Injectable Composite Resin Technique: An Alternative for Anterior Esthetic Restorations - Case Report / Técnica de Resina Compuesta Inyectable: Una Alternativa para Restauraciones Estéticas Anteriores - Reporte de Caso

This article aims to describe a clinical case of the use of the injectable restorative technique with composite resin in a patient with an esthetic complaint in the anterior teeth. Producing direct restorations in anterior teeth when performed with composite resin demands a long clinical time. Results often depend on the operator's ability to reproduce proper form, function, and esthetics. Lately, the versatility of composite resins has increased. As this material evolved, new techniques were introduced to simplify the restorative process and save time. The restorative technique with injectable fluid composite resin, in addition to delivering faster and with a certain ease, is capable of increasing the predictability of treatment results. However, it is known that flowable resins have lower wear resistance and color stability compared to conventional resins. Thus, a version of this material with a higher filler content in its composition was introduced to the market, to improve wear resistance and gloss retention. Long-term studies evaluating the use of low-viscosity resins are needed. The injectable technique can accurately reproduce the morphology obtained in the wax-up of the case, generating a satisfactory esthetic and functional result. Despite simplifying the fabrication of restorations when compared to the conventional technique, it is still necessary for the operator to have some experience and aptitude. The clinical time for the production of restorations has been considerably reduced. The material showed good flow, shine, and polish in the immediate result. However, the finishing and polishing of the restorations required a longer clinical period than usual and in the short- term follow-up, flaws in the gingival margins and a new finishing and polishing procedure were necessary. Therefore, the technique described in this article can be considered a restorative alternative, but it is still not able to replace the tradit ional method of making previous esthetic restorations.

Este artículo tiene como objetivo describir un caso clínico del uso de la técnica restauradora inyectable con resina compuesta en un paciente con una queja estética en los dientes anteriores. Producir restauraciones directas en dientes anteriores cuando se realizan con resina compuesta demanda un largo tiempo clínico. Los resultados a menudo dependen de la capacidad del operador para reproducir la forma, la función y la estética adecuadas. Últimamente, la versatilidad de las resinas compuestas ha aumentado. A medida que este material evolucionó, se introdujeron nuevas técnicas para simplificar el proceso de restauración y ahorrar tiempo. La técnica restauradora con resina compuesta fluida inyectable, además de una entrega más rápida y segura, es capaz de aumentar la previsibilidad de los resultados del tratamiento. Sin embargo, se sabe que las resinas fluidas tienen menor resistencia al desgaste y estabilidad del color en comparación con las resinas convencionales. Así, se introdujo en el mercado una versión de este material con un mayor contenido de relleno en su composición, con el objetivo de mejorar la resistencia al desgaste y la retención del brillo. Se necesitan estudios a largo plazo que evalúen el uso de resinas de baja viscosidad. La técnica inyectable es capaz de reproducir fielmente la morfología obtenida en el encerado del caso, generando un resultado estético y funcional satisfactorio. A pesar de simplificar la fabricación de restauraciones en comparación con la técnica convencional, todavía es necesario que el operador tenga cierta experiencia y aptitud. El tiempo clínico para la producción de restauraciones se ha reducido considerablemente. El material mostró buena fluidez, brillo y pulido en el resultado inmediato. Sin embargo, el acabado y pulido de las restauraciones requirió de un período de tiempo clínico más largo de lo habitual y en el seguimiento a corto plazo, fueron necesarios defectos en los márgenes gingivales y un nuevo procedimiento de acabado y pulido. Por lo tanto, la técnica descrita en este artículo puede considerarse una alternativa restauradora, pero aún no es capaz de reemplazar el método tradicional de realizar restauraciones estéticas previas.

Multiple gingival recessions associated with non-carious cervical lesions treated by partial restoration and modified coronally advanced flap with either connective tissue graft or xenogeneic acellular dermal matrix: A randomized clinical trial.

BACKGROUND: This study aimed to compare a connective tissue graft (CTG) to a (porcine) xenogeneic acellular dermal matrix (XDM), both associated with modified coronally advanced flap (MCAF) and partial resin composite restoration to treat multiple combined defects (CDs). METHODS: Seventy-eight defects in 38 patients presenting multiple combined defects, that is, gingival recession associated with non-carious cervical lesions, were treated by partial resin composite restoration (apical margin up to 1 mm of the estimated cement-enamel junction) and MCAF along with CTG or XDM. After 6 months, the groups were compared with regard to clinical, patient-centered, and esthetic outcomes. RESULTS: CD coverage was 72.9% for CTG versus 50.7% for XDM (P < 0.001). Recession reduction was 2.3 mm for CTG versus 1.5 mm for XDM (P < 0.001). CTG resulted in a greater increase in keratinized tissue width (CTG: 0.96 mm vs. XDM: 0.3 mm, P = 0.04) and gingival thickness (CTG: 0.9 mm vs. XDM: 0.3 mm, P < 0.001). Both treatments successfully reduced dentin hypersensitivity and increased esthetics satisfaction, with no statistically significant intergroup differences. Moreover, XDM patients experienced a shorter surgery duration (CTG: 57.2 min vs. XDM: 37.4 min, P < 0.001) and less time to no pain (visual analog scale  =  0; CTG: 6.5 days vs. XDM: 3.5 days, P = 0.04). CONCLUSION: CTG resulted in significantly greater root coverage and increased keratinized tissue width compared to XDM for treating multiple partially restored CDs. However, increased root coverage at the CTG sites was accounted for by increased probing depth compared to the XDM sites.

Evaluation of a novel restorative protocol to treat non-carious cervical lesion associated with gingival recession: a 2-year follow-up randomized clinical trial.

OBJECTIVE: To compare 2 different resin composites and 2 adhesive systems used in a new restorative protocol (partial restoration) to treat non-carious cervical lesions associated with gingival recession type 1 (RT1). MATERIAL AND METHODS: Eighty combined defects (CDs) were treated with a partial restoration and periodontal plastic surgery for root coverage. The CDs were randomly assigned to one of the following groups: NP + TE (n = 20), nanofilled composite and 2-step total-etch adhesive system; NP + UA (n = 20), nanofilled composite and universal adhesive system; MH + TE (n = 20), microhybrid composite and 2-step total-etch adhesive; MH + UA (n = 20), microhybrid composite and universal adhesive. Restorations were assessed using the United States Public Health Service (USPHS) criteria at 1 week (baseline) and 6, 12, and 24 months. Survival rate, periodontal parameters, dentin hypersensitivity (DH), and aesthetics were also evaluated. RESULTS: After 24 months, only the MH + TE group did not lose any restoration, with no significant differences between groups. For surface roughness parameter, MH presented 83.3% of the restorations scoring Bravo, whereas NP presented 48.5% of the restorations scoring Bravo. All groups presented restorations with marginal discoloration. All periodontal parameters behaved similarly, regardless of the restorative material. All groups presented significant reductions of dentin hypersensitivity and improved aesthetic perceptions (p < 0.05). CONCLUSION: Both resin composites and adhesives tested can be combined for partial restorations to treat CDs. CLINICAL RELEVANCE: This new restorative-surgical protocol to treat CDs presents satisfactory outcomes. The partial restorations can be successfully executed with both combinations of adhesives and resin composites evaluated in this investigation. TRN : ClinicalTrial.gov: NCT03215615; registration date July 12, 2017.

Color and surface gloss stability of bis-acryl and resin composite after exposure to cigarette smoke / Estabilidade de cor e brilho superficial de resinas compostas e bisacrílicas após exposição por fumaça de cigarro

Objective: To evaluate color and surface gloss stability of bis-acryl resins and resin composites, submitted to artificial staining with cigarette smoke. Material and Methods: Specimens of each material were prepared (n=15). Two resin composites (GrandioSO [RCG], Filtek Supreme [RCZ]) and five bis-acryl resins (Luxatemp Star [BisLUX], Protemp4 [BisPRO], Structor3 [BisSTR], Visalys Temp [BisVIS] and Yprov [BisYPR]) were tested. Initial color was assessed using a spectrophotometer and surface gloss with a glossmeter. Samples were submitted to smoke exposure (10 cigarettes under 8 minutes per cycle). After 3 and 6 cycles, color and gloss were reassessed. Final readings were performed after brush prophylaxis. Data were analyzed using two-way repeated ANOVA and Tukey's test (p<0.05). Results: Differences and interaction of factors (p<0.01) were detected for both color and gloss readings. Resin composites were the least affected by aging, with gloss reduction after prophylaxis. Differences were detected among bis-acryl resins, with better results for BisLUX and BisPRO. BisPRO and BisSTR, showed reduction in gloss after 60 cigarettes, while BisYPR gloss decreased at all evaluated periods. Conclusion: Resin composites are less susceptible to changes after smoke exposure, while bis-acryl resins results are brand-dependent. Prophylaxis negatively influenced the surface gloss of most of the tested materials (AU)

Objetivo: Avaliar a estabilidade de cor e brilho superficial de resinas compostas e bisacrílicas, submetidos ao manchamento artificial por fumaça de cigarro. Material e Métodos: Foram preparados espécimes de cada material (n=15). Duas resinas compostas (GrandioSO [RCG], Filtek Supreme [RCZ]) e cinco resinas bisacrílicas (Luxatemp Star [BisLUX], Protemp4 [BisPRO], Structor3 [BisSTR], Visalys Temp [BisVIS] e Yprov [BisYPR]) foram testados. A cor inicial foi avaliada usando um espectrofotômetro e o brilho de superfície com um medidor de brilho. As amostras foram submetidas à exposição de fumaça de cigarro (10 cigarros com até 8 minutos por ciclo). Após 3 e 6 ciclos, a cor e o brilho foram reavaliados. As leituras finais foram realizadas após a profilaxia escova de robinson. Os dados foram analisados usando de medidas repetidas e teste de Tukey (p<0,05). Resultados: Foram detectadas diferenças e interação de fatores (p<0,01) tanto para leituras de cor quanto para leituras de brilho. As resinas compostas foram as menos afetados pelo envelhecimento, com redução do brilho após a profilaxia. Foram detectadas diferenças entre as resinas bisacrílicas, com melhores resultados para BisLUX e BisPRO. BisPRO e BisSTR, mostraram redução de brilho após 60 cigarros, enquanto que o brilho da BisYPR diminuiu em todos os períodos avaliados. Conclusão: As resinas compostas são as menos suscetíveis a mudanças após a exposição à fumaça, enquanto os resultados das resinas bisacrílicas são dependentes da marca. A profilaxia influenciou negativamente o brilho de superfície da maioria dos materiais testados.(AU)

Effect of fluoride, chlorhexidine or Nd:YAG on the progression of root dentin demineralization after removal of the demineralized organic matrix

Abstract Quantification of collagen degradation is an important parameter to evaluate dentin caries for preventive aid. Objectives: Evaluate preventive methods against root collagen degradation by the hydroxyproline assay (HYP) and microradiography technique (MRT). Methodology: Five bovine root dentin blocks were obtained and subjected to an artificial demineralization process by acetate buffer (pH 5) to induce carious lesion formation. Samples were subjected to the following therapeutic treatments: 1) 0.12% chlorhexidine for 1 min, 2) 2% fluoride for 1 min, 3) Nd:YAG Laser (400 μm diameter optical fiber, 10 Hz frequency, 60 mJ/pulse energy, 48 J/cm2 energy density, in noncontact mode for 10 s), 4) deionized water (control) for 1 min, 5) MRT control group (without treatment and removal of collagen). Samples were exposed to degradation by a collagenase enzyme for five days. The enzyme solution was collected, by colorimetry in a spectrophotometer, from the collagen matrix for the hydroxyproline release analysis. The same samples were subjected to an additional two days of demineralization to induce the progression of mineral loss. Samples were analyzed by MRT for the visualization of their degraded areas (estimation of lesion depth and mineral loss). ANOVA was applied to compare hydroxyproline release rates. MRT data were subjected to the Kruskal-Wallis test, followed by the Dunn's test. Comparisons between the initial five-day and the subsequent two-day demineralization processes were performed by repeated t-test or Wilcoxon (p<0.05) measurements. Results: The amount of HYP released from the dentin samples failed to show significant differences among the groups (p=0.09). Fluoride and chlorhexidine were able to interact with the samples, reducing the progression of dentin caries after removal of the demineralized organic matrix. CHX was the only treatment able to show significant lower lesion depth than the negative control. Conclusion: Chlorhexidine and fluoride were effective in reducing root caries progression.

Influence of Preparation Design, Restorative Material and Load Direction on The Stress Distribution of Ceramic Veneer in Upper Central Incisor / Influência do desenho de preparo, material restaurador e direção de carga na distribuição de tensão de laminado cerâmico em incisivo central superior

Objective: Evaluate the effect of four preparation designs, two ceramic materials, and two occlusion contact types on the stress distribution of ceramic veneer in upper central incisor. Material and methods: 3D-models were performed in the modeling software containing enamel, dentin, pulp, periodontal ligament and a base of polyurethane resin. The designs were modeled and exported to the computer aided engineering software to perform the static structural analysis. For the mesh, a total of 155429 tetrahedron elements and 271683 nodes were used, after a 10% convergence test. Two materials, lithium disilicate and feldspathic ceramics, were simulated. A static load of 100 N on 45º was applied on the incisal and middle thirds of the palatal tooth region, guided by the occlusal plane. The base was constrained in all directions. The Maximum Principal Stress was the failure criteria chosen for the analysis. Results:The Finite Element Analysis showed that the most conservative designs presented less stress concentration on the ceramic veneer. However, the highest tensile stress concentrations were observed on lithium disilicate veneer with extend design, on the middle third. The type of occlusal contact presented different stress patterns among the preparation designs; the incisal contact showed higher stress concentration compared to middle third contact regardless the ceramic material. Conclusion: To perform a ceramic veneer in upper central incisor, the feldspathic ceramic presented promising results and should be recommended when the extended design was done. Regarding contact types, the incisal contact is more prone to failure regardless the ceramic and preparation design. (AU).

Objetivo: Avaliar o efeito de quatro desenhos de preparo, dois materiais cerâmicos e dois tipos de contato oclusais na distribuição de tensão de laminado cerâmico em incisivo central superior. Material e métodos: Modelos 3D foram realizados em software de modelagem contendo esmalte, dentina, polpa, simulador de ligamento periodontal e uma base de resina de poliuretano. Os desenhos foram modelados e exportados para o software de engenharia para realizar análise estatística estrutural. Para a malha, foram usados um total de 155429 elementos tetraedros e 271683 nós, após teste de convergência de 10%. Dois materiais, dissilicato de lítio e cerâmica feldspática, foram simulados. Uma carga estática de 100N em 45º foi aplicada no terço incisal e médio na região palatina do dente, guiada pelo plano oclusal e a base foi restringida em todas as direções. A tensão de tração foi o critério de falha escolhido para a análise. Resultados: A análise de elementos finitos mostrou que os desenhos mais conservadores apresentaram menor concentração de tensão no laminado cerâmico. Contudo, as maiores concentrações de tensões foram observadas no laminado de dissilicato de lítio com preparo estendido no terço médio. O tipo de contato oclusal apresentou diferentes padrões de tensões entre os diferentes desenhos, o contato incisal mostrou maior concentração de tensão em relação ao contato do terço médio independentemente do material cerâmico Conclusão: Para a confecção de laminado cerâmico em incisivo central superior, a cerâmica feldspática apresentou resultados promissores e é recomendada quando for feito preparo estendido. Em relação aos tipos de contato, o contato incisal é mais sujeito a falhas independentemente da cerâmica e desenho do preparo. (AU)

Amalgam allergy and Burning Mouth Syndrom: treatment and 25 years recall / Alergia ao amálgama e Síndrome da ardência bucal: tratamento e 25 anos de proservação

Background: Burning mouth syndrome (BMS) is a non-neuropathic chronic orofacial pain condition, characterized by the presence of burning/warm sensation without specific mucosal lesions. Objective: The aim of the present clinical case report is to describe the positive outcome of dental treatment of a patient with BMS and followed up for 25 years. Data Treatment: This report describes the case of a 50-year-old black woman sought treatment for burning, and persistent swelling of tong (24h/day) occurring over years. Clinical evaluation of the oral environment revealed the tongue with cracking, darkened points areas, surrounded by whitish areas. Twelve teeth presented extensive amalgam restorations. Patch testing revealed a very strong hypersensitivity to Amalgam. All amalgam restorations were substituted by composite resin restorations. Results and Conclusion: Burning sensation disappeared completely after these restorations had been changed. After 25-year follow-up period, it was observed that burning sensation has never been felt anymore. Clinical Significance: Burning mouth syndrome is a chronic orofacial pain, usually without specific mucosal lesions. The etiology is complex and multifactorial and the treatment should be made specifically for each pacient. (AU)

Introdução: A síndrome de ardência bucal (SAB) é uma condição de dor orofacial crônica não neuropática, caracterizada pela presença de sensação de queimação/calor sem lesões específicas da mucosa. Objetivo: Oobjetivo do presente relato de caso clínico é descrever a evolução positiva do tratamento odontológico de uma paciente com SAB e o retorno após 25 anos. Tratamento dos Dados: Este relato descreve o caso de uma mulher negra de 50 anos que buscou tratamento por queimadura e edema persistente da língua (24h/dia) ocorrendo ao longo dos anos. A avaliação clínica da cavidade bucal revelou a língua com áreas fissuradas e áreas com pontos escurecidos circundadas por áreas esbranquiçadas. Doze dentes apresentavam restaurações extensas de amálgama de prata. O teste de contato revelou hipersensibilidade muito forte ao amálgama de prata. Todas as restaurações de amálgama de prata foram substituidas por restaurações de resina composta. Resultados e Conclusão: A sensação de queimação desapareceu completamente após a substituição das restaurações. Após um periodo de 25 anos, observou-se que a sensação de queimação nunca foi mais relatada. Significado Clínico: a síndrome da ardência bucal é uma dor orofacial crônica, geralmente sem lesões específicas da mucosa. A etiologia é complexa e multifatorial e o tratamento deve ser feito especificamente para cada paciente.(AU)

A prospective and randomized clinical trial evaluating the effectiveness of ART restorations with high-viscosity glass-ionomer cement versus conventional restorations with resin composite in Class II cavities of permanent teeth: two-year follow-up

Abstract Objective To compare the effectiveness of ART restorations using High Viscosity Glass-ionomer cement (HVGIC) with conventional restorations using resin composite in Class II cavities of permanent teeth, in a 2-year follow-up. Methodology Seventy-seven restorations were made with each restorative material, Equia Fil-GC Corporation (ART restorations) and Z350-3M (conventional restoration), in 54 participants in this parallel and randomized clinical trial. Restorations were evaluated at 6 months, 1 and 2 years using the ART and the modified United States Public Health Service (USPHS) criteria. Chi-square test and Survival Analysis (p<0.05) were used for statistical analysis. Results The success rates for ART restorations were 98.7% (6 months) and 95.8% (1 year) for both criteria. At 2 years, success rate was 92% and 90.3% when scored by the modified USPHS and ART criteria (p=0.466), respectively. The success rates for conventional restorations were 100% (6 months), 98.7% (1 year) and 91.5% (2 years) for both assessment criteria. ART restorations presented a lower survival rate by the criterion of ART (83.7%) when compared to the modified USPHS criterion of (87.8%), after 2 years (p=0.051). The survival of conventional restorations was 90.7% for both evaluation criteria. Conclusion At the 2-years follow-up evaluation, no statistically significant difference was observed between the success rate of ART restorations with HVGIC compared to conventional restorations with resin composite in Class II cavities of permanent teeth.

Protocols to control contamination and strategies to optimize the clinical practice in Restorative Dentistry during the COVID-19 pandemic / Protocolos para controle de contaminação e estratégias para otimizar a prática clínica em Odontologia Restauradora durante a pandemia de COVID-19

The current outbreak of coronavirus 2019 (COVID-19) challenges how professional standards have been defined so far. In Dentistry, biosafety measures already taken by professionals have been intensified, aiming to offer the patient urgent and emergency treatment with safety for both. In this context, Restorative Dentistry is responsible for the care of patients with caries injuries, with or without symptoms and, fractures of teeth and existing restorations. This article guides professionals, during the pandemic period, on the risks involved in adult and pediatric dental care for patients with restorative needs. It also discusses strategies to optimize clinical practice, reducing risks of contamination and virus transmission. (AU)

O atual surto de coronavírus 2019 (COVID-19), fez com que muitos profissionais repensassem sua postura de trabalho. Na Odontologia, medidas de biossegurança já realizadas pelos profissionais, foram intensificadas, com o objetivo de oferecer ao paciente um tratamento de urgência e emergência com segurança para ambos. Neste contexto, a Odontologia Restauradora é responsável pelo atendimento de pacientes com lesões de cárie, com ou sem sintomatologia, e fraturas de dentes e restaurações já existentes. Este trabalho orienta os profissionais quanto aos riscos envolvidos no atendimento odontológico, adulto e pediátrico, de paciente com necessidades restauradoras durante o período de pandemia. O artigo também discute estratégias para otimizar o atendimento, diminuindo riscos de contaminação e transmissão do vírus. (AU)

Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial

Abstract Objective: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. Methodology: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. Results: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). Conclusion: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Clinical performance of whitening on devitalized teeth: a retrospective observational study / Desempenho clínico do clareamento em dentes desvitalizados: estudo observacional retrospectivo

Objective: This retrospective observational study evaluated the clinical performance of intracoronal whitening and correlated the main factors that interfere with its stability and patient satisfaction. Material and Methods: The paper was designed following the STROBE statement. Patients from the Institute of Science and Technology - ICT/UNESP database who underwent nonvital tooth whitening from August 2010 to July 2015 were selected. Data collection was performed by researching the institution records, patients interview, clinical and radiographic examination. Data were analyzed using MannWhitney test and Spearman's correlation (p < 0.05). Results: The initial search on 1275 records resulted in 43 patients, of whom 18 were selected according to eligibility criteria. There was positive correlation only between the degree of patient's satisfaction and the perception of color difference after whitening treatment (p < 0.05). Color relapse was observed in all conditions, independently of the period of followup (p > 0.05). There was no case of external cervical root resorption. Conclusion: Color changes after whitening influenced patient's satisfaction. There was no correlation among the color relapse and height of gutta-percha, return interval or cause of darkening (AU)

Objetivo: Este estudo observacional retrospectivo avaliou o desempenho clínico do clareamento interno e correlacionou os principais fatores que interferem em sua estabilidade e satisfação do paciente. Material e Métodos: O artigo foi elaborado seguindo o STROBE. Pacientes do banco de dados do Instituto de Ciência e Tecnologia ­ ICT/UNESP que foram submetidos ao clareamento dental em dentes desvitalizados entre agosto de 2010 e julho de 2015 foram selecionados. A coleta de dados foi realizada por meio de pesquisa em prontuários da instituição, entrevista com os pacientes, exames clínico e radiográfico. Os dados foram analisados usando o teste de Mann-Whitney e correlação de Spearman (p < 0,05). Resultados: A pesquisa inicial em 1275 registros resultou em 43 pacientes, dos quais 18 foram selecionados de acordo com os critérios de elegibilidade. Houve correlação positiva apenas entre o grau de satisfação do paciente e a percepção da diferença de cor após o tratamento clareador (p < 0,05). A recidiva da cor foi observada em todas as condições, independentemente do tempo de acompanhamento (p > 0,05). Não houve nenhum caso de reabsorção cervical externa. Conclusão: As mudanças de cor após o clareamento influenciaram a satisfação do paciente. Não houve correlação entre a recidiva da cor e a altura do guta-percha, o intervalo de retorno ou a causa do escurecimento. (AU)

The wear performance of glazed and polished full contour zirconia

Abstract This study evaluated the influence of zirconia surface finishes on the wear of an enamel analogue. 40 zirconia discs were divided into four groups: control (without finish); glazed; polished; polished and glazed. All samples were subjected to wear against steatite antagonists. The specimens underwent roughness, topographic, scanning electron microscopy (SEM) and wettability analyses. Quantitative wear measurements were performed on both steatites and discs. To measure wear of steatites the weight before and after the test and the diameter after the test were used. Profilometer measurements were performed to determine the wear on discs. Roughness, volumetric wear and mass loss were analyzed using the Kruskal-Wallis and Dunn tests (5%), while contact angle values were analyzed with One-way ANOVA and Tukey tests (5%). The polished group had the lowest roughness means, being statistically different from the other groups (p-value=0.0001). The glazed group presented the lowest steatite volumetric wear (p-value=0.0001), but not statistically different from the polished and glazed group, whereas these groups presented the highest zirconia volumetric wear, with statistically different (p-value=0.0002) compared to the others. SEM showed irregularities on the control groups surface, grooves on the polished group, and a homogeneous surface for the glazed group with a few pores. All groups presented contact angles lower than 90 degrees, characterizing hydrophilic surfaces. It can be concluded that just glazed zirconia caused less wear on the antagonist when compared to no finish and polished zirconia.

Resumo Este estudo avaliou a influência dos acabamentos superficiais da zircônia no desgaste de um análogo de esmalte. 40 discos de zircônia foram divididos em quatro grupos: controle (sem acabamento); glazeado; polido; polido e glazeado. Todas as amostras foram submetidas ao desgaste contra antagonistas de esteatita. Os espécimes foram submetidos à análise de rugosidade, topografia, microscopia eletrônica de varredura (MEV) e análise de molhabilidade. Medidas quantitativas de desgaste foram realizadas nos antagonistas e nos discos de zircônia. Para medir o desgaste das esteatitas, foi mensurado o peso antes e depois do desgaste e o diâmetro após o teste. A análise de perfilometria mensurou o desgaste dos discos. Rugosidade, desgaste volumétrico e perda de massa foram analisados pelos testes de Kruskal-Wallis e Dunn (5%), enquanto os valores de ângulo de contato foram analisados com os testes One-way ANOVA e Tukey (5%). O grupo polido apresentou as menores médias de rugosidade, sendo estatisticamente diferente dos demais grupos (p-valor=0,0001). O grupo glazeado apresentou o menor desgaste volumétrico do antagonista (p-valor=0,0001), mas não foi estatisticamente diferente do grupo polido e glazeado, enquanto que esses grupos apresentaram o maior desgaste volumétrico da zircônia, com diferença estatisticamente diferente (p-valor=0,0002) em comparação com os outros. MEV mostrou irregularidades na superfície do grupo controle, sulcos no grupo polido e uma superfície homogênea para o grupo glazeado, com poucos poros. Todos os grupos apresentaram ângulos de contato menores que 90 graus, caracterizando superfícies hidrofílicas. Dentro das limitações deste estudo in vitro, é possível concluir que zircônia glazeada causou menos desgaste ao antagonista quando comparada a zircônia sem tratamento ou polida. Além disso, não foi encontrada diferença no desgaste do antagonista para os grupos de zirconia polida e controle.

Six-month performance of restorations produced with the ethanol-wet-bonding technique: a randomized trial

Abstract This double-blind randomized controlled clinical trial evaluated the effectiveness of dentin pretreatment with 100% ethanol (EWBT - ethanol wet bonding technique) and different adhesive protocols in noncarious cervical lesions (NCCL) after 6 months. Patients presenting at least one NCCL were included. NCCLs (n=148) were randomly assigned to 4 groups: NE (Non-EWBT + three-step etch-and-rinse (Scotchbond Multi Purpose, 3M ESPE [MP]), E (EWBT + MP); EB (EWBT + [Bond - third step of MP]), and EU (EWBT + universal adhesive (Single Bond Universal, 3M ESPE). Conventional acid-etching (Condac 37%, FGM) and nanohybrid resin composite (Z350, 3M ESPE) were used. Trained and calibrated examiners (Kappa = 0.61) evaluated the restorations at baseline (7 days) and 6-month recall using the USPHS modified criteria. Data were subjected to Chi square (α = 0.05). Differences in the success rate were found for the treatments (p = 0.003). EB presented the lowest success rate compared with the other groups (p < 0.02). No significant differences were detected among NE, E, and EU (p > 0.49). The survival rates were 97.23%, 97.30%, 78.95%, and 97.30% for NE, E, EB, and EU, respectively. Regarding postoperative sensitivity, a significant reduction was found for groups E (p = 0.027) and EU (p < 0.01) after 6 months. After 6 months, EWBT associated to the hydrophobic adhesive system had the highest failure rate.

Effect of age-related alterations on the biomechanics of teeth affected by non-carious cervical lesions / Efeito de alterações relacionadas à idade na biomecânica de dentes afetados por lesões cervicais não-cariosas

Objective: The prevalence of non-carious cervical lesions (NCCLs) has increased in the recent years, especially in the elderly population. The successful prevention and treatment of those lesions requires an understanding of the biomechanics of aged teeth. Considering the importance of such aspect, the impact of the age-related dentin deposition on the stress distribution of NCCLs was evaluated by means of finite element analysis. Material and Methods: A 2-dimensional model of a sound maxillary first premolar was created using CAD software. Two tooth geometries (sound, aged) and two lesion shapes (wedge, saucer) were simulated to the model. The mesh was built with 35,000 triangle and square elements of 0.1 mm in length. All tissues were considered isotropic, homogeneous and linear. Occlusal surfaces were loaded with 300 N for simulating normal chewing forces. The stress distribution was analyzed by a color scale and by the maximum principal stress at the cavosurface line angle. Results: The aged models presented lower stress concentration in the overall system in comparison to sound models. The sharp angle of wedge shaped lesions promoted higher stress concentration at the center of cavosurface angle, favoring the lesions progression. Conclusion: Considering the limitations of the current methodology, it is possible to conclude that aged tooth is a more compact structure that can better respond to stress loadings. This protective intrinsic mechanism should be considered when adopting preventive and restorative measures for NCCLs for the elderly. (AU)

Objetivo: A prevalência de lesões cervicais nãocariosas (NCCLs) tem aumentado nos últimos anos, especialmente em idosos. A prevenção e o tratamento bem-sucedidos dessas lesões requerem um entendimento da biomecânica dos dentes envelhecidos. Considerando a importância de tal aspecto, o impacto da deposição de dentina que ocorre com a idade na distribuição de estresse de NCCLs foi avaliado por meio da análise de elementos finitos. Material e Métodos: Um modelo bidimensional de um primeiro pré-molar superior foi criado usando o software CAD. Duas geometrias de dentes (padrão, envelhecido) e duas formas de lesão (cunha, pires) foram simuladas ao modelo. A malha foi construída com 35.000 elementos triangulares e quadrados de 0,1 mm de comprimento. Todos os tecidos foram considerados isotrópicos, homogêneos e lineares. Superfícies oclusais foram carregadas com 300 N para simular forças normais de mastigação. A distribuição das tensões foi analisada por uma escala de cores e pela tensão principal no ângulo da linha cavo-superficial. Resultados: Os modelos envelhecidos apresentaram menor concentração de tensão no sistema geral em comparação aos modelos padrão. O ângulo agudo das lesões em cunha promoveu maior concentração de tensão no centro do ângulo cavo-superficial, favorecendo a progressão das lesões. Conclusão: Considerando as limitações da metodologia atual, é possível concluir que o dente envelhecido é uma estrutura mais compacta que pode responder melhor às cargas de estresse. Este mecanismo intrínseco de proteção deve ser considerado ao adotar medidas preventivas e restaurativas para as NCCLs em idosos. (AU)

Influence of Zingiber officinale Extract on Push-Out Bond Strength of Glass-Fiber Post

Abstract The aim of this study was to evaluate in vitro the influence of 20% glycolic ginger extract on the bond strength of glass-fiber post cemented with etch-and-rinse or self-etching resin cement. Forty-eight bovine roots were standardized (17±0.5 mm) and randomly divided into two groups, according to irrigant used during biomechanical preparation: NaOCl: 1% sodium hypochlorite and GEN: 20% glycolic ginger extract. Root canal was prepared and randomly assigned to one of two subgroups (n=12), according to luting protocol: self-etching (RelyX U200) and etch-and-rinse (RelyX ARC). After 48 h, the roots were sectioned perpendicularly (4 in cervical third and 3 in middle third) and submitted to push-out bond strength test (50 kgf load cell, 1.0 mm/min). Failure mode was analyzed in SEM and stereomicroscopy. Data were analyzed by three-way ANOVA and Tukey tests (p<0.05). ANOVA revealed that there were no significant differences between U200 (2.01±0.17)B and ARC (1.93±0.12)B in GEN group, and at the cervical third for both irrigants, 2.69±0.16A and 2.54±0.17A, respectively. Middle third showed lower bond strength than cervical third, regardless the irrigant. Overall, the cervical third regardless the irrigant employed and the association between NaOCl and ARC, presented better adhesive performance.

Resumo O objetivo deste estudo foi avaliar in vitro a influência do extrato de gengibre 20% na resistência adesiva de pinos de fibra de vidro cimentados com cimentos resinosos convencional ou autocondicionantes. Quarenta e oito raízes bovinas foram padronizadas (17±0.5mm) e aleatoriamente divididas em dois grupos (n=24), de acordo com o irrigante utilizado durante o preparo biomecânico: NaOCl: hipoclorito de sódio 1%; e GEN: extrato glicólico de gengibre 20%. Os canais radiculares foram preparados e aleatoriamente distribuídos em dois subgrupos (n=12), conforme o protocolo de cimentação: autocondicionante (RelyX U200) e convencional (RelyX ARC). Após 48 h, as raízes foram seccionadas perpendicularmente (4 no terço cervical e 3 no terço médio) e submetidas ao teste de resistência adesiva push-out (50 kgf carga, 1.0 mm/min). O modo de falha foi analisado em MEV e estereomicroscopia. Os dados foram analisados pelos testes ANOVA 3-fatores e Tukey (p<0.05). ANOVA mostrou que não houve diferenças significativas entre U200 (2.01±0.17)B e ARC (1.93±0.12)B no grupo GEN, e no terço cervical para ambos os irrigantes (2.69±0.16A and 2.54±0.17A, respectivamente). O terço médio apresentou menor resistência adesiva que o terço cervical, independente do irrigante. Em geral, o terço cervical, independentemente do irrigante empregado, e a associação entre NaOCl e ARC apresentaram melhores desempenhos adesivos.

Influence of ethanol-wet dentin, adhesive mode of application, and aging on bond strength of universal adhesive

Abstract The aim of this study was to evaluate the effect of ethanol on the bond longevity of a universal adhesive system to bovine dentin, under different modes of adhesive application and artificial aging. Bovine dentin was exposed, and the smear layer was standardized by sandpaper polishing. Specimens were randomly divided into 2 groups: ethanol (E) and non-ethanol (N). Groups were subdivided according to adhesive mode of application into etch-and-rinse (Er) and self-etching (S). Resin blocks were built onto the treated surface, and the specimens were stored in deionized water at 37°C for 48 h. Half of the specimens (n = 10) were subjected to thermomechanical aging (A for aged and Na for non-aged). Resin/dentin beams were obtained and subjected to microtensile test in a universal testing machine. Data were analyzed using a three-way ANOVA and Tukey's tests (α = 5%). There was interaction among the three factors (p=0.0003). The use of ethanol resulted in higher values, except for the Er and Na groups (E_Er_Na = N_Er_Na). The mode of application was similar, except for the N and A groups (N_S_A > N_Er_A). For the A groups, the values were lower, except in the cases using ethanol, in which the results were not affected. The study concluded that the use of ethanol resulted in higher microtensile bond strength values, even after aging. The mode of adhesive application did not influence the results.

Effect of thermocycling aging on the flexural strength of feldspathic ceramic / Efeito da termociclagem na resistência flexural de uma cerâmica feldspática

Objective: The aim of the study was to evaluate the effect of aging through different thermocycling protocols on the flexural strength of a feldspathic ceramic. Material and Methods: Fifty ceramic bars, Vitablock Mark II (VITA), with dimensions of 18X4X2mm were prepared. The bars were randomly distributed to the groups (n = 10), which were defined according to the number of thermal cycles (TCy): G0 - no TCy; G500 - 500 cycles of TCy; G6000 - 6000 TCy; G10000 - 10000 TCy; G15000 - 15000 TCy. After aging, the specimens were subjected to the three point bending test in a universal testing machine (EMIC DL 1000), under 0.5mm/min speed and loading of 50kgf, until catastrophic failure. A sample of each group was evaluated for topographic morphology under Scanning Electron Microscopy. Results: For mechanical testing, the following mean values and standard deviation (MPa) were obtained: G0 (99.78 ± 5.07); G500 (101.64 ± 5.59); G6000 (98.13 ± 4.95); G10000 (91.77 ± 9.68); G15000 (101.51 ± 4.22). An analysis of variance by regression equation (p = 0.387) was performed, demonstrating a weak and non-significant correlation between flexural strength and number of thermal cycles. Conclusion: It can be concluded that aging in water solely by different numbers of temperature cycles did not influence on the flexural strength of a feldspathic ceramic. (AU)

Objetivo: O objetivo do estudo foi avaliar o efeito do envelhecimento por meio de diferentes protocolos de ciclos térmicos na resistência à flexão de uma cerâmica feldspática. Material e Métodos: Cinquenta barras de cerâmica, Vitablock Mark II (VITA), com dimensões de 18X4X2mm foram preparadas. As barras foram distribuídas aleatoriamente pelos grupos (n = 10), os quais foram definidos de acordo com o número de ciclos térmicos (CT): G0 ­ nenhum; G500 - 500 CT; G6000 - 6000 CT; G10000 ­ 10000 CT; G15000 - 15000 CT. Após envelhecimento, as amostras foram submetidas ao ensaio de flexão de três pontos em uma máquina de ensaios universal (EMIC DL 1000), sob a velocidade de 0,5 mm / min e célula de carga de 50kgf, até uma falha catastrófica. Uma amostra de cada grupo foi avaliada quanto à morfologia topográfica sob microscopia eletrônica de varredura. Resultados: Para os testes mecânicos, foram obtidos os seguintes valores médios e desvio padrão (MPa): G0 (99,78 ± 5,07); G500 (101,64 ± 5,59); G6000 (98,13 ± 4,95); G10000 (91,77 ± 9,68); G15000 (101,51 ± 4,22). Uma análise de variância pela equação de regressão (p = 0,387) foi realizada, o que demonstra uma correlação fraca e não significativa entre a resistência à flexão e do número de ciclos térmicos. Conclusão: Pode-se concluir que o envelhecimento somente em água por diferentes números de ciclos térmicos não influenciou na resistência à flexão de uma cerâmica feldspática (AU)

Influence of illuminants and different observers on the perception of surface gloss of resin composite / Influência de diferentes iluminantes e observadores na percepção do brilho superficial da resina composta

Objective: To evaluate the visual perception of surface gloss of resin composite under different illuminants by different observers. Material and methods: twelve cylindrical specimens (6mm x 1mm) were fabricated using a nanofilled resin composite (Z350, A2E shade) in order to compare different observers and to determine the limit of perceptibility of surface gloss. Bovine tooth specimen with similar dimensions was obtained for the comparison of different illuminants. Polishing of resin specimens was performed resulting in 6 groups, presenting surface gloss values at 10, 25, 40, 55, 70, and 85 GU (gloss units), measured by glossmeter (NOVOCURVE). Fifteen individuals were selected: 5 lay-person, 5 undergraduate students, and 5 dental professionals. Participants observed the specimens in a light booth (Gti lightbox) under three different illuminants, and rated the possible combinations between resin specimens or with the bovine enamel specimen (85GU). Data obtained were analyzed by PROBIT non-linear regression analysis (α=0.05). Results: Differences were observed among types of illuminants (p=0.042) and ΔGU (p=0.004), with no interaction between factors (p=0.139). The fluorescent light presented lower surface gloss perceptibility values in relation to incandescent light. There was no influence by type of observers (p=0.598). The surface gloss perception limit was 17.6 GU under the presented tested conditions. Conclusion: the illuminant type influenced perception of gloss, with lower percentage of perceptibility for fluorescent light, while such perceptibility was not influence by different observers. (AU)

Objetivo: Avaliar a percepção visual e táctil do brilho superficial da resina composta sob diferentes iluminantes e por diferentes observadores. Material e métodos: foram utilizados doze espécimes cilindricos (6mm x 1mm) fabricados em resina composta nanoparticulada (Z350, 3M ESPE- cor A2E) para comparar diferentes observadores e determinar o limite de perceptibilidade do brilho superficial. Um espécime em dente bovino com dimensões similares foi obtido para a comparação de diferentes iluminantes. O polimento do espécime de resina foi realizado, resultando em 6 grupos (n=2), apresentando valores de brilho superficial em 10, 25, 40, 55, 70 e 85 UB (unidades de brilho), medido por um medidor de brilho (NOVOCURVE ­ Rhopoiny TM, East Sussex, Inglaterra). Foram selecionados quinze indivíduos : 5 leigos, 5 alunos de graduação e 5 profissionais de odontologia. Os participantes observaram espécimes em uma cabine de luz (Gti lightbox, New Jersey, USA), sob três iluminantes diferentes, e avaliaram as possíveis combinações entre espécimes de resina ou com espécime de esmalte bovino (85 UB). Resultados: os dados obtidos foram analisados por análise de regressão não-linear PROBIT (5%). As diferenças foram observadas entre os tipos de iluminantes (p= 0,042) e Δ UB (p= 0,004), sem interação entre os fatores (p= 0,139). A luz fluorescente apresentou valores de percepção de brilho da superfície inferior em relação á luz incandescente. Não houve influência pelo tipo de observadores (p= 0,598). O limite de percepção do brilho superficial foi de 17,6 UB sob as condições testadas apresentadas. Conclusão: o tipo de iluminante influenciou na percepção do brilho, com menor porcentagem de perceptibilidade para luz fluorescente (p=0,042), enquanto que a perceptibilidade não foi influenciada pelos diferentes observadores. (AU)

Nova abordagem no tratamento de recessões gengivais associadas à lesão cervical não cariosa / New approach in the treatment of gingival recessions associated with non-carious cervical lesion ­ case report

A recessão gengival está frequentemente associada à lesão cervical não cariosa (LCNC), originando uma lesão combinada que tem um prognóstico de tratamento diferente de quando as duas lesões se apresentam sozinhas. Tratamentos propostos possuem limitações, e o protocolo clínico ideal para o manejo dessas lesões ainda não foi estabelecido. Assim, o objetivo do presente relato de caso foi apresentar uma nova técnica cirúrgico-restauradora para o tratamento de recessões gengivais associadas à LCNC. Para tal, uma restauração parcial em resina composta foi realizada somente na parte coronal da lesão cervical. Em uma segunda sessão, o procedimento cirúrgico para recobrimento radicular com enxerto de tecido conjuntivo foi realizado. Seis meses após o procedimento, a paciente estava satisfeita com o resultado final alcançado, demonstrando que esse protocolo pode ser uma alternativa de tratamento aos protocolos existentes para o tratamento de recessões gengivais associadas à LCNC.

Gingival recession is often associated with non-carious cervical lesion (NCCL), resulting in a combined lesion which has a different treatment prognosis when the two lesions appear alone. Proposed treatments have limitations and the ideal clinical protocol for the management of these lesions has not been established. Thus, the aim of this case report is to present a new surgical-restorative technique for the treatment of gingival recessions associated with NCCL. For this, a composite resin partial restoration was performed only in the coronal part of the cervical lesion. In a second session, the surgical procedure for root coverage with connective tissue graft was performed. Six months after the procedure, the patient was satisfied with the final result achieved, demonstrating that this protocol may be an alternative to the existing protocols for the treatment of gingival recessions associated with NCCL.

Guidelines for conducting split-mouth clinical studies in restorative dentistry / Guia para condução de estudos em boca dividida em dentistica

O desenho experimental proposto em estudos clínicos do tipo boca dividida objetivam uma aleatorização em nível local, no qual dois tratamentos são randomizados em cada um dos lados da boca. O objetivo dessa revisão foi resumir em um guia as normas para condução de estudos clínicos do tipo boca dividida na área de Dentística Restauradora. Foram selecionados estudos clínicos indexados nas bases de dados MEDLINE, PubMed e Scielo, entre 2004 e 2014, que utilizaram o critério USPHS ou FDI. O presente guia mostrou as principais características que devem ser consideradas em estudos do tipo boca dividida na área de Dentística, tais como os aspectos éticos, calculo amostral, métodos de seleção e avaliação e pacientes, como forma de facilitar e conduzir estudos clínicos. (AU)

The split-mouth design used in some clinical trials make a randomization scheme on site level where two treatments are randomly assigned to sites of one of the two halves of the mouth. The aim of this review was to summarize guidelines for conducting split-mouth clinical studies in Restorative Dentistry. This is a review performed through scientific articles published between 2004 and 2014 indexed in MEDLINE, PubMed and Scielo databases. The study evaluated USPHS and FDI criteria. The current review showed the main characteristics used in splitmouth studies presented the Restorative Dentistry literature, as ethical aspects, sample calculation, methods of selection and evaluation patients, in order to provide a guideline for clinical conduction. It showed a standard of methodologies to enable comparison among studies.(AU)