Do non-clinical subjective factors influence the treatment decisionmaking of Brazilian dentists? / Fatores subjetivos não clínicos influenciam na tomada de decisão do tratamento de cirurgiões-dentistas brasileiros?

ABSTRACT The literature contains little information on several non-clinical factors such as the association between graduate residency programs and the application of minimally invasive dentistry, or on dentists' clinical decision-making processes for replacing restorations for esthetic reasons. This study evaluated whether non-clinical subjective factors influence the treatment decisions made by Brazilian dentists regarding technical and esthetic matters. Dentists were invited to participate in a cross-sectional survey by answering an electronic questionnaire containing clinical cases, regarding what treatment they would select for: T1 - a molar tooth with significant crown destruction and spontaneous pain, and T2 - premolar teeth with extensive amalgam restorations and no carious lesion or associated complaint. The survey also included questions about subjective variants (sociodemographic and professional). Chi Square test and Fischer's Exact test were used to analyze the answers to T1, and one-factor analysis of variance and post-hoc Tamhane were applied to T2. The significance level was set at 5% for all analyses. A total 302 professionals participated in the study. For T1, it was found that clinical decision-making was influenced by the Brazilian region of clinical practice (p=0.005). For T2, a significant association was found between increased loss of patient tooth tissues and whether the professional had completed a residency program in Operative Dentistry (p=0.035), worked in a private practice (p=0.033), or if most of his/her patients belonged to a high estimated socioeconomic level (household income above $4350) (p=0.002). In conclusion, the clinical decision-making of Brazilian dentists varies according to professional profile, mainly with relation to the replacement of restorations due to esthetic concerns.

RESUMO Vários fatores não clínicos, como a associação entre programas de especialização e a aplicação da odontologia minimamente invasiva, ainda são escassos na literatura. Outro aspecto relevante é a tomada de decisão clínica do dentista quanto à substituição de restaurações em função da aparência estética. Este estudo avaliou se fatores subjetivos não clínicos influenciam na tomada de decisão clínica de dentistas brasileiros com base em questões técnicas e estéticas. Foi realizado um estudo transversal com um questionário eletrônico contendo casos clínicos que foram apresentados a uma lista de profissionais. No questionário, interrogou-se o tratamento proposto para um dente molar com destruição coronária significativa e dor espontânea (T1). Também foi questionado o tratamento proposto para dentes prémolares com extensas restaurações de amálgama e sem lesão cariosa ou queixas associadas (T2). Em seguida, foram questionadas as variantes subjetivas (sociodemográfica e profissional). Na análise de T1, foram utilizados os testes Qui Quadrado e Exato de Fischer. Em T2, foi aplicada a análise de variância de um fator e post-hoc Tamhane. Para todas as análises, o nível de significância foi estabelecido em 5%. Um total de 302 profissionais participaram deste estudo. A tomada de decisão clínica para T1 foi influenciada pela região brasileira de prática clínica (p = 0,005). Em T2, realizar especialização em Dentística Operatória (p = 0,035), trabalhar em consultório particular (p = 0,033) e a maioria dos pacientes apresentar nível socioeconômico estimado elevado (renda familiar acima de R$10.000,00) (p = 0,002) aumentou significativamente a perda de tecidos dentários. Em conclusão, a tomada de decisão clínica dos dentistas brasileiros varia de acordo com o perfil dos profissionais, principalmente no que se refere à substituição de restaurações por questões estéticas.

Patients' Management Patterns for Restorative Treatment Procedures: A 4-Year Overview at the Restorative Clinic of a Tertiary Hospital in Nigeria

Abstract Objective: To determine the patients' management pattern for restorative treatment procedures at the Restorative Dentistry Clinic at the Lagos State University Teaching Hospital (LASUTH). Material and Methods: A descriptive and retrospective study design was employed to determine patients' management patterns for the restorative treatment procedures at the Restorative Dentistry Clinic at LASUTH. Treatment records of patients who attended the Restorative Clinic at the Lagos State University Hospital, Ikeja, Lagos, Nigeria, from 2011 to 2014 were reviewed; the effective treatments during the period under review were recorded as treatment procedures and were recorded as operative, endodontic, fixed prosthodontics, and removable procedures. Results: A total of 14,437 (75%) operative; 1,353 (7.0%) endodontic; and 559 (2.9%) fixed prosthodontics and 2,852 (14.9%) removable prosthodontic procedures were carried out during the period under review. This study showed that operative procedures were the most performed restorative procedures, whereas removable prosthodontics and endodontic procedures ranked second and third, respectively, to operative procedures. Fixed prosthodontics procedures were the least performed restorative procedures. Conclusion: This study showed that more efforts were being expended by dentists on operative services compared to endodontic, removable, and fixed prosthodontics services combined. Comprehensive studies, embracing all disciplines of dentistry, should be carried out to determine the level of demand and clinical relevance of procedures in clinical dental practice and hence to set specific and general objectives of dental education for the populace. Access to dental health Insurance services should also be increased in the country.

Prevalência de lesões cervicais não cariosas na dentição decídua / Prevalence of non-carious cervical lesions in the primary dentition

Objetivo: Determinar a prevalência de lesões cervicais não cariosas em crianças na dentição decídua e possíveis fatores etiológicos associados. Métodos:Após a aprovação do Comitê de Ética ­ CEP/UESPI (3.289.732), o estudo transversal foi realizado em 360 crianças com idade entre 2 a 6 anos, de escolas públicas e privadas, divididas em dois grupos: G1 (com lesões cervicais) e G2 (sem lesões cervicais). Foi aplicado um questionário aos pais, seguido do exame clínico das crianças. Foram consideradas lesões detectadas pelo tato e visualmente. Foram realizadas avaliações das médias e dos desvios padrão para variáveis quantitativas. Obteve-se porcentagens e frequências, realizando-se análises de associação entre as variáveis qualitativas a partir do qui-quadrado e comparação da idade média a partir do teste t (p < 0,05). Resultados: Somente lesões do tipo abfração foram encontradas na amostra (5%) e os indivíduos de raça branca apresentaram uma maior prevalência em relação aos demais (55,5%). Houve diferença estatisticamente significativa (p < 0,001) e essas lesões foram identificadas somente em escolas privadas. Quanto ao sexo, em G1, houve diferença estatisticamente significativa, (p = 0,01) com maior prevalência no masculino (66,7%). Os dentes mais acometidos em ordem decrescente foram os caninos e incisivos centrais superiores seguidos dos caninos e incisivos centrais inferiores. Conclusão: A prevalência de lesões cervicais não cariosas, do tipo abfração, em crianças de 2 a 6 anos de idade foi de 5%, tendo sido encontradas somente em escolas privadas, com predominância no sexo masculino. Houve associação entre a abfração e o tipo de escova utilizada na escovação dentária, apresentando maior frequência de lesões quando escovas duras eram utilizadas e escovação forte era executada.

Aim:To determine the prevalence of non-carious cervical lesions in children in the primary dentition and possible associated etiological factors. Method: After approval by the Ethics Committee - CEP / UESPI (3,289,732) ­ this cross-sectional study was carried out on 360 children, from 2 to 6 years of age, from public and private schools, divided into two groups: G1 (with cervical lesions) and G2 (without cervical lesions). A questionnaire was applied to the parents, followed by the children's clinical examination. Lesions detected by touch and visually were considered. Evaluations of means and standard deviations were performed for quantitative variables. Percentages and frequencies were obtained, analyzing the association between qualitative variables based on the chi-square test and comparing the average age using the t test (p < 0.05). Results:Only abfraction-type lesions were found in the sample (5%), and white individuals presented a higher prevalence in relation to the others (55.5%). There was a statistically significant difference (p < 0.001), and these lesions were found only in private schools. As for sex, in G1, there was a statistically significant difference (p = 0.01) with a higher prevalence in males (66.7%). The most affected teeth in decreasing order were the canines and upper central incisors, followed by the canines and lower central incisors. Conclusion: The prevalence of non-carious cervical lesions of the abfraction type in children from 2 to 6 years of age was 5%, which was only found in private schools, with a predominance in males. An association was found between the abfraction and the type of brush used in toothbrushing, with a higher frequency of lesions when hard brushes were used and strong brushing was performed.

Are Brazilian dentists and dental students using the ICCC recommendations for caries management?

Abstract The aim of this study was to evaluate whether dentists and dental undergraduate students know the terminology of the International Caries Consensus Collaboration (ICCC), and make their restorative treatment decisions regarding carious tissue removal accordingly. Data collection was performed using an electronic questionnaire, considering: a) profile of the respondent; b) analysis of four clinical cases with respect to possible management strategies; and c) questions on cariology field terminology. Sample size consisted of 175 dentists and 66 last semester dental students. Statistical analyses were performed comparing profile, type of institution and dental specialty of the participants. Results showed students were less conservative and agreed less with the ICCC than dentists, and private schools, less than public institutions. Private institutions were 12% (95%CI = 0.833-0.949; p = 0.000) more likely to be less updated with the ICCC recommendations than public institutions, and dentists were 20% more likely to agree with them than students (95%CI = 1.118-1.302; p = 0.000). Dentists were 66% more likely to be conservative than students (95%CI = 0.203-0.554; p = 0.000); dentists and students who graduated or were graduating from public universities were twice as likely to be conservative as those from private universities (95%CI = 1.336-3.333; p = 0.001). In conclusion, students in the last semester are less conservative than dentists, and respondents who graduated or were graduating from public dental schools were more aligned with the current concepts of the ICCC. Several answers were not aligned with ICCC directives, thus showing that management of deep carious lesions still causes restorative therapeutic insecurity.

Factors associated with the number of filled teeth in adolescents from public schools: a cohort study

Abstract This study aimed to assess the association of demographic conditions, socioeconomic status, clinical variables, and psychosocial factors with the number of filled teeth in adolescents from public schools. This cohort study comprised 1,134 12-year-old adolescents enrolled in public schools in Santa Maria, Brazil, in 2012. They were followed-up in 2014, where 743 individuals were reassessed (follow-up rate of 65.52%) for the number of filled teeth. Data were collected via dental examinations and structured interviews. Demographic and socioeconomic characteristics were collected from parents or legal guardians. The psychosocial factor comprised students' subjective measurement of happiness (Brazilian version of the Subjective Happiness Scale - SHS). Dental examinations were performed to assess the number of filled teeth through decay, missing, and filled teeth index (DMF-T). Unadjusted and adjusted Poisson regression analyses were performed to assess the association between baseline variables and filled teeth at follow-up. The number of filled teeth in 2012 and 2014 were 193 (17.02%) and 235 (31.63%), respectively. The incidence of filled teeth in 2014 was 42 (5.65%). Adolescents with untreated dental caries, those who visited the dentist in the last 6 months, those that exhibited being happier, and those who had filled teeth at baseline were associated with a higher number of filled teeth at follow-up. We conclude that the number of filled teeth in adolescents was influenced by clinical and psychosocial factors, emphasizing the need to focus on oral health policies in individuals with higher disease burden and those who feel psychologically inferior.

Frequency of Post-Operative Sensitivity in Class II Composite Restorations in Iranian Patients

Objective: To determine the frequency of sensitivity after treatment in composite resin restorations Class II of premolars in Iranian patients. Material and Methods: In this descriptive-cross-sectional study, questionnaires were used which included questions about the extent of post-operative sensitivity in posterior composite resin restorations among 178 patients referred to the restoration section. After restoration of the teeth, the patients were called to record sensitivity after the treatment. Post-operative sensitivity was measured 24 h and 1 month with cold stimulation using Visual Analog Scale (VAS) method. The data were analyzed with the SPSS software, through descriptive statistical methods (frequency and percentage, mean, standard deviation). Group comparisons were evaluated using Mann-Whitney U test and p-value <0.05 was considered to be statistically significant. Results: The mean frequency of sensitivity in terms of gender was 0.75 and 0.76 in males and females, respectively. The mean frequency of sensitivity in terms of type of jaw was 0.59 and 1.1, in the upper and lower jaw, respectively. It was also observed that the frequency of sensitivity is higher in adolescent age group, in comparison with other age groups. No significant association between gender as well as type of jaw and post-operative sensitivity frequency was observed (p>0.05). However, age group has a statistically significant association with the frequency of post-operative sensitivity (p<0.05). Conclusion: There is a significant relationship between extent of sensitivity after treatment in composite resin restorations Class II and the age group of patients.

Effect of filler size and filler loading on wear of experimental flowable resin composites

Abstract The relationship between wear resistance and filler size or filler loading was clarified for the universal resin composite; however, their relationship in flowable resin composites has not been clarified. Objectives: The purpose of this study was to investigate the effect of filler size and filler loading on wear of experimental flowable resin composites by using a cyclic loading device. Material and Methods: Nine experimental flowable resin composites consisting of three different sizes (70, 200 and 400 nm) and loading (50, 55 and 60 wt%) of filler were prepared. Bowl-shaped cavities were prepared on a flat surface of ceramic blocks using a No. 149 regular cut diamond point. The cavities were treated with a silane coupling agent and an all-in-one adhesive and then filled with each experimental flowable resin composite. The restored surfaces were finished and polished with a 1500-grit silicon carbide paper. The specimens were subjected to an in vitro two-body wear test using a cyclic loading device. The localized worn surfaces were evaluated at 10,000, 20,000, 30,000, and 40,000 cycles using a computer-controlled three-dimensional measuring microscope (n=5). The volumetric wear loss of the materials was calculated automatically by the equipment. Data were statistically analyzed with two-way ANOVA and post hoc Tukey test. Results: Two-way ANOVA showed that the filler size significantly influenced wear volume (p<0.003), but the filler loading did not have a significant effect (p>0.05). A post hoc Tukey test detected significant differences in filler size between 70 nm and 400 nm, and 200 nm and 400 nm (p<0.007). Conclusion: The experimental flowable resin composite containing a mean filler size of 400 nm exhibited significantly lower wear resistance in two-body wear compared with those containing mean filler sizes of 200 nm or 70 nm.

Uso de hidróxido de cálcio e MTA na odontolgia: conceitos, fundamentos e aplicação clínica / Use of calcium hydroxide and mta in dentistry: concepts, rationele and clinical practice

Introdução: atualmente os produtos à base de hidróxido de cálcio são amplamente utilizados e difundidos na odontologia em várias situações clínicas, desde capeador em exposição pulpar à pulpotomias, em virtude de suas propriedades físicas, mecânicas, do baixo custo e de seu próprio mecanismo de ação, representando assim, o material mais próximo do ideal. Objetivo: descrever os conceitos, os fundamentos e a aplicação clínica do Hidróxido de Cálcio e do MTA, por meio de uma revisão da literatura. Material e Métodos: foi realizada uma revisão da literatura, por meio de busca bibliográfica nas seguintes bases de pesquisa online: Lilacs, Scielo, PubMED/Medline e Bireme, com uso dos descritores: hidróxido de cálcio (calcium hydroxide); hidróxido de cálcio e MTA (calcium hydroxide and MTA) e MTA, rastreando artigos relevantes publicados entre o período de 2010 a 2015. Resultados e Discussão: materiais a base de hidróxido de cálcio, são biocompatíveis e apresentam propriedades antimicrobianas, anti-inflamatórias, estimulantes da formação de dentina esclerosada, de tecido ósseo mineralizado além de proteger a polpa contra estímulos termoelétricos e tóxicos, provenientes de alguns materiais restauradores, mantendo assim, a integridade pulpar. São amplamente utilizados para: proteção pulpar, pulpotomias, cimentação protética, forramento cavitário, apicificação e em casos de reabsorção radicular. As formas de apresentação desses materiais pode ser produtos na forma de pó, ou na forma de pastas, autoativadas ou fotoativadas. O Agregado Trióxido Mineral (MTA) apresenta muitas propriedades coincidentes com o hidróxido de cálcio, mas uma das suas principais desvantagens é seu alto custo, o que inviabiliza o rotineiro na clínica, esse material é apresentado na forma de pó e líquido, o qual é composto apenas por água destilada. Conclusão: Diante das várias opções de produtos presentes no mercado, recomenda-se ao profissional a escolha do melhor material para cada caso, incluindo seguir protocolos adequados durante a aplicação dos materiais para alcançar resultados clínicos satisfatórios.

Introduction: products of calcium hydroxide are largely used in a variety of dental clinical condition due to its physical and mechanical properties and its low cost as well as its rationelle. In this contexto, it representes a material close to the ideal. Objective: to describe the concepts, fundamentals and clinical application of Calcium Hydroxide and MTA, through a review of the literature. Materials and Methods: a review of the literature was carried out by means of bibliographic search in the following online databases: Lilacs, Scielo, PubMED/Medline and Bireme, using the descriptors: calcium hydroxide; Calcium hydroxide and MTA, and MTA, tracking relevant articles published between the period 2010-2015. Results and Discussion: materials based on calcium hydroxide, are biocompatible and exhibit antimicrobial, anti-inflammatory, stimulating properties of the formation of sclerosed dentin, of mineralized bone tissue, besides protecting the pulp against thermoelectric and toxic stimuli from some restorative materials, thus maintaining pulp integrity. They are widely used for: pulp protection, pulpotomies, prosthetic cementation, cavity lining, apicification and in cases of root resorption. The forms of presentation of such materials may be products in the form of powder, or in the form of pastes, either self-activating or photoactivated. The Mineral Trioxide Aggregate (MTA) has many properties that coincide with calcium hydroxide, but one of its main disadvantages is its high cost, which makes the routine in the clinic unfeasible. This material is presented in the form of powder and liquid, which is Composed only of distilled water. Conclusion: in view of the various product options present in the market, the professional is advised to choose the best material for each case, including following appropriate protocols during the application of the materials to achieve satisfactory clinical results.

Efeito da aplicação adicional de silano a um sistema adesivo universal sobre a resistência de união entre uma cerâmica reforçada por dissilicato de lítio e uma resina composta / Effect of adittional silane application to a universal adhesive system on the bond strength between a lithium disilicate ceramic and a composite resin

O objetivo deste estudo foi avaliar, por meio de ensaio de resistência ao microcisalhamento, o efeito da aplicação adicional de silano a um sistema adesivo universal na interface adesiva entre uma cerâmica reforçada por dissilicato de lítio e uma resina composta. Duzentos discos de IPS e.max Press/Ivoclar Vivadent (13x3mm) foram confeccionados, receberam acabamento com lixas de carbeto de silício (220-600) e limpeza com ácido fosfórico 37% (30s) imediatamente antes da aplicação do agente silano ou sistema adesivo. Sobre cada disco, foram confeccionados cinco cilindros de resina, o que totalizou mil cilindros de resina. O tratamento aplicado à superfície de cerâmica, anterior à inserção de resina foi realizada de acordo com cada um destes grupos: G1: 20s de ácido fluorídrico (HF) + silano (S) + Adper Single Bond 2/3M ESPE (SB); G2: 20s HF + S + Single Bond Universal/3M ESPE (U); G3: 20s HF + U; G4: 20s HF + S + Single Bond Universal misturado ao Otimizador para Cimentação/3M ESPE (OPC); G5: 20s HF + OPC; G6: S + SB; G7: S + U; G8: U; G9: S + OPC; G10: OPC. Os grupos G11 até o G20 receberam os mesmos tratamentos de superfície, mas foram submetidos à termociclagem de 10.000 ciclos. Os grupos G1 ao G10 foram levados à máquina de ensaio universal EMIC para o teste de microcisalhamento, enquanto os grupos G11 ao G20 foram submetidos à ciclagem térmica com banhos de 20s alternados em temperatura de 5ºC e 55ºC, para depois serem levados para o microcisalhamento. A análise estatística foi realizada através de análise de variância (ANOVA dois fatores), com nível de confiança de 95% (p=0,000) seguido pelo teste Post Hoc de Tukey. Os resultados demonstraram que todos os grupos condicionados por HF obtiveram valores de resistência de união significativamente mais elevados, enquanto a termociclagem apenas provocou diferença significativa entre os grupos de mesmo tratamento de superfície sem condicionamento prévio com HF e entre G1 e G11. O modo de fratura avaliado por microscopia ótica, microscopia eletrônica de varredura e a análise dos elementos químicos por EDS demonstrou o total de 24,3% de fraturas mistas; 74,5% de fraturas adesivas e 1,2% de fraturas coesivas. Pode-se concluir que a aplicação adicional prévia de silano aumentou a resistência de união entre o adesivo universal e a cerâmica e que o condicionamento com ácido fluorídrico foi fator determinante para obtenção de resultados mais altos, principalmente após a termociclagem.

The aim of this study was to evaluate, through a microshear bond strength test, the effect of an additional silane application before a universal adhesive system on the interface between a lithium disilicate ceramic system and a flowable resin. Two hundred IPS e.max Press/Ivoclar Vivadent discs (13x3mm) were made, abraded with sandpaper silicon carbide (220-600) and cleaned with 37% phosphoric acid (30s) immediatelly before application of silane agent or adhesive system. On each disc five resin cylinders were built, which summarized one thousand cylinders. The treatment applied to the ceramic surface previous to the resin insertion was performed according to each of these groups: G1: 20s hydrofluoric acid (HF) + silane (S) + Single Bond 2 / 3M ESPE (SB); G2: 20s HF + S + Single Bond Universal / 3M ESPE (U); G3: 20s HF + U; G4: 20s HF + S + Single Bond Universal mixed with Dual Cure Activator / 3M ESPE (OPC); G5: 20s HF + OPC; G6: S + SB; G7: S + U; G8: U; G9: S + OPC; G10: OPC. The groups from G11 to G20received the same surface treatment, but they were submitted to 10.000 thermal cycles. The G1 to G10 were taken to the universal testing machine EMIC for microshear test, while the G11 to G20 were subjected to thermal cycling with alternating baths of 20s at 5°C and 55°C temperature, and then were submitted to the microshear test. The statistical analysis was done with ANOVA with 95% confidence level (p = 0.000) and Tukey's post-hoc test. The results showed that all groups etched with HF had significantly higher bond strength values while thermocycling only caused significant difference between groups of the same surface treatment without prior etching with HF and between G1 and G11 groups. The fracture mode evaluated by optical microscopy, scanning electron microscopy and analysis of chemical elements by EDS demonstrated total of 24.3% of mixed fractures; 74.5% adhesive fractures and 1.2% of cohesive fractures. It can be concluded that the additional prior silane application increased the bond strength between the universal adhesive and ceramics, besides the etching with hydrofluoric acid was determining factor for obtaining higher results, especially after thermal cycling.

Acabamento e polimento das restaurações de amálgama e resina composta: conceitos práticos e fundamentos clínicos / Finishing and polishing the amalgam restorations and composite resin: concepts practical and clinical fundamentals

Introdução: O passo final da confecção de uma restauração consiste no acabamento e polimento. Polir uma superfície é riscá-la continuamente, até que em determinado momento, ela pareça macroscopicamente lisa. Ao deixar uma restauração mais lisa, aumenta-se o conforto do paciente e diminui-se o acúmulo de placa. Objetivo: Esse trabalho consiste em uma revisão sistemática da literatura, que objetiva discutir e esclarecer como deve ser feito o acabamento e polimento das restaurações diretas de amálgama e resina composta, a fim de que seja destacada a importância de sua realização. Material e Métodos: foi realizada uma revisão sistemática da literatura por meio de uma busca bibliográfica nas seguintes bases de pesquisa on-line: PUBMED/MEDLINE, LILACS, BBO e SCIENCE DIRECT limitando-se a busca ao período de 2006 a 2014. Resultados: o tratamento e a técnica restauradora dos dentes prejudicados pela doença cárie e por fraturas tem sido matéria de estudo científico nos últimos anos, com o objetivo de melhorar a estética, durabilidade, propriedades físico-mecânicas dos materiais restauradores e pela busca de um tratamento mais conservador. De forma geral o acabamento e o polimento têm como funções regularizar e corrigir os defeitos existentes que foram obtidos durante a confecção de uma restauração além de deixar as superfícies perfeitamente lisas sem presença de irregularidades macroscópicas. Conclusão: o conhecimento das técnicas e dos materiais disponíveis atualmente por parte dos cirurgiões dentistas possibilita o emprego de condutas clínicas adequadas, seguras e com eficácia. O polimento produz uma superfície muito lisa, altamente reflexiva, sem riscos visíveis, simulando os tecidos dentais. O cirurgião-dentista deve respeitar a regra de que toda restauração deverá ser considerada concluída quando estiver devidamente acabada e polida.

Introduction: the final step in a restoration is finishing and polishing. To polish a surface, to some extent, is to scratch out a surface till is appears smooth from the macroscopic point of view. Making it smoother we increase the comfort of the patient and diminish the plaque occurrence. Objective: this study consists of a systematic literature review, which aims to discuss and clarify how it should be done finishing and polishing of direct amalgam restorations and composite resin, so that it is highlighted the importance of his achievement. Material and Methods: a systematic review of the literature through a literature search in the following search online databases was performed: PubMed / MEDLINE, LILACS, BBO and SCIENCE DIRECT, limiting the search to the period from 2006 to 2014. Results: treatment and restorative technique of teeth affected by caries and fractures has been the subject of scientific study in recent years, aiming to improve the aesthetics, durability, physical and mechanical properties of restorative materials and the search for a more conservative treatment. In general finishing and polishing have as functions to regulate and correct the existing defects that were obtained during the making of a restoration in addition to leaving the perfectly smooth surfaces without the presence of macroscopic irregularities. Conclusion: knowledge of techniques and materials currently available by the dentists enables the use of appropriate clinical procedures, safe and effectively. Polishing produces a very smooth, highly reflective, without visible scratches, simulating the dental tissues. The dentist must respect the rule that all restoration will be considered complete when properly finished and polished.

Clinical research of endodontic mandibular first molar by different restoration methods / 中国基层医药

Objective To compare the clinical results of endodontic mandibular first molar by different restoration methods.Methods From January 2011 to February 2013,96 patients in our hospital dental visits with 110 defective teeth who accepted the dental restoration were randomly selected in this clinical research.The repairing of defective teeth were divided into 3 groups randomly:36 were fabricated with CAD/CAM zirconia all -ceramic crowns,35 were CAD/CAMzirconia all -ceramic onlays,39 were direct filling and repairing with composite resins. The clinical effects of 3 groups were evaluated and compared at baseline,and 1,6,12 months after restoration using modified USPHS criteria.The results were analyzed statistically by SPSS 13.0.Results It was not found that 110 defective teeth were debonded at 12 months after restoration.There were significant differences in assessment results of secondary caries,marginal fitness,appearance and color matching at 12 months after restoration by different restoration methods (χ2 =6.705,7.768,6.910,11.624,all P <0.05).Conclusion The dental restorations with CAD/CAMzirconia all -ceramic crowns and CAD/CAM zirconia all -ceramic onlays show satisfactory clinical performance in short time.

Changes in irradiance and energy density in relation to different curing distances

The present study aimed to assess the influence of curing distance on the loss of irradiance and power density of four curing light devices. The behavior in terms of power density of four different dental curing devices was analyzed (Valo, Elipar 2, Radii-Cal, and Optilux-401) using three different distances of photopolymerization (0 mm, 4 mm, and 8 mm). All devices had their power density measured using a MARC simulator. Ten measurements were made per device at each distance. The total amount of energy delivered and the required curing time to achieve 16 J/cm2 of energy was also calculated. Data were statistically analyzed with one-way analysis of variance and Tukey’s tests (p < 0.05). The curing distance significantly interfered with the loss of power density for all curing light devices, with the farthest distance generating the lowest power density and consequently the longer time to achieve an energy density of 16 J/cm2 (p < 0.01). Comparison of devices showed that Valo, in extra power mode, showed the best results at all distances, followed by Valo in high power mode, Valo in standard mode, Elipar 2, Radii-Cal, and Optilux-401 halogen lamp (p < 0.01). These findings indicate that all curing lights induced a significant loss of irradiance and total energy when the light was emitted farther from the probe. The Valo device in extra power mode showed the highest power density and the shortest time to achieve an energy density of 16 J/cm2 at all curing distances.

Acciones metodológicas para el perfeccionamiento de la educación en el trabajo en Operatoria Clínica / Methodological actions for the improvement of education at work in Clinical Operative Dentistry

Fundamento: la educación en el trabajo constituye la forma organizativa fundamental de la docencia en las ciencias médicas. Objetivo: diseñar acciones metodológicas para el perfeccionamiento de la educación en el trabajo en la asignatura Operatoria Clínica. Métodos: se realizó un estudio descriptivo transversal en la Facultad de Estomatología de la Universidad de Ciencias Médicas de Villa Clara, en el período febrero-mayo de 2013. Se utilizaron métodos teóricos: análisis-síntesis, inducción-deducción y empíricos: la revisión documental, y la encuesta, y se conformó un grupo nominal. Se aplicó además una guía de observación para las actividades de educación en el trabajo. Resultados: en el programa de la asignatura Operatoria Clínica se observa poco tiempo para el desarrollo de habilidades, los resultados de los exámenes prácticos evidencian dificultades por parte de los estudiantes, lo cual se refleja en el informe del claustro de la facultad. Los profesores señalan el bajo número de horas clases que se les dedican a los contenidos y las cifras elevadas de alumnos en los escenarios docentes. La mayoría de los estudiantes argumentan tener inseguridad en el manejo del paciente, del instrumental, y en ocasiones, temor a ese primer contacto por no encontrarse suficientemente preparados en las habilidades que exige la asignatura. Conclusiones: se identificaron necesidades de aprendizaje para el desarrollo de la educación en el trabajo, lo que origina dificultades en la adquisición de las habilidades prácticas en los estudiantes. Las acciones metodológicas propuestas fueron valoradas por especialistas, los que consideraron que son novedosas, pertinentes, necesarias, factibles y accesibles.

Background: education at work is the essential organizational form of teaching in medical sciences. Objective: to design methodological actions for the improvement of education at work in the subject Clinical Operative Dentistry. Methods: a descriptive cross-sectional study was conducted at the Faculty of Dentistry of the Medical University in Villa Clara, from February to May 2013. Theoretical methods such as analysis-synthesis and induction-deduction were used; as well as empirical methods such as documentary analysis and a survey. A nominal group was also formed, and an observation guide was used for education at work activities. Results: in the syllabus of the subject Clinical Operative Dentistry, little time is devoted for skill development; the results of practical test show difficulties in the students, which is reflected in the report of the teaching staff of the faculty. Teachers said there is insufficient time devoted to the content and point to the large number of students in the educational scenarios. Most students claim to be insecure about handling the patients, and the instruments; and sometimes they are afraid of that first contact, for not being sufficiently trained in the skills required by the subject. Conclusions: learning needs for the development of education at work were identified by teachers, which causes difficulties in the acquisition of practical skills by students. Methodological actions were assessed by expert judgment, who considered them to be innovative, relevant, necessary, feasible and accessible.

Proporção áurea em dentes permanentes anteriores superiores / Golden proportion in upper anterior teeth

Este trabalho foi uma revisão de literatura que discorre sobre a regra de proporção áurea em dentes anteriores superiores, no período de 1998 a 2012, utilizando como base de dados o periódico Capes e o acervo da biblioteca da Faculdade de Odontologia da Universidade Federal de Juiz de Fora (UFJF). Concluiu-se que a proporção áurea pode ser encontrada nos dentes anteriores superiores, numa visão frontal, entre a largura do incisivo central e a largura do lateral, e entre a largura do incisivo lateral e largura do canino. Porém, esta proporção não ocorre naturalmente na maior parte da população. Nos tratamentos restauradores estéticos de dentes anteriores superiores a proporção divina pode ser usada como guia, devolvendo de forma eficiente a harmonia do sorriso, porém não garantindo a beleza do sorriso, já que este é um conceito bastante subjetivo.

This study is a literature review about golden proportion in upper anterior teeth between the period of 1998 to 2012, searched in Periodicos Capes and from the library collection of the Faculty of Dentistry UFJF. It was concluded that the golden proportion can be found in the upper anterior teeth, from a front view, between the central incisor width and the lateral incisor width and between the lateral incisor width and the canine width. However, this proportion does not occur naturally in most people. In esthetic restorative treatments of upper anterior teeth the divine proportion can be used as a guide, effectively returning the harmony of the smile, however not warranting the beauty of the smile as this is a very subjective concept.

Harmonização estética do sorriso com laminados cerâmicos / Esthetic harmony of the smile with porcelain laminate veneers

Atualmente, observa-se grande valorização da estética do sorriso, o qual representa significativa influência no comportamento psicossocial do paciente. Dentre os materiais odontológicos utilizados, os laminados cerâmicos apresentam excelentes propriedades ópticas e podem ser empregados com previsibilidade e segurança, sem necessidade de desgastes da estrutura dental. O objetivo deste trabalho é apresentar um caso clínico em que, após a verificação da insatisfação estética dos dentes, relatada pela paciente, foi planejada a confecção de seis laminados cerâmicos. Os laminados cerâmicos confeccionados a partir de vidro ceramizado à base de dissilicato de lítio foram cimentados sobre o esmalte não desgastado, recriando uma nova dimensão aos dentes anteriores. Foi possível concluir que, por meio de uma análise estética minuciosa e a elaboração de um planejamento criterioso, o emprego de laminados cerâmicos garantiu o resultado estético almejado pela paciente e equipe odontológica.

Today, people value the smile esthetics, and this strongly influences the psychosocial behavior of the population. Among the available dental materials, porcelain laminate veneers have excellent optical properties and can be used safely and predictably without significant wear of the dental tissues. The aim of this study was to report a case where the patient complained about the esthetics and it was planned the fabrication of six porcelain laminate veneers. Lithium disilicate glass-ceramic laminate veneers were bonded to enamel without wear, rebuilding the predominance of the anterior teeth. It was concluded that after a thoughtful esthetic analysis and a thorough treatment planning, the desired esthetic result for the patient and dental team can be obtained with the use of laminate veneers.

Effect of different restorative procedures on the fracture resistance of teeth submitted to internal bleaching

The aim of this study was to evaluate the influence of different restorative procedures on the fracture resistance of endodontically treated teeth submitted to intracoronal bleaching. Fifty upper central incisors were distributed into 5 groups: GI - healthy teeth; GII - endodontically treated teeth sealed with Coltosol; GIII - endodontically treated teeth bleached and sealed with Coltosol; GIV - endodontically treated teeth bleached and restored with composite resin; and GV - endodontically treated teeth bleached and restored with a fiberglass post and composite resin. In the bleached specimens, a cervical seal was made prior to bleaching with 38% hydrogen peroxide. The gel was applied on the buccal surface and in the pulp chamber, and was then light-activated for 45 s. This procedure was repeated three times per session for four sessions, and each group was submitted to the restorative procedures described above. The specimens were submitted to fracture resistance testing in a universal testing machine. There were statistically significant differences among the groups (p < 0.05). The mean value found for GIII was the lowest (0.32 kN) and was significantly different from the values found for GI (0.75 kN), GII (0.67 kN), GIV (0.70 kN), and GV (0.72 kN), which were not significantly different from each other (p > 0.05). The restorative procedures using composite resin were found to successfully restore the fracture resistance of endodontically treated and bleached teeth.

Papain-based gel for biochemical caries removal: influence on microtensile bond strength to dentin

This study investigated the influence of a papain-based gel(Papacárie) for chemo-mechanical caries removal on bond strength todentin. Human molars were assigned to the following groups: Group 1:sound teeth were flattened to expose dentin; Group 2: after flattening ofsurfaces, the papain-based gel was applied on the sound dentin; Group3: overlying enamel from carious teeth was removed and mechanical excavationof dentin was conducted; Group 4: chemo-mechanical excavationof carious dentin was conducted using the papain-based gel. ThePrime&Bond NT or Clearfil SE Bond adhesive systems were used forrestorative procedures. A microtensile bond strength test was performed,and the modes of failure were determined under SEM. The data weresubmitted to two-way ANOVA and Tukey’s test (p ≤ 0.05). No significantdifferences were observed between the sound dentin groups. Forboth excavation methods, Clearfil presented a significantly higher bondstrength than Prime&Bond NT. Also, for Clearfil, the mechanically excavatedsamples disclosed a significantly higher bond strength than thechemo-mechanically ones. For Prime&Bond NT, no significant differenceswere detected between the excavation methods. Predominance ofmixed failures for the sound substrate and of adhesive failures for thecarious dentin one was detected. The bond strength to carious dentinof the self-etching system was negatively affected by chemo-mechanicalexcavation using the papain-based gel.

Evaluation of the dental structure loss produced during maintenance and replacement of occlusal amalgam restorations

The aim of this in vitro study was to evaluate four different approaches to the decision of changing or not defective amalgam restorations in first primary molar teeth concerning the loss of dental structure. Ditched amalgam restorations (n = 11) were submitted to four different treatments, as follows: Control group - polishing and finishing of the restorations were carried out; Amalgam group - the ditched amalgam restorations were replaced by new amalgam restorations; Composite resin group - the initial amalgam restorations were replaced by composite resin restorations; Flowable resin group - the ditching around the amalgam restorations was filled with flowable resin. Images of the sectioned teeth were made and the area of the cavities before and after the procedures was determined by image analysis software to assess structural loss. The data were submitted to ANOVA complemented by the Student Newman Keuls test (p < 0.05). The cavities in all the groups presented significantly greater areas after the procedures. However, the amalgam group showed more substantial dental loss. The other three groups presented no statistically significant difference in dental structure loss after the re-treatments. Thus, replacing ditched amalgam restorations by other similar restorations resulted in a significant dental structure loss while maintaining them or replacing them by resin restorations did not result in significant loss.