Therapeutic solutions for discoloration of calcified teeth based on CBCT diagnosis.

Single tooth orange discoloration secondary to root canal calcification occurs as a consequence of dental trauma, orthodontic treatment, or for unknown rea- sons. A correct case history must be compiled and a CBCT study carried out in order to establish the diag- nosis and define the best treatment plan in each case. The aim of the present study was to offer a therapeutic protocol involving a clinical decision-making tree dia- gram based on the presence or absence of apical dis- ease and the degree of canal calcification. Dental bleaching and the use of ceramic veneers allow es- thetic restoration in such cases.

Multidisciplinary conservative management of a severely discolored nonvital tooth.

This clinical report describes a multidisciplinary protocol for the management of a severely discolored nonvital maxillary anterior tooth based on minimally invasive treatment with in-office and home bleaching combined with restoration with composite resin.

Prospective study of monolithic zirconia crowns: clinical behavior and survival rate at a 5-year follow-up.

Purpose To evaluate the clinical behavior and survival of full coverage monolithic zirconia crowns on posterior teeth over a 5-year follow-up.Methods Fifty patients were recruited and underwent restoration with a Lava Plus monolithic zirconia crown (Lava™ Frame Zirconia, 3M Espe, Germany) on premolars or molars. Patients were monitored over a 5-year follow-up (2014-19), recording any biological and/or mechanical complications; these data were used to estimate the crowns' success rate. Periodontal clinical parameters were recorded (pocket probing depth (PPD), plaque index (PLI), bleeding on probing (BOP), and gingival recession (GR)). Wear to the zirconia crowns and antagonist teeth were also evaluated with Geomagic software (3D Systems, U.S.A.). Patients' satisfaction with treatment was evaluated in a questionnaire.Results For the 50 monolithic zirconia crowns analyzed, the survival rate was 98% after 5 years. Only 6% of the crowns presented some type of complication (two debonding and one root fracture). No fracture or fissures were detected. GR and BOP were the only clinical parameters found to be significantly greater around teeth restored with crowns. The monolithic zirconia crowns suffered less wear than the enamel of antagonist teeth. Patient's general satisfaction with treatment was high.Conclusions Monolithic zirconia crowns on posterior teeth are a highly predictable treatment option, with a high survival rate. The single treatment failure was due to a biological complication arising from root fracture. This treatment may be recommended as a treatment that conserves dental structure, and requires minimal dental preparation.

Comparative Analysis of Peri-Implant Bone Loss in Extra-Short, Short, and Conventional Implants. A 3-Year Retrospective Study.

OBJECTIVE: To evaluate the influence of implant length on marginal bone loss, comparing implants of 4 mm, 6 mm, and >8 mm, supporting two splinted crowns after 36-month functional loading. MATERIALS AND METHODS: this retrospective clinical trial evaluated the peri-implant behavior of splinted crowns (two per case) on pairs of implants of the same length placed in the posterior maxilla (molar area). Implants were divided into three groups according to length (Group 1: extra-short 4 mm; Group 2: short 6 mm; Group 3: conventional length >8 mm). Marginal bone loss was analyzed using standardized periapical radiographs at the time of loading and 36 months later. RESULTS: 24 patients (19 women and 5 men) were divided into three groups, eight rehabilitations per group, in the position of the maxillary first and second molars. The 48 Straumann® Standard Plus (Regular Neck (RN)/Wide Neck (WN)) implants were examined after 36 months of functional loading. Statistical analysis found no significant differences in bone loss between the three groups (p = 0.421). No implant suffered biological complications or implant loss. Long implants were associated with less radiographic bone loss. CONCLUSIONS: extra-short (4 mm); short (6 mm); and conventional length (>8 mm) implants in the posterior maxilla present similar peri-implant bone loss and 100% survival rates in rehabilitation, by means of two splinted crowns after 36 months of functional loading. Implants placed in posterior positions present better bone loss results than implants placed in anterior positions, regardless of the interproximal area where bone loss is measured. Conventional length (>8 mm) implants show better behavior in terms of distal bone loss than short (6 mm) and extra-short (4 mm) implants.

What can we do with a dental avulsion? A multidisciplinary Clinical Protocol.

PURPOSE: The aim of this case report was to explain a multidisciplinary and conservative approach carrying out the replantation of an avulsed closed apex central incisor stored in dry conditions for a 16-hour period from the moment of trauma. CASE REPORT: This report describes a case of a 28 year-old male who suffered contusion of the upper lip, avulsion of right upper central incisor, enamel cracks after trauma of left upper central incisor and upper left lateral incisor crown fracture due to an accident. Avulsed tooth was dry stored and it was replanted 16h after the trauma. The root was disinfected and the necrotic periodontal tissue removed, the endodontic treatment was done before replantation and a flexible splint was applied to tooth 13 to tooth 23. Two months later a contralateral tooth presented crown discoloration occurred due to pulp necrosis an endodontic treatment as well as bleaching were carried out. An esthetic restoration for lateral incisor crown fracture was also done. In the one year review the patient remains asymptomatic, with no signs of root resorption or ankylosis of the damaged teeth. CONCLUSIONS: A conservative approach of tooth with delayed reimplantation can be a stable and functional with the appropriate treatment procedures. A clinical protocol for patients and professionals for the treatment of the avulsed tooth is proposed. Key words:Endodontics, dental avulsion, avulsed tooth protocol.

Bleaching in vital teeth: Combined treatment vs in-office treatment.

BACKGROUND: The aim of this study was to verify that there will be greater whitening in teeth treated with combined bleaching than in those that have been applied a clinical one and to evaluate the efficiency of the clinical treatment, those cases in which it is not able, or it is not wanted, to carry out the home phase. MATERIAL AND METHODS: They were used 66 extracted anterior human teeth, which were divided into two study groups. On the one hand, the clinical group (ClG) consisted of 33 teeth, which were treated with a clinical guideline using 37.5% hydrogen peroxide in a single session of 4 applications of 8 minutes. On the other hand, the combinate group (CoG) consisted of 33 teeth, which were treated with a combined guideline, applying first a clinical treatment as in the ClG and, at home treatment with carbamide peroxide at 16% for 22 days, 90 minutes a day. The colour of the tooth was measured before and after each treatment and was made through an individualized whitening splint with a spectrophotometer. RESULTS: The 66 teeth were bleached, showing an increase in luminosity, a drecrease in yellow and a shift towards the green colours, where b (yellow-blue axis) was the only variable with a statistically significant change (p<0.001). The CoG obtained a significantly higher absolute value (p<0.001) than the ClG, being 12.99 for the first one and 19.70 for the second one. CONCLUSIONS: Combined therapy bleached more than clinical one, but both techniques were effective. In addition, it is affirmed that the clinical could be an alternative in those cases in which it is not able, or it is not wanted, to carry out the home phase. Key words:Carbamide peroxide, CIELab, combined guidelines, dental bleaching, hydrogen peroxide.

Effect of two whitening agents on the color of composite dental restorations.

BACKGROUND: To evaluate color changes to composite resins used to restore extracted teeth compared with composite discs after whitening with two agents: hydrogen peroxide (HP) and carbamide peroxide (CP). MATERIAL AND METHODS: Ten human molars with class V vestibular and palatine cavity preparation obturated with Vita hybrid nanocomposite were hemisected to obtain 20 specimens assigned randomly to two groups: O1 and O2. Twenty composite discs were divided into two groups: D1 and D2. The groups O1 and D1 were treated with 16% CP, while groups =2 and D2 were treated with 37.5 % HP. Chromaticity coordinates L*, a* and b* were registered using a spectrophotometer. RESULTS: Statistically significant differences were found in O1 for L* and a*, in O2 for all three coordinates, and in D1 and D2 only for L*. Comparisons between groups found significant differences in ΔEe (end of treatment) between O1 and O2, between O2 and D2, and between D1 and O1. CONCLUSIONS: Both whitening agents produced significant decreases in the three-color components of composites used for dental restorations, while color changes to composite discs were limited to changes in luminosity. HP produced a greater color change to composite dental restorations than to composite discs. Key words:In vitro study, whitening agents, hydrogen peroxide, and carbamide peroxide, dental restorations.

In vivo evaluation of the effects of 10% carbamide peroxide and 3.5% hydrogen peroxide on the enamel surface.

OBJECTIVES: Bleaching of vital teeth performed at home by the patient under the dentist's supervision, using low-concentration peroxides and custom-fitted trays specifically designed for this purpose, is one of several options for this type of dental treatment, whether alone or in combination with another in-office bleaching technique. The objective of this study is to analyse the effect on the enamel surface of two bleaching products recommended for this technique. MATERIALS & METHODS: Two bleaching products were used: VivaStyle (Vivadent), a 10% carbamide peroxide, and FKD (Kin), a 3.5% hydrogen peroxide. They were applied in trays to the anterior teeth of 20 patients (10 in each group). The application times were 2 and 3 hours a day respectively for 28-33 days. Replicas of the tooth surfaces before and after treatment were obtained. These were observed with a scanning electron microscope. RESULTS: The images obtained showed that the tooth surfaces remained entire and the enamel surface structures remained normal. CONCLUSIONS: The results show that neither of the products affects the enamel surface: no post-operatory changes were observed.

At-home vital bleaching: a comparison of hydrogen peroxide and carbamide peroxide treatments.

Tray bleaching of vital teeth performed at home by the patient under the dentist s supervision, whether alone or in combination with any of the in-office techniques, provides an interesting alternative to other methods employed in this type of dental treatment. This bleaching procedure applies low-concentration peroxides to the enamel by means of a custom-made mouth tray specifically designed for this purpose. The aim of this study is to examine and compare two commercially-available bleaching products, at equivalent concentrations, for use in this technique: VivaStyle (Vivadent) and FKD (Kin); the former is a 10% carbamide peroxide and the latter a 3.5% hydrogen peroxide formulation. It examines the parameters that must be monitored during the application of this type of procedure and presents 6 cases (3 treated with one of the above-mentioned products and the other 3 with the other), establishing the bleaching power of the products and the appearance and intensity of post-operatory hypersensitivity. The results obtained show that both products are effective for the purpose for which they were designed. In general, dental hypersensitivity was minimal.