Abordagem multidisciplinar para o tratamento da reabsorção cervical externa: relato de caso / Multidisciplinary approach for the treatment of external cervical resorption: case report

Introdução: a reabsorção radicular é um processo patológico que resulta na perda de cemento, dentina e osso, sendo desencadeada por desequilíbrio entre osteoblastos e osteoclastos. O diagnóstico geralmente ocorre por meio de exame radiográfico e/ou tomográfico. Objetivo: relatar o tratamento de um caso de reabsorção cervical no dente #14 com abordagem multidisciplinar envolvendo Endodontia, Ortodontia, Periodontia e Prótese. Métodos: após realização de tomografia, verificou-se que a imagem correspondia a uma reabsorção cervical externa na raiz palatina, estendendo-se desde distal, seguindo para palatal e mesial. Após abertura e medicação intracanal, o endodontista optou por encaminhar a paciente para avaliação com ortodontista, sendo sugerida a realização de tracionamento ortodôntico, numa tentativa de expor a área da lesão. Para se atingir a posição final do dente, entre ativações de segunda e terceira ordens e ajustes oclusais, a etapa ortodôntica durou onze meses, incluindo três meses de contenção. Um mês antes de remover o aparelho ortodôntico e após um ano desde o início do tracionamento, realizou-se a obturação dos canais radiculares. Ainda com o dispositivo ortodôntico, foi realizada a cirurgia para correção do nível ósseo e gengival, que tende a acompanhar o dente, visualizando-se totalmente a área da reabsorção. Após um mês da cirurgia de aumento de coroa clínica, removeu-se o aparelho ortodôntico e realizou-se o tratamento protético com núcleo metálico fundido com liga de ouro e coroa em cerâmica com infraestrutura de zircônia. Conclusão: a partir de uma abordagem multidisciplinar, torna-se possível o tratamento de casos de reabsorções cervicais externas.

Morphology of root canal surface: A reflection on the process of cementation of the composite relined glass fiber post.

BACKGROUND: The present study was conducted to evaluate the bond strength in the different root thirds (premolars and maxillary central incisors) of composite relined glass fiber posts compared to untreated glass fiber posts cemented with dual- or chemical-cure cements. MATERIALS AND METHODS: Sixty human single-rooted premolars (flat canal) (n = 15) and 12 maxillary central incisors were used (round canal) (n = 3). The teeth were sectioned, and the roots received endodontic treatment. The standardized preparation of the canals was carried out, and the roots were randomly divided into four groups according to the cementation systems: G1: cemented posts (dual: Ambar/Allcem); G2: relined posts (dual: Ambar/Allcem); G3: cemented posts (chemical: Fusion Duralink/Cement Post); and G4: relined posts (chemical: Fusion Duralink/Cement Post). The roots were cut to give two slices of each third of the root canal per specimen. Push-out test was conducted at a speed of 0.5 mm/min. Data were analyzed by analysis of variance and Tukey's post hoc test (α = 0.05). RESULTS: There was no statistically significant difference between groups for the premolars (flat canal) (P = 0.959). There was a significant difference in the central incisors between the middle and apical thirds in the cemented group when using the dual system (P = 0.04) and between the middle and apical thirds (P = 0.003) and cervical and apical thirds (P = 0.033) when using the chemical system. CONCLUSION: Due to the anatomy of the root canal, flat canal of the premolars does not require relining, but round canal of the maxillary central incisors demands it for more secure in the bond strength.

Estratégia clínica para minimizar a fragilidade do remanescente radicular / Clinical strategy to minimize the fragility of the remaining root

As endocoroas adesivas (endocrowns) propiciam, comprovadamente, retenção e estética suficientes para suportar tensões e forças mastigatórias. Sua infraestrutura a base de dissilicato de lítio, suscetível ao condicionamento ácido e à silanização, fornece ótima adesão entre peça e cimento resinoso, proporcionando um bloco único entre remanescente dentário e coroa cerâmica. Pacientes jovens, com endodontia satisfatória, são bastante indicados para receber este tipo de tratamento, pois, ao ferulizar a raiz, a endocoroa oferece ao paciente a chance de ser submetido a uma futura intervenção sem a perda radicular. Desta forma, o profissional estará adiando o momento de um procedimento mais invasivo. No presente relato clínico, esta estratégia clínica visa minimizar a fragilidade do remanescente radicular, objetivando proporcionar ao paciente uma reabilitação estética e funcional menos invasiva e mais adequada para a sua idade

Light-activation through indirect ceramic restorations: does the overexposure compensate for the attenuation in light intensity during resin cement polymerization?

OBJECTIVES: This study evaluated the effects of light exposure through simulated indirect ceramic restorations (SICR) on hardness (KHN) of dual-cured resin cements (RCs), immediately after light-activation and 24 h later. MATERIAL AND METHODS: Three dual-cured RCs were evaluated: Eco-Link (Ivoclar Vivadent), Rely X ARC (3M ESPE), and Panavia F (Kuraray Medical Inc.). The RCs were manipulated in accordance to the manufacturers' instructions and were placed into cylindrical acrylic matrixes (1-mm-thick and 4-mm diameter). The RC light-activation (Optilux 501; Demetron Kerr) was performed through a glass slide for 120 s (control group), or through 2-mm or 4-mm thick SICRs (IPS Empress II; Ivoclar Vivadent). The specimens were submitted to KHN analysis immediately and 24 h after light-activation. The data obtained at the 2 evaluation intervals were submitted to 2-way ANOVA repeated measures and post-hoc Tukey's test (pre-set alpha of 5%). RESULTS: Lower KHN was observed when light-activation was performed through SICRs for Eco-Link at all evaluation intervals and for Rely X ARC 24 h later. For Panavia F, no significant difference in KHN was observed between control and experimental groups, regardless of evaluation interval. Most groups exhibited higher KHN after 24 h than immediately after light-activation, with the exception of Rely X ARC light-activated through SICR, as no significant difference in KHN was found between evaluation intervals. CONCLUSIONS: Light overexposure did not compensate for light intensity attenuation due to the presence of SICR when Rely X and Eco-Link were used. Although hardness of such RCs increased over a 24-h interval, the RCs subjected to light overexposure did not reach the hardness values exhibited after direct light exposure.

Light-activation through indirect ceramic restorations: does the overexposure compensate for the attenuation in light intensity during resin cement polymerization?

OBJECTIVES: This study evaluated the effects of light exposure through simulated indirect ceramic restorations (SICR) on hardness (KHN) of dual-cured resin cements (RCs), immediately after light-activation and 24 h later. MATERIAL AND METHODS: Three dual-cured RCs were evaluated: Eco-Link (Ivoclar Vivadent), Rely X ARC (3M ESPE), and Panavia F (Kuraray Medical Inc.). The RCs were manipulated in accordance to the manufacturers' instructions and were placed into cylindrical acrylic matrixes (1-mm-thick and 4-mm diameter). The RC light-activation (Optilux 501; Demetron Kerr) was performed through a glass slide for 120 s (control group), or through 2-mm or 4-mm thick SICRs (IPS Empress II; Ivoclar Vivadent). The specimens were submitted to KHN analysis immediately and 24 h after light-activation. The data obtained at the 2 evaluation intervals were submitted to 2-way ANOVA repeated measures and post-hoc Tukey's test (pre-set alpha of 5 percent). RESULTS: Lower KHN was observed when light-activation was performed through SICRs for Eco-Link at all evaluation intervals and for Rely X ARC 24 h later. For Panavia F, no significant difference in KHN was observed between control and experimental groups, regardless of evaluation interval. Most groups exhibited higher KHN after 24 h than immediately after light-activation, with the exception of Rely X ARC light-activated through SICR, as no significant difference in KHN was found between evaluation intervals. CONCLUSIONS: Light overexposure did not compensate for light intensity attenuation due to the presence of SICR when Rely X and Eco-Link were used. Although hardness of such RCs increased over a 24-h interval, the RCs subjected to light overexposure did not reach the hardness values exhibited after direct light exposure.

Efeito do carbopol como agente espessante sobre a rugosidade superficial do esmalte na técnica de clareamento dental caseiro / Effect of the thickener agent carbopol on dental enamel surface in the at-home dental bleaching

O objetivo deste estudo foi avaliar in vitro o efeito do clareamento caseiro sobre a rugosidade superficial do esmalte dental, utilizando agentes clareadores com e sem o carbopol e o efeito do tratamento com o agente espessante carbopol. Fragmentos de esmalte dental bovino com 3 x 3 mm foram obtidos, incluídos em resina de poliestireno e receberam polimento seqüencial. Em seguida, foram divididos aleatoriamente em 4 grupos, de acordo com o tratamento clareador: G1: peróxido de carbamida 10% com carbopol, G2: peróxido de carbamida 10% sem carbopol, G3: carbowax, e G4: carbopol. O tratamento clareador foi realizado por 6 horas diárias, permanecendo o restante do período em uma solução remineralizadora durante 4 semanas. Os corpos de prova permaneceram imersos na solução remineralizadora por um período adicional de 2 semanas. O efeito dos tratamentos clareadores sobre o esmalte dental foi comparado através da avaliação de rugosidade superficial com o parâmetro RA antes e após o 14, 28 e 42º dias do início do tratamento. A avaliação foi realizada por modelo de análise de variância, sendo em seguida utilizado o teste de Tukey. Após 28 dias de tratamento, todos os produtos testados diminuíram a rugosidade superficial do esmalte dental, permanecendo assim até 14 dias depois do término do tratamento.

The aim of this study was to evaluate in vitro the effect of the at-home dental bleaching on the enamel surface roughness after the use of bleaching agents with and without carbopol and the treatment with the thickner carbopol. Dental bovine slabs with 3 x 3 mm were obtained, embedded in polystyrene resin, and sequentially polished. They were randomized into four groups according to the bleaching treatment: G1: 10% carbamide peroxide with carbopol; G2: 10% carbamide peroxide without carbopol; G3: carbowax; and G4: carbopol. Four weeks of bleaching treatment was performed daily for 6 hours and immersed in artificial saliva for the remaining time. Follow that, the slabs were maintained in artificial saliva for 2 additional weeks. The effect of the bleaching treatments on the dental enamel was compared by surface roughness analyses employing the RA parameter obtained before and after 14th, 28th, and 42nd days of the treatment beginning. The results were statistically analyzed by ANOVA, followed by Tukey’s test. All beaching systems and thickeners agents reduced the enamel surface roughness over 28 days of treatment and also after 14 days after the end of the treatment.