Legislation in Hospital Dentistry: Gaps, Perspectives and Desires

Abstract Objective: To analyze the existing state legislation, including not only the ordinary laws, but also their infralegal regulation and the state legislation on Hospital Dentistry. Material and Methods: A survey was carried out in the databases of the Legislative Assemblies of the Brazilian States and the Federal District, as well as the Regional and Federal Councils of Dentistry in Brazil. Subsequently, a survey was carried out in the databases of the Ministry of Health, State Dental Councils and Federal Dental Council in Brazil. Results: Only 8 Brazilian states have legislation in force regarding hospital dentistry, which represents 29.63% of the federative units. Among the Brazilian regions, the Midwest presented the highest prevalence of the laws found (37.50%), followed by the North (25%) and the other regions with the same coverage (12.50%). Also, an orientation and an ordinance from the Ministry of Health, six resolutions from the Federal Council of Dentistry, and a technical note from the National Health Surveillance Agency were found. Conclusion: Several States do not have rules on the subject, making it imperative to create a federal rule that not only imposes the presence of the dentist, but also regulates the proportion of the team, workload, and availability.

Desensitizing Agent Previously Applied During In-Office Bleaching: A Double-Blind Randomized Clinical Trial

Abstract Objective: To compare the clinical effect of two desensitizing agents used before the application of a bleaching gel based on 35% hydrogen peroxide (HP). Material and Methods: 30 patients were selected, and two desensitizing agents with different mechanisms of action were applied: Fluorine Neutral 2% (FN), which acts by blocking dentinal canaliculi while Potassium Nitrate 5% with 2% Sodium Fluoride (PN/SF) that acts in nerve transmission and blockade. Desensitizers were used before the application of 35% HP. For whitening, three clinical sessions were performed, with an interval of seven days, with three applications of the bleaching gel for 15 minutes, totaling 45 minutes/session. Tooth sensitivity (TS) was assessed with the numerical analog scale, and a spectrophotometer was used to obtain the color variation (ΔE). ΔE were submitted to ANOVA and Tukey test (p<0.05), and TS data were submitted to a two-way ANOVA analysis. Results: For sensitivity experience, the Tukey test indicated differences between PN/SF and the placebo I, but there was no statistically significant difference between FN and the placebo II. The TS was lower when the desensitizing gel was used during the bleaching procedure compared to after treatment, regardless of the desensitizing agents. Conclusion: PN/SF before in-office tooth bleaching can reduce TS intensity, and the use of desensitizing gel before bleaching did not affect the bleaching efficacy.

Health changes during Covid-19: a nationwide study with dental students

ABSTRACT OBJECTIVE To assess the changes in stress levels, social behavior, dietary and parafunctional habits, oral hygiene, among other conditions perceived by dental students in Brazil during the Covid-19 pandemic and evaluated the correlations between stress level and other variables. METHODS An online questionnaire was developed and validated. Undergraduates enrolled in private and public dental schools were recruited by convenience sampling. Data were collected on the perceived changes regarding stress levels, financial and social characteristics, dietary habits, oral hygiene, health conditions, and parafunctional habits. Quantitative variables were expressed as absolute and relative frequencies. Wilcoxon test evaluated comparisons between perceived changes, and correlations between changes in stress levels and other variables were analyzed by Spearman correlation (α = 0.05). RESULTS A total of 638 dental students, mean age of 22.95 ± 4.10 years, participated in the study. During the pandemic, the reported stress levels increased while household income decreased (p < 0.05). Late dinners and mindless eating increased in frequency, whereas oral hygiene decreased (p < 0.05). Most of the health conditions and parafunctional habits assessed changed (p < 0.05). Perceived stress levels showed poor negative correlations with household income (rS = −0.14), poor positive correlations with the pressure to contribute financially in the household (rS = 0.19), and poor positive correlations with food choice frequency (rS = 0.15) (p < 0.05). CONCLUSIONS Dental students reported perceived changes in stress levels, dietary habits, oral hygiene, health conditions, parafunctional habits, and social behavior. Moreover, the results showed poor correlations, as students with higher stress levels tended to have the lowest household income, feel pressured to contribute financially in the household, and present a high meal intake frequency.

Acquired enamel pellicle protects gastroesophageal reflux disease patients against erosive tooth wear

Abstract The objective of this study was to compare the protein profile of the acquired enamel pellicle (AEP) formed in vivo in patients with or without gastroesophageal reflux disease (GERD), and with or without erosive tooth wear (ETW). Twenty-four volunteers were divided into 3 groups: 1) GERD and ETW; 2) GERD without ETW; and 3) control (without GERD). The AEP formed 120 min after prophylaxis was collected from the lingual/palatal surfaces. The samples were subjected to mass spectrometry (nLC-ESI-MS/MS) and label-free quantification by Protein Lynx Global Service software. A total of 213 proteins were identified, or 119, 92 and 106 from each group, respectively. Group 2 showed a high number of phosphorylated and calcium-binding proteins. Twenty-three proteins were found in all the groups, including 14-3-3 protein zeta/delta and 1-phosphatidylinositol. Several intracellular proteins that join saliva after the exfoliation of oral mucosa cells might have the potential to bind hydroxyapatite, or participate in forming supramolecular aggregates that bind to precursor proteins in the AEP. Proteins might play a central role in protecting the dental surface against acid dissolution.

Surface roughness evaluation and whitening efficiency on tooth enamel after using whitening toothpaste: a randomized double-blinded study

The aim of this randomized double-blinded study was to evaluate the enamel surface roughness and color change after one month of whitening toothpaste use and the color stability obtained 1 month after its interruption. 30 volunteers were divided into 3 groups (n = 10) corresponding to the dentifrices: 1) Colgate Total 12 Clean Mint (TD) (Control), 2) Colgate Luminous White (LW) and 3) Sensodyne Whitening Extra Fresh (SB). The volunteers were impression with addition silicone to obtain an epoxy resin replica of the upper central incisor for the initial surface roughness evaluation using a profilometer and the initial color of the incisors and canines was evaluated with a spectrophotometer after one week of wash-out. After 1 month, the color of the central incisors and canines was measured again, and the volunteers were molded to obtain a second replica to the final roughness analysis. Data were submitted to ANOVA-one way (p≤0.05). The results showed that there was no statistical difference between the dentifrices for color difference and surface roughness for all the studied conditions. It was possible to conclude that the whitening dentifrices used in this study were not able to alter the initial color of the teeth and did not cause changes in the surface roughness of enamel.

Ellagic acid on the quality of the adhesive interface of class I composite resin restorations after aging

To evaluate the effect of ellagic acid on the inhibition of matrix metalloproteinase by analyzing the quality of the adhesive interface with bond strength measures in periods of 24 hours and six months of storage. Method: 40 healthy human third molars were prepared with class I cavities (5x4x3mm). The teeth were divided into four experimental groups: Group 1- without application of ellagic acid and storage time of 24 hours; Group 2- with ellagic acid/24 hours; G3- without ellagic acid/six months; Group 4- with ellagic acid/six months. Then, the cavities were restored with Single Bond Universal adhesive and Z350 composite resin, with and without the previous application of ellagic acid. Subsequently, hourglass-shaped specimens were obtained and subjected to the bond strength (BS) test (n = 10) in a universal testing machine. The bond test was performed after 24 hours and six months of storage. For the standard evaluation (n = 3) the samples were infiltrated with silver nitrate and placed in a developing solution for analysis in a Scanning Electron Microscope (SEM). The data obtained were analyzed with the Kruskal-Wallis non-parametric test, showing a statistically significant difference. Results: The highest bond strength values were found for the 24-hour groups followed by the groups with six months of storage. For nano-infiltration, groups G1 and G2 showed lower infiltration than groups G3 and G4. Conclusion: The previous application of ellagic acid did not affect the BS of the adhesive interface of the adhesive system analyzed, regardless of storage time.

Minimally invasive aesthetic treatment of white spots by dental fluorosis in children: case report

The presence of white spots due to dental fluorosis can cause aesthetic discomfort, being one of the factors for a search for dental treatment. Objective: Report a clinical case in which the aesthetic complaint was solved through the association of the dental bleaching to the microabrasion technique. Case report: Male patient, 13 years, attended to the Integrated Clinic of the School of Dentistry of the Federal University of Rio de Janeiro, with fluorosis, mainly in the antero-superior teeth and aesthetic complaint. Initially, it was made an immediate bleaching with hydrogen peroxide at 35%, in 3 sessions of 15 minutes each, to soften the disparity of shades between tooth-stain. The result was insufficient and the dental microabrasion technique was adopted. A pumice paste was applied together with gel of phosphoric acid at 37% under relative isolation, in a total of 8 applications (1 minute each). At the end of each application, it was made an abundant water washing, microengine mounted fine-grained disc polishing and topical application of neutral NaF2 in gel (4 minutes each application) to eliminate possible postoperative sensitivity. Conclusion: The dental bleaching and the microabrasion technique promoted satisfactory immediate clinical results that increased self-esteem of the patient in a minimally invasive way to dental structure.

Introdução: A presença de manchas brancas por fluorose dentária pode causar desconforto estético, sendo um dos fatores para busca de tratamento odontológico. Objetivo: Relatar um caso clínico em que a queixa estética foi resolvida através da associação do clareamento dentário à técnica de microabrasão. Relato do caso: Paciente do sexo masculino, 13 anos, compareceu a Clínica Integrada da Faculdade de Odontologia da UFRJ, com fluorose, principalmente nos dentes ântero-superiores e queixa estética. Inicialmente, realizou-se clareamento imediato com peróxido de hidrogênio a 35%, em 3 sessões de 15 minutos, para suavizar a disparidade de tons entre mancha-dente. O resultado obtido foi insuficiente e a técnica de microabrasão dentária foi adotada. Uma pasta de pedra pomes foi aplicada juntamente com gel de ácido fosfórico a 37% sob isolamento relativo, perfazendo um total de 8 aplicações (1 minuto cada). Ao final de cada aplicação, foi realizada lavagem abundante com água, polimento com disco de granulação fina montado em micromotor e aplicação tópica de NaF2 neutro em gel (4 minutos cada aplicação) para eliminar possível sensibilidade pós-operatória. Conclusão: O clareamento dentário e a técnica de microabrasão promoveram resultados clínicos imediatos satisfatórios que elevaram a autoestima do paciente, de maneira minimamente invasiva para estrutura dentária.

Effect of tooth enamel staining by coffee consumption during at-home tooth bleaching with carbamide peroxide / Efeito da coloração do esmalte dentário pelo consumo de café durante o clareamento dentário caseiro com peróxido de carbamida

Introduction: Obtaining the result expected during tooth bleaching requires a correct diagnosis of the type of staining presented. The causes of tooth staining differ depending on the etiological factor. Objective: To assess the color change caused by the immersion of bovine teeth in coffee solution during at-home tooth bleaching using a 16% carbamide peroxide gel. Material and method: Thirty-three sound bovine teeth were assigned to three groups of eleven teeth each: 1 - Teeth bleached (TB) four hours per day for 21 days; 2 - TB four hours per day for 21 days and immersed in coffee solution immediately after tooth bleaching; 3 - TB four hours per day for 21 days and immersed in coffee solution four hours after the end of tooth bleaching. Immersed in coffee was performed for 15 minutes and tooth color was assessed before the start of the bleaching procedure and after 21 days with an intraoral spectrophotometer. Test Shapiro-Wilk was used to assess homoscedasticity and data were submitted to one-factor Analysis of Variance (ANOVA) and Tukey's test (p <0.05). Result: The color change observed in group 1 (5.76 ± 2.74)A was not statistically different from group 2 (8.83 ±5.11)A, which was immersed in coffee solution immediately after tooth bleaching, and from group 3, which was immersed in coffee solution four hours after tooth bleaching (8.20 ±3.71)A. Conclusion: Coffee did not interfere with the tooth bleaching results, regardless of the time after the procedure. Hence, diet restrictions are not necessary during tooth bleaching.

Introdução: A obtenção do resultado esperado durante o clareamento dental exige um diagnóstico correto do tipo de coloração apresentado. As causas da coloração dos dentes diferem dependendo do fator etiológico. Objetivo: Avaliar a mudança de cor causada pela imersão dos dentes bovinos na solução de café durante o clareamento dentário caseiro, utilizando gel de peróxido de carbamida a 16%. Material e método: Trinta e três dentes bovinos hígidos foram distribuídos em três grupos de onze dentes cada: 1 - Dentes clareados quatro horas por dia durante 21 dias; 2 - Dentes clareados quatro horas por dia durante 21 dias e imerso em solução de café imediatamente após o clareamento dentário; 3 - Dentes clareados quatro horas por dia durante 21 dias e imerso em solução de café quatro horas após o término do clareamento dentário. Imersão em café foi realizada durante 15 minutos e a cor dos dentes foi avaliada antes do início do procedimento do clareamento e após 21 dias com um espectrofotômetro intraoral. O teste Shapiro-Wilk foi utilizado para avaliar a homocedasticidade e os dados foram submetidos à análise de variância de um fator (ANOVA) e ao teste de Tukey (p <0,05). Resultado: A mudança de cor observada no grupo 1 (5,76 ± 2,74)A não foi estatisticamente diferente do grupo 2 (8,83 ± 5,11)A, imerso em solução de café imediatamente após o clareamento dentário, e do grupo 3, imerso em café quatro horas após o clareamento dental (8,20 ± 3,71). Conclusão: O café não interferiu nos resultados do clareamento dental, independentemente do tempo após o procedimento. Portanto, restrições alimentares não são necessárias durante o clareamento dental.

Effect of pigmenting agents on tooth enamel staining during immediate tooth whitening: an in vitro study / Efeito de agentes pigmentantes no manchamento do esmalte dental durante o clareamento dentário imediato: estudo in vitro

Introduction: Considering the increased search for esthetic procedures, questions emerge about the maintenance and regression of color, especially regarding the need to restrict dark foods during bleaching procedures or their influence on the stability and effectiveness of the treatment. Objective: To assess the influence of staining agents on tooth enamel during immediate bleaching treatment with 35% hydrogen peroxide. Material and method: Sixty bovine teeth were divided into six groups (G) (n=10): G1: distilled water (control); G2: coffee; G3: cola soft drink; G4: wine; G5: mate tea; and G6: industrialized açaí. The samples were subjected to immediate bleaching using 35% hydrogen peroxide for 21 days (three applications of 15 minutes per session, every seven days) and pigment immersion between each session for 15 minutes. The color was assessed before starting bleaching and after 21 days, using a spectrophotometer. The data obtained were subjected to one-way ANOVA and heteroscedasticity analysis by the Welch and Brown-Forsythe tests. The Tamhane test was used for group comparison. Result: The color change was visible to the naked eye, considering the mean ΔE in all groups tested was higher than 3.7. However, there was no statistical difference between the control group and the groups assessed. Conclusion: The contact of staining agents on bovine tooth enamel did not affect the final result of the immediate tooth bleaching.

Introdução: Com o aumento da procura por procedimentos estéticos, dúvidas surgem quanto à manutenção e regressão de cor, especialmente, no que tange a necessidade de restrição quanto à alimentos escuros durante o procedimento clareador ou a sua influência quanto à estabilidade e eficácia do tratamento. Objetivo: Avaliar a influência de agentes pigmentantes sobre o esmalte dental durante o tratamento clareador imediato com peróxido de hidrogênio a 35%. Material e método: 60 dentes bovinos foram divididos em 6 grupos (G) (n=10): G1: água destilada (controle), G2: café, G3: refrigerante à base de cola, G4: vinho, G5: chá-mate, e G6: açaí industrializado. As amostras foram submetidas ao clareamento imediato utilizando peróxido de hidrogênio a 35% durante 21 dias (3 aplicações de 15 minutos por sessão a cada 7 dias) e submetidas à imersão dos pigmentos entre cada sessão durante 15 minutos. A avaliação da cor foi realizada antes do inicio do clareamento e após 21 dias, mediante o uso do espectrofotômetro. Os dados obtidos foram submetidos ao ANOVA one-way e análise de heterocedasticidade pelos testes de Welch e Brown-Forsythe. O teste de Tamhane foi utilizado para a comparação entre os grupos. Resultado: Houve alteração de cor visível ao olho nu, uma vez que a média de ΔE em todos os grupos testados foi maior que 3,7. Contudo, não houve diferença estatística entre o grupo controle em relação aos grupos avaliados. Conclusão: O contato de agentes pigmentantes no esmalte dental bovino não influenciou o resultado final do clareamento dental imediato.

Influence of cavo superficial enamel acid-etching on the microtensile bond strength of low-shrinkage composite resin / Influência do condicionamento ácido do ângulo cavo superficial na resistência adesiva de restaurações em um compósito de baixa contração de polimerização

Introduction: To prevent the shrinkage stresses produced during polymerization, composite resins of low polymerization shrinkage were developed. Objective: To evaluate the microtensile bond strength in class I cavities restored by acid-etching the cavosurface angle and with composite resins indicated for posterior teeth. Material and method: 48 healthy molars were selected and divided into six groups (n = 8), considering that the cavosurface enamel of three groups was etched with 35% phosphoric acid. The teeth were restored with the Clearfil SE Bond adhesive system and Filtek Z350 XT, Empress Direct, and Charisma Diamond composite resins, which were light-cured for 40 seconds. After 24 hours, the teeth were taken to a cutting machine, which produced sections in the buccolingual and mesiodistal directions. This resulted in toothpicks of 0.9×0.9 mm that were taken to the universal testing machine for the microtensile bond strength test. Statistical analysis was performed with ANOVA and Tukey's test (p < 0.05). Result: There was no statistically significant difference between the groups evaluated. Conclusion: Acid-etching the cavosurface angle did not affect the performance of restorations, probably due to the adhesive system used.

Introdução: Com o intuito de se evitar as tensões geradas durante a contração de polimerização das resinas compostas, foram desenvolvidas as resinas compostas de baixa contração de polimerização. Objetivo: Avaliar a resistência à microtração em cavidades classe I restauradas com tratamento ácido do ângulo cavo superficial e resina composta indicada para dentes posteriores. Material e método: Foram selecionados 48 molares hígidos que foram divididos em 6 grupos (n=8), sendo que 3 desses tiveram o esmalte cavo superficial condicionado com ácido fosfórico a 35%. Os dentes foram restaurados com o sistema adesivo Clearfil SE Bond e as resinas compostas Filtek Z350 XT, Empress Direct e Charisma Diamond, fotoativadas por 40 segundos. Após 24 horas, os dentes foram levados para máquina de corte, na qual foram realizados cortes no sentido vestíbulo-lingual e no sentido mésio-distal obtendo - se palitos de 0,9×0,9 mm que foram levadas para a máquina de ensaio universal para a realização do teste de microtração. Para análise estatística foi realizado análise de variância e teste de Tuckey (p < 0,05). Resultado: Não houve diferença estatística significante entre os grupos avaliados. Conclusão: O condicionamento ácido do ângulo cavo superficial não influenciou no desempenho das restaurações provavelmente devido ao sistema adesivo utilizado.

O efeito do tabagismo na ocorrência da cárie dentária: uma revisão de literatura / The effect of smoking on the occurrence of dental caries: a literature review

Introdução: A cárie dentária é a doença bucal mais prevalente no mundo, sendo uma das mais estudadas há anos. Diversos fatores estão envolvidos em seu desenvolvimento, alguns de forma direta, outros indiretamente. O hábito de fumar considerado como contribuinte para diversas patologias bucais, como doença periodontal, câncer oral e atualmente relacionado com a doença cárie. Objetivo: Analisar a associação do tabagismo com a ocorrência da cárie dentária. Materiais e Métodos: Este trabalho tratou-se de um estudo de revisão de literatura sobre os efeitos do tabagismo na cárie dentária onde as informações foram obtidas a partir de 61 artigos científicos em português, inglês, espanhol e francês, consultados em bases de dados online, com disponibilidade na íntegra, que apresentavam coerência com a temática e com data de publicação entre 2008 e 2019. Foram excluídas da pesquisa, publicações cujos títulos e/ou objetivos não possuíam ligação direta com a temática ou que fugiam do objeto de estudo. Resultados: Os resultados da literatura mostraram que fumantes têm risco aumentado de desenvolver cárie dental em comparação com não fumantes. A nicotina é apontada como o componente do tabaco responsável pelo aumento da proliferação bacteriana dentro do biofilme dental. Além disso os biofilmes tornam-se mais compactos e resistentes em presença dessa substância. Conclusão: A comunidade científica tem mostrado que a nicotina é um dos fatores modificadores para o desenvolvimento da doença, sendo necessárias mais trabalhos nesse âmbito para elucidar essa questão.

Introduction: Dental caries is the most prevalent oral disease in the world, being one of the most studied for years. Several factors are involved in its development, some directly, others indirectly. The habit of smoking has been considered as a contributor to several oral pathologies, such as periodontal disease, oral cancer and currently has been related to caries disease. Objective: To analyze the association between smoking and the occurrence of dental caries. Materials and Methods: This work was a study of literature review on the effects of smoking on dental caries where the information was obtained from 61 scientific articles in Portuguese, English, Spanish and French, consulted in online databases , with full availability, which were coherent with the theme and with publication date between 2008 and 2019. Publications whose titles and / or objectives did not have a direct link with the theme or which escaped the object of study were excluded from the research. Results: Results in the literature have shown that smokers are at increased risk of developing dental caries compared to non-smokers. Nicotine is identified as the tobacco component responsible for the increase in bacterial proliferation within the dental biofilm. In addition, biofilms become more compact and resistant in the presence of this substance. Conclusion: The scientific community has shown that nicotine is one of the modifying factors that contributes to the development of the disease, requiring further research in this area to further clarify this issue.

Effects of desensitizing products on the reduction of pain sensitivity caused by in-office tooth bleaching: a 24-week follow-up

Abstract Objective To clinically assess the effect of desensitizing gels and dentifrices on the reduction in pain sensitivity and color variation during tooth bleaching. Methodology A total of 108 volunteers were randomly separated into the following groups of n=12: GT/S-glycerine and thickener/sucralose; NF/S-potassium nitrate and sodium fluoride/sucralose; NA/S-potassium nitrate and arginine/sucralose; GT/AC-glycerine and thickener/arginine and calcium carbonate; NF/AC-potassium nitrate and sodium fluoride/arginine and calcium carbonate; NA/AC-potassium nitrate and arginine/arginine and calcium carbonate; GT/PN-glycerine and thickener/potassium nitrate; NF/PN-potassium nitrate and sodium fluoride/potassium nitrate; and NA/PN-potassium nitrate and arginine/potassium nitrate. Sensitivity was assessed with the numerical analogue scale, and color variation (ΔE) was measured with a spectrophotometer. The sensitivity values obtained were subjected to a multivariate analysis of variance (MANOVA) and color variation values were subjected to a randomized analysis of variance (p<0.05). Results The NF/AC, NA/AC, NF/PN, and NA/PN groups presented lower sensitivity values and reduced sensitivity compared to those of the other groups throughout the clinical sessions. None of the groups showed sensitivity at the 24-week assessment. Statistically, no significant difference were observed in the color values among the groups four weeks after the beginning of bleaching (p=0.074). Additionally, the color assessment of all groups was statistically similar four weeks (p=0.084) and 24 weeks (p=0.118) after the beginning. Conclusion Our results indicate that adding NF/S, NA/S, NF/AC, and NA/AC desensitizers to tooth bleaching protocols reduces pain sensitivity without affecting its effectiveness.

Do commercial whitening dentifrices increase enamel erosive tooth wear?

Abstract Objective This in vitro study evaluated the effect of commercial whitening dentifrices on erosive tooth wear (ETW) of bovine enamel samples, in comparison with commercial regular dentifrices. Methodology Sixty bovine crowns were embedded in acrylic resin, polished and then had their baseline profile determined. They were randomly assigned to 5 groups (n=12/group), according to the type of commercial dentifrice to be tested: GI - Crest Anti-cavity Regular; GII - Crest 3D White; GIII - Colgate Total 12 Clean Mint; GIV - Colgate Optic White; GV - Placebo (negative control, fluoride-free dentifrice). The samples were submitted to daily erosive and abrasive challenges for 3 days. The erosive challenges were performed 3 times a day by immersing the specimens in 0.1% citric acid solution (pH 2.5) for 90 s. Each day after the first and last erosive challenges, the specimens were subjected to the abrasive challenge for 15 s, using a toothbrushing machine (Biopdi, São Carlos, SP, Brazil), soft toothbrushes and slurry (1:3 g/ml) of the tested toothpastes (1.5 N). The specimens were kept in artificial saliva between the challenges. The final profile was obtained and the ETW (µm) was calculated. Data were analyzed by Kruskal-Wallis and Dunn's tests (p<0.05). Results All dentifrices tested significantly reduced the enamel wear in comparison with the Placebo, except GIII. The median (95% CI) ETW was 1.35 (1.25-1.46)bc for GI, 1.17 (1.01-1.34)cd for GII, 1.36 (1.28-1.45)ab for GIII, 1.08 (1.04-1.14)d for GIV and 2.28 (2.18-2.39)a for GV. Conclusion When dentifrices from the same manufacturer were compared, the whitening dentifrices led to similar or less wear than the regular ones.

Aesthetic recovery of the smile using a simple and effective application of prepolymerized composite veneers

Introduction: The prefabricated composite resin veneers are prepolymerized laminates of composite that appeared in the market to simplify the restorative procedure, reducing working time. They are extremely thin veneers fabricated in several sizes, which allows performing restorations with high aesthetic standard in anterior teeth using a minimally invasive technique. Objectives: This study aimed to show the use of prefabricated resin veneers in the re-anatomization and recovery of dental aesthetics of a young patient with history of fracture and darkening of anterior teeth after aesthetic periodontal surgery. Case report: The patient attended the clinic with a smile complaint and the clinical examination showed tooth 11 with cervical fracture, tooth 21 with color change and caries infiltration, and tooth 22 with inclination of the distal surface toward the palatal region. As treatment, was opted for the use of prefabricated composite resin veneers. Conclusion: The aesthetic results of this case were highly satisfactory, especially when compared with clinical time, cost, and the laboratory work of ceramic veneers, showing the quality and advantages of this material.

Introdução: As facetas pré-fabricadas de resina composta são laminados prépolimerizados de compósito que surgiram no mercado para simplificar o procedimento restaurador, reduzindo o tempo de trabalho. São facetas extremamente finas, fabricadas em diversos tamanhos, com as quais é possível realizar restaurações com alto padrão estético em dentes anteriores através de uma técnica minimamente invasiva. Objetivo: Esse trabalho teve como objetivo demonstrar o uso de facetas pré-fabricadas de resina na reanatomização e recuperação da estética dentária de um paciente jovem com histórico de fratura e escurecimento dos dentes anteriores, após cirurgia estética periodontal. Relato de caso: Paciente compareceu à clínica com queixa do sorriso e ao exame clínico, observou-se dente 11 com fratura cervical, dente 21 com alteração de cor e infiltração por cárie e dente 22 com inclinação da face distal para palatina. Como tratamento, foi optado pela utilização das facetas pré-fabricadas de resina composta. Conclusão: Os resultados estéticos deste caso foram altamente satisfatórios, principalmente quando comparados ao tempo clínico, custo e trabalho laboratorial de facetas de cerâmica, mostrando a qualidade e as vantagens desse material.

Integrated treatment between orthodontics and pediatric dentistry using the ulectomy technique: case report

Introduction: In the pediatric dental clinic the impacted teeth can be observedeventually, which can lead to the development of occlusion disorders. Objective:This study aimed to report a clinical case in which the surgical technique ofulectomy was used in conjunction with orthodontic treatment to aid the eruptionof a maxillary central incisor. Case Report: Male patient, 13 years old, Angle ClassI in the mixed dentition stage, with the tooth 21 impacted and reduced space forits eruption due to the migration of adjacent teeth. Fixed appliance was mountedwith Edgewise brackets using 0.20" stainless steel archwire with tight omega andactive spring between teeth 11 and 22 to recover the space of 21, but the passiveeruption was not observed. A fibrous gingival tissue was found, which by palpationrevealed the incisal edge of the tooth 21. The patient was referred to a pediatricdental clinic for a ulectomy. The minimally invasive surgical procedure consistedof the excision of the gingival tissue that covered the crown of the tooth 21 allowingits eruption in the dental arch. After the surgery, the teeth erupted and correctiveorthodontic treatment continued. Conclusion: The ulectomy technique associatedwith orthodontic treatment allowed to reestablish conditions for the developmentof dentition with satisfactory aesthetic and functional characteristics.

Introdução: Eventualmente na clínica odontológica, pode ser observada aimpacção de dentes, que pode acarretar transtornos para o desenvolvimento daoclusão. Objetivo: Objetivou-se relatar um caso clínico no qual a técnica cirúrgicade ulectomia foi utilizada, associada ao tratamento ortodôntico para auxiliar aerupção dentária de um incisivo central superior. Relato de Caso: Paciente dosexo masculino, 13 anos de idade, Classe I de Angle na fase de dentição mista, comdente 21 incluso e espaço reduzido para sua erupção em função da migração dosdentes adjacentes. Foi montado aparelho fixo com bráquetes prescrição Edgewise,utilizando arco 0,20" aço inoxidável com ômega justo e mola ativa entre osdentes 11 e 22 para recuperação do espaço do 21, mas não observou-se a erupçãopassiva. Constatou-se presença de tecido gengival fibroso que, ao toque,evidenciava a borda incisal do referido dente. O paciente foi encaminhado paraclínica de Odontopediatria para a realização da ulectomia. O procedimentocirúrgico minimamente invasivo, consistiu na exérese do tecido gengival querevestia a coroa do dente 21 não irrompido, permitindo sua erupção no arcodentário. Após a cirurgia, o dente irrompeu e o tratamento ortodôntico corretivoprosseguiu. Conclusão: A técnica da ulectomia associada ao tratamentoortodôntico permitiu restabelecer condições para desenvolvimento da dentiçãocom características estético-funcionais satisfatórias.

Bulk-fill resins in pediatric dentistry: case reports with six-month follow-up

Introduction: Minimally invasive dental procedures are aimed at recovering function and aesthetics in a practical manner, providing excellent treatment options. Bulk-fill composites offer some benefits, such as placement in single increments up to 4-mm thickness, decreased polymerization shrinkage, and general reduction in clinical time, while keeping aesthetic properties similar to those of conventional composite resins. Objective: To report two clinical cases of class I restorations in permanent molars with dentin carious lesions (ICDAS 4) treated with bulk-fill composites using the occlusal stamp technique. Cases were followed up for 6 months and the restorations were evaluated according to the World Dental Federation (FDI) and Public Health Service (USPHS) criteria. Case report: Restorations were performed using the following materials: Case 1 ­ Filtek ™ bulk-fill flowable resin (3M ESPE) associated with Filtek Z350 XT resin (3M ESPE); Case 2 - Filtek bulk- ill packable resin (3M ESPE). Three blinded evaluators assessed the materials and techniques in the follow-up period. Results: Case 1 achieved the lowest scores by the FDI and USPHS criteria, presenting better aesthetic, functional, and biological properties. Conclusion: Both treatments were clinically satisfactory after 6 months. Bulk-fill composites are good materials, allowing for a fast, effective, and quality treatment for the pediatric patient.

Introdução: A evolução dos procedimentos operatórios minimamente invasivos possibilitou a recuperação da função e estética com praticidade, proporcionando tratamentos de excelência. Resinas bulk-fill apresentam vantagens: inserção em incrementos únicos de até quatro milímetros, menor contração de polimerização e redução do tempo clínico, mantendo propriedades estéticas semelhantes às resinas compostas convencionais. Objetivo : Relatar dois casos clínicos de restaurações classe I em lesão cariosa em dentina não cavitada (ICDAS 4), em molares permanentes, com resina bulk-fill utilizando a técnica da réplica oclusal. Adicionalmente, foi realizado o acompanhamento dos casos após seis meses, avaliando-se de acordo com os critérios World Dental Federation (FDI) e Public Health Service (USPHS). Relato : As restaurações foram realizadas utilizando-se os materiais: Caso 1: resina Filtek bulk-fill flow (3M ESPE) associada à resina de cobertura Filtek Z350 XT (3M ESPE); Caso 2: resina Filtek bulk-fill condensável (3M ESPE). Avaliações foram conduzidas por três avaliadores cegos em relação aos materiais e técnicas. Resultados : Caso 1 apresentou menores pontuações nos critérios FDI e USPHS, com melhores propriedades estéticas, funcionais e biológicas, comparado ao Caso 2. Conclusão : Ambos os tratamentos apresentaram resultados clínicos satisfatórios após 6 meses de avaliação. Resinas bulk- ill possibilitam um tratamento rápido, eficaz e de qualidade.