Restablecimiento de guía anterior con restauraciones adhesivas / Reestablishing of anterior guidance with adhesive restorations

La estética ha llegado a formar una parte muy importante en la odontología actual. Sin embargo, no debemos sobreponer las necesidades estéticas sobre las necesidades funcionales. La pérdida de estructura dental asociada a bruxismo puede ser considerada patológica cuando compromete la guía anterior, la cual es la influencia en los movimientos mandibulares que proveen las superficies contactantes de los dientes maxilares anteriores con los mandibulares anteriores y evita contactos excéntricos dañinos en los dientes posteriores. El objetivo de este reporte de caso es presentar una alternativa conservadora para restablecer tanto la estética como la funcionalidad de una paciente de 34 años de edad que acudió a la Clínica de Prostodoncia de la Universidad Autónoma de Guadalajara en busca de rehabilitación estética de dientes anteriores. Una vez realizada su evaluación inicial se llegó al diagnóstico de pérdida de guía anterior por desgaste patológico asociado a bruxismo. El tratamiento incluyó tratamientos de conductos, remoción de caries y restauraciones mal ajustadas, coronas y carillas para restablecer la guía anterior. Se cumplieron con las expectativas estéticas que tenía la paciente al igual que con las necesidades funcionales que fueron objetivo desde el inicio, logrando un restablecimiento de la guía anterior de manera conservadora (AU)

Esthetics has become a very important part of dentistry today. However, we should not superimpose esthetic needs over functional needs. The loss of tooth structure associated with bruxism can be considered pathologic when it compromises the anterior guidance, which is the influence on mandibular movements that provides the contacting surfaces of the maxillary anterior teeth with the mandibular anterior teeth and avoids damaging eccentric contacts in the posterior teeth. The aim of this case report is to present a conservative way to restore both esthetics and function in a 34-year-old patient who came to the Prosthodontics Clinic of the Universidad Autónoma de Guadalajara in search of an esthetic appearance of her anterior teeth. After her initial evaluation, a diagnosis of anterior guide loss due to pathological wear associated with bruxism was made. Treatment included root canal treatment, removal of caries, and ill-fitting restorations, crowns, and veneers to reestablish the anterior guidance. The aesthetic expectations of the patient have met as well as the functional needs that were aimed from the beginning, achieving a conservative reestablishment of the anterior guidance system (AU)

Microcirculation changes in gingival tissue after ultrasonic tooth preparation in beagle dogs

Abstract Ultrasonic wave technology is widely used during dental treatments. We previously demonstrated that this method protects the gingival tissue. However, the physiological change on the gingival microvasculature caused by this method remains unclear. Objective The aim of this study was to investigate the relationship between the morphological and physiological effects on gingival microcirculation when preparing teeth, using the conventional dental turbine or ultrasonic method. Methodology The lower premolar teeth of beagle dogs were prepared along the gingival margin by using a dental turbine or ultrasonic wave instrument. Gingival vasculature changes were investigated using scanning electron microscopy for corrosion resin casts. Gingival blood flow at the preparation site was determined simultaneously by laser Doppler flowmetry. These assessments were performed immediately (Day 0), at 7 days and 30 days after tooth preparation. Results At day 0, in the turbine group, blood vessels were destroyed and some resin leaked. Furthermore, gingival blood flow at the site was significantly increased. In contrast, the ultrasonic group demonstrated nearly normal vasculature and gingival blood flow similar to the non-prepared group for 30 days after preparation. No significant alterations occurred in gingival circulation 30 days after either preparation; however, the turbine group revealed obvious morphological changes. Conclusions Based on multiple approach analyses, this study demonstrated that ultrasonic waves are useful for microvascular protection in tooth preparation. Compared with a dental turbine, ultrasonic wave instruments caused minimal damage to gingival microcirculation. Tooth preparation using ultrasonic wave instruments could be valuable for protecting periodontal tissue.

Dentin pretreatment and adhesive temperature as affecting factors on bond strength of a universal adhesive system

Abstract Objectives: To evaluate the effects of dentin pretreatment and temperature on the bond strength of a universal adhesive system to dentin. Material and Methods: Ninety-six extracted non-carious human third molars were randomly divided into 12 groups (n=8) according to Scotchbond Universal Adhesive (SbU) applied in self-etch (SE) and etch-and-rinse (ER) mode, adhesive temperature (20°C or 37°C) and sodium bicarbonate or aluminum oxide air abrasion. After composite build up, bonded sticks with cross-sectional area of 1 mm2 were obtained to evaluate the microtensile bond strength (μTBS). The specimens were tested at a crosshead speed of 0.5 mm/min on a testing machine until failure. Fractured specimens were analyzed under stereomicroscope to determine the failure patterns in adhesive, cohesive (dentin or resin) and mixed fractures. The microtensile bond strength data was analyzed using two-way ANOVA and Tukey's test (α=5%). Results: Interaction between treatment and temperature was statistically significant for SbU applied in self-etch technique. Both dentin treatments showed higher bond strength for ER mode, regardless of adhesive temperature. When compared to control group, sodium bicarbonate increased bond strength of SbU in SE technique. Adhesive temperature did not significantly affect the μTBS of tested groups. Predominantly, adhesive failure was observed for all groups. Conclusions: Dentin surface treatment with sodium bicarbonate air abrasion improves bond strength of SbU, irrespective of adhesive application mode, which makes this approach an alternative to increase adhesive performance of Scotchbond Universal Adhesive to dentin.

Restauração unitária de cerâmica em dente anterior: relato de caso / Unitary restoration of ceramic in anterior tooth: case report

Laminados de cerâmica são recomendados para dentes que exigem alto padrão estético, como os dentes anteriores, recobrindo com material estético, dentes com alteração de cor, forma ou função. Este trabalho tem como objetivo descrever a sequência clínica dos procedimentos para confecção de uma restauração unitária cerâmica em dente anterior. Paciente H.D.C., sexo feminino, 24 anos, apresentou-se à clínica do Curso de Odontologia da UFMA com queixa estética no elemento 21. No exame clínico, verificou-se a presença de escurecimento dental, causado por traumatismo. Em uma primeira sessão clínica, foi realizado procedimento de moldagem para confecção de restauração provisória posteriormente à execução do preparo. Realizou-se a seleção de cor, o preparo dentário para faceta de cerâmica pura, a moldagem do preparo e, em seguida, confeccionou-se a restauração provisória à base de bis-acrilato, com o auxílio de uma matriz de silicone. Foi realizado o acabamento e polimento da provisória. Em uma nova sessão clínica, foi realizado o ajuste da restauração cerâmica e os procedimentos de cimentação adesiva. O resultado final alcançado possibilitou a restituição da forma, função e estética adequadas

Ceramic laminate veneers are prostheses recommended to teeth that require a good aesthetic, as anterior teeth, covering with aesthetic material teeth with color, shape or function alteration. The aim of this paper is to describe the sequence of clinical procedures for making a unitary ceramic restoration in anterior tooth. Patient H.D.C., female, 24 years old, presented herself to the clinic of the Faculty of Dentistry - UFMA with esthetic complaint of the element 21. On clinical examination, there was the presence of tooth darkening, caused by trauma. It was proposed as initial treatment the manufacture of a ceramic laminate. In a single clinical session, it was performed molding procedure for making temporary restoration after the execution of the tooth preparation. We performed the color selection, preparation dental ceramic veneering, the molding of the tooth preparation and, subsequently, was made the provisional restoration with bis-acrylate, using the technique of the silicone matrix. It was conducted the finishing and polishing of the provisional restoration. The result achieved enabled the restoration of form, function and aesthetics appropriate

Reemplazo de postes metálicos por postes de base orgánica reforzados con fibras de cuarzo: presentación de un caso / Replacement of metallic posts by organic-based quartz fiber posts: report of a case

Los postes de base orgánica reforzados con fibras opseen ventajas, no sólo mecánicas, sino también estéticas. Algunas situaciones clínicas nos permiten colocar un poste de base orgánica, mientras otras nos indican la necesidad de cambiar los postes existentes. En este último caso, la técnica de desgaste centralizada constituye una alternativa clínica posible. Cuando el conduccto tiene un diámetro mayor al del poste de mayor diámetro, utilizar postes accesorios y personalizar los postes en una técnica combinada, puede resultar una solución óptima, en casos de inexistente remanente dentario coronario.

Algoritmo matemático para cuantificar directamente el ángulo de convergencia en preparaciones de dientes artificiales / Mathematical algorithm to directly quantify the convergence angle in tooth preparations dyes

El objetivo de este trabajo fue determinar un algoritmo matemático para cuantificar directamente el ángulo de convergencia (AC) en troqueles de preparaciones dentarias. El modelo experimental consistió en preparaciones coronarias simuladas sobre troqueles de yeso, en el cual el AC fue calculado por tres formulas trigonométricas. Las formulas fueron obtenidas de un modelo matemático en el cual la preparación coronaria representa una forma de pirámide truncada, la cual permite una proyección triangular en un plano. Fueron realizadas 60 mediciones in situ sobre las paredes de 15 troqueles. Se obtuvo una imagen de cada troquel usando una cámara digital (Schick® CDR). El AC fue medido usando la herramientas del software (Control). Los datos fueron analizados estadísticamente y se aplicaron test de propagación de errores. Los ángulos calculados con las tres fórmulas matemáticas ([F1], [F2] y [F3]) mostraron un alto nivel de correlación con el grupo control excepto para dos muestras. Dentro de las limitaciones de este estudio podemos concluir que a través de este algoritmo matemático, es posible cuantificar directamente el AC de las preparaciones coronarias en troqueles. Actualmente la evaluación de los AC tanto en preparaciones realizadas por alumnos de pregrado de odontología como por dentistas, se hacen de manera subjetiva. Las tres fórmulas presentadas en el algoritmo tiene una correlación alta para cuantificar el AC en troqueles. La [F3], es la que mas correlación logra en todas las muestras (0,89).

The aim of this study was to determine a mathematical algorithm to directly quantify the convergence angle (AC) dyes tooth preparations. The experimental model system consisted of crown preparations dyes simulated on plaster, which the CA was quantify by three trigonometric formulas. Formulas were obtained from mathematical models representing the crown preparation as a truncated pyramid shape, allowing a triangular projection on the plane. 60 direct measurements were made in situ on the walls of 15 dyes. An image was obtained from each dye using a digital camera (Schick ® CDR). The CA were measured using software tools (Control). The data were statistically analyzed and test data were applied to propagation of errors. The angles calculated with the three math formulas ([F1], [F2] and [F3]) showed a high level of correlation with the control except for two samples. Within the limitations of this study we can conclude that through this mathematical algorithm, it is possible to directly quantify the AC preparation coronary dyes. Currently the evaluation of AC in both preparations made by undergraduate students of dentistry as well as dentists, are made subjectively. The three formulas presented in the algorithm have a high correlation to quantify the AC dyes. The [F3], correlation is the most accomplished in all samples.

Preparos dentais para coroas totais anteriores cerâmicas / Dental preparations for anterior all-ceramic crown restorations

O objetivo deste trabalho é descrever, ilustrar clinicamente e discutir uma forma efetiva, simples e racional de preparos dentais para coroas totais anteriores cerâmicas. Essa técnica visa à confec-ção de preparos dentais por meio da utilização de número reduzido de etapas clínicas e pontas diamantadas. Os princípios biológicos, mecânicos, funcionais e estéticos são atingidos de maneira lógica, dentro dos requisitos regidos pela odontologia estética contemporânea. Ao final da leitura, espera-se que o cirurgião dentista compreenda a configuração das paredes axial e cervical dos preparos para coroas totais anteriores cerâmicas e realize o procedimento de maneira rápida e eficiente. Apesar da citação numérica específica das pontas diamantadas utilizadas, espera-se que o leitor as utilize como referência, lembrando ser mais importante a compreensão de sua configuração geométrica e volume. Outros fabricantes possuem pontas diamantadas com a mesma configuração geométrica das pontas recomendadas nesta técnica. Dessa forma, cabe ao profissional selecionar as pontas diamantadas de acordo com seu fabricante de eleição

The aim of this study is to describe, illustrate and discuss a simple, effective and rational method for preparing anterior all-ceramic restorations. This procedure uses a reduced number of diamond burs and a few clinical steps. The biological, mechanical, functional and aesthetic principles are obtained in a reasonable manner, regarding the requirements’ supported by the contemporary aesthetic dentistry. At the end of reading, it is expected that the professionals understand the design of the axial and cervical dental walls. Finally, the dental preparations will be made in a rapid and efficient manner. Despite the citation of specific diamond burs, it is expected that the reader use them as a reference. The understanding of their geometric configuration and volume are more important than their manufacturer’s reference number. Other manufacturers have diamond burs with the same geometric configuration of those recommended in this technique. Thus, the clinical professional must select the diamond points according to their manufacturer of choice

In in-vitro evaluation of effect of different finish lines on marginal adaptation in metal-ceramic restorations under thermo-mechanical loading.

The aim of this study was to evaluate the marginal gap in terms of cement film thickness associated with shoulder, shoulder with 45° bevel, shoulder with 30° bevel and chamfer, under thermo-mechanical loading. Forty human mandibular molars were prepared and restored with ceramo-metal crowns. Teeth were thermo-mechanically loaded and vertically sectioned to evaluate the cement film thickness. Shoulder with 45° bevel provided the least marginal gap as compared with all the tested finish lines.

in vitro evaluation of marginal leakage using invasive and noninvasive technique of light cure glass ionomer and flowable polyacid modified composite resin used as pit and fissure sealant.

Aim: This study compared the microleakage of light cure glass ionomer and flowable compomer as pit and fissure sealant, with and without tooth preparation. Materials and Methods: One hundred premolars that were extracted for orthodontic purpose were used. After adequate storage and surface debridement, the teeth were randomly divided into four groups. In Group I and III, the occlusal surfaces were left intact, while in Group II and Group IV, tooth surfaces were prepared. Teeth in Group I and Group II were sealed with Light cure glass ionomer, whereas flowable compomer was used to seal teeth in Group III and IV. The sealed teeth were then immersed in dye. Subsequently, buccolingual sections were made and each section was examined under stereomicroscope for microleakage followed by scoring. Results: In group I, microleakage score ranged from 2 to 4 with mean of 3.64 (±0.757), while in group II the range was observed to be 1-4 with mean of 2.88 (±1.236). Group III recorded a range of 0-4 with the mean of 2.20 (±1.443) while 0-2 and 0.60 (±0.707) being the range and mean observed, respectively, for group IV. Conclusion: Flowable compomer placed after tooth preparation showed better penetration and less marginal leakage than the light cure glass ionomer.

Optimizando la estética en el tratamiento de diastemas / Optimizing aesthetics in the treatment of diastemas

Los parámetros de estética dictados por la sociedad obligan a las personas a buscar cada vez más, armonía dentofacial. En consecuencia, se incrementó el número de tratamientos estéticos relacionados a cambios de forma, posición y color de los dientes. Una alteración estética de etiología múltiple, encontrada frecuentemente en la clínica odontológica, y que a menudo afecta la composición dentofacial, es el diastema anterior. La evolución...

Pinos intrarradiculares estéticos: caso clínico / Esthetics root posts: clinical case

O objetivo desse estudo foi demonstrar a técnica de utilização de pinos intrarradiculares em fibras de vidro translúcido. Foi selecionado um elemento dentário (incisivo lateral superior) de uma paciente do gênero feminino, 36 anos de idade atendida na disciplina de Dentística Restauradora da Universidade Estadual de Ponta Grossa (UEPG). O elemento dentário foi tratado endodonticamente e possuía restauração provisória deficiente. Esse procedimento foi realizado com o intuito de gerar retenção ao material restaurador definitivo e reforçar a porção coronária remanescente do elemento dentário, minimizando, assim, a probabilidade de fratura. A utilização do pino intrarradicular em fibras de vidro contribui para a manutenção da estética do elemento dentário, além de promover uma melhor distribuição das tensões nas estruturas dentárias e a retenção do material restaurador. Pinos em fibras de vidro contribuem para a estética natural dos elementos dentários.

The aim of this study was to demonstrate the technique of use of translucent glass fiber root posts. It was selected a teeth (maxilar lateral incisor) of a female patient, 36 years old assisted in the discipline of Dentistry of the State University of Ponta Grossa (UEPG). The dental element sufferred endodontics treatment and it has deficient temporary restoration. That procedure was accomplished with the intention of to generate retention to the definitive restoring material and to reinforce the remaining coronary portion of the dental element, minimizing, like this, the fracture probability. The use of the glass fiber root posts contributed to the maintenance of the aesthetics of the dental element, besides promoting a better distribution of the tensions in the dental structures and the retention of the restoring material. Glass fiber posts contribute to the natural aesthetics of the dental element.

Effect of enamel preparations on fracture resistance of composite resin buildup of fractures involving dentine in anterior bovine teeth: an in vitro study.

Sixty bovine teeth with simulated mesio-incisal angle fracture were randomly and equally divided in one untreated (control) group and three experimental groups (Bevel, Chamfer and newly introduced Stair-step Chamfer preparation group) to evaluate the effect of enamel preparations on the fracture resistance of composite resin. Post restoration, fracture mechanics approach was used to quantify the failure of composite resins in testing the samples in Instron testing machine. Mean peak failure load (Newton) of composite amongst experimental groups was observed in the order; Chamfer (326.09 +/- 72.73), Stair-step chamfer (315.21 +/- 81.77) and Bevel (253.83 +/- 67.38). Results of the One-Way ANOVA revealed significant difference in the mean peak failure load values of the four different groups. (P<0.001) Scheffe's Post-Hoc comparison test (Subset for alpha = 0.05) revealed that there was no significant difference in the mean peak failure load values of the bevel, stair-step chamfer and chamfer preparation when considered together, but the mean peak values of control group (605.22 +/- 48.96) were observed significantly higher. Failure mode evaluation revealed, majority of failures occurred as cohesive and mixed type for all the experimental groups. Adhesive type failure was observed maximum (33%) in the bevel group. Stair-step chamfer preparation showed greatest potential for application and use as it no only demonstrated comparable values to Chamfer preparation ['t' value (0.39) (P > 0.05)] but also involved sacrificing less amount of tooth structure adjacent to fractured edge.

Efeito de água de coco e do leite pasteurizado sobre a superfície radicular de dentes reimplantados: estudo histológico em ratos / Effect of green coconut water and pasteurized milk on the radicular surface of reimplanted teeth: histological analysis in rats

O reimplante dentário consiste na reposição do dente avulsionado no seu respectivo alvéolo. Seu sucesso pode ser prejudicado pelo fato de o dente reimplantado desenvolver reabsorção radicular, sendo esta minimizada quando se preserva a vitalidade do ligamento periodontal, a qual está diretamente relacionada com o tempo de permanência extra-alveolar e o meio de armazenagem. O presente trabalho avaliou, mediante estudo histológico em ratos, a influência da solução de água de coco verde in natura sobre a superfície radicular de dentes extraídos e reimplantados, quando comparada à do leite pasteurizado em relação à presença e natureza da reabsorção radicular e da anquilose. Foram utilizados 80 ratos Rattus novergicus, Albinus Wistar, machos, que tiveram seus dentes extraídos, armazenados nas soluções propostas e reimplantados. Os ratos foram divididos em grupos: Grupo I (leite pasteurizado, 30 minutos); Grupo II (leite pasteurizado, 90 minutos); Grupo III (água de coco, 30 minutos); e Grupo IV (água de coco, 90 minutos). Os animais de cada grupo foram sacrificados nos períodos de 10, 30, 60 e 90 dias. Os resultados obtidos mostraram que a reabsorção inflamatória foi o fenômeno mais freqüente. Os dentes conservados em leite pasteurizado por 30 minutos e 90 minutos demonstraram menores índices de reabsorção e anquilose quando comparados com aqueles dos demais grupos. A água de coco mostrou-se inadequada para a conservação de dentes avulsionados.

Postes radiculares y sellado endodóntico / Radicular posts and endodontic sealing

Todos los dientes tratados endodónticamente necesitan ser restaurados; en muchos de los casos estará indicada la colocación de un poste, ya sea prefabricado o colado. Crear el espacio para poste requiere eliminar parte de la gutapercha y del cemento sellador, así como manipular el conducto radicular, con lo que se incrementa el riesgo de debilitar o perforar la raíz. El objetivo de la presente revisión es ofrecer un punto de vista de la forma en que la preparación del espacio para un poste intrarradicular puede provocar la filtración coronal de bacterias que conllevarían al fracaso del tratamiento endodóntico realizado

Educational material of dental anatomy applied to study the morphology of permanent teeth

O objetivo deste trabalho é de apresentar um material didático que permita ao aluno de odontologia, identificar com maior facilidade, as características morfológicas dos dentes permanentes assim como entender mais facilmente a oclusão dos dentes. Para isto, foram confeccionados macromodelos de dentes permanentes sem desgaste, que foram obtidos da seguinte maneira: foram esculpidos macromodelos em cera; posteriormente estes foram moldados com alginato e os moldes foram preenchidos com gesso pedra e resina acrílica. Os macromodelos de gesso pedra foram montados em oclusão em uma base de cera #7 sendo obtidas desta maneira as arcadas superior e inferior. Estas arcadas montadas em cera foram moldadas novamente e o molde foi preenchido com gesso pedra, obtendo então as duas arcadas totalmente em gesso. Os autores concluíram que os macromodelos permitem uma melhor visualização das características morfológicas dos dentes permanentes bem como da oclusão; os alunos conseguem esculpir dentes permanentes em cera, com maior facilidade, quando observam macromodelos.

Estudio comparativo de la limpieza de las preparaciones para anclaje intrarradicular inmediatas y mediatas / A comparative study of the cleaning of immediate and mediate preparations for intra-radicular anchorage

El propósito del presente estudio fue evaluar la capacidad de limpieza luego de la preparación para anclaje intrarradicular con diferentes métodos. Se emplearon 30 caninos humanos extraídos, cuyos conductos radiculares fueron instrumentados y posteriormente obturados con cemento de Grossman y conos de gutapercha con la técnica híbrida. Los especímenes se dividieron al azar en 3 grupos. Grupo I: preparación para anclaje intrarradicular inmediata; grupo II: preparación medianta, limpieza con Endobrush cilíndrico embebido en alcohol a los 7 días de la obturación endodóntica y limpieza con Endobrush cilíndrico embebido en alcohol por 10 seg. Los dientes fueron radiografiados en sentido orto-radial y mesio-distal. A continuación se seccionaron los especímenes a la altura de los tercios cervical, medio y apical de la preparación para anclaje. Las radiografías fueron evaluadas con una lupa X3 y los cortes transversales por medio de un microscopio óptico a X10. Los resultados no mostraron diferencias estadísticas significativas entre los grupos ni entre los diferentes tercios de cada grupo (p>0.05). La frecuencia y cantidad de material obturador remanente fueron mayores en las caras libres que en las caras proximales. En tanto, en las imágenes radiográficas no fue posible detectar restos pequeños de material obturador; éstos sí fueron observados en el análisis microscópico. Como conclusión podemos señalar que el emplo del Endobrush cilíndrico embebido en alcohol no mejoró la limpieza obtenida por la preparación convencional.

Muñones artificiales con espiga en dientes anteriores / Tang artificial stumps for front teeth

Un diente tratado endodónticamente debe tener un buen pronóstico y puede cumplir la totalidad de sus funciones, por ello, el propósito de esta investigación fue realizar una revisión de la literatura publicada acerca de las necesidades de realizar un refuerzo interno de los dientes anteriores desvitalizados, y los sistemas para postes y muñones artificiales disponibles en la actualidad. Sin embargo, existen factores a considerar en cuanto a la utilización de estos pernos, como ser: la técnica utilizada para su elaboración (prefabricados o colados) y los materiales que están construidos, en este sentido, el significativo avance tecnológico de los nuevos materiales dentales permiten restauraciones protésicas libre de metal, estéticamente mejoradas y de mayor resistencia .

Evaluación radiográfica de 1.000 anclajes intrarradiculares / Radiographic evaluation of 1000 intraradicular anchorages

Se evaluaron en forma radiográfica 1.000 anclajes intrarradiculares en consideración a su tipo, longitud, calibre, orientación, interfase entre la obturación endodóntica y el anclaje intrarradicular y presencia de obturación endodóntica. Los resultados de esta experiencia representan un panorama amplio de errores y aciertos en la preparación para anclaje intrarradicular, y enfatizan la importancia de los aspectos evaluados, a fin de lograr una adecuada interacción entre el tratamiento endodóntico y el protésico