A conservative approach for restoring anterior guidance: a case report.

UNLABELLED: One of the most common dental problems in today's clinics is tooth wear, specifically when related to bruxism. In such cases, the esthetics of anterior teeth may be compromised when excessive wear to the incisal surfaces occurs. Anterior tooth wear resulting from parafunctional bruxism can be conservatively treated with the use of direct resin composite restorations. This restorative approach has the advantages of presenting good predictability, load resistance, acceptable longevity, preservation of healthy dental tissues, and lower cost when compared with indirect restorations. The use of resin composites to solve esthetic problems, however, requires skill and practice. Thus, the present article demonstrates a conservative approach for restoring the esthetics and function of worn anterior teeth with the aid of direct resin composite restorations and selective occlusal adjustment. CLINICAL SIGNIFICANCE: A conservative approach to restore anterior teeth with excessive wear is possible with direct resin composites.

The golden proportion concept: smile makeover with an 18-month follow-up.

AIM: The altered size, shape or position of the teeth affect their proper alignment, the harmony of the smile, and the dentofacial composition. The aim of this article is to describe a minimally invasive approach to improve the esthetics of a patient through the golden proportion (GP) concept with the use of direct composite resin stratification. MATERIALS AND METHODS: A 26-year-old female complained about the appearance of her smile due to the existing spaces between her anterior teeth; her small, peg-shaped lateral incisors; the wear of her canines; and the color of her teeth. The clinical examination confirmed diastemas in the anterior teeth, peg-shaped maxillary lateral incisors, and incisal wear of the canines. Treatment with dental whitening followed by composite restorations was performed in line with the current conservative approach in dentistry. The patient was followed up for 18 months. CONCLUSION: The use of the additive technique with composite for the closure of diastemas under the GP concept illustrates an example of viable management to restore esthetic harmony through a minimally invasive approach, with reliability over time and the advantages of being less laborious, less time consuming, and less expensive than other approaches. The treatment plan was acceptable to the patient.

Bio-additive and enameloplasty technique for restoring anterior esthetics: 54-month clinical follow-up.

Teeth with altered size and shape, incisal wear, and inadequate position affect the smile and dentofacial harmony. The aim of this article was to describe a simple and safe protocol for an additive technique with composite resin and cosmetic enameloplasty to improve a patient's smile. A 24-year-old man complained about the appearance of his smile regarding color, shape, and position of the maxillary anterior teeth. Relevant dental history included previous orthodontic treatment with inadequate completion. The clinical examination revealed a disharmony of the smile caused by size and shape alterations of the incisors, a white spot on the right central incisor, incisal wear of the canines, and uneven incisal edges between the maxillary anterior teeth. Treatment with direct composite restoration and enameloplasty was performed in line with the current conservative approach in dentistry. The patient was recalled for 54 months. The use of appropriate techniques in enameloplasty allowed the desired outcome to be observed over the 54 months of follow-up. With this method, it is possible to perform future repair and/or modification, and it may increase the longevity of the restoration. Esthetic and functional results were achieved by careful planning and execution as well as periodic recalls. This conservative approach is a useful alternative to conventional restorations, reducing invasive treatments, chairside time, and costs.

Cosmetic recontouring for achieving anterior esthetics.

Cosmetic recontouring based on the enameloplasty of natural teeth is a treatment with esthetic benefits that can be considered both economical and safe. Not only does the clinician need to restore the harmony of the smile, but treatment planning must also take the functional aspects of the restoration into consideration. One way to recontour is through an additive technique with direct composite resin that improves the esthetic outcome of the final treatment. Of the various types of treatment that can be offered in the dental clinic, cosmetic recontouring is a conservative one with low biological and financial cost that obtains good functional and esthetic results. This article describes a clinical case including enameloplasty and the addition of direct composite resin to improve the balance and harmony of the smile and dentition.

A direct composite resin stratification technique for restoration of the smile.

Composite resins can be used to improve the esthetics of the smile at a low cost and with relatively high clinical performance. The aim of this article was to describe an approach to restore and enhance the esthetic appearance of the anterior dentition through vital tooth whitening and the direct layering of composite resin during predictable esthetic procedures.

Evaluación del desgaste por cepillado, in vitro, de una resina compuesta, fotopolimerizada por lámpara halógena: en dos tiempos diferentes / Wear evaluation of the in vitro toothbrushing of a composite resin cured by halogent light curing: in two different times

El objetivo de este trabajo fue evaluar el desgaste abrasivo por cepillado in vitro de la resina compuesta 4Seasons, de dos colores diferentes (A3 y C4) y polimerizadas por dos diferentes tiempos (20 e 40 s), utilizando cepillo dental y dentífrico; también se uso como material de referencia, el PMMA. Fueron confeccionados 10 especímenes, para cada uno de los 5 grupos (PMMA, A3 20s, A3 40s, C4 20s, C4 40s). Después de su confección, cada espécimen era almacenado en agua desmineralizada a 37 ± 2 ºC, por 24 horas, regularizados con lija; después del lavado en ultrasonido, volvían a ser almacenados en las mismas condiciones por 7 días. El cepillado fue realizado en una máquina para desgaste por cepillado, aplicándose una carga de 3N, con frecuencia de 4,5 ciclos/seg; el período de cepillado de un espécimen comprendía 150,000 ciclos. Fueron realizados 5 lotes de cepillado, de modo que un espécimen de cada material de cada grupo fuese sometido a cada una de las posiciones ocupadas por los 10 cepillos. La cantidad de masa pérdida fue calculada por pesaje (pre y post cepillado). Este trabajo también fue ilustrado con gráficos de rugosidad y MEB. La tasa media de desgaste fue de 2,8 mg para PMMA, de 5,5 mg para A3-20s, 4,7 mg para A3-40 s, 5,4 para C4-20s y 4,2 mg para C4-40s. ANOVA mostro que no hubo diferencia significante entre los grupos, para p=0,166. Concluyéndose que no existió diferencia de resistencia al desgaste abrasivo entre los grupos

To evaluate abrasive wear, by weight changes, of a resin composite to in vitro toothbrushing, of two different colors (A3 and C4), cured by two times (20 and 40 s). Resin composite 4Seasons was material studied and PMMA was used as reference material. Ten cylindric samples had been prepared for each one of the five evaluated groups (PMMA, A3 20s, A3 40s, C4 20s, C4 40s). After confection, samples were immersed in deionized water, at 37± ºC, for 24 h, and then regularized by abrasive gritting with sandpaper, after that, were cleaned in ultrasound bath, and restored to the same described conditions, for 7 days. The toothbrushing was then conducted in a proper machine that holds 10 specimens, with 3 N load of each toothbrush on the respective sample using dentifrice and water. 150.000 cycles were applied per group. Five lots of toothbrushing had been performed; in a way that one sample of each group had been submitted to the brushing action at one position in the machine. The amount of weight loss for each sample was calculated by means of weighting. Roughness and MEV were also evaluated. Data were analyzed with one-way ANOVA. The average rate of wear was of 2.8 mg for PMMA, 5.5 mg for A3-20s, 4.7 mg for A3-40 s, 5.4 for C4-20s, and 4,2 mg for C4-40s. One-way ANOVA showed no significant difference between groups (p=0.166). It was possible to conclude that difference of the resistance to the abrasive wear between the studied groups did not exist

Restablecimiento estético y funcional de la guía anterior utilizando la técnica de estratificación con resina compuesta

En Odontología, un problema observado constantemente en pacientes adultos en este inicio de siglo es sin duda, el desgaste dental patológico. Este tipo de desgaste ocurre cuando existe pérdida acentuada de la estructura dentaria, lo que generalmente ocasiona el compromiso estético de los dientes antero superiores. En consecuencia, la sociedad se está concientizando sobre la importancia de la salud y de la estética, de esta manera, la demanda por tratamientos estéticos rehabilitadores en casos de desgaste dental patológico ha aumentado. La rehabilitación estética puede ser realizada tanto por medio de tratamientos directos como indirectos. Debido a las ventajas de las resinas compuestas, el presente trabajo tiene por finalidad describir la técnica operatoria para el restablecimiento de la guía anterior con resina compuesta, mediante la técnica de estratificación, que permite simular las características ópticas de la estructura dental. Así, con la evolución de los sistemas adhesivos, asociado a las mejoras en las propiedades químicas, mecánicas y estéticas de las resinas compuestas, tratamientos restauradores extensos, como la reconstrucción directa de las guías anteriores en los casos de desgaste dental patológico, se tornan viables.

In Dentistry, a common problem observed in this beginning of century is the pathologic tooth wear. This type of wear occurs when there is accentuated loss of tooth structure, which frequently results in aesthetic compromise of the anterior maxillary teeth. As a result of the society’s awareness of the importance of health and aesthetics, the request for reparative aesthetic treatments in cases of pathologic tooth wear has increased. This aesthetic rehabilitation may be achieved either through indirect or direct treatments. Due to the advantages of the resin composites, the aim of the present paper is to show specifically the direct approach throughout the use of a layering technique to simulate the optical characteristics of the tooth structure. Hence with the evolution of the adhesive systems associated with improving in the chemical-mechanical-aesthetical charecterics of the resin composites, extensive restorative treatments as the direct reconstruction of the anterior guidance in cases of pathologic tooth wear are now feasible.

Remodelación Cosmética de la Sonrisa / Cosmetic Contouring of Smile

La remodelación cosmética de los dientes naturales es una modalidad de tratamiento con beneficios estéticos que puede ser considerada económica y conservadora. No obstante, demanda del profesional no solo restaurar una sonrisa armoniosa, sino también, al mismo tiempo preocuparse con el aspecto funcional del tratamiento. Además, la remodelación cosmética pude ser relacionada a otros recursos operatorios como los restauradores adhesivos directos, proporcionando resultados aún más satisfactorios a los pacientes. De esta manera, este trabajo tiene por objetivo presentar un caso clínico, en el cual la remodelación cosmética asociada a diferentes recursos operatorios, puede ser empleada como una opción de tratamiento estético conservador.

Cosmetic contouring of natural teeth is a treatment with aesthetic benefits that can be considered economical as well as conservative. The dental professional has however not only to restore the smile harmony, but the functional aspects have to be considered at the same time in the treatment planning. Other treatments such as direct adhesive restorative treatments may additionally be used to provide better outcomes to the patients. The aim of the present work thus is to present a case of cosmetic contouring as a suitable aesthetic treatment option.

Avaliação do desgaste por escovação, in vitro, de uma resina composta, fotopolimerizada por lâmpada halógena, em dois diferentes tempos / In vitro toothbrushing wear evaluation of a resin composite cured by QTH curing unit in two different times

Um dos principais problemas dos materiais restauradores (incluindo a resina composta) é o desgaste por abrasão. Portanto, o objetivo neste trabalho foi avaliar in vitro o desgaste abrasivo por escovação da resina composta 4Seasons, de duas cores diferentes (A3 e C4) e com fotopolimerização por dois diferentes tempos (20 e 40 s), utilizando escova Sorriso, da Colgate, e creme dentifrício Colgate Tripla Ação; também foi usado, como material de referência, o polimetil metacrilato. Assim, foram confeccionados dez corpos-de-prova, para cada um dos cinco grupos formados (PMMA, A3 20s, A3 40s, C4 20s, C4 40s). Cada espécime consistia basicamente num cilindro de cerca de 1,8 mm de altura e 8 mm de diâmetro. Cada espécime, após sua confecção, era imerso em água deionizada, a 37 ± 2 ºC, por 24 horas, quando então eram regularizados com lixa (granulação # 600 e # 1.000); após lavagem com ultrassom, voltavam a ser armazenados nas mesmas condições, até completar-se um período de uma semana. A escovação foi então efetuada numa máquina própria, que comportava dez espécimes simultaneamente, sendo de 3 N a carga de cada escova sobre o respectivo espécime; a velocidade de cada escova era de 18 cm/s, com a freqüência (ida e volta, num percurso total de 4 cm) de 4,5 ciclos/s; o período de escovação de um espécime compreendia 150. 000 ciclos. Foram efetuados cinco períodos (ou lotes) de escovação, de modo que um espécime do material de cada grupo tivesse sido submetido à ação de cada uma das posições ocupadas pelas dez escovas.

A quantidade de massa perdida, para cada espécime, foi calculada por meio de pesagem (pré e pós escovação), numa balança com acuidade de milionésimo de grama. O trabalho foi também ilustrado com gráficos de rugosidade e com fotomicrografias tomadas ao MEV. A taxa média de desgaste foi de 2,8 mg para o PMMA, de 5,5 mg para o A3-20s, 4,7 mg para o A3-40 s, 5,4 para o C4-20s e 4,2 mg para o C4-40s; a respectiva análise de variância mostrou não existir diferença significante entre os grupos, para p=0,166; o coeficiente de variação entre os grupos foi bastante semelhante. Foi possível concluir que não existiu diferença da resistência ao desgaste abrasivo entre os grupos estudados.

One of the main problems of dental restorative materials (including the resin composites) is the abrasion wear. Therefore, the aim of this work was to evaluate in vitro the abrasive wear by toothbrushing of the resin composite 4Seasons, of two different colors (A3 and C4), cured by two different times (20 and 40 s), using a toothbrush (Sorriso - Colgate), and a dentifrice (Tripla Ação Colgate). Polimetil meth-acrylate was used as reference material. Ten cylindric samples (approximately 1.8 mm height and 8 mm diameter) had been prepared for each one of the five evaluated groups (PMMA, A3 20s, A3 40s, C4 20s, C4 40s). After confection, samples were immersed in deionized water, at 37 ± 2ºC, for 24 h, and then regularized by abrasive gritting with sandpaper (from #600 to # 1 000); after that, were cleaned in ultrasound bath, and restored to the same described conditions, until completing the period of one week. The toothbrushing was then conducted in a proper machine that holds 10 specimens simultaneously, with a 3 N load of each toothbrush on the respective sample. The speed of each toothbrush was of 18 cm/s, at a frequency of 4.5 cycles/s (each cycle consisting of 2 cm forward and 2 cm backward). 150. 000 cycles were applied per sample. Five periods (or lots) of toothbrushing had been performed, in a way that one sample of each group had been submitted to the brushing action at one position in the machine.

The amount of weight loss for each sample was calculated by means of weighting (before and after toothbrushing), in an analytical balance with accuracy of millionth of gram. Roughness and MEV photomicrographies were also evaluated. The average rate of wear was of 2.8 mg for PMMA, 5.5 mg for A3-20s, 4.7 mg for A3-40 s, 5.4 for C4-20s, and 4,2 mg for C4-40s. One-way ANOVA showed no significant difference between groups (p = 0.166). The coefficient of variation between the groups was sufficiently similar. It was possible to conclude that difference of the resistance to the abrasive wear between the studied groups did not exist.

Reabilitação estética e funcional da guia anterior: uma sequência lógica e conservadora / Aesthetic and functional rehabilitation of the anterior guide: a logical sequence and conservative

A procura por tratamentos estéticos, em casos de desgaste dentário patológico, tem aumentado devido à conscientização da sociedade sobre a importância da saúde e da estética. Esta é uma doença multifatorial que afeta o sistema estomatognático funcional e esteticamente. Sua ocorrência é cada vez mais presente na clínica diária. Com a evolução dos materiais odontológicos de inserção direta, tratamentos restauradores mais conservadores tornaram-se possíveis com o uso de resinas compostas. O tratamento demanda do profissional enfoque à doença oclusal em sua totalidade, o diagnóstico e a avaliação da extensão dos danos. Desta forma, este trabalho apresenta uma possibilidade de tratamento do desgaste dentário através de uma técnica restauradora adesiva direta, associada a uma técnica de ajuste oclusal.