Restauração indireta em resina composta: um relato de prontuário / Indirect resin composite restoration: a dental record report

Restaurações diretas em resina composta são amplamente utilizadas em odontologia para restaurar dentes posteriores. Todavia, quando há grande destruição coronária, onde a distância do istmo excede dois terços da distância intercuspídea, as restaurações indiretas em resina composta são indicadas. O presente estudo teve como objetivo relatar a análise de um prontuário de um paciente que recebeu uma restauração indireta em resina composta em dente posterior amplamente destruído. Através da análise de prontuários de pacientes atendidos nas disciplinas de Estágios Supervisionados do Curso de Odontologia da FSG Centro Universitário no ano de 2023, foi selecionado um prontuário de um paciente que compareceu a clínica odontológica da FSG com uma restauração em amálgama fraturada com reparo em resina composta que apresentou sintomatologia dolorosa. O procedimento diagnóstico ocorreu através de exame clínico e radiográfico, que constatou a indicação de substituição da restauração insatisfatória e realização de uma restauração indireta em resina composta. Os resultados estéticos e funcionais apresentados demostraram a viabilidade da técnica restauradora indireta em resina composta para reabilitar dentes posteriores com ampla destruição coronária(AU)

Direct composite resin restoration are widely used in dentistry to restore posterior teeth. However, when there is large coronary destruction, that the distance from the isthmus exceeds two- thirds of the intercuspal distance, indirect composite resin restorations are indicated. This study aimed to report the analysis of a dental record of a patient who received an indirect restoration in composite resin in a badly destroyed posterior tooth. Through the analysis of dental records of patients seen in the disciplines of Supervised Internship of the Dentistry Course at FSG Centro Universitário in the year 2023, the dental record of a patient who attended the FSG dental clinic with fractured amalgam restoration with composite resin repair was selected who had painful symptoms. The diagnostic procedure took place through clinical and radiographic examination, which revealed the indication of replacing the unsatisfactory restoration and carrying out an indirect restoration in composite resin.The aesthetic and functional results presented demonstrated the viability of the indirect composite resin restoration technique for rehabilitating posterior teeth with extensive coronal destruction(AU)

Restauração em resina composta semidireta em dente posterior: relato de caso / Semi-direct composite restoration in posterior toth: a case report

A escolha da técnica restauradora desempenha papel fundamental na eficácia e duração de um tratamento reabilitador. O objetivo deste relato de caso foi descrever a utilização da técnica semidireta para a confecção de uma restauração em resina composta em um primeiro molar inferior. A paciente apresentava uma restauração insatisfatória no dente 36, que necessitava ser substituída devido à infiltração por cárie. Optou-se pela técnica semidireta devido à amplitude da cavidade, que envolvia estruturas de suporte, e pela combinação das vantagens das abordagens direta e indireta. O procedimento envolveu a remoção de tecido cariado, a aplicação de hidróxido de cálcio pasta, seguida da aplicação de uma fina camada de ionômero de vidro e, posteriormente, resina fluída para realizar o selamento dentinário. O preparo foi realizado seguindo os princípios necessários. O elemento em questão foi moldado com silicone de adição e o arco antagonista, com alginato. Ambos modelos foram vertidos com silicone para modelos semirrígidos e montados em oclusor de peças de brinquedo. A restauração semidireta foi confeccionada em resina composta Filtek Z350 XT, respeitando a anatomia do dente 36. Pigmentos foram utilizados para aprimorar detalhes estéticos. Após acabamento e polimento, a peça foi condicionada e cimentada com cimento dual Relyx Ultimate. Pode-se concluir que a abordagem restauradora por meio da técnica semidireta construída em modelo semirrígido é uma opção terapêutica conservadora e vantajosa para dentes com extensa destruição coronária. Essa técnica possibilita a restauração de forma eficaz, garantindo tanto a estética quanto a função adequada do dente afetado(AU)

The choice of restorative technique plays a fundamental role in the effectiveness and duration of rehabilitation treatment. The objective of this case report was to describe the use of the semi-direct technique to create a composite resin restoration in a lower first molar. The patient had an unsatisfactory restoration on tooth 36, which needed to be replaced due to cavity infiltration. The semi-direct technique was chosen due to the amplitude of the cavity, which involved support structures, and the combination of advantages of the direct and indirect approaches. The procedure involved the removal of carious tissue, and the application of calcium hydroxide paste, followed by the application of a thin layer of glass ionomer and, subsequently, fluid resin to seal the dentin. The preparation was carried out following the necessary principles. The element in question was molded with addition silicone and the antagonist arch was molded with alginate. Both models were poured with silicone for semi-rigid models and mounted on toy parts occluders. The semi-direct restoration was made in Filtek Z350 XT composite resin, respecting the anatomy of tooth 36. Pigments were used to improve aesthetic details. After finishing and polishing, the piece was conditioned and cemented with Relyx Ultimate dual cement. It can be concluded that the restorative approach using the semi-direct technique built on a semi-rigid model is a conservative and advantageous therapeutic option for teeth with extensive coronal destruction. This technique allows for effective restoration, ensuring both the aesthetics and adequate function of the affected tooth(AU)

Evidence-practice gap in treatment decisions about defective composite and amalgam restorations among Brazilian dentists

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). This study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap

Reparar ou substituir? quando e como intervir em restaurações defeituosas / Repair or replace? when and how to intervene in defective restorations

A alta prevalência de cárie ao redor do mundo faz com que os tratamentos restauradores figurem entre os procedimentos mais executados pelos cirurgiõesdentistas. Também é bastante comum os profissionais relatarem novas lesões de cárie ao redor das restaurações ou até mesmo fraturas parciais ou totais das mesmas, fatores que podem ser considerados como "falhas" do procedimento restaurador. Diante dessas situações, a maioria dos profissionais entende que é necessário realizar a substituição completa da restauração. No entanto, existem outras técnicas mais conservadoras e que podem ser tão efetivas quanto a substituição/troca, como por exemplo a realização de reparo das restaurações apresentando defeitos. O objetivo deste artigo é apresentar de forma clara e objetiva aos clínicos que se deparam diariamente com este cenário, qual seria o melhor momento para intervir, e quais as alternativas de tratamento, baseadas na melhor evidência científica disponível, a se realizar frente às falhas dos procedimentos restauradores, sempre alinhadas com a filosofia de Mínima Intervenção.

The high prevalence of caries worldwide makes restorative treatments some of the most commonly performed dental treatments. It is pretty common to find new caries lesions around the restorations or even partial or total fractures, factors that can be considered a "failure" for the restorative procedure. In these situations, most professionals understand that it is necessary to replace the restoration, but other more conservative techniques are as effective as a replacement, such as repairing the restorations. This article aims to present a clear and evidence-based when is the best time to intervene and what is the best treatment to be carried out in case of failure of the restorative procedures, in line with Minimal Intervention principles.

Sellado de lesiones de caries: reporte de caso / Selamento de lesões de cárie: relato de caso / Sealing of caries lesions: case report

El objetivo de este estudio fue informar un caso clínico de sellado de lesiones activas de caries, puntuación 5 del Sistema Internacional de Detección y Evaluación de Caries - ICDAS, en los primeros molares permanentes de un chico de 9 años. En el examen clínico, se identificaron lesiones activas, código 5 y 3 en los dientes 16 y 26, respectivamente. Sin embargo, en el examen radiográfico se observó que la lesión del diente 26 también se encontraba en la mitad externa de la dentina. Por lo tanto, ambas lesiones fueron consideradas como código 5. Así, para el sellado de las lesiones, se realizó un tratamiento de intervención mínima, usando sellante resinoso con capa intermedia de adhesivo. Después de 6 meses de acompañamiento, se observó la pérdida de la integridad del sellado del diente 16 realizándose la reparación del mismo; después de un año ambas lesiones estaban inactivas. Por lo tanto, el sellado de las lesiones de caries parece ser adecuado para las lesiones del esmalte que alcanzan la mitad exterior de la dentina

O objetivo deste estudo foi relatar um caso clínico de selamento de lesões de cárie ativas, escore 5 do International Caries Detection and Assessment System- ICDAS, em primeiros molares permanentes de um menino de 9 anos. Ao exame clínico, foram identificadas lesões ativas, escore 5 e 3 nos elementos 16 e 26, respectivamente. Entretanto, no exame radiográfico observou-se que a lesão do dente 26 também estava em metade externa de dentina. Dessa forma, ambas as lesões eram escore 5. O tratamento de mínima intervenção com o selamento das lesões de cárie foi realizado, usando selante resinoso com camada intermediária de adesivo. Em 6 meses de acompanhamento, observou-se perda de integridade do selante no dente 16, sendo realizado o reparo; após um ano, as lesões estavam paralisadas. Portanto, o selamento de lesão de cárie parece ser adequado para lesões em esmalte atingindo metade externa de dentina

The aim of this study was to report a clinical case of sealing active caries lesions, score 5 of the International Caries Detection and Assessment System- ICDAS, in the first permanent molars of a 9-year-old boy. On clinical examination, active lesions were identified, score 5 and 3 in molars 16 and 26, respectively. However, radiographic examination determined that the lesion of tooth 26 was also in the external half of dentin. Thus, both lesions were score 5. The minimal intervention treatment with the sealing of the carious lesions was performed, using resinous sealant with an intermediate layer of adhesive. In 6 months of follow-up, loss of integrity of the sealant was observed on tooth 16, and the repair was carried out; after one year, the lesions were paralyzed. Therefore, the sealing of caries lesions seems to be suitable for enamel lesions reaching the external half of dentin

Effect of Light Sources on Bond Strength of Different Composite Resins Repaired with Bulk-Fill Composite / Efecto del tipo de fuente luz en la resistencia adhesiva de distintas resinas compuestas reparados con una resina bulk-fill

Abstract: The aim of this study was to evaluate and compare the effects of different light sources on shear bond strength when bulk-fill composite was used for the repair of different composite resins. A total of 126 samples made from six resin composites with different properties were aged (thermal-cycling with 5000 cycle), exposed to the same surface treatments and adhesive procedure. Then, they were repaired with a bulk-fill composite. At the polymerization step, each group was divided into three subgroups (n=7) and light cured with a QTH light source for 40s and two different LED light sources for 20s. Subsequently, the specimens were aged in distilled water at 37 ºC for 4 weeks and then subjected to shear bond strength test. Then, the specimens were examined under a stereomicroscope to identify modes of failure and visualized by Scanning Electron Microscope. Data obtained from the study were analyzed using ANOVA and Tukey HSD Test (α=0.05). In all groups, the light curing units had an impact on shear bond strength (p<0.05). Among the study groups, the greatest bond strength values were observed in the specimens repaired using the LED and the specimens repaired with the QTH light curing unit had the lowest bond strength values. It was concluded that the content of composite resins and light curing units may influence bond strength of different composites repaired with the bulk-fill composite.

Resumen: El objetivo de este estudio fue evaluar y comparar los efectos de diferentes fuentes de luz sobre la resistencia de la unión al cizallamiento cuando se utiliza una resina bulk-fill para la reparación de diferentes resinas compuestas. Se envejecieron un total de 126 muestras fabricadas con seis compuestos de resina con diferentes propiedades (ciclo térmico con 5000 ciclos), expuestas a los mismos tratamientos de superficie y procedimiento adhesivo. Luego, fueron reparadas con una resina bulk- fill. En el paso de polimerización, cada grupo fue dividido en tres subgrupos (n=7) y fotopolimerizado con una fuente de luz QTH por 40s y dos fuentes de luz LED por 20s. Posteriormente, los especímenes se envejecieron en agua destilada a 37 ºC durante 4 semanas y luego se sometieron a una prueba de resistencia adhesiva de cizalla. Luego, los especímenes fueron examinados bajo un estereomicroscopio para identificar los modos de falla y visualizados por el Microscopio Electrónico de Barrido. Los datos obtenidos del estudio fueron analizados usando el ANOVA y la prueba Tukey HSD (α=0.05). En todos los grupos, las unidades de fotopolimerización tuvieron un impacto en la fuerza de adhesión al cizallamiento (p<0,05). Entre los grupos de estudio, los mayores valores de fuerza de adhesión se observaron en los especímenes reparados utilizando el LED y los especímenes reparados con la unidad de fotopolimerización QTH tuvieron los valores de fuerza de adhesión más bajos. Se llegó a la conclusión de que el contenido de las resinas compuestas y las unidades de fotopolimerización pueden influir en la fuerza de adhesión de los diferentes compuestos reparados con resinas bulk-fill.

Machinability of Zirconia Toughened Mica Glass Ceramics for Dental Restorations / Usinabilidade de cerâmica de vidro de mica temperada com zircônia para restaurações dentárias

Objective: For a dental material to be machinable for CAD/CAM technology, it must offer convenient machining, under a given set of cutting conditions. Quantitative evaluation of machinability has been assessed in literature through various parameters such as tool wear, penetration rates, surface roughness, cutting force and power. A machinable ceramic will typically demonstrate a higher tool penetration rate with signs of reduced diamond tool wear and edge chipping. The purpose of this in vitro study was to evaluate the feasibility of machining an experimental ceramic, 20 wt.% zirconia reinforced mica glass ceramics (G20Z) for indirect dental restorations and compare the tool penetration rates of G20Z to commercially available dental ceramics, Presintered Zirconia (PSZ) and IPS emax CAD. Material and Methods: Precursors of base glass (SiO2 -Al2O3 -K2O -MgO-B2O3 -F) were melted at 15000C for 2 h in a platinum crucible and quenched in deionised water. The glass frit was ball milled with 20 wt. % YSZ (G20Z) and subject to two stage heat treatment in a muffle furnace. Specimens of G20Z (12 X 2 mm) were evaluated for their feasibility of machining under varying spindle speed, depth of cut, and feed rates. Influence of depth of cut, spindle speed and feed rate (vc=8000-16000 rpm, d=0.4-0.8 mm, f=0.1- 0.3 mm/tooth) on cutting forces, material response, surface roughness and tool wear were investigated. Tool penetration rates, tool wear and margin chipping were also evaluated and compared with Pre-sintered Zirconia (PSZ) and e.max CAD in a custom dental milling surveyor at 30,000 rpm with a load of 0.98 N under water lubrication for 6 min. Tool penetration rates were calculated as the ratio of length of cut and milling time with a measuring microscope and scanning electron microscope was used for tool wear and edge chipping. ANOVA and Tukey Kramer tests were used for statistically comparing the means of each group. Results: Spindle speed and feed rate play a significant role in influencing surface roughness, thrust force, cutting forces and tool wear. Penetration rates of G20Z (0.32 ±0.12 mm/min) was significantly greater than PSZ (0.26 ±0.06 mm/min) and IPS e.max CAD (0.21 ±0.05 mm/min). SEM observations reveal tool abrasion and edge chipping regardless of the ceramic type. Conclusion: High spindle speeds delivers low cutting forces with an average surface roughness of 1.61 µm, with abrasive wear of the tool insert and brittle fracture of zirconia mica glass ceramic composites. G20Z with its machinable nature demonstrates greater tool penetration rates than PSZ and IPS e.max CAD. Tool wear and edge chipping is seen in all the investigated ceramics. (AU)

Objetivo: Para que um material odontológico seja usinável para a tecnologia CAD / CAM, ele deve oferecer uma usinagem conveniente, sob um determinado conjunto de condições de corte. A avaliação quantitativa da usinabilidade tem sido avaliada na literatura por meio de vários parâmetros, como desgaste da ferramenta, taxas de penetração, rugosidade da superfície, força de corte e potência. Uma cerâmica usinável normalmente demonstrará uma maior taxa de penetração da ferramenta com sinais de desgaste reduzido da ferramenta de diamante e lascamento da borda. O objetivo deste estudo in vitro foi avaliar a viabilidade da usinagem de uma cerâmica experimental, 20% em peso de cerâmica de vidro de mica reforçada com zircônia (G20Z) para restaurações dentárias indiretas e comparar as taxas de penetração da ferramenta de G20Z com as cerâmicas dentais comercialmente disponíveis, Zircônia Presinterizada (PSZ) e IPS emax CAD. Material e Métodos: Precursores de vidro base (SiO2-Al2O3-K2O -MgO-B2O3 -F) foram fundidos a 15000C por 2 h em um cadinho de platina e temperados em água deionizada. A frita de vidro foi moída com 20% em peso de YSZ (G20Z) e submetida a tratamento térmico em duas fases em mufla. Amostras de G20Z (12 x 2 mm) foram avaliadas quanto à sua viabilidade de usinagem sob variação de velocidade do fuso, profundidade de corte e taxas de avanço. A influência da profundidade de corte, velocidade do fuso e taxa de avanço (vc = 8000-16000 rpm, d = 0,4-0,8 mm, f = 0,1- 0,3 mm / dente) nas forças de corte, resposta do material, rugosidade da superfície e desgaste da ferramenta foram investigadas. As taxas de penetração da ferramenta, o desgaste da ferramenta e o lascamento da margem também foram avaliados e comparados com Zircônia pré-sinterizada (PSZ) e e.max CAD em um topógrafo de fresamento dentário personalizado a 30.000 rpm com uma carga de 0,98 N de lubrificação subaquática por 6 min. As taxas de penetração da ferramenta foram calculadas como a razão entre o comprimento de corte e o tempo de fresamento com um microscópio de medição e um microscópio eletrônico de varredura foi usado para o desgaste da ferramenta e lascamento da borda. Os testes ANOVA e Tukey Kramer foram usados para comparar estatisticamente as médias de cada grupo. Resultados: a velocidade do fuso e a taxa de avanço desempenham um papel significativo em influenciar a rugosidade da superfície, força de impulso, forças de corte e desgaste da ferramenta. As taxas de penetração de G20Z (0,32 ± 0,12 mm / min) foram significativamente maiores do que PSZ (0,26 ± 0,06 mm / min) e IPS e.max CAD (0,21 ± 0,05 mm / min). As observações do SEM revelam a abrasão da ferramenta e o lascamento da borda, independentemente do tipo de cerâmica. Conclusão: As altas velocidades do fuso proporcionam baixas forças de corte com uma rugosidade superficial média de 1,61 µm, com desgaste abrasivo do inserto da ferramenta e fratura frágil de compósitos de cerâmica de vidro de zircônia. G20Z com sua natureza usinável demonstra maiores taxas de penetração da ferramenta do que PSZ e IPS e.max CAD. O desgaste da ferramenta e o lascamento da borda são vistos em todas as cerâmicas investigadas. (AU)

Reparación comparada con reemplazo de restauraciones directas posteriores defectuosas en pacientes con dentición permanente / Repair versus complete replacement for defective direct restorations in permanent teeth

RESUMEN: Introducción: Las restauraciones directas posteriores defectuosas han sido tratadas tradicionalmente a través del reemplazo de la restauración. Sin embargo, por las posibles complicaciones de este procedimiento, la reparación de las restauraciones ha sido ampliamente utilizado en la práctica clínica, pero su uso sigue siendo controvertido. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos una revisión sistemática que incluyó nueve estudios primarios, todos correspondientes a ensayos aleatorizados. Como conclusión podemos señalar que la reparación comparado con el reemplazo de restauraciones directas posteriores defectuosas podría aumentar el riesgo de necesidad de reintervención, podría resultar en poca o nula diferencia en el riesgo de sensibilidad postoperatoria y podría aumentar el riesgo de caries secundaria, pero la certeza de la evidencia es baja.

ABSTRACT: Introduction: Traditionally, restoration replacement has been widely used for the treatment of defective restorations in permanent teeth. Due to complications related to total replacement, restoration repair has been incorporated into dental practice. However, the use of repair over replacement for defective restorations is still controversial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified one systematic review including nine studies overall, of which all were randomized trials. We conclude that repair versus complete replacement may improve the risk of reintervention, may make little or no difference to risk of postoperative sensibility and may improve the risk of secondary caries, but the certainty of the evidence has been assessed as low.

Inverse gas chromatography in the examination of adhesion between tooth hard tissues and restorative dental materials.

The adhesion is a crucial issue in the bonding of dental restorative materials to tooth hard tissues. A strong and durable bond between artificial and natural materials is responsible for the success of the restoration in the oral cavity; therefore it has to be thoroughly examined before new restorative material is introduced to the market and used clinically. Among all methods used to examine bonding strength, most of them require a large number of healthy teeth to be conducted. In this paper, the bond strength between tooth hard tissues (dentin and enamel) and an exemplary restorative composite was examined with the non-conventional method, i.e. inverse gas chromatography. Dentin and enamel from bovine teeth were separated and subjected to the standard preparation procedure using the 3-component etch-and-rinse commercial bonding system. Tissues, as well as commercial restorative composite, were examined using inverse gas chromatography. The work of adhesion between dentin/enamel and composite was calculated. Obtained results were compared with the values of shear bond strength of six configurations, i.e. etched dentin/enamel-composite, primed dentin/enamel-composite, and bonded dentin/enamel-composite. All obtained results proved that there is a correlation between the values describing bond strength obtained from inverse gas chromatography and direct mechanical tests (shear bond strength tests). It proves that inverse gas chromatography is a powerful perspective tool for the examination of bond strength between tooth hard tissues and potential dental materials without using a large number of health tooth tissues.

Como reparar uma restauração oclusal de resina composta em dentes decíduos? Relato de caso / How to repair an occlusal composite resin restoration on primary teeth? Case report

Frente à necessidade de reintervenção em restaurações insatisfatórias, os clínicos podem, em geral, optar pela substituição ou reparo. Este artigo relata um caso clínico de reparo de uma restauração de resina composta com falha em dente decíduo. Após profilaxia e isolamento relativo, a porção da resina composta a ser reparada foi asperizada com uma ponta diamantada em alta rotação com o intuito de melhorar a união mecânica entre a resina envelhecida e a nova (reparo). Foi realizado o condicionamento com gel de ácido fosfórico a 34% por 15 segundos, seguido de lavagem e secagem. Uma camada do sistema adesivo Single Bond Universal (3M ESPE) foi aplicada ativamente durante 20 segundos, seguido de jato de ar comprimido por 5 segundos e fotoativação por 10 segundos. Por fim, a resina composta fluida (Filtek Z350 XT Flow; 3M ESPE) foi inserida e fotoativada por 20 segundos. A realização de um adequado protocolo clínico envolvendo tratamentos físicos e químicos de superfície é fundamental para a efetividade da intervenção e a manutenção do dente decíduo clinicamente funcional até a esfoliação fisiológica.

Facing need for reintervention in unsatisfactory resto-rations, clinicians may generally choose for replacement or repair. This paper reports a clinical case of repair of a composite resin restoration with failure in primary tooth. After prophylaxis and relative isolation, the portion of the composite resin to be repaired was roughed with a high-speed diamond bur to improve the mechanical bond between the aged and new resin (repair). Conditioning with 34% phosphoric acid gel was performed for 15 seconds, followed by washing and drying. One layer of the adhesive system Single Bond Universal (3M ESPE) was actively applied for 20 seconds and light- cured for 10 seconds. Finally, the flowable composite resin (Filtek Z350 XT Flow; 3M ESPE) was inserted and light-cured for 20 seconds. An adequate clinical protocol involving physical and chemical surface treatments is essential for the effectiveness of the intervention and the main-tenance of the primary tooth clinically functional until physiological exfoliation.

Influence of dental restoration under general anaesthesia on the low-dose dexamethasone suppression test in dogs.

It was the aim of the study to assess the impact of a minor surgical intervention under general anaesthesia on results of a low-dose dexamethasone suppression test (LDDST) in dogs. Five clinically healthy dogs underwent a LDDST (standard protocol) prior and 1, 4, 7, 14 and 28 days after a dental restoration under general anaesthesia. All LDDSTs revealed negative results. On all test days after intervention some dogs had basal cortisol concentrations below the reference range. Accordingly, plasma cortisol concentrations 4 and 8 h after dexamethasone injection were noticeably lower than before surgery and often even below the lower detection limit of 2.0 ng/ml. The study results may indicate a suppressive effect of a minor surgery under general anaesthesia on cortisol measurements during LDDSTs. It may be speculated that this could possibly lead to false negative test results in the postsurgical period, although transfer of these results to clinical cases is subject to limitations.

Comportamento biomecânico das diferentes conexões entre restaurações monolíticas de zircônia e bases de titânio em próteses implanto-suportadas / Torque maintenance capacity, vertical misfit, load to failure and stress concentration in zirconia restorations cemented or notched to titanium bases

Este estudo avaliou a eficiência da pré-carga antes e após fadiga, desajuste vertical, carga para fratura e a concentração de tensões em restaurações de zircônia cimentadas ou acopladas a uma base de titânio (TB). Para isto, quarenta implantes foram incluídos em cilindros de polióxido de metileno (POM-DelrinDupont) e separados em dois grupos: restauração de zircônia cimentada em um TB ou acoplada em um TB experimental. Os corpos de prova tiveram o torque e o desajuste vertical avaliados antes e após a fadiga cíclica (200 N / 2 Hz / 2 x 106 ciclos / 37 °C). A carga até a fratura foi calculada em uma máquina universal de ensaios (1 mm / min, 1000 kgf) e as falhas foram avaliadas por estereomicroscopia e microscopia eletrônica de varredura. Modelos tridimensionais foram criados baseados na geometria dos espécimes laboratoriais e a concentração de tensão calculada pelo método dos elementos finitos. Os dados dos testes in vitro foram submetidos à análise de variância dois fatores e teste de Tukey (α = 0,5). As restaurações cimentadas apresentaram menor perda de torque (19,79 N.cm), menor desajuste vertical (3,77 µm), menor concentração de tensão na restauração (88,2 MPa) e maior carga de fratura (451,3 N) do que as restaurações acopladas (15,95 N.cm, 10,51 µm, 99,8 MPa e 390,8 N, respectivamente). Conclusão: A presença de uma camada de cimento entre a restauração e a base de titânio reduziu a suscetibilidade ao afrouxamento do parafuso do pilar, melhorou a resistência à carga compressiva e reduziu a concentração de tensão na restauração(AU)

The goal of this study was to evaluate the torque and vertical misfit before and after fatigue, the load to failure and the stress concentration of zirconia restorations cemented or notched to a titanium base (TB). Forty implants were included in Acetal Polyoxymethylene (POM-Delrin-Dupont) cylinders and divided in two groups: zirconia restoration cemented on a TB and zirconia restoration notched on an experimental TB. The specimens had their torque loosening and vertical misfit evaluated before and after cyclic fatigue (200 N / 2 Hz/ 2 x 106 cycles /37 °C). Load to failure was calculated in an universal testing machine (1 mm/min, 1000 kgf) and failures were evaluated by optical microscopy and scanning electron microscopy. Three-dimensional models were created based in the in vitro geometries and the stress concentration calculated using the finite element method. Data from the in vitro tests were submitted to two-way analysis of variance and Tukey test (α = 0.5). The cemented restorations presented less torque loosening (19.79 N.cm), lower vertical misfit (3.77 µm), lower stress concentration in the restoration (88.2 MPa) and higher fracture load (451.3 N) than notched restorations (15.95 N.cm, 10.51 µm, 99.8 MPa and 390.8 N, respectively). Conclusion: The presence of a cement layer between restoration and titanium base reduced the susceptibility to abutment screw loosening, improved the resistance to compressive load and reduced the stress concentration in the restoration(AU)

Oxidative Damage in Human Periodontal Ligament Fibroblast (hPLF) after Methylmercury Exposure.

Human exposure to mercury (Hg) is primary associated with its organic form, methylmercury (MeHg), through the ingestion of contaminated seafood. However, Hg contamination is also positively correlated with the number of dental restorations, total surface of amalgam, and organic mercury concentration in the saliva. Among the cells existing in the oral cavity, human periodontal ligament fibroblast (hPLF) cells are important cells responsible for the production of matrix and extracellular collagen, besides sustentation, renewal, repair, and tissue regeneration. In this way, the present study is aimed at investigating the potential oxidative effects caused by MeHg on hPLF. Firstly, we analyzed the cytotoxic effects of MeHg (general metabolism status, cell viability, and mercury accumulation) followed by the parameters related to oxidative stress (total antioxidant capacity, GSH levels, and DNA damage). Our results demonstrated that MeHg toxicity increased in accordance with the rise of MeHg concentration in the exposure solutions (1-7 µM) causing 100% of cell death at 7 µM MeHg exposure. The general metabolism status was firstly affected by 2 µM MeHg exposure (43.8 ± 1.7%), while a significant decrease of cell viability has arisen significantly only at 3 µM MeHg exposure (68.7 ± 1.4%). The ratio among these two analyses (named fold change) demonstrated viable hPLF with compromised cellular machinery along with the range of MeHg exposure. Subsequently, two distinct MeHg concentrations (0.3 and 3 µM) were chosen based on LC50 value (4.2 µM). hPLF exposed to these two MeHg concentrations showed an intracellular Hg accumulation as a linear-type saturation curve indicating that metal accumulated diffusively in the cells, typical for metal organic forms such as methyl. The levels of total GSH decreased 50% at exposure to 3 µM MeHg when compared to control. Finally, no alteration in the DNA integrity was observed at 0.3 µM MeHg exposure, but 3 µM MeHg caused significant damage. In conclusion, it was observed that MeHg exposure affected the general metabolism status of hPLF with no necessary decrease on the cell death. Additionally, although the oxidative imbalance in the hPLF was confirmed only at 3 µM MeHg through the increase of total GSH level and DNA damage, the lower concentration of MeHg used (0.3 µM) requires attention since the intracellular mercury accumulation may be toxic at chronic exposures.

Reparación de defecto localizado en restauración de amalgama como tratamiento de mínima intervención en cariología / Repair of a localized defect in a restoration with amalgam filling as minimal intervention treatment in cariology

Introducción: La reparación de restauraciones ha sido estudiada desde muy recientemente, pero a pesar de haber demostrado efectividad y mejoras en la terapéutica de la caries dental, aún tiene seguidores y detractores, lo que justifica la necesidad de estudios que sigan avalando tales prácticas. Objetivo: Describir, a través de la presentación de un caso, la reparación de un defecto localizado en una restauración de amalgama como tratamiento de mínima intervención en cariología. Presentación del caso: Paciente femenina de 16 años con antecedentes de salud acude a consulta refiriendo una pequeña fractura de restauración en diente 4.6 desde hace varias semanas. La regularización del defecto en la restauración, la mínima preparación cavitaria, la eliminación del fragmento de la base intermedia, la protección del complejo dentino-pulpar y el llenado de la cavidad resultante, fueron los primeros pasos de una técnica que se cumplimentó luego del pulido final de la interface tejido dentario-restauración y se evolucionó cinco años después. Se evidenció el estado y presencia de la reparación de la restauración realizada, sin fracturas añadidas, microfiltraciones, sintomatologías, desplazamientos ni pérdidas de la continuidad. Conclusiones: La reparación del defecto localizado de amalgama se realizó con el fin de preservar los tejidos dentarios no afectados como lo dicta la mínima intervención en cariología. Cinco años más tarde, la evolución evidencia una práctica que se tradujo en resultados satisfactorios e incremento de la calidad de vida de la paciente(AU)

Introduction: Restoration repair has been studied recently; but, even when it has demonstrated effectiveness and improvements in the therapy of dental caries, it still has followers and detractors that justify the need for studies that continue supporting such practices. Objective: To describe, through a case presentation, the repair of a defect located in a restoration with amalgam filling as minimal intervention treatment in cariology. Case presentation: Sixteen-year-old female patient with health history that went to the clinic reporting a small fracture of a restoration performed in tooth 4.6 several weeks ago. The regularization of the defect in the restoration, minimum cavity preparation, elimination of the fragment of the intermediate base, protection of the dentin-pulp complex, and filling of the resulting cavity were the first steps of a technique that was completed after the final polishing of the dental tissue/restoration interface that was evolved five years later. The status and presence of the restoration repair performed without added fractures, microfiltration, symptomatology, displacement or loss of continuity was evidenced. Conclusions: The repair of the localized defect in a restoration with amalgam filling was performed with the aim of preserving the unaffected dental tissues as dictated by minimal intervention in cariology. Five years later, the patient´s evolution shows a practice that resulted in satisfactory results and an increase in the patient's quality of life(AU)

Association of dietary habits with restorative dental treatment need and BMI among Finnish conscripts: a cross-sectional epidemiological study.

OBJECTIVE: Processed foods and fatty, sugary snacking products, such as fizzy drinks and desserts, have become more popular, causing a desire to replace meals with snacks worldwide. High-sugar and fat-rich food components have been reported to be associated with increased level of dental caries as well as underweight and overweight. The aim of the present cross-sectional population-based study was to analyse the eating behaviours of young, healthy Finnish males in association with oral health and BMI, considering self-reported and residential background factors. DESIGN: Cross-sectional study. SETTING: Finnish Defence Forces, Finland. PARTICIPANTS: The used clinical data were gathered from 13 564 Finnish conscripts born in the beginning of the 1990s through clinical check-ups. In addition, about 8700 of the conscripts answered a computer-assisted questionnaire ('Oral Health of the Conscripts 2011' data) about their background information and health habits. RESULTS: There was distinct variation in dietary patterns. Eating breakfast, regular physical exercise and daily tooth brushing all decreased the odds for restorative dental treatment need (decayed teeth), whereas smoking and drinking fizzy drinks for quenching thirst increased it. Eating breakfast and dinner were each associated with lower BMI, but smoking increased the odds for higher BMI (≥25 kg/m2). CONCLUSIONS: Regular, proper meals and especially eating breakfast decreased the odds for both dental caries and high BMI (≥25 kg/m2).

A Monte Carlo study on dose perturbation due to dental restorations in a 15 MV photon beam.

AIM: The main purpose of this study is to evaluate the effect of dose perturbation due to common dental restoration materials in the head and neck radiotherapy with a 15 MV external photon beam. SETTING AND DESIGN: Teeth with three dental restorations such as tooth filled with Amalgam, Ni-Cr alloy, and Ceramco were simulated by MCNPX Monte Carlo code. In this simulation, the dental materials were exposed by a 15 MV photon beam from a Siemens Primus linac, inside a water phantom. MATERIALS AND METHODS: A Siemens Primus linear accelerator and a phantom including: tooth only, tooth with Amalgam, tooth with Ni-Cr alloy, and tooth with Ceramco were simulated by MCNPX Monte Carlo code, separately. The percentage dose change was evaluated relative to dose in water versus depth for these samples on the beam's central axis. The absolute dose by prescription of 100 cGy dose in water phantom at 3.0 cm depth was calculated for water, tooth, tooth with Amalgam, tooth with Ni-Cr alloy, and tooth with Ceramco. RESULTS: The maximum percentage dose change is related to tooth with Ni-Cr alloy, tooth, tooth with Ceramco, and tooth with Amalgam with amounts of 7.73%, 6.95%, 4.7%, and 3.06% relative to water at 0.75 cm depth, respectively. When 100.0 cGy dose was prescribed at 3.1 cm, the maximum absolute dose was 201.0% in the presence of tooth with Ni-Cr alloy at 0.75 cm. CONCLUSION: Introduction of the compositions of dental restorations can improve the accuracy of dosimetric calculations in treatment planning and protect the healthy tissues surrounding teeth from a considerable overdose.

[Features of dental rehabilitation of elderly patients after treatment of maxillofacial neoplasm.]

The purpose of this study is a comparative analysis of the effectiveness of the use of dental trays-transformers for the manufacture of prosthetic designs for elderly patients with acquired microstomia. Was conducted a clinical study of 12 hemimaxillectomy patients from 60 to 72 years. The 1st group included 6 patients with acquired microstomia, impressions of the jaws were obtained with dental trays-transformers. The 2nd group includes 6 patients who have less traumatic oral opening, they were removed with standard dental trays. The group of clinical control consisted of 6 patients with partial absence of maxillary teeth, who needed to prosthetic dentistry. The results of the study indicate the effectiveness of the use of trays-transformers to impressions of the jaw in elderly patients with restricted oral opening, as well as in patients with normal oral opening. Optimization of the stages of obturator prostheses allows to provide qualitative prosthetic care of patients with malignant neoplasms of the oropharyngeal region, which has a positive effect on the quality of life of elderly patients with acquired defects of the oropharyngeal region.

Carilla dentales con técnica de resina inyectada. Reporte de caso / Dental veneers with injectable composite resin technique. Case Report

La técnica de resina inyectada es un trata-miento estético con el que es posible prede-cir el resultado final y trasladar del encerado diagnóstico la forma anatómica deseada a una restauración sobre la superficie dental, prediciendo el aspecto estético para esco-ger el color y la textura del material restaura-dor; estableciendo parámetros oclusales como modificar la posición y alineación de dientes, contorno fisiológico, perfil labial, posición del borde incisal y orientación gingi-val. Además, esta técnica puede realizarse con o sin preparación de la superficie, ase-gura una adaptación uniforme del material de restauración y aumenta el potencial para diseñar preparaciones más conservadoras, pues conservar tejido dental y predecir el resultado final son objetivos de esta técnica. El presente reporte de caso es sobre la rehabilitación estética y funcional con cari-llas dentales de resina inyectada en pacien-te femenina de 19 años que se presentó a la clínica dental de la Subdirección de Desa-rrollo Estudiantil, Cultural, Arte y Deporte (SUDECAD), de la Universidad Nacional Autonóma de Honduras en el Valle de Sula (UNAH-VS), con 4 dientes afectados que presentaban dolor, grietas a nivel del esmal-te, pigmentaciones oscuras, restos de restauraciones previas con pobre anatomía y mal adaptadas; como resultado, una sonri-sa poco favorecedora. En este caso se presenta una opción de tratamiento funcio-nal y estético con el que se le dió solución rápida y predecible. Tratamiento que forma parte de la continua búsqueda para brindar una sonrisa estética y saludable que todo profesional de la Odontología debe ofrecer...(AU)

Acute Management of Massive Epistaxis After Nasotracheal Extubation.

Epistaxis is one of the most common complications of nasotracheal intubation and can be life-threatening. However, there is little discussion in the current literature on the acute management of massive epistaxis after nasotracheal extubation. This is a report of 2 patients who experienced severe unanticipated nasal bleeding immediately after extubation, 1 after a surgical procedure for oral cancer and another after restorative dental treatment. In both cases the significant epistaxis was managed successfully with a Foley balloon catheter used to pack the posterior nasal cavity. The Foley catheter technique may be useful for managing and arresting sudden postextubation epistaxis.

Malignant Hyperthermia: A Case Study in the Dental Ambulatory Surgery Setting.

Historically, patients who developed malignant hyperthermia had an extremely high rate of mortality. Today, if treated appropriately, patients who experience an episode of malignant hyperthermia will most likely survive. This dramatic decrease in mortality associated with malignant hyperthermia is due to several factors, including an increased understanding of the disease, improved diagnostic and monitoring equipment, and the development of lifesaving pharmacologic agents. This article presents the very likely case of acute malignant hyperthermia in a 24-year-old man with special needs, who presented for restorative dentistry under general anesthesia in the outpatient clinic of The Ohio State University's College of Dentistry.