Restablecimiento oclusal mediante procedimientos multidisciplinarios / Occlusal restoration by multidisciplinary procedures

RESUMEN Introducción: El edentulismo es la pérdida total o parcial de dientes, ocasionado principalmente por la caries y la enfermedad periodontal; es un proceso gradual que está comúnmente asociado al aumento de edad. Actualmente es considerado una discapacidad debido a la limitación funcional que ocasiona en quien lo presenta. Objetivo: Exponer el tratamiento rehabilitador multidisciplinario, funcional y estético en un paciente con desarmonías oclusales. Presentación del caso: Paciente masculino de 74 años, diagnosticado con edentulismo parcial bimaxilar, mediante examen clínico y radiológico. Se sometió a terapia periodontal generalizada, cirugía preprotésica, restauración de plano oclusal de forma directa e indirecta y rehabilitación bucal con prótesis removibles total superior y parcial inferior; lo cual le permitió recuperar funcionalidad, estética y autoestima. Conclusiones: El edentulismo desencadena alteración en el estado funcional y emocional del paciente. Un diagnóstico integral y plan de tratamiento multidisciplinario y ordenado desencadenó éxito en el presente caso(AU)

ABSTRACT Introduction: Edentulism is total or partial tooth loss mainly caused by dental caries and periodontal disease. It is a gradual process often associated to aging. At present edentulism is considered to be a disability, due to the functional limitations undergone by sufferers. Objective: Describe the multidisciplinary, functional and esthetic rehabilitation treatment provided to a patient with occlusal disharmony. Case presentation: A 74-year-old male patient was diagnosed with bimaxillary partial edentulism based on clinical and radiographic examination. The patient underwent generalized periodontal therapy, pre-prosthetic surgery, direct and indirect occlusal plane restoration, and oral rehabilitation with total upper and partial lower removable prostheses, as a result of which he recovered his functionality, esthetic appearance and self-esteem. Conclusions: Edentulism triggers changes in the functional and emotional state of patients. Comprehensive diagnosis and orderly multidisciplinary treatment led to success in the case herein presented(AU)

Does the adhesive strategy influence the post-operative sensitivity in adult patients with posterior resin composite restorations?: A systematic review and meta-analysis.

OBJECTIVES: A systematic review and meta-analysis were performed on the risk and intensity of postoperative sensitivity (POS) in posterior resin composite restorations bonded with self-etch (SE) and etch-and-rinse (ER) adhesives. SOURCE: A comprehensive search was performed in the MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE without restrictions. The abstracts of the annual conference of the IADR (1990-2014), unpublished and ongoing trials registry were also searched. Dissertations and theses were searched using the ProQuest Dissertations and Periodicos Capes Theses databases. STUDY SELECTION: We included randomized clinical trials that compared the clinical effectiveness of SE and ER used for direct resin composite restorations in permanent dentition of adult patients. The risk/intensity of POS was the primary outcome. The risk of bias tool of the Cochrane Collaboration was used. The meta-analysis was performed on the studies considered 'low' risk of bias. DATA: After duplicates removal, 2600 articles were identified but only 29 remained in the qualitative synthesis. Five were considered to be 'high' risk of bias and eleven were considered to be 'unclear' in the key domains, yielding 13 studies for meta-analysis. The overall relative risk of the spontaneous POS was 0.63 (95% CI 0.35 to 1.15), while the stimuli-induced POS was 0.99 (95% CI 0.63 to 1.56). The overall standardized mean difference was 0.08 (95%CI -0.19 to 0.35). No overall effect was revealed in the meta-analyses, meaning that no influence of the ER or SE strategy on POS. SIGNIFICANCE: The type of adhesive strategy (ER or SE) for posterior resin composite restorations does not influence the risk and intensity of POS. CRD42014006617.

Influence of rubber dam isolation on human pulp responses after capping with calcium hydroxide and an adhesive system.

OBJECTIVE: The objective was to evaluate the influence of rubber dam isolation on the response of human pulps capped with calcium hydroxide and an adhesive system. METHODS AND MATERIALS: Direct pulp capping was performed in 40 caries-free human premolars scheduled for extraction as part of orthodontic treatment. The teeth were randomly divided into 8 groups (n = 5) according to the combination of treatment factors: capping agent (adhesive resin or calcium hydroxide), isolation (rubber dam or cotton pellets only), and period of evaluation (30 or 60 days). Class 2 cavities were prepared, and pulp exposures were created on the occlusal floor. After capping, all teeth were restored with Z-100 placed incrementally. After 30 or 60 days, patients were asked about their symptoms, teeth were extracted, and serial sections were evaluated. The data were subjected to a nonparametric test. RESULTS: Overall, the histologic features showed that the pulp response was worse for groups capped with adhesive. For adhesive-capped groups, the pulp response varied from pulp necrosis to acute inflammatory cell infiltrate, and most of the pulps capped without rubber dam isolation showed severe inflammatory cell infiltrate involving the coronal pulp with chronic abscesses. For the calcium hydroxide groups, all specimens showed dentin bridge formation, regardless of the type of isolation used. CONCLUSION: Calcium hydroxide should be used as the material of choice for pulp capping with or without rubber dam isolation. The use of adhesive systems in vital pulp capping is contraindicated, especially if rubber dam isolation is not implemented.

Effect of smear layer thickness and acidity of self-etching solutions on early and long-term bond strength to dentin.

OBJECTIVES: To evaluate the effect of smear layer thickness (SL) on early and 6-month bond strength (BS) of self-etching adhesives to dentin and to measure the ultimate microtensile strength (UTS) of the adhesives. METHODS: Clearfil SE Bond; Optibond Solo Plus Self-Etch Primer; Tyrian Self Priming Etchant (TY) and as controls, Single Bond (SB) and Scotchbond Multi-Purpose Plus (SBMP) were applied on flat superficial dentin surface with thick and thin SL thicknesses. After adhesive's application (n=6) a resin build-up was made. After 24h, resin-dentin beams (0.8mm(2)) were prepared to be tested immediately and after 6-month (6M) at 0.5mm/min. For the UTS measurement, hour-glass specimens were prepared with the bonding resin alone or after mixing (1:1). BS values were analyzed by three-way repeated measures ANOVA and Tukey's multiple comparison tests. Two-way ANOVA (bonding resin and bonding resin+self-etching primer) and Tukey's test were used for the UTS values. The bonding resins were re-evaluated separately by a one-way ANOVA and Tukey's test, since Single Bond is a one-bottle adhesive (alpha=0.05). RESULTS: The SL thickness was not significant (p=0.64). BS values were reduced after 6M, except for the SBMP. TY provided the lowest BS mean while SB and SBMP the highest BS. The UTS of the SBMP was the highest. TY yielded the lowest UTS. Regression analysis revealed a linear and significant relationship between the UTS of self-etch systems and the mean BS (R=0.95, p=0.02). CONCLUSIONS: The performance of a self-etching system does not seem to be dependent on the SL thickness. The total-etch, three-step system provided the highest BS to dentin and maintained the BS stable over 6 months. The performance of the self-etching systems can be envisaged by their UTS.