond strength of composite cement to zirconia when All Bond Universal or Clearfil Universal Bond Quick were used.

Carbamide peroxide nanoparticles for dental whitening application: Characterization, stability and in vivo/in situ evaluation.

Carbamide peroxide is the popular home dental whitening agent. However, it has critical stability. Nanoparticles have been applied to develop products with advantages properties as better efficacy and stability increase. The aim of this study was the characterization of carbamide peroxide polymeric nanoparticles, their bleaching efficacy, effects on pulp damage and stability evaluation. Particle size demonstrated a spherical morphology and bimodal distribution (11 and 398 nm). Nanoparticles presented high entrapment efficiency (98.94%) and the zeta potential value was slightly positive (+10.26 mV). Regardless of the zeta potential, the steric effect may contribute to carbamide peroxide nanoparticle stabilization. The stability studies conducted at room temperature suggested that carbamide peroxide nanoparticles could maintain all the parameters evaluated (size, polydispersity index, zeta potential, entrapment efficiency, pH and content) for at least 90 days. Instability index was determined by dispersion analyzer (LUMiSizer ®), was 0.018, and the light transmission profile did not present sedimentation. Carbamide peroxide nanoparticles were able to prevent thermal degradation and photostability. Clinical efficacy of the whitening gels was obtained by color change in the spectrophotometer and the results showed that all the evaluated gels containing the nanoparticles (0, 1, 2 and 5% of real carbamide peroxide) were effective at bleaching after 2 h of home whitening treatment (during 30 days). After the treatment, the extracted teeth showed no in situ pulp damage by histological evaluation. The nanotechnology strategy of converting carbamide peroxide into polymeric nanoparticles revealed a new product with improved stability, a good approach for carbamide peroxide delivery.

In Vitro Fatigue Resistance of Teeth Restored With Bulk Fill versus Conventional Composite Resin.

The aim of this study was to compare the fatigue resistance of restored teeth with bulk fill composite resin, conventional composite resin with incremental insertion and unprepared sound teeth. Twenty-eight extracted maxillary premolars were selected and divided into 4 groups based on composite resin and insertion technique: control (C), conventional composite resin with incremental insertion (I) and bulk fill composite resin with three (BF3) or single increment (BF1). The restored specimens were submitted to fatigue resistance test with a 5 Hz frequency. An initial application of 5,000 sinusoidal load cycles with a minimum force of 50 N and a maximum force of 200 N was used. Next, were applied stages of 30,000 load cycles with the maximum force increasing gradually: 400, 600, 800, 1000, 1200 and 1400 N. The test was concluded when 185,000 load cycles were achieved or the specimen failed. The fatigue resistance data were recorded for comparison, using the Kaplan-Meier survival curve and analyzed by log-rank test at 0.05 significance. Fractures were classified based on the position of the failure - above or below the cementoenamel junction (CEJ). Statistical analysis of the Kaplan-Meier survival curve and log-rank test showed a significant difference between groups (p=0.001). The fracture analysis demonstrated that only 28.58% of failures were below the CEJ in group C, while for groups I, BF1 and BF3 they were 42.85%, 85.71% and 85.71%, respectively. Teeth restored with composite bulk fill in both techniques present similar fatigue resistance values compared with those restored with a conventional incremental insertion of composite, while the fatigue strength values of unprepared sound teeth were higher. Furthermore, unprepared sound teeth showed a lower percentage of fractures below the CEJ.

O uso do ensaio restaurador para resultados previsíveis em restaurações classe III de resina composta: relato de caso

Introdução: a demanda estética em odontologia está ainda mais exigente. Restaurações do tipo classe III são, na maioria das vezes, as mais difíceis de se tornarem imperceptíveis. A escolha de um bom material aliada a uma técnica correta diminui os erros e, consequentemente, as imperfeições. Objetivo: o objetivo deste trabalho foi apresentar um caso clínico de um tratamento restaurador em dentes anteriores com presença de lesão de cárie, em que o ensaio restaurador foi determinante para o sucesso da cor e da forma. Relato de caso: o caso clínico exposto neste artigo trata de restaurações classe III na região mesial dos dentes 11 e 21. Os dentes da paciente apresentavam coloração não usual, o que orientou a escolha da técnica de ensaio restaurador, para que a cor utilizada fosse correspondente. Foi realizado mapa cromático, e foram selecionadas as cores para o ensaio. Depois de concretizado o ensaio, a paciente retornou, e foi efetivada a restauração permanente. Considerações finais: o ensaio restaurador permitiu que a cor escolhida fosse adequada ao paciente. Este procedimento proporcionou à restauração uma reprodução imperceptível de anatomia e cor.

Técnica semidireta: abordagem prática e eficaz para restauração em dentes posteriores / Semidirect technique: practical and effective approach to restoration in posterior teeth

Introdução: Embora as restaurações diretas tenham boas propriedades mecânicas, quando utilizadas sem indicação em cavidades amplas ficam susceptíveis a fratura e ao desgaste. Nesses casos, o ideal é que sejam feitas restaurações indiretas do tipo inlay ou onlay, entretanto o custo da etapa laboratorial das restaurações indiretas limitam a realização dessa técnica. Para tentar minimizar o custo e melhorar as propriedades da técnica direta existe as restaurações semidiretas. Objetivo: Descrever na forma de Um caso clínico a confecção de uma restauração do tipo onlay pela técnica semidireta. Relato de caso: Paciente compareceu a clínica odontológica para substituição de restauração insatisfatória no elemento 46. O tratamento de escolha foi substituição da restauração de resina composta por uma restauração do tipo onlay. A técnica semidireta foi eleita para confecção da restauração, uma vez que agrega as vantagens das técnicas direta e indireta, com um menor custo operacional e tempo de execução. Conclusão: A técnica semidireta é uma opção de tratamento para restaurações em dentes posteriores, com menor custo para o paciente e pode ser seguramente indicada em cavidades amplas (AU).

Introduction: Although direct restorations have good mechanical properties when used without large cavities indicated they are susceptible to fracture and wear. In such cases, the ideal is that indirect restorations of inlay or onlay type are carried out, however the cost of the laboratory stage of indirect restorations limit the realization of this technique. To attempt to minimize the cost and improve the properties of the direct technique exists semidiretas restorations. Objective: To describe the form of a clinical case the making of a restoration type onlay by semidirect technique. Case report: Patient attended the dental clinic for poor restoration replacing the element 46. The treatment of choice was replacement of the composite resin restoration by a restoration of the onlay type. The semi-direct technique was chosen to construct the restoration as it adds the advantages of direct and indirect techniques with a lower cost and execution time. Conclusion: The semidirect technique is a treatment option for restorations in posterior teeth, with less cost to the patient and can be safely displayed in large cavities (AU).

In Vitro Fatigue Resistance of Teeth Restored With Bulk Fill versus Conventional Composite Resin

Abstract The aim of this study was to compare the fatigue resistance of restored teeth with bulk fill composite resin, conventional composite resin with incremental insertion and unprepared sound teeth. Twenty-eight extracted maxillary premolars were selected and divided into 4 groups based on composite resin and insertion technique: control (C), conventional composite resin with incremental insertion (I) and bulk fill composite resin with three (BF3) or single increment (BF1). The restored specimens were submitted to fatigue resistance test with a 5 Hz frequency. An initial application of 5,000 sinusoidal load cycles with a minimum force of 50 N and a maximum force of 200 N was used. Next, were applied stages of 30,000 load cycles with the maximum force increasing gradually: 400, 600, 800, 1000, 1200 and 1400 N. The test was concluded when 185,000 load cycles were achieved or the specimen failed. The fatigue resistance data were recorded for comparison, using the Kaplan-Meier survival curve and analyzed by log-rank test at 0.05 significance. Fractures were classified based on the position of the failure - above or below the cementoenamel junction (CEJ). Statistical analysis of the Kaplan-Meier survival curve and log-rank test showed a significant difference between groups (p=0.001). The fracture analysis demonstrated that only 28.58% of failures were below the CEJ in group C, while for groups I, BF1 and BF3 they were 42.85%, 85.71% and 85.71%, respectively. Teeth restored with composite bulk fill in both techniques present similar fatigue resistance values compared with those restored with a conventional incremental insertion of composite, while the fatigue strength values of unprepared sound teeth were higher. Furthermore, unprepared sound teeth showed a lower percentage of fractures below the CEJ.

Resumo O objetivo deste estudo foi comparar a resistência à fadiga de dentes restaurados com uma resina composta bulk fill, resina composta convencional de inserção incremental e dentes hígidos sem preparo. Vinte e oito pré-molares maxilares extraídos foram selecionados e divididos em quatro grupos conforme a resina composta e técnica de inserção: controle (C), resina composta convencional com inserção incremental (I) e resina composta bulk fill inserida em três (BF3) ou único incremento (BF1). O preparo das cavidades foi padronizado para todos os grupos. As amostras foram restauradas e submetidas ao testes de resistência à fadiga com uma frequência de 5 Hz. Foram aplicados 5.000 ciclos de carregamento senoidal inicial com valor de força mínima igual a 50 N e força máxima de 200 N. Após, foram aplicados estágios de 30.000 ciclos de carga com a força máxima sendo aumentada gradativamente a cada estágio, para 400, 600, 800, 1000, 1200 e 1400 N. O ensaio foi finalizado ao ser alcançado 185.000 ciclos de carga (número máximo de ciclos de carga), ou na fratura da amostra. A resistência à fadiga foi registrada para comparação usando a curva de sobrevivência de Kaplan-Meier e analisada pelo teste log-rank a um nível de significância de 0.05. As fraturas foram classificadas conforme a posição da falha - acima ou abaixo da junção cemento esmalte (JCE). A análise estatística da curva de sobrevivência de Kaplan-Meier pelo teste log-rank demonstrou diferença significativa entre os grupos (p=0.001). Na análise de fratura somente 28.58% das falhas foram abaixo da JCE para o grupo C, enquanto para os grupos I, BF1 e BF3 foram 42.85%, 85.71% e 85.71%, respectivamente. Os dentes restaurados com a resina composta bulk fill em ambas as técnicas de inserção apresentaram valores de resistência à fadiga similares àqueles dos dentes restaurados com a resina composta convencional pela técnica incremental. Entretanto, dentes hígidos mostraram uma menor porcentagem de fraturas abaixo da JCE e maior resistência à fadiga.

Clinical evaluation of 4% hydrogen peroxide bleaching in mandibular teeth

Introduction: Bleaching agents have been constantly introduced into market; however, the efficacy of new hydrogen peroxides still needs to be evaluated. Objective: The aim of this study was to evaluate in vivo the effectiveness of 4% hydrogen peroxide bleaching agent in color change, bleaching maintenance, tooth sensitivity, and patients' satisfaction. Material and methods: Forty subjects were selected, lower bleaching trays were constructed, and the patients were instructed to apply 4% hydrogen peroxide bleaching agent at home. Shade measurements of the mandibular anterior teeth were carried out with a spectrophotometer and Vita Classical shade guide (VITA) at the following moments: baseline, 14 days, after patients' satisfaction, and after 90 days. In addition, tooth sensitivity was evaluated using a visual analogue scale (VAS) at the first 14 days. Shade measurements were submitted to repeated measures ANOVA with Bonferroni adjustment and level of significance set at 5%. Results: Statistically significant differences were found for mandibular tooth shade after at-home bleaching (p < 0.001). After 14 days of bleaching, 90% of the subjects were not pleased with the achieved bleaching; however, after 27 days most of the patients reported to be satisfied. Tooth sensitivity was reported to range from 1.01 in a scale from 0-10. Conclusion: At-home bleaching using 4% hydrogen peroxide is effective in lower teeth with reduced tooth sensitivity.

Evolução da resina composta como material restaurador indireto / Evolution of the composite resin as an indirect restorative material

O objetivo deste trabalho foi, por meio de uma revisão de literatura, apresentar a evolução da resina composta como material restaurador indireto. Para isso, foram selecionada bibliografia de 1991 a 2012. Diante dos artigos analisados, notou-se que a pós-polimerização das resinas compostas é um procedimento questionável. Já o cerômero e os blocos de Paradigm MZ100 são materiais superiores à resina composta direta e apresentam-se como alternativa viável ao uso das cerâmicas odontológicas em restaurações indiretas.

The aim of this study, by means of a literature review, is to present the evolution of the composite resin as an indirect restorative material. To this end, literatures of the years 1991 to 2012 were selected. After the articles analysis, it was noted that the post-polymerization of composite resins is a questionable procedure. On the other hand, ceromer and Paradigm MZ100 Books are superior materials when compared to the direct composite resin and present themselves as an alternative to the use of the dental ceramics in indirect restorations.

Fotografia em odontologia: a escolha do equipamento fotográfico / Dental photography: choosing the photographic equipment

A fotografia odontológica tem se beneficiado dos avanços tecnológicos que ocorreram nos últimos anos. O preço dos equipamentos está mais acessível e sua qualidade atingiu níveis superiores. Isso tem permitido aos cirurgiões-dentistas utilizar essas ferramentas de diagnóstico, tratamento e na comunicação com pacientes e demais profissionais da área odontológica. Assim, o objetivo deste artigo é orientar os profissionais na escolha de equipamentos fotográficos de uso odontológico.

Dental photography has taken advantage of the technological developments in the last years. Price are more affordable and quality attained superior levels. It has allowed dentists to use these tools for diagnosis, treatment and communication with patients and dental professionals. The purpose of this paper was to guide practitioners to choose dental photographic equipment.

Avaliação da contração de polimerização de resinas compostas por um mecanismo de vídeo e imagem: AcuVol / Polymerization shrinkage evaluation os composite resins using video image equipament: AcuVol

O objetivo deste trabalho foi avaliar o percentual de contração volumétrica livre de seis resinas microhíbridas [Opallis (OP), Filtek Z250 (FZ), Tetric Ceram (TC), FillMagic (FM), EsthetX (EX), Charisma (CH)] e uma resina de nanopartículas [Filtek Supreme (FS)] através de um mecanismo de vídeo imagem (AcuvolTM, Bisco, Schaumburg, EUA). O percentual de contração volumétrica (n = 5) foi determinado após 10 minutos da fotoativação, realizada com aparelho de luz halógena Optilux 501 (Demetron), com intensidade de 600 mw/cm2. Os testes ANOVA e Tukey (p<0,05) revelaram diferenças estatisticamente significantes entre os materiais avaliados. Em ordem decrescente de média, seguiram as resinas: (CH)>(TC)>(FM)>(OP)>(EX)>(FZ)>(FS). A resina de nanopartículas apresentou o menor percentual de contração vo!umétrica. As resinas microhíbridas que continham em sua composição os monômeros BisEMA e/ou UDMA apresentaram baixos percentuais de contração volumétrica livre.

The purpose of this research was to evaluate the volumetric shrinkage of 6 hybrid composite resins [Opallis (OP), Filtek Z250 (FZ), Tetric Ceram (TC), FillMagic (FM), EsthetX (EX), Charisma (CH)] and ane nanocomposite [Filtek Supreme (FS)] (n = 5) by a video imaging equipment (AcuvolTM, Bisco, Schaumburg, USA). The volumetric shrinkage was determined was determined after 10 min of light curing (Optilux 501, 600 mW/cm2 intensity). One-way ANOVA and Tukey's tests (p<0,05) revealed significant differences among the materiaIs evaluated: (CH)>(TC)>(FM)>(OP)>(EX)>(FZ)>(FS). The nanocomposite has shown lower percentage volumetric shrinkage. The hybrid composites wich contain BisGMA and/or UDMA presented low percentage volumetric shrinkage.

Protetores bucai parte II: tipos e técnica de confecção / Mouthguards Part II: types and fabrication technique

Tendo em vista a importância do uso de protetores bucais como mecanismo de prevenção para pacientes considerados de risco potencial a injúrias orofaciais, neste artigo, são abordados os tipos de protetores bucais disponíveis, considerando-se vantagens, desvantagens, técnica de confecção, manutenção e higiene. Ainda, considerando-se que os protetores bucais laminados sob pressão podem ser empregados em todas as categorias esportivas, este artigo apresenta passo a passo sua técnica de confecção.