Odontología restauradora mínimamente invasiva: caso clínico / Minimally invasive restorative dentistry: a clinical case

La decoloración de las piezas dentarias puede te-ner un impacto estético y social que lleva a los pa-cientes a buscar una intervención para mejorar su sonrisa. Las manchas superficiales y las irregula-ridades del esmalte pueden deberse a hipoplasias, hipomineralización molar, fluorosis, uso de medica-mentos, manchas blancas causadas por traumatis-mos o infección en la dentición primaria, o manchas post ortodóncicas. El diagnóstico de los defectos del esmalte se realiza a través de un examen visual por transiluminación. Se han propuesto técnicas micro abrasivas con diferentes agentes para eliminar las manchas superficiales del esmalte, así también como el uso de agentes blanqueadores a baja concentra-ción para equilibrar el color de las piezas dentarias. Si las manchas son profundas se requiere de una mega abrasión y posterior restitución anatómica con resinas compuestas. Los avances tecnológicos en los materiales de restauración adhesivos permi-ten imitar las piezas dentarias naturales permitien-do la mínima destrucción de la estructura dental sin comprometer futuras opciones de restauración. El objetivo de este trabajo es mostrar una secuencia de procedimientos mínimamente invasivos para devol-ver la estética perdida en una paciente que concurre a la Cátedra de Odontología Restauradora (AU)

The discoloration of dental pieces can have an aesthetic and social impact that leads patients to seek an intervention to improve their smile. Superficial stains and enamel irregularities may be due to hypoplasia, molar hypomineralization, fluorosis, drug use, white spots caused by trauma or infection in the primary dentition, or post-orthodontic stains. The diagnosis of enamel defects is made through a visual examination by transillumination. Microabrasive techniques with different agents have been proposed to remove surface stains from the enamel, as well as the use of low-concentration whitening agents to balance the color of the teeth. If the stains are deep, a mega abrasion and subsequent anatomical restoration with composite resins are required. Technological advances in adhesive restorative materials make it possible to mimic natural teeth, allowing minimal destruction of tooth structure without compromising future restorative options. The objective of this work is to show the sequence of minimally invasive procedures to return the lost aesthetics in a patient who attends the Chair of Restorative Dentistry (AU)

Efectividad de la terapia láser combinada con la técnica convencional en pacientes con discromías dentales / Effectiveness of laser therapy combined with the conventional technique in patients with dental dischromya

Introducción: La discromía dental es una afectación estética, de causa multifactorial, caracterizada por el cambio de coloración de uno o varios dientes. Objetivo: Evaluar la efectividad de la terapia láser como fuente de luz y calor en pacientes con discromías dentales. Método: Se realizó un estudio cuasi experimental, de intervención terapéutica, en 24 pacientes con discromías dentales atendidos en la Clínica Estomatológica Provincial DocenteMártires del Moncada de Santiago de Cuba, desde julio de 2017 hasta julio de 2018. Los integrantes del estudio se asignaron de forma aleatoria a 2 grupos de tratamiento:a los pares (grupo de estudio) se les aplicó láser combinado con la técnica convencional de peróxido de hidrógeno;a los impares (grupo control), tratamiento convencional solamente.Se utilizaron las frecuencias absoluta y relativa como medidas de resumen, así como la prueba de X 2 de homogeneidad para la validación estadística, con un nivel de significación de 0,05. Resultados: Para los pacientes del grupo de estudio, la segunda y tercera sesiones fueron más efectivas. Al culminar el tratamiento, ambos resultaron efectivos, pero los que recibieron láser evolucionaron más rápidamente que los tratados solo con peróxido de hidrógeno. Conclusiones: El uso de la terapia láser y peróxido de hidrógeno fue efectivo en pacientes con discromías dentales y demostró que no provoca efectos adversos en los dientes tratados.

Introduction: The dental dischromya is an esthetic disorder, of multifactorial cause, characterized by the change of coloration of one or several teeth. Objective: To evaluate the effectiveness of laser therapy as a source of light and heat in patients with dental dischromya. Method: A quasi-experiment, of therapeutic intervention study, was carried out in 24 patients with dental dischromya assisted in Mártires del Moncada Teaching Provincial Stomatological Clinic in Santiago de Cuba, from July, 2017 to March, 2018. The members of the study were assigned at random with 2 treatment groups: a study group (pairs) to whom laser combined with the conventional technique of peroxide of hydrogen was applied; to odd number patients (control group), conventional treatment only. The absolute and relative frequencies were used as summary measures, as well as the chi-square test of homogeneity for the statistical validation, with a level of significance of 0.05. Results: For the patients of the study group, the second and third sessions were more effective. When culminating the treatment, both were effective, but those that received laser evolved more quickly than those treated with peroxide of hydrogen. Conclusions: The use of the laser therapy and peroxide of hydrogen was effective in patients with dental dischromya and it was demonstrated that doesn't cause adverse effects in the treated teeth.

Microabrasión del esmalte. Indicaciones, limitaciones y alcance clínico / Enamel micro-abrasion. Indications, limitations and clinical scope

Existen muchas patologías pigmentarias que alteran la estética del color dentario; algunas de ellas pueden circunscribirse a la superficie externa del esmalte y por ende ser tratadas con una técnica microabrasiva para su eliminación. La indicación de un tratamiento más agresivo en relación al blanqueamiento convencional, dependerá no solo de la ubicación de la lesión, sino también de la severidad de la misma, de la calidad de la estructura del tejido adamantino y de la anatomía dentaria entre muchas otras variables (AU)

ere are many pigment pathologies that alter the aesthetics of tooth color; Some of them can be confined to the outer surface of the enamel and therefore be treated with a microabrasive technique for their removal. e indication of a more aggressive treatment in relation to conventional whitening will depend not only on the location of the lesion, but also on its severity, the quality of the structure of the adamantine tissue and the dental anatomy among many other variables (AU)

Study of masking ability of laminate veneers for discolored teeth / 北京大学学报(医学版)

OBJECTIVE@#To select the most effective method among different masking treatments, such as different thickness and transparence, tissue surface's opaque coating, and opaque resin cement to restore discolored teeth esthetically by porcelain veneer.@*METHODS@#Four extracted intact maxillary central incisors were prepared for porcelain veneer restoration and each three heat pressed porcelain veneers from three thicknesses (0.8 mm, 1.0 mm, 1.2 mm) and two transparency(high transparence, HT and low transparence, LT))in Vita shade A2 were fabricated for each tooth, in total of 72 pieces. The surfaces of three prepared teeth were then painted to mimic situations of severe dental fluorosis, severe tetracycline teeth, and necrotic teeth. Each of the veneers was temporarily cemented to the corresponding tooth surface using try-in cements with three different colors (transparent, opaque, and yellow), then used the shade guide (3D master) and electronic colorimeter (easy shade) to record the shade of each porcelain veneer through hue, lightness, and chroma reading. After that, high-transparence porcelain veneers in thickness of 0.8 mm was fused with a layer of opaque porcelain in tissue surface, and were shade matched again after cementation. Statistic treatments were performed to analyze the difference in each masking method.@*RESULTS@#For each 0.2 mm increase in the veneer thickness of porcelain, the average lightness was reduced by 1 unit, while the chroma was not changed which was independent of the type of the resin cements. When the thickness of the porcelain veneer was decreased to 0.8 mm, the opacity effect was not remarkable even if a low-transparence porcelain veneer was used. Transparent and yellow resin cements had poor opaque performance, while opaque resin cement could reduce the lightness by 2 units and the chroma was also reduced. The opaque layer of the tissue surface could be applied uniformly, and the lightness and chroma could be reduced to Vita 2M1 to 2M1.5 levels regardless of the color of resin cements, which suggested a stable opacity effect for different discolored teeth in this study.@*CONCLUSION@#For porcelain veneer restoration of discolored teeth, thickened veneers are the most effective means to display a natural transmittance and color. Tissue surface's opacity coatings and opaque resin cements can also be used to reduce grayscale and increase lightness.

Odontología estética mínimamente invasiva / Minimally invasive esthetic dentistry

La odontología de mínima invasión se ha convertido en la filosofía de tratamiento dental más aceptada en la actualidad. La posibilidad de incorporarla se ha debido en gran medida a la aparición de nuevos materiales dentales que se adhieren a la estructura dental, a técnicas más conservadoras de estructura dental sana y sobre todo a una nueva forma de pensar tanto de clínicos como de los mismos pacientes. La odontología estética contemporánea se ha visto infl uenciada por este nuevo paradigma. El tratamiento de pigmentaciones dentales también se ha visto benefi ciado por esta nueva tendencia y nuevos materiales han aparecido recientemente que conservan la mayor cantidad de tejido dental sano sin necesidad de preparaciones no conservadoras. Lo más importante al incorporar estas nuevas tecnologías es la realización de un diagnóstico adecuado entendiendo la causa que origina esta condición y así poder implementar el mejor tratamiento posible (AU)

Minimally invasive dentistry has become the standard of care most widely accepted today. This trend has been posible in great extent to the advent of new dental materials that adhere to dental structure, more conservative techniques of healthy dental tissue but mainly from clinicians and patients with a new way of thinking. Contemporary esthetic dentistry has been influenced by this new paradigm. Treatment of dental stainings has also been infl uenced by this new trend and new materials have recently surfaced that keep healthy dental tissue without the need of non conservative preparations. The most important aspect in order to incorporate this new technologies is a correct diagnosis understanding the cause that originated this condition in order to implement the best posible treatment (AU)

Discromia en Incisivo central superior derecho / Dischromya in Upper righ central incisive

Paciente masculino de 52 años de edad, tez blanca, residente en una comunidad urbana en La Habana, sin antecedentes patológicos referidos; que acude a consulta estomatológica preocupado por su estética; al examen bucal se observa cambio de color en el diente 11 (Incisivo central superior derecho) hacia carmelita oscuro que evidencia una discromía. A la imagen de una radiografía periapical se observa previo tratamiento pulpo radicular (TPR), por lo que se decide comenzar un tratamiento de recromia; en 5 consultas a intervalos con posterior restauración del diente en cuestión. Después del tratamiento se observó recuperación del color normal del diente, mejoría en la estética y gran satisfacción nuestra y del paciente.

A 52 years old male patient of white race, resident in an urban community of Habana City, he does not suffer from any disease; he was worried because his aesthetic, the oral examination shows a different colour on tooth 11 (upper righ central incisive) to dark brown that confirm a diagnosis of dischromya. The periapical x-ray disclosed a previous root canal treatment, according to the signs the treatment to recover from the disease is a rechromya, in 5 appointment with a dental restoration the patient presents good evolution and report a better appearance and a great satisfaction from ours and the patient.

Alternativa terapéutica en la discromía de un diente con distrofia pulpar por fuerzas ortodóncicas: presentación de caso / Therapeutic alternative for the decoloration of a tooth with pulp dystrophy caused by orthodontic forces: a case report

FUNDAMENTO: las fuerzas ortodóncicas excesivas pueden producir distrofias pulpares al modificar el sistema neuro-vascular de la pulpa. La necrosis de este tejido es la causa más conocida de alteración de color de los dientes. El tratamiento endodóntico y el blanqueamiento convencionales en estos casos se ven comprometidos cuando se desarrolla, además, una degeneración cálcica pulpar. OBJETIVO: mostrar una alternativa terapéutica a la discromía por necrosis pulpar de un diente con calcificación total de la pulpa. Caso clinico: se presenta una paciente de 18 años de edad con calcificación total de la pulpa posterior a un tratamiento ortodóncico y discromía en tercio cervical de corona del incisivo central superior derecho. CONCLUSIONS: se realizó tratamiento restaurador con carilla vestibular de composite fotocurable, logrando resultados estéticos satisfactorios.

BACKGROUND: excessive orthodontic forces may cause pulp dystrophies since they modify the pulp neuro vascular system. Necrosis of this pulp tissue is the most known cause of teeth color changes. Conventional endodontic treatment and bleaching are compromised in these cases whenever pulp calcification is developed. OBJECTIVE: to show an alternative therapy for dental discoloration due to pulpal necrosis in a tooth with pulp calcification. CLINICAL CASE: a eighteen year-old female is reported with pulp calcification following an orthodontic treatment and tooth discoloration in cervical third of a maxillary central right incisor. CONCLUSIONS: a restorative treatment with visible light cure composite veneer was performed, achieving satisfactory aesthetic results.

Microabrasión de esmalte dentario en odontología restauradora / Dental enamel microabrasion in restorative dentistry

La estética es el paradigma de la odontología restauradora. En la actualidad, se utilizan procedimientos combinados, por la exigencia sostenida de los pacientes por tener piezas dentarias blancas y brillantes. Es así que, para cumplir con esas expectativas, clínicas, en algunos casos se utilizan técnicas de blanqueamiento dentario, mientras que en otros se necesitan procedimientos como los de microabrasión o micro-macro abrasión, para remover manchas oscuras o blancas del esmalte dentario, buscando de esta manera, la satisfacción en lo que a estética se refiere. La microabrasión es un procedimiento muy utilizado en la actualidad por los profesionales odontólogos, por lo anteriormente expuesto o como técnica previa al uso de sistemas adhesivos. Por ello, se pretende con este documento, presentar una revisión sobre conceptos actuales, como así también los condicionantes al momento de seleccionar materiales o realizar el procedimiento de microabrasión.

Microabrasion in tooth enamel discoloration defects: three cases with long-term follow-ups

Superficial irregularities and certain intrinsic stains on the dental enamel surfaces can be resolved by enamel microabrasion, however, treatment for such defects need to be confined to the outermost regions of the enamel surface. Dental bleaching and resin-based composite repair are also often useful for certain situations for tooth color corrections. This article presented and discussed the indications and limitations of enamel microabrasion treatment. Three case reports treated by enamel microabrasion were also presented after 11, 20 and 23 years of follow-ups.

Potassium-titanyl-phosphate (KTP) laser and dental bleaching: literature review / Láser potasio-titanil-fosfato (KTP) y blanqueamiento dental: revisión narrativa

Objective: To determinate if dental bleaching with KTP laser is a safe, effective and efficient technique. The use of KTP laser for dental bleaching was only investigated in combination with a high concentration of hydrogen peroxide (35 percent). The recommended protocol was: for the use of KTP laser at 3W power and an irradiation time of ten seconds, three to four cycles are needed. For a power of 1W and an irradiation time of thirty seconds the number of cycles is three with a maximum of four. Under these conditions KTP laser bleaching was considered not to alter surface morphology, to have no influence on enamel micro hardness, to maintain the pulp temperature within normal values, to obtain lighter tooth color which can be maintained for months (no long term studies were conducted). Because the bleaching effect was obtained in a short period of time and maintained for months, KTP laser bleaching was considered an effective and efficient technique. Conclusion: KTP-assisted dental bleaching is a safe, effective and efficient technique when combined with high concentration of hydrogen peroxide.

Objetivo: Determinar si el blanqueamiento dental con láser KTP es una técnica segura, efectiva y eficiente. El uso de láser KTP para blanqueamiento dental fue solo investigado en combinación con una alta concentración de peróxido de hidrogeno (35 por ciento). El protocolo recomendado fue: para el uso de láser KTP a 3W de potencia y un tiempo de irradiación de diez segundos, tres a cuatro repeticiones son necesarias. Para una potencia de 1W y un tiempo de irradiación de treinta segundos, el número de repeticiones son tres con un máximo de cuatro veces. Bajo estas condiciones, el blanqueamiento dental con esta técnica no altera la morfología de la superficie dental, no tiene influencia en la microdureza del esmalte, mantiene la temperatura pulpar dentro de valores normales y logra un color más claro el cual puede ser mantenido por meses (no se han realizado estudios a largo plazo). Conclusión: Debido a que, el efecto blanqueador se obtiene en poco tiempo y se mantiene por meses, el blanqueamiento dental con láser KTP se considera una técnica eficiente y efectiva, además de segura. Esto cuando es combinada con peróxido de hidrogeno de concentración alta.

Pigmentaciones extrínsecas en el paciente pediátrico / Extrinsec stains in the pediatric patient

Las pigmentaciones extrínsecas negras son puntos o pequeñas áreas de coloración osecura que pueden unirse, formando una línea definida o difusa. Pueden contener sal férrica insoluble, sulfuro férrico y un alto contenido de calcio y fosfato. Su etiología y taxonomía sigue siendo controversial. Algunos investigadores la asocian con una baja frecuencia de caries dental en dentición primaria y permanente joven. La remoción mecánica de estas pigmentaciones requiere intervención profesional

Tratamiento estético de manchas blancas de esmalte posortodoncia: asociación de blanqueamiento dental e infiltración resinosa / Esthetic treatment of postorthodontic enamel white spots: an association between tooth whitening and resin infiltration

Objetivo: describir la asociación entre blanqueamiento dental en el consultorio y la infiltración resinosa de manchas blancas originadas postratamiento ortodóntico. Caso clínico: el tratamiento estético de dientes anteriores se inició con el blanqueamiento con peróxido de hidrógeno en el consultorio. Después de siete días, las manchas blancas fueron infiltradas con resina de alta fluidez, con el fin de mejorar el aspecto estético. Conclusión: la asociación de las técnicas de blanqueamiento dental e infiltración resinosa permite corregir alteraciones cromáticas de un modo altamente conservador, con resultados satisfactorios

In vitro evaluation of the whitening effect of mouth rinses containing hydrogen peroxide

The aim of this study was to evaluate the bleaching effect of two mouth rinses containing hydrogen peroxide. Thirty premolars were randomly divided into two groups (n = 15): Listerine Whitening (LW) and Colgate Plax Whitening (PW). The teeth were fixed on a wax plate and with acrylic resin, at a distance of 5 mm between each other, exposing the buccal surfaces. All teeth were stored in artificial saliva for 45 days, being removed twice a day to be immersed for 1 min in each mouthwash, followed by 10-second washing in tap water. The pH of each product was measured. Digital images of each tooth were captured under standardized conditions. These images were cut in areas previously demarcated and analyzed in Adobe Photoshop 7.0 using the CIEL*a*b* color space system. Data were statistically analyzed by a paired t test and an independent samples t test (p < 0.05). The pH values were 5.6 and 3.4 for LW and PW, respectively. Both treatment groups showed a decrease in the b* parameter (p < 0.01), but a decrease of a* was observed only for PW (p < 0.01). While the LW group showed an improvement in lightness (L*) (p = 0.03), the PW group had a decrease in the L* parameter (p = 0.02). Within the limitations of this study, it is possible to conclude that both products caused some degree of whitening; however, extreme care should be taken when using Colgate Plax Whitening, since its decline in luminosity might be due to its lower pH.

Habilidade dos odontopediatras e clínicos gerais em diagnosticar e tratar defeitos do esmalte / Ability of pediatric and general dentists to diagnose and treat enamel defects

Objetivo: Fazer um levantamento, frente aos odontopediatras e clínicos gerais, quanto ao conhecimento do diagnóstico e tratamento dos defeitos do esmalte em pacientes na cidade de João Pessoa, Paraíba. Métodos: Foram entrevistados 25 odontopediatras e 56 clínicos gerais inscritos no Conselho Regional de Odontologia de João Pessoa, onde foram apresentados dois casos clínicos para serem relatados o diagnóstico e o tratamento dos mesmos. Resultados: Ao se observar a relação entre os diagnósticos corretos nos referidos casos clínicos, verificou-se que apenas 4,9% dos entrevistados acertaram o diagnóstico da opacidade e 19,8% o da hipoplasia (p>0.05). Com relação ao tratamento indicado, em cada caso, pelos profissionais, observou-se que 4,07% acertaram o da opacidade e 87,7% o da hipoplasia (p>0.05). Conclusão: Os conceitos de diagnóstico e tratamento dos defeitos do esmalte necessitam ser atualizados entre os profissionais da odontologia que lidam com crianças, em virtude de representarem fatores de grande relevância na predisposição ao desenvolvimento da cárie precoce na infância.

Objective: The objective of this study was to determine the knowledge of pediatric dentists and general practitioners on the diagnosis and treatment of enamel defects in patients from the city of João Pessoa, state of Paraíba. Methods: A total of 25 pediatric dentists and 56 general dentists registered at the Regional Dental Council of João Pessoa were interviewed. Two clinical cases were presented to them for them to diagnose and suggest treatment. Results: The percentage of correct diagnoses for the clinical cases presented to the dentists was low: only 4.9% of the dentists correctly diagnosed opacity and 19.8% correctly diagnosed hypoplasia (p>0.05). As for treatment, only 4.07% of the interviewed dentists proposed a correct treatment for opacity and 87.7% proposed a correct treatment for hypoplasia (p>0.05). Conclusion: Dental care professionals that work with children need to update their knowledge on the diagnosis and treatment of enamel defects because these are very relevant factors that predispose the child early to caries lesions.

Amelogenesis Imperfecta, hypoplastic type associated with some dental abnormalities: a case report

Amelogenesis imperfecta (AI) is a hereditary disorder expressing a group of conditions that cause developmental alterations in the structure of enamel. AI is a serious problem that reduces oral health-related quality of life and causes some physiological problems. The treatment of patients with AI may upgrade the quality of life and reinforce their self-esteem. Among the treatment options for AI, full-mouth metal reinforced porcelain restoration constitutes an important alternative because of its properties. This paper presents a case of AI of the hypoplastic rough type associated with a group of dental anomalies, and describes the prosthetic management of the patient. A 26-year-old female patient presented with a chief complaint of discolored teeth. Clinical and radiographic examination of the patient confirmed the diagnosis of rough pattern hypoplastic AI. The patient was treated with full-mouth metal reinforced porcelain fixed bridge. The adaptation of the temporomandibular joints and masticatory muscles was carefully observed periodically during 4 months and, after this period, the patient tolerated well her new vertical dimension. The patient received instructions on cleansing of the subpontic and interproximal areas. Follow-up visits were scheduled at 3 months and then at 6 months. No esthetic or functional problems were seen after the follow up period.

Amelogenesis imperfecta (AI) é uma desordem hereditária que expressa um grupo de condições que causam alterações de desenvolvimento na estrutura do esmalte. A AI é um problema grave que compromete a qualidade de vida relacionada à saúde bucal e causa alguns problemas psicológicos. O tratamento de pacientes com AI pode melhorar sua qualidade de vida e reforçar sua auto-estima. Dentre as opções de tratamento para AI, a restauração de toda a boca com porcelana reforçada com metal representa uma alternativa importante devido a suas propriedades. Este artigo apresenta um caso de AI do tipo hipoplásica rugosa associada a um grupo de anomalias dentais, e descreve o tratamento protético da paciente. Uma paciente de 26 anos apresentou-se com queixa principal de dentes manchados. O exame clínico e radiográfico da paciente confirmou o diagnóstico de AI hipoplásica rugosa. A paciente foi tratada com a construção de próteses fixas de porcelana reforçada com metal em toda a boca. A adaptação das articulações temporomandibulares e dos músculos mastigatórios foi cuidadosamente observada periodicamente durante 4 meses e, após este período, a paciente mostrou tolerar bem sua nova dimensão vertical. A paciente recebeu instruções sobre limpeza das áreas sob o pôntico e áreas interproximais. As visitas de acompanhamento foram agendadas a cada 3 meses e subseqüentemente a cada 6 meses. Não foram observados problemas estéticos ou funcionais após o período de acompanhamento.

Effectiveness of carbamide peroxide and sodium perborate in non-vital discolored teeth

Objective: To evaluate the efficacy of 16% carbamide peroxide gel (CP16%), tetrahydrate sodium perborate (SP) and mixture (CP16% + SP), in walking bleaching of non-vital discolored teeth. Materials and methods: Sixty single-rooted human premolars with intact crowns were used and initial color was assessed using Vita shade guide and standardized photos. The teeth were stained using rabbit fresh blood for 18 days and photos of discolored teeth and color evaluation were performed. The teeth were divided into 4 groups (n= 15), according to bleaching agent used: G1) CP16% gel; G2) CP16% gel + SP; G3) SP + distilled water; G4: control.The bleaching agents were replaced twice at 7-day intervals for 21 days. All teeth were evaluated by two endodontists at days 0, 7, 14 and 21 and the color changes were assessed using Vita shade guide and standardized photos. The results were analyzed byKruskal-Wallis and Dunn’s tests (p=0.05). Results: The experimental groups presented statistically similar bleaching results (p>0.05) at the end of 7, 14 and 21 days. These groups presented significantly higher bleaching efficacy than control group (G4) (p<0.05). The mixture CP16% + SP promoted return of original color in 100% of teeth at the end of 21 days. Conclusion: It was concluded that three bleaching agents were effective in bleaching of stained teeth with blood products, especially at the end of 21 days.

Blanqueamiento con peróxido de hidrógeno activado por fuente de luz LED: relato de caso / Tooth bleaching with hydrogen peroxide activated by a LED source: report of a case

En la odontología actual, existen varias opciones para el tratamiento de las alteraciones de color. Entre los procedimientos más conservadores, el blanqueamiento dental con soluciones de peróxido de hidrógeno en diferentes concentraciones, es uno de ellos. Si bien resultados más satisfactorios son obtenidos cuando la aplicación de los diferentes productos en determinadas concentraciones se prolonga en el tiempo, la utilización de peróxido de hidrógeno 35 por ciento aplicado sobre la superficie de dientes vitales, complementada con la activación por luz, es una opción cuando se necesitan resultados rápidos y cuando existen leves diferencias de color en el sector anterior. El siguiente caso clínico relata el tratamiento del segmento anterior con peróxido de hidrógeno 35 por ciento activado por fuente de luz.

Efficacy of 35 per cent hydrogen peroxide on human enamel: in vitro evaluation in different tooth areas / Eficácia do peróxido de hidrogênio a 35 por cento sobre o esmalte dentário humano

This study aimed to assess the efficacy of a 35% hydrogen peroxide – based gel without activation in vitro on three areas of the tooth surface. Vestibular faces of human premolar teeth were darkened, followed by two whitenings at 7-day intervals. The efficacy of whitening was determined in the cervical third, medium third and incisal third of the tooth surface with an Easyshade-Vita spectrophotometer based on the CIELab system. The L*, a*, b* parameters were determined for each third by the identification of high luminosity and hues tending to green and yellow; pigmentation luminosity was then reduced, and the parameters a* and b* became reddish and yellowish, respectively. Seven days after the first whitening, there were significant improvements in L* and a* values. Seven days after the second whitening, the three parameters returned to valuesclose to the initial values; the b* parameter was most strongly correlated with whitening efficacy. DE values revealed a visually perceptible difference.There was a satisfactory removal of pigmentation after both whitenings, while the lack of uniformity among the tooth-surface thirds after the first session justified the performance oftwo whitening procedures. With regard to each third, DE indicated a visibly perceptible difference, although L*, a* and b* values showed no statistically significant differences.

Objetivo: Avaliar, in vitro, a eficácia do gel do peróxido de hidrogênio a 35%, sem ativação, nos três terços dentários. Faces vestibulares de dentes pré-molares humanos foram escurecidos,seguindo-se de duas sessões de clareamento com intervalos de 7 dias. A eficácia do clareamento foi determinada no terço cervical, terço médio e terço incisal pelo espectrofotômetro Easyshade-Vita, com base no sistema CIELab. Os parâmetros L *, a *, b * determinados em cada um terço revelaram alta luminosidade e tendênciaaos tons verde e amarelo; após a pigmentação, a luminosidade foi reduzida e os parâmetros a* e b* revelaram as tonalidades avermelhadae amarelada. 7 dias após o primeiro clareamento houve uma melhora significativa dos parãmetros L * e a*. 7 dias após o segundo clareamento, os três parâmetros retornaram aos valorespróximos àqueles iniciais, sendo que o parâmetro b * foi o principal fator responsável pela eficácia de clareamento. Os valores referentes ao parâmetro DE indicaram haver percepção visual. A remoção da pigmentação foi satisfatória após os dois clareamentos, sendo que a falta de uniformidade entre os terços após aprimeira sessão justificou a realização de dois procedimentos de clareamento. Em relação a cada terço, o parâmetro DE mostrou percepção visual, embora os valores de L*, a* e b* não demonstraram diferenças estatisticamente significativas.

Blanqueamiento dental interno / Internal dental bleaching

El cambio de color de una o más piezas dentarias puede conllevar a problemas en la autoestima y de relación, tanto social como laboral, en nuestra cultura occidental, ya que la estética atraviesa hoy todos los ejes de nuestra vida. Las causas de la pigmentación endógena son variadas, pero generalmente están relacionadas con hemorragia pulpar, con una mala técnica endodóntica o por el uso de materiales que producen tinciones, como la amalgama o el eugenol. Para dar solución a esta situación clínica es que apelamos a una técnica de blanqueamiento interno, a fin de dar respuesta al requerimiento estético por parte de los pacientes que, cada vez más, bregan por la conservación de la integridad de sus piezas dentarias.