Selamento dentinário imediato em restauração semidireta: relato de caso / Immediate dentin sealing in semi-direct restoration: case report

O selamento dentinário imediato é um procedimento essencial na Odontologia, que envolve a aplicação de agentes de selamento na interface entre a dentina e o material restaurador imediatamente após a remoção da cárie e do preparo da cavidade dentária. Este processo busca selar os túbulos dentinários expostos, proporcionando proteção à polpa dentária. O presente caso foi realizado em um paciente do sexo masculino, 56 anos que se queixou de desconforto no elemento dentário 17. Após avaliação clínica e radiográfica, foi constatado uma ampla restauração desadaptada na porção mesio - oclusal do referido dente, sendo que o elemento em questão não possui tratamento endodôntico. Após planejamento e assinatura do TCLE, os seguintes passos foram realizados: remoção da lesão cariosa do dente 17, seguido da realização do levantamento marginal mesial e a realização do selamento dentinário imediato. Moldagem com silicone de adição do dente em questão e do antagonista, assim como registro da mordida. Foi confeccionada uma restauração semidireta em resina composta sob o modelo de gesso obtido. A cimentação da restauração foi feita na consulta seguinte, cumprindo os requisitos fundamentais para restaurar forma, função e estética, resultando na melhoria da qualidade de vida do paciente(AU)

Immediate dentin sealing is an essential procedure in dentistry, involving the application of sealing agents at the interface between dentin and the restorative material immediately after caries removal and cavity preparation. This process aims to seal exposed dentinal tubules, providing protection to the dental pulp. The present case involved a 56-year-old male patient who complained of discomfort in tooth number 17. After clinical and radiographic evaluation, a wide, maladapted restoration in the mesio-occlusal portion of the tooth was identified, with no endodontic treatment in the affected element. Following planning and informed consent, the following steps were taken: removal of the carious lesion from tooth number 17, followed by the execution of mesial marginal elevation and immediate dentin sealing. Silicone addition molding of the affected tooth and antagonist, along with bite registration, was performed. A semi-direct restoration in composite resin was fabricated based on the obtained gypsum model. The restoration was cemented in the subsequent appointment, meeting the essential requirements to restore form, function, and aesthetics, resulting in an improvement in the patient's quality of life(AU)

Utilizing Laser-Induced Fluorescence to Evaluate the Efficiency of Carbon Dioxide and Diode Lasers in Dentin Sealing after Tooth Preparation: An in-vitro Study.

Adhesive dentistry has made it feasible to design restorations with high aesthetic qualities and little invasiveness. However, the freshly cut dentin after the tooth preparation needs to be sealed to prevent its contaminations, bacterial leakage, and hypersensitivity. Consequently, the immediate dentin sealing (IDS) method has been advised. This study examines different dentinal tubule sealing methods via CO2 laser, diode laser (980-nm) and a two-step self-etch adhesive system applied directly to the fresh cut dentin preceding the placement of the provisional phase. The sealing efficiency of each laser and bond system was evaluated based on the laser-induced fluorescence (LIF) properties and image analysis by scanning electron microscopy. Moreover, the obtained LIF spectra were evaluated using partial least square progression. A two-step adhesive containing a high concentration of S-PRG fillers produced a thick layer that was not perfectly uniform at all sites due to uneven filler distribution in the bond with totally and partially closed dentinal tubules. However, the peaks of the LIF spectra dropped after applying laser because of its sealing effectiveness. Accordingly, CO2 and diode lasers have strong evidence in dentinal tubule sealing and a definitive treatment modality for dentinal hypersensitivity. Moreover, IDS with an adhesive system is superior in occluding dentinal tubules in a biomimetic manner based on its filler content and bioactive properties.

Sealing of pulp chamber dentin in endodontics: Influence of bond strategy and time-point application.

Context: Seal the dentin of the pulp chamber during endodontic treatment to avoid interfering with the restorative treatment performed afterward. Aims: The aim was to evaluate the effect of three adhesive systems applied in different bonding strategies (etch-and-rinse, self-etch, and universal adhesive) and time-point application (immediately after the cavity access preparation or after endodontic obturation) on the hybrid layer formation and dentinal penetrability. Materials and Methods: Forty-eight sound molars were randomly distributed into six groups (n = 10) according to the adhesive system used: Forty-eight sound molars were randomly distributed into six groups (n = 10) according to the adhesive system used and the time-point application: Adper Scotchbond Multi-purpose (AS), Clearfil SE (CF) and Scotchbond Universal (SU) in strategy of immediate endodontic sealing (IES) or delayed endodontic sealing (DES). In IES-AS, IES-CF, and IES-SU groups, dentin sealing was performed immediately after the cavity access, while in DES-AS, DES-CF, and DES-SU, after root canal obturation. The specimens were sectioned in the long axis, in a buccal-lingual direction, and the dentinal penetrability of the adhesive systems was evaluated using confocal microscopy images. Hybrid layer formation was analyzed by scanning electron microscopy images. Statistical Analysis Used: Dentinal penetrability data were analyzed with the ANOVA test and the Kruskal-Wallis test was performed for hybrid layer data (α = 0.05). Results: IES-CF showed the lowest dentinal penetrability (P < 0.05), while the other protocols were similar to each other (P > 0.05). No significant differences were found between groups regarding the hybrid layer formation (P > 0.05). Immediate and DES protocols do not influence the hybrid layer formation, regardless of the bond strategy used. Conclusions: Sealing the pulp chamber dentin before endodontic treatment can improve the bond strength of the final restoration but the formation of the hybrid layer was not influenced by the bond strategy.

Influence of Immediate Dentin Sealing on Bond Strength of Resin-Based CAD/CAM Restoratives to Dentin: A Systematic Review of In Vitro Studies.

Immediate dentin sealing (IDS) is a method of improving the bond strength of indirect dental restorative materials to dentin and belongs to the biomimetic protocols of contemporary dentistry. The purpose of this systematic review was to evaluate the effect of IDS on the bond strength of resin-based CAD/CAM materials to dentin. PubMed and MEDLINE, Scopus, and the Web of Science were searched by two individual researchers, namely for studies that have been published in English between 1 January 2005 and 31 December 2023 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The inclusion criteria encompassed articles related to in vitro studies, measuring the bond strength through microtensile bond strength (µ-TBS), micro-shear bond strength (µ-SBS), tensile bond strength (TBS) or shear bond strength (SBS) tests after the use of the IDS technique. The included restorative materials comprised resin-based CAD/CAM materials bonded to dentin. A total of 1821 studies were identified, of which 7 met the inclusion criteria. A meta-analysis was not deemed appropriate due to the high level of diversity inthe publications and techniques. The use of IDS yielded higher bond strength outcomesin various experimental conditions and resin-based CAD/CAM materials. Overall, IDS in CAD/CAM restorations may contribute to better clinical outcomesand improved restoration longevity due to this property.

Partial glass-ceramic posterior restorations with margins beyond or above the cemento-enamel junction: An observational retrospective clinical study.

PURPOSE: This observational retrospective clinical study aimed to investigate the survival and success rates of partial indirect lithium disilicate restorations with margins extending above or beyond the cementoenamel junction (CEJ). METHODS: The study included patients who underwent partial indirect lithium disilicate restorations with immediate dentin sealing (IDS) between January 2008 and October 2018. All the restorations were placed in a single general dental practice following a standardized protocol. The impact of various predictive variables on the survival rates was assessed. Moreover, modified United States Public Health Service (USPHS) criteria were used to evaluate the survival quality. RESULTS: Totally 1146 partial indirect lithium disilicate restorations in 260 patients were evaluated over an average period of 7.5 years. The cumulative survival and success rates were 97.3% and 95.3%, respectively. Margins extending beyond the cemento-enamel junction did not increase the risk of success or survival failure (P > 0.05). Patients with a high risk of caries, male sex, or non-vital teeth had a significantly higher risk of restoration failure (P < 0.05). Restorations with longer clinical service times exhibited marginally lower clinical quality (P < 0.001). CONCLUSIONS: Partial indirect glass-ceramic restorations demonstrated survival and success rates of 97.3% and 95.3%, respectively, over an extended period. However, a higher risk of restoration failure existed in patients with a high caries risk for (pre)molars that had undergone endodontic treatment and in males. In terms of the risk of success or survival failure, comparable results were obtained for the positions of the restoration margin in relation to the cemento-enamel junction.

Influence of different immediate dentin sealing strategies on bond strength of indirect resin nanoceramic restorations.

In this study, we evaluated the effect of four different strategies for bonding a CAD/CAM resin nanoceramic restoration (Lava Ultimate, 3M) to the dentin surface using a universal adhesive (Scotch Bond Universal, 3M) and adhesive resin cement (RelyX Ultimate, 3M) on the shear bond strength (SBS) and failure mode. The strategies comprised: (i) immediate sealing, immediate bonding; (ii) immediate sealing, bonding after 2 weeks with provisional restoration; (iii) immediate sealing with flowable resin composite reinforcement and bonding after 2 weeks with provisional restoration; and (iv) no immediate sealing, and bonding after 2 weeks with provisional restoration. After bonding, all the specimens were thermocycled, shear tests were performed using a universal testing machine, and failure modes were determined using stereomicroscope and scanning electron microscopy. The highest mean SBS was recorded with immediate sealing, immediate bonding strategy. Most adhesive failures with exposed dentinal tubules were noted in specimens exposed to bonding after 2 weeks with no immediate sealing, which was associated with the lowest SBS. Mixed failures predominated in all immediate dentin sealing groups. Immediate sealing with universal adhesives improves SBS, particularly in the single-visit approach, which has shown significantly better performance, whereas the provisional phase has a negative effect.

Effect of Immediate Dentin Sealing on the Bonding Performance of Indirect Restorations: A Systematic Review.

The popular immediate dentin sealing (IDS) technique is used to improve the bond strength of indirect restorations. This systematic review assessed whether bond strength is affected by the type of aging conditions, bonding agents, flowable resin composites, impression materials, temporary materials, and/or resin cement used within the IDS procedure. A comprehensive database search of PubMed, Embase, Scopus, Ovid Medline, Web of Sciences, Cochrane Library, Dentistry & Oral Sciences Source, and ProQuest was carried out up to 30 January 2024 without publication year or language limitations. Only in vitro full-texts regarding the effect of IDS on bond strength were included, and the quality of their methods was assessed via a Risk of Bias (RoB) test. In total, 1023 pertinent studies were initially found, and 60 articles were selected for review after screening for the title, abstract, and full texts. IDS application improves the bond strength of indirect restorations to dentin and reduces the negative effects of temporary materials on the bond durability of final indirect restorations. Filled dentin bonding agents or combinations with flowable resin composite are preferred to protect the IDS layer from conditioning procedures.

Is immediate dentin sealing a mandatory or optional clinical step for indirect restorations?

OBJECTIVE: The use of immediate dentin sealing (IDS) following tooth preparation for indirect restorations is well-supported by laboratory studies. The inclusion of IDS as a mandatory clinical step, it must be firmly supported by evidence from randomized clinical trials (RCT). The objective of this study is to assess whether IDS should be added as a mandatory procedure in all indirect restorations, taking into consideration clinically significant outcomes for the patient, such as restoration longevity and hypersensitivity. MATERIALS AND METHODS: A bibliographic search was carried out in the PubMed. In addition, a manual search was conducted in the references of literature reviews. RESULTS: Data from four RCT were included. Two studies assessed preparations for full crowns, and two assessed preparations for partial restorations. Data from full crown preparations were subjected to a meta-analysis, revealing a reduction in hypersensitivity incidence in the IDS group 1 week after restoration cementation. With respect to hypersensitivity, IDS seems to offer advantages exclusively during the provisional phase and up to 1 week following the cementation of the final restoration. One study has shown no difference on longevity. CONCLUSION: The use of IDS should be considered as an elective clinical step during the rehabilitation with indirect restorations. CLINICAL SIGNIFICANCE: IDS is an elective clinical step that should be considered in patients and preparations with a higher risk of sensitivity between appointments.

Effect of immediate dentin sealing on the fracture strength of indirect overlay restorations using different types of luting agents (A comparative in vitro study).

Objective: This study evaluates the effects of immediate dentin sealing (IDS) on the fracture resistance of lithium disilicate overlays using three different types of resin-luting agents (preheated composite, dual-cure adhesive resin, and flowable composite). Materials and Methods: Forty-eight maxillary first premolars of equal size were prepared using a butt joint preparation design. The teeth were separated into two primary groups, each with 24 teeth: Group DDS - delay dentin sealing (DDS) (non-IDS) teeth were not treated. Group IDS - dentin sealing was applied immediately after teeth preparations. Each group was subsequently separated into three separate subgroups of eight teeth. Subgroups DDS+Phc and IDS+Phc - cemented with preheated composite (Enamel plus HRi, Micerium, Italy), subgroups DDS+Dcrs and IDS+Dcrs - cemented with dual-cured resin cement (RelyX Ultimate, 3M ESPE, Germany), and subgroups DDS+Fc and IDS+Fc - cemented with flowable composite (Filtek Supreme Flowable, 3M ESPE, USA). The fracture resistance of each sample was evaluated using a test of a single load till failure, which was automatically recorded in Newton by a computer-controlled universal testing system. Results: The fracture resistance of the subgroup IDS+Phc was the highest mean value, in which the overlay was cemented with preheated composite (1954 N), and the lowest mean was noted in the subgroup DDS+Fc, by which the overlay cemented with flowable composite without IDS (887 N). All IDS subgroups had a high mean fracture load. Both the Bonferroni test and the one-way ANOVA test identified a significant difference between all groups of 0.05. Conclusion: In general, teeth with IDS were stronger than teeth without IDS. When the preheated composite is used as a luting agent improves overall fracture resistance, followed by resin cement and flowable composite, respectively. However, the result showed that the ceramic overlays with and without IDS are strong enough to withstand the normal mastication force. Overlays was failed in a more catastrophic, irreparable mode of fracture than the clinical situation.

Effect of immediate dentin sealing on load-bearing capacity under accelerated fatigue of thin occlusal veneers made of CAD-CAM glass-ceramic and resin composite material.

OBJECTIVE: The objective of this study was to assess the influence of immediate dentin sealing (IDS) on the fatigue behavior of laminate occlusal veneers fabricated with CAD/CAM lithium disilicate ceramic and resin composite. METHODS: Forty sound human molars were prepared and randomly divided into 4 groups (n = 10): RC-IDS+ (IDS and resin composite occlusal laminate veneer); RC-IDS- (resin composite occlusal laminate veneer without IDS); LD-IDS+ (IDS and lithium disilicate laminate veneer); LD-IDS- (lithium disilicate occlusal laminate veneer without IDS). The restorations were obtained using a digital workflow. After surface conditioning and bonding, thermocycling and accelerated fatigue tests (20 Hz, 5000 cycles with an initial load of 300 N, step-size of 100 N for 10,000 cycles, up to 1000 N, and then a step-size of 50 N until failure) were conducted. Fatigue data were recorded for both outcomes (crack or fracture) and statistically analyzed. Fractographic and adhesive interface analysis were conducted. RESULTS: The indirect resin composite groups showed better fatigue behavior compared to lithium disilicate. IDS only had a positive effect for the survival of resin composite restorations for the 'fracture' outcome. Evident presence of micro-gaps at the adhesive interface in the LD-IDS- group could be noted. SIGNIFICANCE: Immediate dentin sealing improved fatigue resistance behavior of resin composite occlusal veneers. However, this effect was not observed in lithium disilicate veneers.

Effect of temporary cements and their removal methods on the bond strength of indirect restoration: a systematic review and meta-analysis.

OBJECTIVES: For a conventional indirect restoration, temporary cementation inevitably contaminated collapsed dentin collagen. The purpose of this review was to evaluate the optimal strategy for minimizing its negative effects. MATERIAL AND METHODS: Databases such as PubMed, Web of Science, EMBASE, and the Cochrane Library were searched for in vitro studies, involving the influence of immediate dentin sealing (IDS), different temporary cements, and their removal strategies on dentin bond strength. The meta-analysis used the inverse variance method with effect method of the standardized mean difference and statistical significance at p ≤ 0.05. The I2 value and the Q-test were used to assess the heterogeneity. RESULTS: A total of 14 in vitro trials were subjected to the meta-analysis. Within the study's limitations, we assumed that IDS eliminated the negative effects of temporary bonding, achieving the comparable immediate bond strength with the control (p = 0.46). In contrast, under delayed dentin sealing (DDS), temporary cementation statistically decreased bond strength (p = 0.002). Compared with resin-based and non-eugenol zinc oxide cements, polycarboxylate and calcium hydroxide cements performed better on bond strength with no statistical difference from the control group (p > 0.05). Among the removal methods of temporary cements, the Al2O3 abrasion restored the decreased bond strength (p = 0.07) and performed better than hand instruments alone (p = 0.04), while pumice removal slightly reduced the bond strength in contrast with the control group (p = 0.05, 95% CI = - 1.62 to 0). CONCLUSIONS: The choices of IDS, polycarboxylate and calcium hydroxide temporary cements, Al2O3 abrasion removal method were feasible and efficient to enhance the bond strength. CLINICAL RELEVANCE: It is worthwhile applying IDS technique, polycarboxylate and calcium hydroxide temporary cements during indirect restoration. The Al2O3 abrasion of cleaning dentin can minimize the negative effects of temporary cement.

Appropriate Immediate Dentin Sealing to Improve the Bonding of CAD/CAM Ceramic Crown Restorations.

This study aimed to use quantitative and qualitative evaluations based on micro-tensile bond strength (µTBS) to clarify the appropriate immediate dentin sealing (IDS) approach for improving the bonding of CAD/CAM ceramic crown restorations. Forty-eight extracted human molars were prepared to obtain standardized abutment specimens and divided into three groups: no IDS (group C: control), IDS performed by a single application of an all-in-one adhesive system (group A), and IDS performed by the combined application of an adhesive system and a flowable resin composite (group F). All specimens were restored with a ceramic crown fabricated by a chair-side CAD/CAM system and were divided into no-stress and stressed groups. After cyclic loading (78.5 N; total, 3 × 105 cycles; 90 cycles/min) on the specimens in the stressed group, all specimens were sectioned. The µTBS values for the occlusal and mesioaxial walls were measured (n = 16) and analyzed statistically. The quantitative bonding performance of groups A and F were superior to that of group C, regardless of the cyclic loading and abutment wall conditions. Group F showed the maximum bond strength and the highest bond durability in the qualitative bonding performance even under the cyclic loading condition simulating clinical mastication.

Effect of immediate dentin sealing on the fracture strength of lithium disilicate ceramic onlays.

This study aimed to evaluate the effect of immediate dentin sealing (IDS) on the fracture strength of ceramic onlays when compared with delayed dentin sealing (DDS). Twenty extracted human maxillary premolars were randomly divided into 2 groups according to the dentin sealing technique (n=10). A standardized mesio-occlusal-distal cavity was prepared with reduction of the palatal cusp. The dentin surfaces of the IDS group were immediately sealed after finishing the preparation (before taking impressions, temporization, and 14-day storage at 37°C) using a bonding system (ALL-BOND 3®, ALL-BOND 3® RESIN) and flowable composite (Te-Econom Flow). Impressions were made and temporary restorations were fabricated using PRO-V FILL®. The wax patterns were milled and the onlays were fabricated by heat-pressing technique (IPS e.max Press). After bonding the final restorations with resin cement (Variolink N), the specimens were thermocycled. Fracture strength was measured using a universal testing machine (Testometric M350-10KN) at 1 mm/min until failure occurred. Student's t-test was used to evaluate the results of the fracture strength test. The failure mode was examined using a stereomicroscope. The mean fracture strength in the IDS group (1335 ± 335 N) was statistically significantly higher than that for the DDS group (931 ± 274 N) (p < 0.05). Fracture of the restoration with a small portion of the tooth was the most frequent mode of failure. Within the limitation of this in vitro study, there was an improvement in the fracture strength of ceramic onlays with the use of IDS. However, the ceramic onlays were strong enough to withstand the physiological mastication force in both groups.

Immediate Dentin Sealing for Adhesive Cementation of Indirect Restorations: A Systematic Review and Meta-Analysis.

Immediate dentin sealing (IDS) involves applying an adhesive system to dentin directly after tooth preparation, before impression. This was considered an alternate to delayed dentin sealing (DDS), a technique in which hybridization is performed following the provisional phase and just before the indirect restoration luting procedure. This study aimed to compare the bond strength of restorations to dentin of the IDS and the DDS techniques throughout a systematic review and meta-analysis. The following PICOS framework was used: population, indirect restorations; intervention, IDS; control, DDS; outcomes, bond strength; and study design, in vitro studies. PubMed (MedLine), The Cochrane Library, ISI Web of Science, Scielo, Scopus, and Embase were screened up to January 2022 by two reviewers (L.H. and R.B.). In vitro papers studying the bond strength to human dentin of the IDS technique compared to the DDS technique were considered. Meta-analyses were carried out by using a software program (Review Manager v5.4.1; The Cochrane Collaboration). Comparisons were made by considering the adhesive used for bonding (two-step etch-and-rinse, three step etch-and-rinse, one-step self-etch, two-step self-etch, and universal adhesives). A total of 3717 papers were retrieved in all databases. After full-text assessment, 22 potentially eligible studies were examined for qualitative analysis, leaving a total of 21 articles for the meta-analysis. For the immediate bond strength, regardless of the adhesive strategy used, the IDS technique improved the bond strength of restorations to the dentin (p < 0.001). Taking into account the subgroup analysis, it seems that the use of the IDS technique with a two-step etch-and-rinse or a one-step self-etch adhesive system does not represent any advantage over the DDS technique (p = 0.07, p = 0.15). On the other hand, for the aged bond strength, regardless of the adhesive strategy used, the IDS technique improved the bond strength of restorations to the dentin (p = 0.001). The subgroups analysis shows that this improvement is observed only when a three-step etch-and-rinse adhesive system (p < 0.001) or when a combination of an adhesive system plus a layer of flowable resin (p = 0.01) is used. The in vitro evidence suggests that the use of the IDS technique improves the bond strength of dentin to resin-based restorations regardless of the adhesive strategy used. The use of a three-step etch-and-rinse adhesive system or the combination of an adhesive system plus a layer of flowable resin seems to considerably enhance the bond strength in the long term.

Immediate dentin sealing: effect of sandblasting on the layer thickness.

OBJECTIVES: The objective of this study was to observe and to measure the impact of corundum sandblasting on the thickness of the Immediate dentin sealing layer. METHODS: 20 recently extracted molars were collected and divided randomly into two groups. A standardized preparation was performed on each tooth and the Optibond FL dentin bonding agent (Kerr, Orange, USA) was applied on the prepared surface according to the manufacturer's instructions. The surface was then partially sandblasted. RONDOflex plus 360 (KaVo, Bieberach an der Riss, Germany) and Airsonic Mini-Sandblaster (Hager et Werken, Duisburg, Germany) were used. Microscope observations were made. RESULTS: The arithmetic mean of the Optibond FL dentin bonding agent film thickness was 48.72 µm (Group 1=45.55 µm and Group 2=51.88 µm). The dentin bonding agent layer thickness was reduced to the average value of 17,12 µm by RONDOflex plus 360 sandblasting (Group 1). The zero value was recorded in 16 % of the locations. The Airsonic Mini-Sandblaster sandblasting changed the average thickness of the dentin bonding agent layer to 13.25 µm with 31 % of zero values (Group 2). CONCLUSION: The results of this research lead to a reflection on modifications of the immediate dentin sealing procedure (Tab. 4, Fig. 3, Ref. 28).

Does immediate dentin sealing influence postoperative sensitivity in teeth restored with indirect restorations? A systematic review and meta-analysis.

OBJECTIVE: This study comprehensively reviewed clinical trials that investigated the effect of immediate dentin sealing (IDS) technique on postoperative sensitivity (POS) and clinical performance of indirect restorations. MATERIALS AND METHODS: The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement, and was guided by the PICOS strategy. Clinical trials in which adult patients received at least one indirect restoration cemented with IDS approach and one restoration cemented following the delayed dentin sealing (DDS) were considered. RESULTS: Following title screening and full-text reading, four studies met the inclusion criteria and were included for qualitative synthesis, while two studies were selected for quantitative synthesis. According to Risk of bias-2 tool, two studies were classified as "some concerns" for the outcome POS. No statistically significant differences were found between teeth restored with indirect restorations using the IDS and DDS approach for POS (p > 0.05), neither at the baseline (very low certainty of evidence according to GRADE) nor after 2 years of follow-up (low certainty of evidence according to GRADE). CONCLUSION: There is low-certainty evidence that IDS does not reduce POS in teeth restored with indirect restorations. CLINICAL SIGNIFICANCE: There is no clinical evidence to favor IDS over DDS when restoring teeth with indirect restorations.

Reinforced Immediate Dentin Sealing vs Conventional Immediate Dentin Sealing on Adhesive Behavior of Indirect Restorations: A Systematic Review.

AIM: The aim of this systematic review is to compare the bonding performance of indirect restoration with the reinforced immediate dentin sealing (IDS) method as opposed to the conventional IDS method. MATERIALS AND METHODS: A literature search was conducted in PubMed, Cochrane, and EBSCOHost up to January 31st 2022, accompanied by a hand search in Google Scholar. Inclusion criteria involved studies comparing conventional IDS and reinforced IDS protocol and evaluating various parameters influencing the bonding performance, such as type of indirect restoration, etching protocol, cavity design, tooth surface preparation, method of oral cavity simulation, and processing after luting. The quality of six included studies was appraised using CRIS guidelines. RESULTS: A total of 29 publications was identified, and 6 of them fulfilled the inclusion criteria. All of the included studies were in vitro studies. The predetermined data were independently extracted and evaluated by four reviewers. It was observed that most of the studies showed an improvement in bond strength with reinforced IDS when compared with conventional IDS. Also, etch-and-rinse and 2-step self-etch adhesive protocols have shown better bonding performance than universal adhesive systems. CONCLUSION: Reinforced IDS has similar or better bond strength to that of conventional IDS strategies. The need for prospective studies is highlighted. The future clinical studies for immediate dentin sealing ought to be reported in a uniform and methodological way. CLINICAL SIGNIFICANCE: Application of an additional layer of low-viscosity resin composite provides a thicker adhesive layer, prevents re-exposure of dentin during the final restoration, and allows a smoother preparation in lesser clinical chair time and eliminates any possible undercuts. Thus, reinforced IDS has shown to result in better preservation of the dentinal seal than IDS technique.

Influence of different separating mediums applied on the immediate dentin sealing in the tensile strength of temporary restorations / Influência de diferentes agentes isolantes aplicados sobre o selamento dentinário imediato na resistência à tração de restaurações provisórias

Objective: To evaluate the ability of different separating mediums to prevent adhesion between provisional restorations and hybridized dentin surfaces when used with the Immediate Dentin Sealing technique (IDS). Material and Methods: 120 extracted human teeth ­ 40 premolars and 80 molars ­ were selected to integrate acrylics samples separated into 4 different groups (n=10) according to the separating medium used for IDS protection. Forty samples were made of three teeth mounted in a self-cure acrylic resin block (Jet, Classic, São Paulo, Brazil) arranged side by side, simulating the positioning and proximal contacts present in the dental arch between the second premolar, first molar and second molar. A standard dental preparation for ultra-thin occlusal veneer was performed and complete occlusal dentin exposure was achieved by selective removal of the occlusal enamel with a high-speed conical round burr (Code: 1801.4138 FG, KG Sorensen, Medical Burs Ind. e Com. de Pontas e Brocas Cirúrgicas Ltda, São Paulo, Brazil). Dentin hybridization were performed on the control group and 3 different groups of separating mediums (n=10): PC­commercial provisional separating agent (Pro-V Coat, Bisco, Schaumburg, USA); GG­glycerin gel (K-Y Gel; Johnson & Johnson Industry and Commerce LTDA, São Paulo, Brazil); PJ­petroleum jelly (Rioquímica, São Paulo, Brazil). Provisionalization were manufactured on the prepared teeth. After 2 weeks, the tensile test was performed, and the analysis of the failure pattern was performed by 3D laser confocal microscopy and Scanning Electron Microscopy (SEM). The data were analyzed with the 1-way ANOVA and the Tukey test (α = 0.05). Results: Significantly lower tensile strength values were found for the commercial provisional separating agent (30.39 ± 10.01 N) compared to others (p < 0.05). Conclusion: The commercial provisional separating agent showed greater effectiveness on protecting hybridized dentin against the provisional restorations (AU)

Objetivo: Avaliar a capacidade de diferentes agentes isolantes em prevenir a adesão entre as restaurações provisórias e a superfícies de dentina hibridizadas quando usados com a técnica do Selamento Dentinário Imediato (IDS). Material e Métodos: 120 dentes humanos extraídos - 40 pré-molares e 80 molares - foram selecionados para integrar as amostras de acrílico divididas em 4 grupos diferentes (n = 10) de acordo com o meio de separação usado para proteção IDS. Foram confeccionadas 40 amostras de três dentes montados em um bloco de resina acrílica autopolimerizável (Jet, Classic, São Paulo, Brasil) dispostos lado a lado, simulando o posicionamento e os contatos proximais presentes na arcada dentária entre o segundo pré-molar, primeiro molar e segundo molar. Um preparo dentário padrão para laminado oclusal ultrafino foi realizado e a exposição completa da dentina oclusal foi obtida pela remoção seletiva do esmalte oclusal com uma broca cônica arredondada de alta rotação (Código: 1801.4138 FG, KG Sorensen, Medical Burs Ind. E Com. de Pontas e Brocas Cirúrgicas Ltda, São Paulo, Brasil). A hibridização da dentina foi realizada no grupo controle e em 3 grupos diferentes de agentes isolantes (n = 10): PC - agente de separação provisório comercial (Pro-V Coat, Bisco, Schaumburg, EUA); GG ­ gel de glicerina (K-Y Gel; Johnson & Johnson Industry and Commerce LTDA, São Paulo, Brasil); PJ ­ vaselina (Rioquímica, São Paulo, Brasil). As restaurações provisórias foram fabricadas nos dentes preparados. Após 2 semanas, foi realizado o teste de tração, e a análise do padrão de falha foi realizada por microscopia confocal a laser 3D e Microscopia Eletrônica de Varredura (MEV). Os dados foram analisados com a ANOVA de 1 fator e o teste de Tukey (α = 0,05). Resultados: Valores de resistência à tração significativamente menores foram encontrados para o agente separador provisório comercial (30,39 ± 10,01 N) em comparação com os demais (p < 0,05). Conclusão: O agente separador provisório comercial mostrou maior eficácia para a proteção da dentina hibridizada contra as restaurações provisórias (AU)

Morphology-driven preparation technique for posterior indirect bonded restorations.

Restorative treatment in recent times has seen a paradigm shift due to minimally invasive adhesive dentistry. With advent of material science, bonding mechanisms, and superior isolation techniques, treatments based entirely on adhesion are effectively attainable. The choice between direct and indirect restorative technique, mainly in posterior areas, is still a challenge and involves biomechanical, anatomical, functional, esthetic, and economic considerations. The rationale of this case report is to demonstrate a revised cavity design based on morphological principles in terms of geometry (height of contour and cuspal inclines) and structure (dentinoenamel junction morphology) inspired from conventional preparation techniques.

Substantial in-vitro and emerging clinical evidence supporting immediate dentin sealing.

The application of resin adhesive to freshly cut dentin after teeth preparation, the so-called immediate dentin sealing (IDS) has been suggested as an alternative to the delayed dentin sealing (DDS), a technique in which resin adhesive is applied just before final bonding of indirect restorations. The aim of this review is to demonstrate the evidence of the claimed advantages made by the proponents of IDS technique. The results of this review revealed substantial in-vitro evidence supporting the IDS benefits including improved bond strength, reduced dentin permeability, improved restorations' adaptation, and increased fracture strength of the restorations. Clinical studies have shown that IDS improves survival of ceramic laminate veneers bonded to prepared teeth with increased exposure of dentin. Moreover, it has been shown that IDS reduces post-cementation hypersensitivity in full coverage restorations, which is characterized by exposure of a large number of dentinal tubules. The selection of filled resin adhesive that is capable of producing thick adhesive layer appears to contribute to the success of the technique. Furthermore, careful management of the oxygen inhibition layer before conventional impression making and proper cleaning of the residual temporary cement used with provisional restorations appears to affect the outcome of the restorations.