Inverted Layering Technique as a Biomimetic Procedure in a Multidisciplinary Resolution of Discolored Teeth: A Case Report.

The objective of this work is to report a restorative approach with composite resin applied in reverse in the aesthetic resolution of darkened anterior teeth. A 27-year-old female patient presented with the main complaint of dissatisfaction with the aesthetics of her smile due to dental darkening, a result of childhood trauma, without painful symptoms, pathological clinical signs or change in care. In the intraoral examination, a darkening of teeth 11 and 21 was observed, which radiographically showed thickening of the periodontal ligament, with disharmonious configuration of the marginal gingiva. From the clinical and radiographic characteristics, we opted for periodontal intervention for recovery and gingival levelling, followed by endodontic intervention and aesthetic restorative restoration. The restorative step was carried out sequentially by internal tooth bleaching, removal of dentin still pigmented after bleaching and enamel preservation. Soon after, it was restored in an alternative way and layered using a technique called reverse, using strips of polyethylene fiber over the dentin resin. The technique preserved the remaining enamel with the maintenance of the original remaining guides, proving to be a viable conservative alternative since of the diagnosis to the restorative conclusion in view of the longitudinal confirmation of the restorative efficacy after 1 year.

REANATOMIZAÇÃO DE DENTE CONÓIDE COM RESINA COMPOSTA POR MEIO DE TÉCNICA DE APLICAÇÃO SIMPLIFICADA / RESHAPING OF CONOID TOOTH WITH COMPOSITE RESIN USING A SIMPLIFIED APPLICATION TECHNIQUE

O sorriso com aparência agradável exerce grande influência na harmonia facial, eleva a autoestima e produz nas pessoas um sentido de autoafirmação social. Assim, fatores que interferem de modo significativo no sorriso, como dentes conóides, podem contribuir negativamente para o bem-estar e autoafirmação provenientes de um sorriso harmônico e, portanto, requerem intervenção, desde que o paciente manifeste o desejo de corrigir o problema. Dentes conóides têm alteração de tamanho, estrutura e forma, o que causa desarmonia na composição do sorriso. O presente trabalho apresenta um caso clínico de reanatomização por meio de técnica adesiva direta de um incisivo lateral, a fim de auxiliar na instalação de aparelho para correção ortodôntica. A técnica utilizada foi a preconizada pelo grupo Styleitaliano ® , como o objetivo desta técnica é simplificar os passos operatórios, apenas duas resinas de cor e uma de efeito foram utilizadas para restabelecer tamanho e forma dental. O trabalho concluiu que foi importante a integração entre a ortodontia e a estética para finalização de casos clínicos com características de alteração de forma.

A beautiful smile is often considered to have an important role on people's lives, since it contributes to self-confidence and social relationships. Therefore, dental discrepancies such as conoid teeth could affect negatively one's life and, as long as the patient desires, intervention should take place. Conoid teeth have significant alterations of basic anatomy, size and shape, which lead to a non-proportional smile. This case report regards to a reshape of a conoid lateral incisor, using direct composites, in order to help the orthodontic work. The chosen technique to provide this reshape was developed by the Styleitaliano ® group, in order to simplify the restorative steps, using only three composite shades (one for dentin, one for enamel and one for optical effect). This case report emphasizes that different dentistry areas, such as Cosmetic Dentistry and Orthodontics must perform together in order to achieve good results, especially in cases that require shape changes.

Chitosan incorporated in a total-etch adhesive system: antimicrobial activity against Streptococcus mutans and Lactobacillus casei.

The aim of this study was to investigate the antimicrobial effect of an experimental adhesive system containing chitosan (0.2% and 0.5%) against Streptococcus mutans and Lactobacillus casei. Twenty-four extracted human third molars were used, and 4 cavities were prepared in each tooth. The teeth were contaminated with either S mutans (n = 12 teeth, 48 cavities) or L casei (n = 12 teeth, 48 cavities) microorganisms. One cavity in each tooth received 1 of the following treatments: negative control (no treatment [NC]), positive control (Adper Single Bond 2 [SB]), an experimental adhesive containing chitosan 0.2% (CHI2), or an experimental adhesive containing chitosan 0.5% (CHI5). After sealing of the cavities and an incubation period, dentin scrapings were collected from each cavity for microbiological evaluation. Analysis of variance and Tukey tests revealed no statistically significant differences among the SB, CHI2, and CHI5 groups (P > 0.05), but all 3 differed significantly from the NC group (P ≤ 0.05). The concentrations of chitosan did not influence the antimicrobial effect against S mutans and L casei, presenting a similar effect to that of a conventional 2-step adhesive system.

Low shrinkage composite resins: influence on sealing ability in unfavorable C-factor cavities.

The present investigation observed the sealing ability of low shrinkage composite resins in large and deep cavities, placed and photocured in one increment. Large, deep cavities (5.0 mm diameter and 2.5 mm deep) surrounded by enamel were prepared in bovine teeth, which were then divided into five groups. Groups 1, 2, 3 and 4: acid conditioning + Adper Single Bond (3M/ESPE, St Paul, MN, USA) and restoration with Aelite LS Posterior (BISCO Inc. Schaumburg, IL, USA) (G1); Filtek Z-350 (3M/ESPE,St Paul, MN, USA) (G2); Filtek Z-350 Flow (3M/ESPE, St Paul, MN, USA) (G3); Premisa (KERR Corporation, Orange, CA, USA) (G4). Group 5: Silorane Adhesive system (3M/ESPE, St Paul, MN, USA) + restoration with Filtek Low Shrinkage Posterior P90 (3M/ESPE, St Paul, MN, USA). After polymerization, the teeth were immersed in 0.5% basic fuchsine solution and immediately washed. Using the Imagetool Software, the extent of dye along the margins was calculated as a percentage of total perimeter. The restorations were then transversally sectioned and the depth of dye penetration was calculated in mm, using the same software. Kruskal-Wallis analysis for all groups showed no statistical differences for extent (p = 0.54) or depth (p = 0.8364) of dye penetration. According to this methodology, the so-called low shrinkage composite resins had the same sealing ability compared to regular and flowable nanocomposite materials.

Avaliação da sensibilidade pós-operatória em restaurações diretas profundas utilizando sistemas adesivos autocondicionantes / Evaluation of postoperative sensitivity in deep direct restorations using self-etching adhesive systems

O propósito de presente estudo foi avaliar a sensibilidade pós-operatória (SPO) após 2 dias, 7 dias, 180 dias e 360 dias, em restaurações de dentes posteriores feitas com resina composta (Z-350, 3M-ESPE) associada a adesivos autocondicionantes. Foram realizadas 60 restaurações em 35 pacientes e os grupos experimentais foram assim delineados: GI= 20 cavidades tratadas com o sistema adesivo de três passos SBMU (3M-ESPE); GII= 20 cavidades tratadas com o sistema autocondicionante de dois passos Adper SE Plus (3M_ESPE); GIII= 20 cavidades tratadas com o sistema autocondicionante de um passo All Bond SE (BISCO). Após 48 horas, 7 dias, 180 dias e 360 dias, os pacientes foram chamados para avaliação da SPO. Inicialmente, o relato do paciente era considerado e classificado de zero a três, de acordo com critérios previamente estabelecidos. Posteriormente, teste clínico com frio era realizado e classificado de zero a dez, de acordo com a escala visual analógica modificada. Os resultados foram analisados pelos testes não paramétricos de Kruskall-Wallis, para comparar os diferentes tratamentos ao longo do tempo; e teste de Friedman, para analisar o comportamento de cada sistema ao longo dos períodos. Os testes estatísticos não mostraram diferenças significativas de SPO para os grupos testados em todos os períodos avaliados. Os resultados mostraram que, nesse caso, a SPO não foi influenciada pelos sistemas autocondicionantes.

Low shrinkage composite resins: influence on sealing ability in unfavorable C-factor cavities

The present investigation observed the sealing ability of low shrinkage composite resins in large and deep cavities, placed and photocured in one increment. Large, deep cavities (5.0 mm diameter and 2.5 mm deep) surrounded by enamel were prepared in bovine teeth, which were then divided into five groups. Groups 1, 2, 3 and 4: acid conditioning + Adper Single Bond (3M/ESPE, St Paul, MN, USA) and restoration with Aelite LS Posterior (BISCO Inc. Schaumburg, IL, USA) (G1); Filtek Z-350 (3M/ESPE,St Paul, MN, USA) (G2); Filtek Z-350 Flow (3M/ESPE, St Paul, MN, USA) (G3); Premisa (KERR Corporation, Orange, CA, USA) (G4). Group 5: Silorane Adhesive system (3M/ESPE, St Paul, MN, USA) + restoration with Filtek Low Shrinkage Posterior P90 (3M/ESPE, St Paul, MN, USA). After polymerization, the teeth were immersed in 0.5 percent basic fuchsine solution and immediately washed. Using the Imagetool Software, the extent of dye along the margins was calculated as a percentage of total perimeter. The restorations were then transversally sectioned and the depth of dye penetration was calculated in mm, using the same software. Kruskal-Wallis analysis for all groups showed no statistical differences for extent (p = 0.54) or depth (p = 0.8364) of dye penetration. According to this methodology, the so-called low shrinkage composite resins had the same sealing ability compared to regular and flowable nanocomposite materials.

Sensibilidade pós-operatória em restaurações diretas extensas utilizando sistemas adesivos convencionais atuais / Postoperative sensitivity in large direct restorations using new total etch adhesive systems

O objetivo deste trabalho clínico foi avaliar a sensibilidade pós-operatória após 2, 7, 180 e 365 dias em restaurações de resina composta realizadas em cavidades amplas e profundas em dentes posteriores empregando-se três sistemas adesivos convencionais atuais (condicionamento ácido total+adesivo). Foram realizados 60 procedimentos restauradores pelo mesmo operador, divididos em três grupos com 20 amostras em cada: SB - ADPER SingleBond 2 (3M ESPE®); AB - All Bond 3 (Bisco®); e XP - XP Bond (Dentsply®). Todas as restaurações foram preenchidas com a resina Z350 (3M ESPE®) e os resultados foram submetidos aos testes de Kruskall Wallis e Friedman. Todos os resultados para sensibilidade pós-operatória foram semelhantes ao longo dos tempos testados.

Adhesive systems: important aspects related to their composition and clinical use.

This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and influence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classified according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specific acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and deficiencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplified ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

Clinical evaluation of postoperative sensitivity using self-etching adhesives containing glutaraldehyde.

The present clinical study aimed to assess the postoperative sensitivity (POS) after 48 hours and seven days in occlusal restorations bonded with three different adhesive systems, two of them containing glutaraldehyde. The restorative procedures were performed using the three-step etch-and-rinse Adper SBMP-Plus adhesive (SBMP), the two-step etch-and-rinse Gluma Comfort One Bond + Desensitizer adhesive (GC+D) and the all-in-one self-etching/priming I Bond (IB) adhesive, which also has glutaraldehyde in its formula. All cavities were restored with Filtek Supreme nanoparticle composite resin. After 48 hours and seven days the patients were recalled and the postoperative sensitivity evaluated. The data analyzed by non-parametric Friedman test showed no significant differences in POS among the three tested groups after 48 hours and seven days.

Clinical evaluation of postoperative sensitivity using self-etching adhesives containing glutaraldehyde

The present clinical study aimed to assess the postoperative sensitivity (POS) after 48 hours and seven days in occlusal restorations bonded with three different adhesive systems, two of them containing glutaraldehyde. The restorative procedures were performed using the three-step etch-and-rinse Adper SBMP-Plus adhesive (SBMP), the two-step etch-and-rinse Gluma Comfort One Bond + Desensitizer adhesive (GC+D) and the all-in-one self-etching/priming I Bond (IB) adhesive, which also has glutaraldehyde in its formula. All cavities were restored with Filtek Supreme nanoparticle composite resin. After 48 hours and seven days the patients were recalled and the postoperative sensitivity evaluated. The data analyzed by non-parametric Friedman test showed no significant differences in POS among the three tested groups after 48 hours and seven days.

Adhesive systems: important aspects related to their composition and clinical use

This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and infuence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classifed according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specifc acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and defciencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplifed ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

Cimentos autoadesivos: inter-relação dentina-cimento-pino / Self-adhesive luting cements: dentin-cement-post relationship

Os pinos pré-fabricados, cimentados nos condutos radiculares, são utilizados para aumentar a retenção do material de reconstrução e, em associação com a restauração indireta, aumentam a resistência do conjunto. O interior do conduto radicular é particularmente de difícil acesso e visualização. Assim, simplifica o protocolo de cimentação reduz a possibilidade de erros. Os cimentos autoadesivos, em virtude de sua fácil manipulação e aplicação, têm sido propostos para essa finalidade. No entanto, é necessário que a inter-relação desses materiais com a dentina e com o pino seja mais bem estudada e compreendida, bem como os aspectos relacionados à reação de polimerização. Sendo assim, este artigo tem como propósito apresentar informações das caracteristicas desse tipo de cimento, sua relação com a dentina e pino, com base em informações da literatura específica, bem como por meio de imagens obtidas com microscopia eletrônica de varredura (MEV).