Effect of fluoride or chitosan toothpaste and at-home bleaching in enamel roughness, tooth color, and staining susceptibility.

PURPOSE: To evaluate how fluoride- or chitosan-based toothpaste used during at-home bleaching affects enamel roughness, tooth color, and staining susceptibility. METHODS: Bovine enamel blocks were submitted to a 14-day cycling regime considering a factorial design (bleaching agent x toothpaste, 2 x 3), with n=10: (1) bleaching with 16% carbamide peroxide (CP) or 6% hydrogen peroxide (HP), and (2) daily exposure of a fluoride (1,450 ppm F-NaF) toothpaste (FT), chitosan-based toothpaste (CBT), or distilled water (control). Then, 24 hours after the last day of bleaching procedure the samples were exposed to a coffee solution. Color (ΔEab, ΔE00, L*, a*, b*) and roughness (Ra, µm) analyses were performed to compare the samples initially (baseline), after bleaching, and after coffee staining. The results were evaluated by linear models for repeated measures (L*, a*, b*, and Ra), 2-way ANOVA (ΔEab, ΔE00) and Tukey's test (α= 0.05). RESULTS: After the at-home bleaching procedure (toothpaste vs. time, P< 0.0001), the toothpaste groups presented a statistically lower Ra than the control (CBT 0.05). After coffee exposure, CBT presented lower ΔEab and ΔE00 values in the HP groups (toothpaste, P< 0.0001), and lower b* and a* values in the CP groups (toothpaste vs. time, P= 0.004). CLINICAL SIGNIFICANCE: Fluoride or chitosan delivered by toothpaste can reduce surface alterations of the enamel during at-home bleaching, without affecting bleaching efficacy.

Comparison of conventional ceramic laminate veneers, partial laminate veneers and direct composite resin restorations in fracture strength after aging.

OBJECTIVES: The objectives of this study were to test the fracture strength in vitro of laminate veneers, partial laminate veneers and composite restorations after aging and analyze the failure mode. METHODS: Forty extracted, sound human teeth were selected and divided into four groups: 1) Control group (CG); 2) Conventional Laminate Veneer (CLV); 3) Partial Laminate Veneer (PLV); 4) Direct Composite Resin (DCR). Laminate veneer preparations with incisal overlap were made in group CLV whereas only incisal preparations were made with a 1 mm bevel in group PLV and DCR. The indirect restorations were luted with a resin composite and the DCR group was restored with a direct resin composite restoration. The restored teeth were subsequently aged by thermocycling (20.000 cycles, 5-55 degrees C). Subsequently, the fracture strength was tested by a load to failure test at 135° on the incisal edge. A failure analysis was performed using light microscopy. The results were analyzed using Shapiro-Wilk and Kruska-Wallis test. RESULTS: After thermocycling, one sample from group CLV presented a premature adhesive failure and was excluded. Three restorations from groups PLV and DCR presented small cracks but were taken to the fracture test. After aging mean fracture load + SD (N) were: Group DCR (n = 10): 385 ± 225; Group CG (n = 10): 271 ± 100; Group PLV (n = 10): 266 ± 69; Group CLV (n = 9): 264 ± 66. Fracture strength means from groups CLV and PLV did not differ statistically from each other nor from control (p = 0.05). In the group CLV the root fracture was the most occurring fracture. In groups PLV and DCR, material cohesive failures and a mix (adhesive, tooth and material cohesive) failures were most observed. SIGNIFICANCE: This in vitro study showed for the first time that partial laminate veneers can exhibit fracture strength values similar to direct composite restorations or conventional ceramic laminate veneers. All three restorative procedures presented clinically acceptable values of fracture strength. Even though three samples from groups PLV and three from DCR presented small cracks after thermocycling, these cracks do not appear to have a negative effect on the fracture strength.

Utilizing the optical properties of composite resins to improve esthetics: a layering technique for anterior restorations.

A comprehensive knowledge of the optical properties of composite resins is essential to achieving optimal results in direct anterior restorations. This case report describes an anterior composite resin restoration fabricated with a layering technique and explains how to use a simple photographic method to verify that the desired optical effects are reproduced. A Class IV restoration was completed on a maxillary central incisor with the help of a silicone guide. An esthetic result was achieved through careful color examination as well as material selections that were based on knowledge of the translucency, opacity, and fluorescence of the chosen direct composite resins. The approach of combining a composite resin designed for bleached teeth with highly opalescent and translucent resins as well as matching the natural dental anatomy provided excellent esthetic results. The suitable reproduction of optical characteristics was confirmed by increasing the contrast of the final photograph, which highlighted the translucency achieved in the area of the mamelons.