Cryodehydration protocol to obtain high-quality permanent anatomical material.

The study of anatomy is largely dependent on cadaveric specimens to fulfill the tridimensional comprehension of each structure as well as the relationship between organs. Given the difficult access to fresh anatomical specimens, the constant renovation of samples for research and educational purposes is unsustainable, beyond the ethical issues involved. The standard technique for preserving specimens involves fixation and later immersion in formaldehyde, which enables a good result, but also presents elevated carcinogenic potential. Therefore, safe and efficient preservation methods are mandatory for anatomical practices and investigations. An accessible and inexpensive alternative for specimen preservation is cryodehydration. Cryodehydrated specimens can be kept dry, with no final odor, reducing the use and exposure to formaldehyde. The objective of this study was to propose a simplified step-by-step cryodehydration protocol to obtain high-quality anatomical specimens. Through consecutive freezing and thawing cycles, cryodehydration caused a weight reduction of 60%-70% and allowed anatomical preservation, while maintaining the main morphological aspects of cavitary and parenchymatous organs, muscles, or even full-body sections. The final specimens presented high durability and can be maintained for decades, preserving all relevant anatomical features.

Is the at-home bleaching treatment applied only on the lingual surface as effective as that on the buccal surface? A randomized clinical trial.

OBJECTIVES: This double-blind randomized clinical trial compared the effectiveness and bleaching sensitivity (BS) of at-home dental bleaching performed on the buccal surface and on the lingual surface. METHODS: Using a split-mouth design, 25 patients were assigned to two bleaching groups: 10% hydrogen peroxide (White Class 10%, FGM) applied once daily for 60 min to the buccal surface (BSB) and 10% hydrogen peroxide (White Class 10%, FGM) applied once daily for 60 min to the lingual surface (LSB), both for 14 days. The color was evaluated before bleaching, after the first and second weeks, and 1 month after the bleaching using Vita Classical and Vita Bleachedguide scales and a Vita Easyshade spectrophotometer. BS was recorded daily using a 0-4 numerical rating scale and a 0-10 visual analogue scale. The following statistical tests were used: color changes (Mann-Whitney), absolute risk of BS (McNemar's exact), and the intensity of BS (Mann-Whitney). In all statistical tests, the significance level was 5%. RESULTS: Significant bleaching was observed after the end of bleaching in both groups, with higher bleaching effectiveness for BSB when compared to LSB (p < 0.05). Regarding BS, no significant difference was observed between groups (p = 1.00). CONCLUSIONS: The 10% hydrogen peroxide (White Class 10%, FGM) applied in at-home bleaching performed on the lingual surface did not promote a similar result of color change compared to on the buccal surface. Regarding BS, there was no significant difference between the groups. CLINICAL RELEVANCE: The at-home bleaching performed on the lingual surface promotes a lower result in the color change. BS is similar between the groups. CLINICAL TRIAL REGISTRATION NUMBER: RBR-283byt.

The effectiveness of in-office dental bleaching with and without sonic activation: A randomized, split-mouth, double-blind clinical trial.

OBJECTIVE: This study was aimed at comparing the bleaching efficacy and bleaching sensitivity (BS) of two higher-concentration in-office bleaching gels (37% carbamide peroxide [CP] and 38% hydrogen peroxide [HP]) applied under two conditions: alone or in association with sonic activation. METHODS: Fifty-six volunteers were randomly assigned in the split-mouth design into the following groups: CP, CP with sonic activation (CPS), HP, and HP with sonic activation (HPS). Two in-office bleaching sessions were performed. Color was evaluated using Vita Classical, Vita Bleachedguide, and digital spectrophotometer at baseline and at 30 days post-bleaching. Absolute risk and intensity of BS were recorded using two pain scales. All data were evaluated statistically (color changes [t test], BS [Chi-square and McNemar test], and BS intensity [VAS; t test; NRS; Wilcoxon; α = 0.05]). RESULTS: Significant and higher whitening was observed for HP when compared with CP (p < 0.04). However, higher BS intensity was observed in the former (p < 0.001). No significant difference was observed in whitening effect or BS when the HP or CP bleaching gels were agitated (sonic application) compared with when they were not (p > 0.05). CONCLUSION: The 37% CP gel demonstrated lower bleaching efficacy and lower BS compared with the 38% HP bleaching gel. The whitening effect was not influenced by the use of sonic activation. CLINICAL SIGNIFICANCE: The use of 37% CP gel did not achieve the same whitening effect when compared to 38% HP gel used for in-office bleaching. The use of sonic activation offers no benefit for in-office bleaching.

The influence of final endodontic irrigation techniques and irrigants on the push-out resistance of glass fiber posts.

This study evaluated the influence of different combinations of 3 final endodontic irrigation techniques (positive-pressure irrigation [PPI], passive ultrasonic irrigation [PUI], and continuous ultrasonic irrigation [CUI]) and 2 irrigants (5.25% sodium hypochlorite [NaOCl] and 2% chlorhexidine [CHX]) on the push-out resistance of glass fiber posts. Ninety bovine roots were prepared and divided into 6 groups (n = 15): PPIN, PPI with 5.25% NaOCl; PUIN, PUI with 5.25% NaOCl; CUIN, CUI with 5.25% NaOCl; PPIC, PPI with 2% CHX; PUIC, PUI with 2% CHX; and CUIC, CUI with 2% CHX. In the PPI groups, a 30-gauge needle was used to deliver the irrigating solution. In the PUI groups, a 30-gauge needle was used to deliver the irrigating solution, which was activated for 10 seconds by means of a stainless steel file mounted on an ultrasonic unit. In the CUI groups, delivery and continuous agitation of the irrigating solution for 10 seconds were performed using a stainless steel file mounted on the ultrasonic unit. After canal preparation was completed, glass fiber posts were cemented with a dual-cure resin cement. The roots were sectioned into 1-mm-thick slices (coronal, middle, and apical thirds). After 7 days' storage in distilled water, the slices were submitted to a push-out test. The mean bond strength values were compared using 2-way analysis of variance and Tukey post hoc test (P < 0.05). The mean (SD) overall bond strength values of the specimens were as follows: PPIN, 4.46 (1.43) MPa; PUIN, 6.13 (2.35) MPa; CUIN, 7.41 (1.83) MPa; PPIC, 3.59 (1.70) MPa; PUIC, 5.49 (1.41) MPa; and CUIC, 6.0 (1.63) MPa. Irrespective of the irrigating solution, continuous ultrasonic irrigation achieved significantly greater push-out bond strengths for glass fiber posts, mainly at the apical third of the root specimens (P < 0.05).

Effect of luting cement thickness on the bond strength of glass fiber posts to dentin.

The objective of this study was to evaluate the effect of cement thickness and luting cement type on the push-out bond strength of glass fiber posts (GFPs) to root dentin. Sixty human maxillary root-filled canines or premolars with single straight roots were randomly divided into 6 groups (n = 10) according to the GFP configuration (conventional or relined with composite resin) and the cement used (RelyX U200, Ketac Cem, or Allcem Core). After endodontic treatment and GFP cementation, all of the roots were sectioned perpendicular to their long axis to obtain 1.0-mm-thick slices (n = 6 per group), which were mounted on a universal testing machine and submitted to a push-out test. The data (n = 45 to 51 specimens per group because of pretest failures) were analyzed by means of 2-way analysis of variance (ANOVA) and Tukey tests (α = 0.05). The type of failure was determined under a stereomicroscope, and representative specimens were observed with scanning electron microscopy. Significant interactions between the cements and GFP configurations were detected in the coronal and apical thirds (P < 0.05; 2-way ANOVA). For the coronal third, both RelyX U200 cement groups exhibited the greatest push-out bond strengths but were not significantly different from the Allcem Core relined group. For the middle third, no statistically significant interactions were observed between the cements and GFP configurations (P = 0.232; 2-way ANOVA). Adhesive failure between the dentin and cement layer was the most frequently observed failure mode. As expected, because of the composite resin added to relined GFPs, the cement layer was thinner in those groups. The type of cement used played an important role in the push-out bond strength.

Return temperature after heat shock affects the production of tetraploids in the yellowtail tetra Astyanax altiparanae.

The aim of this study was to evaluate different post-shock temperatures for tetraploid induction in the yellowtail tetra Astyanax altiparanae. Newly fertilized eggs were divided into four groups, three were submitted to heat shock (40°C for 2 min) at 24 min post-fertilization (mpf) and another group remained without shock (control). Groups submitted to temperature shock were further separated at the following temperatures: 22°C, 26°C and 28°C. Survival among embryonic development was counted and at hatching the ploidy was analyzed by flow cytometry. The results showed that the post-shock temperature affects the parameters analyzed and, therefore, must be considered for optimization of the production of tetraploid in A. altiparanae. Those data are innovative and could be used in future studies of basic biology in this species.

In-office bleaching with complete cervical third protection protocol: A split-mouth, double-blind, randomized clinical trial.

PURPOSE: To evaluate the bleaching sensitivity and the bleaching effectiveness of in-office bleaching, following a protocol of complete cervical third protection with gingival dam in comparison with a traditional manner of applying gingival dam (used only in the gingival sulcus area). METHODS: 35 participants were selected for this double-blind split-mouth randomized clinical trial. The control group received the gingival barrier in the traditional manner, and in the experimental group the barrier was extended by about 3 mm to include the cervical region. The bleaching agent was applied in two sessions. The risk and intensity of bleaching sensitivity were assessed using two scales. The bleaching effectiveness was evaluated with a digital spectrophotometer with the tip placed in the cervical area. The absolute risk of bleaching sensitivity was compared by the McNemar's test and bleaching effectiveness (ΔEab, ΔE00 and ΔWi) and intensity of bleaching sensitivity was evaluated by Wilcoxon-paired test (α= 0.05). RESULTS: No significant difference at risk (P= 1.0) and intensity of bleaching sensitivity (P> 0.45) was seen between groups. After 30 days, bleaching effectiveness had no statistical difference between the groups (P> 0.09). CLINICAL SIGNIFICANCE: Extending the barrier in the cervical region of teeth did not reduce the risk and intensity of bleaching sensitivity, nor jeopardize the bleaching effectiveness.

Fatty acid synthase and Ki-67 immunoexpression can be useful for the identification of malignant component in carcinoma ex-pleomorphic adenoma.

BACKGROUND: Fatty acid synthase (FASN) is the key molecule for catalyzing fatty acid synthesis and have been associated with several malignant tumors. METHODS: We analyzed the expression of FASN and Ki-67, by immunohistochemistry on 29 carcinomas ex-pleomorphic adenoma (CXPAs) and 25 pleomorphic adenomas (PAs). RESULTS: Ki-67 proliferation index and FASN expression were significantly higher in patients with CXPA than patients with PA (P < 0.001). We found intense immunoreactivity for FASN in the malignant component of CXPAs, and these malignant areas also had intense nuclear immunoreactivity for Ki-67. CONCLUSIONS: The present results suggest that overexpression of FASN in CXPAs might be associated with malignant transformation of ductal epithelial cells and/or myoepithelial cells from PA. FASN associated with Ki-67 may be useful diagnostic markers for CXPA.

Nutritional planning for Nellore heifers post-weaning to conception at 15 months of age: performance and nutritional, metabolic, and reproductive responses.

The objective of this study was to evaluate the effects of strategic supplementation in the dry period and dry/rainy transition period on the performance and nutritional, metabolic, and reproductive responses of Nellore heifers grazing Urochloa decumbens. Forty-eight Nellore heifers with age and body weight (BW) of eight months and 235 ± 3.3 kg, respectively, were used. The experimental design was a completely randomized design, with four treatments, all with 12 replications. The evaluated strategies were as follows: low supplementation (LOHI; 0.2% of BW/heifer/day) in the first 90 days and high supplementation (0.6% of BW/heifer/day) in the 90 days thereafter; average supplementation (AVER) with 0.4% of BW/heifer/day for 180 days; high supplementation (HILO; 0.6% of BW/heifer/day) in the first 90 days and low supplementation (0.2% of BW/heifer/day) in the 90 days thereafter; only mineral mix (MM) ad libitum during the 180 days. Data were evaluated using orthogonal contrasts. Supplementation improved the performance of the animals during of dry period (P < 0.05) and dry/rainy transition period (P < 0.05). Supplemented animals had higher longissimus muscle area (LMA) and subcutaneous fat thickness (SFT) at the end of the experiment (P < 0.05). Multiple supplementation increased intake of dry matter (DM), organic matter (OM), and crude protein (CP) in kg/day throughout the experiment. The supplementation increased the digestibility of DM, OM, CP, apNDF, and TDN (P < 0.05). Serum urea nitrogen (SUN), glucose (GLUC), insulin (INS), and progesterone (PROG) were higher in supplemented heifers (P < 0.05). Supplementation reduced the concentrations of non-esterified fatty acids (NEFA) (P < 0.05) and increased conception rate (P < 0.05). In summary, the supplementation strategies adopted in this study improve the performance, metabolic status, and carcass traits of heifers under grazing, allowing an improvement in the conception rate of 15-month-old Nellore heifers.

Soybean grain is a suitable replacement with soybean meal in multiple supplements for Nellore heifers grazing tropical pastures.

The research aimed to evaluate the effect of replacing soybean meal with soybean grain on the nutritional parameters and productivity of heifers grazing on Urochloa decumbens in the rainy-dry transition period. Forty crossbred heifers with the initial age and weight of 18 months and 292 ± 6.1 kg, respectively, were used. The experimental design was a completely randomized design, with five treatments and eight replications. The evaluated treatments were as follows: SM0.5-supply of 0.5 kg/animal/day of soybean meal supplement; SG0.5-supply of 0.5 kg/animal/day of soybean grain supplement; SM1.0-supply of 1.0 kg/animal/day of soybean meal supplement; SG1.0-supply of 1.0 kg/animal/day of soybean grain supplement; MM-only mineral mix ad libitum. The supplement was isoprotein with 350 g of crude protein/kg of dry matter. Supplementation improved the performance of the heifers and this fact can be verified by the higher average daily gain (ADG) and final BW (fBW) of the supplemented animals (P < 0.10). The two supplemented treatments with 1 kg/day demonstrated similar performance (P > 0.10), the same happens for the two treatments receiving 0.5 kg/day (P > 0.10). However, animals receiving 1 kg/day of supplementation had an ADG and final BW higher than animals receiving 0.5 kg/day (P < 0.10). Supplementation (P < 0.10) affected the intake of dry matter (DM), organic matter, crude protein, ether extract, non-fiber carbohydrates, total digestible nutrients, and neutral detergent fiber corrected for ash and protein (apNDF). Supplementation improved DM digestibility and all constituents of the diet (P < 0.10), except for apNDF (P > 0.10). In summary, it is concluded that multiple supplementations improve the performance of grazing heifers in the rainy-dry transition period and the total replacement of soybean meal by soybean grain does not alter the performance of the animals.

Supplementation strategies for Nellore female calves in creep feeding to improve the performance: nutritional and metabolic responses.

The objective of this study was to evaluate the effects of supplementation strategy on performance, nutritional and metabolic characteristics of Nellore suckling female calves, on grazing Urochloa decumbens during the rainy-dry transition period. Forty-four Nellore female calves, averaging 147.6 ± 1.34 kg (4 months), were used. A single supplement 20% of crude protein of dry matter was provided, consisting of daily supplement at 0.0, 0.2, 0.4, or 0.6% of body weight. A positive linear effect (P < 0.05) on final body weight and average weight gain of female calves was observed with increased supplementation. Supplementation increased consumption, in kilograms per day, of dry matter (DM), organic matter (OM), crude protein (CP), digested dry matter, and total digestible nutrients (TDN), all calculated as % of dry matter. There was no effect of supplementation on the consumption in kilograms per day of neutral detergent fiber corrected for ash and protein (apNDF) (P > 0.05). Supplementation increased, in a quadratic way, the total apparent digestibility coefficient of DM, OM, CP, apNDF, and TDN (P < 0.05). There was no effect of supplementation (P > 0.05) on non-esterified fatty acid concentrations. There was a positive linear effect (P < 0.05) of supplementation on insulin concentrations. In this study, it is concluded that linearly increasing the feeding level of a supplement with 20% crude protein (% of DM) in the range of 0.2-0.6% of body weight improves the performance, nutritional and metabolic characteristics of the animals, considering these pasture characteristics.

Estimation of daily milk yield of Nellore cows grazing tropical pastures.

Beef cows' milk yield is typically determined by measuring milk yield once daily and then doubling this value to estimate daily production. However, it is not known whether this is accurate. Thus, we aimed to determine the association between morning and afternoon milk yield in grazing Nellore cows. Eighty Nellore cows were used, with initial weight of 516.0 ± 1.0 kg. The experiment was a completely randomized factorial scheme, with 20 replications and four treatments (i.e., + or - pre-partum supplementation in combination with + or - post-partum supplementation): PRMM-1 kg of supplement/cow/day for 90 days pre-partum; MMPS-1 kg of supplement/cow/day for 90 days post-partum; PRPS-1 kg of supplement/cow/day for 90 days pre-partum and 90 days post-partum; and MM-only mineral mix ad libitum during pre- and post-partum. Milk was sampled on days 45, 135, and 225 post-partum (early, middle, and late lactation, respectively). No effects were observed of pre- and post-partum supplementation on milk yield (P > 0.05). The afternoon/morning proportion of 0.45 in the early third of lactation was higher than other stages, which had a proportion of 0.41 (P < 0.05). Post-partum supplementation increased milk protein in the morning and afternoon milking (P < 0.05). There was also no effect of pre- and post-partum supplementation on afternoon-morning proportion other milk components (P > 0.05). We conclude that estimating daily milk production of grazing beef cattle by multiplying a once daily milking amount times two is not accurate. Under the conditions of this study, proportion of total daily production represented by the ratio of afternoon/morning milking was 0.45 in early lactation (first third) and 0.41 in mid- and late lactation.

Day vs night: Does time of presentation matter in acute heart failure? A secondary analysis from the RELAX-AHF trial.

BACKGROUND: Signs and symptoms of heart failure can occur at any time. Differences between acute heart failure (AHF) patients who present at nighttime vs daytime and their outcomes have not been well studied. Our objective was to determine if there are differences in baseline characteristics and clinical outcomes between AHF patients presenting during daytime vs nighttime hours within an international, clinical trial. METHODS: This is a post hoc analysis of the RELAX AHF trial, which randomized 1,161 AHF patients to serelaxin vs placebo, both in addition to usual AHF therapy. Prespecified end points of the primary trial were used: dyspnea, 60-day heart failure/renal failure rehospitalization or cardiovascular (CV) death, and 180-day CV death. Both unadjusted and adjusted analyses for outcomes stratified by daytime vs nighttime presentation were performed. RESULTS: Of the 1,161 RELAX-AHF patients, 775 (66.8%) patients presented during daytime and 386 (33.2%) at nighttime. Baseline characteristics were largely similar, although daytime patients were more likely to be male, have greater baseline body weight, have higher New York Heart Association class, have history of atrial fibrillation, and have more peripheral edema compared with nighttime patients. No differences in dyspnea relief or 60-day outcomes were observed. However, daytime presentation was associated with greater risk for 180-day CV death after adjustment (hazard ratio 2.28, 95% CI 1.34-3.86; c statistic = 0.82, 95% CI 0.78-0.86). CONCLUSION: In this secondary analysis of the RELAX-AHF trial, baseline characteristics suggest that daytime-presenting patients may have more gradual worsening of chronic HF. Patients with AHF who presented at night had less risk for 180-day CV death, but similar risk for 60-day CV death or rehospitalization and symptom improvement for patients who presented during the daytime.

Effects of serelaxin on the outcome of patients with or without substantial peripheral edema: A subgroup analysis from the RELAX-AHF trial.

BACKGROUND: Acute heart failure (AHF) is a heterogeneous disorder, with most of the patients presenting with breathlessness along with varying degrees of peripheral edema. The presence of peripheral edema suggests that volume overload is the cause of decompensation leading to AHF, whereas breathlessness in the absence of edema may reflect a "vascular phenotype." This analysis investigated the characteristics, therapeutic response, and outcome of patients with AHF, with and without overt peripheral edema in the RELAX-AHF trial. METHODS: Physician-assessed edema scores at baseline were used to categorize the population into those with no/mild edema (score 0 or 1+) and moderate/severe edema (score 2+ or 3+). The effect of serelaxin vs placebo was assessed within each subgroup. RESULTS: Patients with moderate/severe edema (n = 583; 50.5%) were more likely to have severe dyspnea, orthopnea (>30°), rales (≥1/3), and elevated jugular venous pressure (>6 cm) than the patients with little or no peripheral edema (n=571; 49.5%). The relative benefits of serelaxin in terms of reduction in breathlessness, lower diuretic requirements, decreased length of initial hospital stay and days in intensive care unit/cardiac care unit, and improved prognosis (180-day cardiovascular and all-cause mortality) were generally similar for patients with or without peripheral edema. However, because patients with moderate/severe peripheral edema had worse outcomes, the absolute benefit was generally greater than in patients with no/mild edema. CONCLUSIONS: Overall, patients with AHF and moderate/severe peripheral edema have a worse prognosis but appear to receive similar relative benefit and perhaps greater absolute benefit from serelaxin administration.

Creep feeding effects on male Nellore calves influencing behavior and performance of their dams.

The objective of the present study was to evaluate the effect of different schemes of calves' supplementation in a creep feeding system, on the behavior of Bos indicus calves and dams, and also the influence of the calves' supplementation on dams' performance. Forty-eight Nellore male calves (147 ± 7 kg body weight and 3 months of age) in the suckling phase and their dams (476 ± 9 kg and 6 years of age) were studied in a completely randomized design. The experiment was divided into two periods of 71 days. The treatments were 5- and 10-g supplement dry matter (DM)/kg BW day offered in periods 1 and 2, respectively (5S/10S); 10- and 5-g supplement DM/kg BW day offered in periods 1 and 2, respectively (10S/5S); 7.5-g supplement DM/kg BW day in both periods 1 and 2 (7.5S); and mineral mix ad libitum in both periods 1 and 2 (MM). No differences (P < 0.05) in body condition score (BCS), final body weight (FBW), and average daily gain (ADG) were found in dams' performance. Calves from MM treatment spent more time (P < 0.05) grazing than the supplemented calves from 5S/10S and 10S/5S treatments, in the first period. No difference in suckling time was found between the treatments (P > 0.05) in the first evaluated period. Calves from 10S/5S treatment spent more time suckling and less time eating supplements (P < 0.05) than 5S/10S treatment animals, in the second evaluated period. Dams of MM treatment's calves had more idle time and lower grazing time when compared with the mothers of calves from 5S/10S and 10S/5S treatments. It was concluded that different schedules of Nellore calves' supplementation on pasture do not affect their mothers' performance, and supplementation decreases the grazing time of calves in the suckling phase.

Noninvasive approach to esthetic rehabilitation of conoid anterior teeth.

Several factors, including anomalies of shape, color, or size, or positioning of the teeth, may interfere with smile esthetics. A 26-year-old woman was dissatisfied with the esthetics of her maxillary lateral incisors, which had defective composite resin restorations with alterations of color and shape. The aim of this article is to present a step-by-step description of the technique used to fabricate esthetic restorations for the conoid maxillary lateral incisors with a minimum of dental preparation. The successful outcome demonstrates the importance of correct planning for successful restorations.

Does supplementation of beef calves by creep feeding systems influence milk production and body condition of the dams?

The aim of this study was to evaluate the effects of beef calves' supplementation in creep feeding systems on milk yield, body weight (BW), and body condition score (BCS) of their dams on tropical pastures using a meta-analytical approach. The database was obtained from 11 experiments conducted between 2009 and 2014 in Brazil, totaling 485 observations (cows). The database consisted of 273 Nellore and 212 crossbred (7/8 Nellore × 1/8 Holstein) cows. All experiments were carried out in the suckling phase (from 3 to 8 months of age of calves) during the transition phase between rainy and dry seasons from February to June of different years. The data were analyzed by a meta-analytical approach using mixed models and taking into account random variation among experiments. Calves' supplementation (P ≥ 0.59) and the calves' sex (P ≥ 0.48) did not affect milk yield of cows. The average fat-corrected milk (FCM) yield was 6.71 and 6.83 kg/day for cows that had their calves supplemented and not supplemented, respectively. Differences were observed (P < 0.0001) for milk yield due to the genetic group where crossbred cows presented greater FCM yield (7.37 kg/day) compared with Nellore cows (6.17 kg/day). There was no effect of the calves' supplementation on BW change (P ≥ 0.11) and BCS change (P ≥ 0.23) of the cows. Therefore, it is concluded that supplementation of beef calves using creep feeding systems in tropical pastures does not affect milk yield, body weight, or body condition of their dams.

Esthetic rehabilitation with tooth bleaching, enamel microabrasion, and direct adhesive restorations.

The aim of this case report is to report esthetic rehabilitation with combined tooth bleaching, enamel microabrasion, and anterior restoration replacement in a 26-year-old man. Clinical examination showed deficient restorations in the maxillary anterior teeth, significant discoloration of the maxillary left central incisor, and hypoplastic stains affecting the maxillary right lateral incisor. A radiograph of the left central incisor showed satisfactory endodontic treatment, allowing preparation for the walking bleach technique. For 3 weeks, 37% carbamide peroxide in the pulp chamber was renewed every week. In-office bleaching with 35% hydrogen peroxide was also performed on the maxillary teeth. After 21 days, all teeth had been bleached to shade A1. After bleaching was completed, enamel microabrasion of the maxillary right lateral incisor was conducted with 6% hydrochloric acid. In later sessions, microhybrid composite resin restorations were placed in all 4 maxillary incisors. A combination of dental bleaching techniques, enamel microabrasion, and resin restorations was a successful and conservative choice for reestablishing the natural appearance of discolored teeth, improving the self-esteem of the patient.

The role of emergence profile in papilla maintenance after diastema closure with direct composite resin restorations.

The dental morphology usually determines the shape and volume of the interdental space, which must be filled by a dense connective tissue covered by oral epithelium to achieve pleasant esthetics. When composite resin restorations are placed to solve esthetic problems, the restorative procedure must be designed to allow the formation of healthy interdental papilla. This case report discusses aspects that should be considered when composite resin restorations are proposed for diastema closure. A 23-year-old man sought treatment for variations of space in the anterior dentition after orthodontic treatment. Direct composite resin restorations were placed in a way that respected the emergence profile, even though "black triangles" were evident immediately after the procedure. At the 45-day follow-up, complete closure of the interdental spaces by healthy papillae was observed. The emergence profile should be identified and respected when restorations are placed to obtain diastema closure because healthy periodontal tissues and acceptable esthetics depend on it.

Noninvasive esthetic treatment for hypomaturation amelogenesis imperfecta: a case report.

Enamel alterations, such as amelogenesis imperfecta, can compromise the harmony of the smile and the patient's self-esteem and may cause tooth sensitivity. A simple and effective treatment approach uses the natural stratification of composite resins to mask deficient enamel formation and mimic the natural appearance of the substrate. The operative steps and principles for restorative success are described in this case report with 36-month follow-up.