Transitional Era: from analogical to digital workflow in oral rehabilitation: a case report / Era de transição: do fluxo de trabalho analógico para o digital em reabilitação oral: relato de caso

ABSTRACT Digital dentistry is a ubiquitous phenomenon nowadays but it requires access to technologies and learning curve. To aid digital workflow implementation, digital steps can be progressively incorporated in conventional workflows. We aimed to demonstrate a multidisciplinary oral rehabilitation performed mixing conventional procedures with digital open-source software programs and low-cost devices. A 46-year-old female patient had photographs, intraoral scans, and cone-beam computed tomography obtained and used in combination with conventional clinical exams to develop a treatment plan. Power point software was used for digital smile planing and Horos for digital implant planning. The digital dataset were used to guide conventional clinical procedures (scaling and root planning, gingivoplasty, in-office tooth bleaching, fiber-post restoration, implant and bone graft placement, teeth preparation, and protheses design and milling). The inclusion of digital steps in the conventional workflow enabled the performance of rehabilitation procedures with reduced clinical time and increased predictability, favoring the overall workflow and the communication among the different dental specialties. A mixed workflow can progressively lead to an exclusively digital workflow as technologies become accessible and learning curve is coped.

RESUMO Atualmente, a Odontologia digital é um fenômeno onipresente, contudo exige acesso à tecnologia e curva de aprendizado. Para auxiliar na implementação de fluxos de trabalho digitais, etapas digitais podem ser progressivamente incorporadas nos fluxos de trabalho convencionais. Nosso objetivo foi demonstrar uma reabilitação oral multidisciplinar realizada combinando procedimentos convencionais e ferramentas digitais de baixo custo e acesso aberto. Uma paciente de 46 anos teve fotografias, exames intraorais e tomografia computadorizada de feixe cônico obtidos e usados em combinação com exame clínico convencional para desenvolvimento de um plano de tratamento. O software Power Point foi utilizado para o planejamento digital do sorriso e o Horos para o planejamento digital dos implantes. O conjunto de dados digitais foi usado para orientar a execução dos procedimentos clínicos convencionais (raspagem e alisamento radicular, gengivoplastia, clareamento dental, restauração com pino de fibra de vidro, inserção de implantes e enxerto ósseo, preparos protéticos e design e fresagem protética). A inclusão de etapas digitais no fluxo de trabalho convencional permitiu redução do tempo clínico na realização da reabilitação aliado à maior previsibilidade, favorecendo o fluxo de trabalho e a comunicação entre as diferentes especialidades odontológicas. O fluxo de trabalho misto pode progressivamente levar a um fluxo de trabalho exclusivamente digital à medida que as tecnologias se tornem acessíveis e a curva de aprendizado superada.

In vivo temperature rise and acute inflammatory response in anesthetized human pulp tissue of premolars having Class V preparations after exposure to Polywave® LED light curing units.

OBJECTIVE: To evaluate the influence of light emitted from two Polywave®, LED light-curing units (LCU) on in vivo pulp temperature (PT) rise and signs of acute inflammatory response in pulps of human premolar having deep Class V preparations. METHODS: Sixty intact, first premolars from 15 volunteers requiring extraction received infiltrative anesthesia. A sterile thermocouple probe was inserted within the pulp tissue through a minute occlusal pulp exposure in only 45 teeth (n = 9) to continuously monitor PT (°C). A deep buccal Class V preparation was created, and the surface was exposed to light from a commercial Polywave LCU (Bluephase 20i (20i), Ivoclar Vivadent) or from an experimental LCU (Exp) using the exposure modes (EM): 1s/Exp and 2s/Exp, 10s/20i, 20s/20i, and 60s/20i. Peak PT and PT rise values above baseline (ΔT) data were evaluated using a one-way ANOVA followed by Tukey's post-hoc test (α = 5%). Teeth used for histological and immunohistochemical analyses (n = 3) were extracted approximately 2 h after exposure to the LCU. RESULTS: No significant difference in peak PT and ΔT values was noted between 2s/Exp and 20s/20i groups, which both exhibited higher values than 1s/Exp and 10s/20i groups (p < 0.001). Dilated and congested blood vessels were seen after exposure to 1s/Exp, 2s/Exp, or 60s/20i EMs. The expression of IL-1ß and TNF-α tended to be more intense when higher irradiance was delivered. SIGNIFICANCE: Although higher irradiance delivered over a short exposure caused lower PT rise than 5.5 °C, such EMs should be used with caution, as they have more potential to harm the pulp tissue.

Comparison of in vivo and in vitro models to evaluate pulp temperature rise during exposure to a Polywave® LED light curing unit.

OBJECTIVES: To measure and compare in vivo and in vitro pulp temperature (PT) increase (ΔTEMP) over baseline, physiologic temperature using the same intact upper premolars exposed to the same Polywave® LED curing light. METHODOLOGY: After local Ethics Committee approval (#255,945), local anesthesia, rubber dam isolation, small occlusal preparations/minute pulp exposure (n=15) were performed in teeth requiring extraction for orthodontic reasons. A sterile probe of a temperature measurement system (Temperature Data Acquisition, Physitemp) was placed within the pulp chamber and the buccal surface was sequentially exposed to a LED LCU (Bluephase 20i, Ivoclar Vivadent) using the following exposure modes: 10-s low or high, 5-s Turbo, and 60-s high. Afterwards, the teeth were extracted and K-type thermocouples were placed within the pulp chamber through the original access. The teeth were attached to an assembly simulating the in vivo environment, being similarly exposed while real-time temperature (°C) was recorded. ΔTEMP values and time for temperature to reach maximum (ΔTIME) were subjected to two-way ANOVA and Bonferroni's post-hoc tests (pre-set alpha 0.05). RESULTS: Higher ΔTEMP was observed in vitro than in vivo. No significant difference in ΔTIME was observed between test conditions. A significant, positive relationship was observed between radiant exposure and ΔTEMP for both conditions (in vivo: r2=0.917; p<0.001; in vitro: r2=0.919; p<0.001). CONCLUSION: Although the in vitro model overestimated in vivo PT increase, in vitro PT rise was close to in vivo values for clinically relevant exposure modes.

Comparison of in vivo and in vitro models to evaluate pulp temperature rise during exposure to a Polywave® LED light curing unit

Abstract Objectives: To measure and compare in vivo and in vitro pulp temperature (PT) increase (ΔTEMP) over baseline, physiologic temperature using the same intact upper premolars exposed to the same Polywave® LED curing light. Methodology: After local Ethics Committee approval (#255,945), local anesthesia, rubber dam isolation, small occlusal preparations/minute pulp exposure (n=15) were performed in teeth requiring extraction for orthodontic reasons. A sterile probe of a temperature measurement system (Temperature Data Acquisition, Physitemp) was placed within the pulp chamber and the buccal surface was sequentially exposed to a LED LCU (Bluephase 20i, Ivoclar Vivadent) using the following exposure modes: 10-s low or high, 5-s Turbo, and 60-s high. Afterwards, the teeth were extracted and K-type thermocouples were placed within the pulp chamber through the original access. The teeth were attached to an assembly simulating the in vivo environment, being similarly exposed while real-time temperature (°C) was recorded. ΔTEMP values and time for temperature to reach maximum (ΔTIME) were subjected to two-way ANOVA and Bonferroni's post-hoc tests (pre-set alpha 0.05). Results: Higher ΔTEMP was observed in vitro than in vivo. No significant difference in ΔTIME was observed between test conditions. A significant, positive relationship was observed between radiant exposure and ΔTEMP for both conditions (in vivo: r2=0.917; p<0.001; in vitro: r2=0.919; p<0.001). Conclusion: Although the in vitro model overestimated in vivo PT increase, in vitro PT rise was close to in vivo values for clinically relevant exposure modes.

Influence of Class V preparation on in vivo temperature rise in anesthetized human pulp during exposure to a Polywave® LED light curing unit.

OBJECTIVE: This in vivo study evaluated pulp temperature (PT) rise in human premolars having deep Class V preparations during exposure to a light curing unit (LCU) using selected exposure modes (EMs). METHODS: After local Ethics Committee approval, intact first premolars (n=8) requiring extraction for orthodontic reasons, from 8 volunteers, received infiltrative and intraligamental anesthesia and were isolated using rubber dam. A minute pulp exposure was attained and sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted into the coronal pulp chamber to continuously monitor PT (°C). A deep buccal Class V preparation was prepared using a high speed diamond bur under air-water spray cooling. The surface was exposed to a Polywave® LED LCU (Bluephase 20i, Ivoclar Vivadent) using selected EMs, allowing 7-min span between each exposure: 10-s in low (10-s/L), 10-s (10-s/H), 30-s (30-s/H), or 60-s (60-s/H) in high mode; and 5-s-Turbo (5-s/T). Peak PT values and PT increases over physiologic baseline levels (ΔT) were subjected to 1-way, repeated measures ANOVAs, and Bonferroni's post-hoc tests (α=0.05). Linear regression analysis was performed to establish the relationship between applied radiant exposure and ΔT. RESULTS: All EMs produced higher peak PT than the baseline temperature (p<0.001). Only 60-s/H mode generated an average ΔT of 5.5°C (p<0.001). A significant, positive relationship was noted between applied radiant exposure and ΔT (r2=0.8962; p<0.001). SIGNIFICANCE: In vivo exposure of deep Class V preparation to Polywave® LED LCU increases PT to values considered safe for the pulp, for most EMs. Only the longest evaluated EM caused higher PT increase than the critical ΔT, thought to be associated with pulpal necrosis.

In vivo temperature rise in anesthetized human pulp during exposure to a polywave LED light curing unit.

OBJECTIVES: This in vivo study evaluated pulp temperature (PT) rise in human premolars during exposure to a light curing unit (LCU) using selected exposure modes (EMs). METHODS: After local Ethics Committee approval, intact first upper premolars, requiring extraction for orthodontic reasons, from 8 volunteers, received infiltrative and intraligamental anesthesia. The teeth (n=15) were isolated using rubber dam and a minute pulp exposure was attained. A sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted directly into the coronal pulp chamber, and real time PT (°C) was continuously monitored while the buccal surface was exposed to polywave light from a LED LCU (Bluephase 20i, Ivoclar Vivadent) using selected EMs allowing a 7-min span between each exposure: 10-s either in low (10-s/L) or high (10-s/H); 5-s-turbo (5-s/T); and 60-s-high (60-s/H) intensities. Peak PT values and PT increases from baseline (ΔT) after exposure were subjected to one-way, repeated measures ANOVAs, and Bonferroni's post hoc tests (α=0.05). Linear regression analysis was performed to establish the relationship between applied radiant exposure and ΔT. RESULTS: All EMs produced higher peak PT than the baseline temperature (p<0.001). The 60-s/H mode generated the highest peak PT and ΔT (p<0.001), with some teeth exhibiting ΔT higher than 5.5°C. A significant, positive relationship between applied radiant exposure and ΔT (r(2)=0.916; p<0.001) was noted. SIGNIFICANCE: Exposing intact, in vivo anesthetized human upper premolars to a polywave LED LCU increases PT, and depending on EM and the tooth, PT increase can be higher than the critical ΔT, thought to be associated with pulpal necrosis.

Direct measurement of time-dependent anesthetized in vivo human pulp temperature.

OBJECTIVES: Human intrapupal tooth temperature is considered to be similar to that of the body (≈37 °C), although the actual temperature has never been measured. This study evaluated the in vivo, human, basal, coronal intrapulpal temperature of anesthetized upper first premolars. METHODS: After approval of the local Ethics Committee was obtained (protocol no. 255,945), upper right and left first premolars requiring extraction for orthodontic reasons from 8 volunteers, ranging from 12 to 30 years old, received infiltrative and intraligamental anesthesia. The teeth (n=15) were isolated using rubber dam and a small, occlusal preparation was made using high-speed handpiece, under constant air-water spray, until a minute pulp exposure was attained. The sterile probe from a wireless, NIST-traceable, temperature acquisition system (Thermes WFI) was inserted directly into the coronal pulp. Once the probe was properly positioned and stable, real-time temperature data were continuously acquired for approximately 25 min. Data (°C) were subjected to 2-tailed, paired t-test (α=0.05), and the 95% confidence intervals for the initial and 25-min mean temperatures were also determined. RESULTS: The initial pulp temperature value (31.8±1.5 °C) was significantly lower than after 25-min (35.3±0.7 °C) (p<0.05). The 95% confidence interval for the initial temperature ranged from 31.0 to 32.6 °C and from 35.0 to 35.7 °C after 25 min. A slow, gradual temperature increase was observed after probe insertion until the pulp temperature reached a plateau, usually after 15 min. SIGNIFICANCE: Consistent coronal, human, in vivo temperature values were observed and were slightly, but significantly below that of body core temperature.

Degree of conversion of a resin cement light-cured through ceramic veneers of different thicknesses and types.

During the cementation of ceramic veneers the polymerization of resin cements may be jeopardized if the ceramics attenuate the irradiance of the light-curing device. The aim of this study was to evaluate the effect of different types and thicknesses of ceramic veneers on the degree of conversion of a light-cured resin-based cement (RelyX Veneer). The cement was light-cured after interposing ceramic veneers [IPS InLine, IPS Empress Esthetic, IPS e.max LT (low translucency) and IPS e.max HT (high translucency) - Ivoclar Vivadent] of four thicknesses (0.5 mm, 1.0 mm, 1.5 mm and 2.0 mm). As control, the cement was light-cured without interposition of ceramics. The degree of conversion was evaluated by FTIR spectroscopy (n=5). Data were analyzed with one-way ANOVA and Tukey's test (α=0.05). Significant differences were observed among groups (p<0.001). The degree of conversion was similar to the control for all light-cured groups with interposition of ceramics of 0.5 mm and 1.0 mm (p>0.05). Among 1.5-mm-thick veneers, IPS e.max LT was the only one that showed different results from the control (p<0.05). At the thickness of 2.0 mm, only the IPS e.max LT and HT veneers were able to produce cements with degrees of conversion similar to the control (p>0.05). The degree of conversion of the evaluated light-cured resin cement depends on the thickness and type of ceramics employed when veneers thicker than 1.5 mm are cemented.

Degree of Conversion of a Resin Cement Light-Cured Through Ceramic Veneers of Different Thicknesses and Types

During the cementation of ceramic veneers the polymerization of resin cements may be jeopardized if the ceramics attenuate the irradiance of the light-curing device. The aim of this study was to evaluate the effect of different types and thicknesses of ceramic veneers on the degree of conversion of a light-cured resin-based cement (RelyX Veneer). The cement was light-cured after interposing ceramic veneers [IPS InLine, IPS Empress Esthetic, IPS e.max LT (low translucency) and IPS e.max HT (high translucency) - Ivoclar Vivadent] of four thicknesses (0.5 mm, 1.0 mm, 1.5 mm and 2.0 mm). As control, the cement was light-cured without interposition of ceramics. The degree of conversion was evaluated by FTIR spectroscopy (n=5). Data were analyzed with one-way ANOVA and Tukey's test (α=0.05). Significant differences were observed among groups (p<0.001). The degree of conversion was similar to the control for all light-cured groups with interposition of ceramics of 0.5 mm and 1.0 mm (p>0.05). Among 1.5-mm-thick veneers, IPS e.max LT was the only one that showed different results from the control (p<0.05). At the thickness of 2.0 mm, only the IPS e.max LT and HT veneers were able to produce cements with degrees of conversion similar to the control (p>0.05). The degree of conversion of the evaluated light-cured resin cement depends on the thickness and type of ceramics employed when veneers thicker than 1.5 mm are cemented.

Durante a cimentação de facetas cerâmicas, a polimerização de cimentos resinosos pode ser comprometida se a cerâmica atenuar a irradiância do aparelho fotopolimerizador. O objetivo deste estudo foi avaliar o efeito de diferentes tipos e espessuras de facetas cerâmicas sobre o grau de conversão de um cimento resinoso fotopolimerizável (RelyX Veneer). O cimento foi fotoativado após a interposição de facetas cerâmicas [IPS InLine, IPS Empress Esthetic, IPS e.max LT (baixa translucidez) e IPS e.max HT (alta translucidez) - Ivoclar Vivadent] de quatro espessuras (0,5 mm; 1,0 mm; 1,5 mm e 2,0 mm). Como controle, o cimento foi polimerizado sem interposição de cerâmica. O grau de conversão foi avaliado por espectroscopia FTIR (n=5). Os dados foram analisados através de ANOVA a um critério e teste de Tukey (α=0,05). Foram observadas diferenças significativas entre os grupos (p<0,001). O grau de conversão foi semelhante ao do controle para todos os grupos polimerizados com interposição de cerâmicas de 0,5 mm e 1,0 mm (p>0,05). Entre as facetas de 1,5 mm de espessura, IPS e.max LT foi a única que apresentou resultados diferentes do controle (p<0,05). Com a espessura de 2,0 mm, apenas IPS e.max LT e HT foram capazes de produzir cimentos com grau de conversão semelhantes aos do controle (p>0,05). O grau de conversão do cimento resinoso fotopolimerizável avaliado depende da espessura e do tipo de cerâmica utilizados quando facetas mais espessas do que 1,5 mm são cimentadas.

Effect of water storage and surface treatment on the microshear bond strength of different luting cements to zirconia.

This study sought to determine the microshear bond strength of 4 luting cements to zirconia. Zirconia substrates were divided randomly into 16 groups (n = 12), according to the luting cement, surface treatment, and storage time. Matrices were placed onto each zirconia substrate, filled with the cements, and photocured for 40 seconds. Microshear bond strength was determined after storage periods of 48 hours and 75 days; the results were analyzed by ANOVA and Tukey's test (α = 0.05). Surface treatment increased the bond strength to zirconia for 3 of the 4 cements tested. Even after a relatively long period of water storage, the results indicated that surface treatment did not significantly decrease the bond strength values for the same 3 cements.

Endocrown para o tratamento de dentes despolpados / Endocrown: an alternative treatment for pulpless teeth

Um dos problemas odontológicos mais vivenciados pelos cirurgiões dentistas refere-se ao tratamento restaurador de dentes despolpados. Nessas situações, a retenção para o material restaurador é normalmente crítica. Quando a região da câmara coronária apresenta condições adequadas para os princípios de retenção podem-se empregar as coroas tipo Endocrown. No entanto, atualmente, este tipo de tratamento se torna não apenas um problema funcional, mas também estético. Dessa forma, o objetivo deste trabalho é apresentar uma sequência operatória para restaurar um dente posterior despolpado utilizando uma coroa Endocrown para restabelecer a função e a estética

One of the most common problems faced by the dentists is the restorative treatment of pulpless teeth. In these situations the retention for the restorative material is usually critic. When the pulp chamber presents appropriate conditions for the retention the Endocrown type crown can be used. However, nowadays, this type of treatment becomes not only a functional problem, but also an aesthetic one. In that way, the aim of this work was to present an operative sequence to restore a non vital tooth using Endocrown to reestablish aesthetics and function

Using chemical vapor deposition diamond finishing burs for conservative esthetic procedures.

The article demonstrates how chemical vapor deposition (CVD) diamond burs were used in a simple esthetic and cosmetic procedure to treat discolored anterior teeth. A patient who experienced discoloration after bleaching was treated with direct resin composite veneers. Excess restorative material close to the periodontium was removed with a CVD diamond bur attached to an ultrasonic handpiece. The results indicate that CVD diamond burs are appropriate for removing excess material at the gingival margins of resin composite restorations without damaging the periodontium.

Síndrome do dente trincado / Cracked tooth syndrome

A síndrome do dente trincado ocorre com grande freqüência. Seu tratamento pode ser complexo e seu diagnóstico é difícil. Em exame radiográfico raramente a presença de fratura pode ser observada. Vários outros termos têm sido usados como sinônimos, como fratura incompleta e fratura de esmalte. Geralmente a presença de dor tem sido usado como indicativo da fratura. Muitos fatores contribuem para fratura incompleta de um dente como a mal oclusão, os grandes preparos cavitários e o traumatismo oclusal. Existem diversas formas de tratamento sugeridas na literatura como, por exemplo: o ajuste oclusal localizado, a restauração adesiva em compósitos e em amálgama, o uso de bandas ortodônticas, os onlays, e os adesivos