Photobiomodulation Therapy in the Management of Late Complications After Facial Filling.

The aim of the present study is to report a clinical case of a patient diagnosed with a late adverse reaction to the injection of filler material - persistent and intermittent delayed swelling (PIDS) - in which photobiomodulation therapy (PBMT) with low-power laser was used for edema reduction. This is an observational, descriptive, and retrospective work of a case report. The female patient, aged 73 years old, had undergone dermal filler six years before and complained of increased volume in the face region (glabellar region, labiomental sulcus, and nasolabial folds) and was submitted to ultrasound and anatomopathological analysis. PBMT using a low-power laser (660 nm and 808 nm, simultaneous irradiation, in contact, 2 J/point, 100 mW) proved to be effective for the non-invasive approach of late adverse reaction to dermal filler, such as PIDS, a common complication related to the use of dermal fillers.

Antimicrobial Photodynamic Therapy in the Approach of Complication After Implantation of Spiculated Polydioxanone Threads.

The present manuscript is a clinical case report in which antimicrobial photodynamic therapy (aPDT) - using a low-power laser (660 nm) associated with methylene blue photosensitizer (0.01%) - was considered for treating a case of complication after implantation of spiculated polydioxanone (PDO) threads, an aesthetic procedure worldwide performed in facial cosmetic non-surgical procedures. A 72-year-old female patient presented an infection in the face region where the PDO thread was implanted (mandible angle). After divulsion and local drainage, it was decided to associate aPDT using a low-level laser associated with a 0.01% methylene blue photosensitizer. Two sessions of aPDT were performed - on sequential days - and within 48 hours the region was dry and without signs of secretion. The use of aPDT seems to be a promising and effective option in cases of infections after implantation of PDO threads, consisting of a safe technique, of low execution complexity and without adverse effects.

Modified technique for esthetic crown lengthening in the natural dentition: case series.

AIM: The objective of the present case series was to propose a modified technique for esthetic crown lengthening surgery (ECLS) and a new method for categorizing esthetic parameters in terms of the gingival tissue as well as to assess treatment outcomes after 6 months. MATERIALS AND METHODS: Patients seeking ECLS were enrolled according to inclusion and exclusion criteria that are decribed in the materials and methods criteria. Digital photographs were obtained at baseline and at 6 months postsurgery. Soft tissue cone beam computed tomography (ST-CBCT) was performed at baseline, and the dimensions of the periodontal tissue were digitally measured. All patients were submitted to the modified ECLS. Periodontal esthetic outcomes were evaluated according to the crown lengthening esthetic score (CLES) system. The mean CLES and its subdomains (gingival zenith [GZ], papillae, and gingival recession [GR]) were compared at baseline and 6 months using the paired t test and the Wilcoxon signed-rank test. RESULTS: Fifteen patients were assessed. At 6 months, the mean CLES (15.23 ± 2.49 to 20.30 ± 2.65), GZ (4.80 ± 1.17 to 7.28 ± 1.97), and papillae (4.62 ± 2.30 to 7.30 ± 0.95) presented statistically significant differences compared with baseline. GR did not present significant changes at 6 months. CONCLUSIONS: The modified ECLS technique effectively improved esthetic periodontal parameters in the present case series. The CLES system may be a useful tool for assessing ECLS outcomes.

Adhesion and optics: The challenges of esthetic oral rehabilitation on varied substrates-Reflections based on a clinical report.

Patients with challenging prosthodontic conditions require rehabilitation with a biological, functional, and esthetic approach. When one or more teeth are badly discolored, their restoration is problematic because poor appearance affects not only the crown but also the periodontal tissues. This clinical report describes a complex esthetic rehabilitation with conservative tissue management and ceramic restorations. Subepithelial connective tissue graft surgery and the replacement of a cast metal post with a glass fiber post addressed the problem of a discolored maxillary central incisor. The discolored right maxillary incisor was restored with a combination of a medium-opaque, lithium-disilicate ceramic coping to mask the dark root and to approximate the color of the other incisors. Subsequently, 6 ceramic veneers were placed. A knowledge of the materials' optical properties and adhesion possibilities helped solve this complex problem.

Periodontal considerations for adhesive ceramic dental restorations: key points to avoid gingival problems.

The stability and health of the periodontal tissues should be a common goal for all dental care providers with regard to natural or restored teeth as well as implant-supported restorations or any other type of prosthesis. The objective of this study was to address the key aspects to be respected when executing adhesive oral rehabilitations involving ceramic restorations, regardless of their thickness, and to reinforce the importance of each step to ensure the success and longevity of the treatment from a periodontal standpoint. This article reviews the fundamentals of the periodontics that relate directly or indirectly to adhesive ceramic dental restorations, and also addresses their clinical relevance.

Microtensile bond strength of etch-and-rinse and self-etch adhesives to artificially created carious dentin.

This article evaluates a pH-cycling model for simulation of caries-affected and caries-infected dentin (CAD and CID, respectively) surfaces, by comparing the bond strength of an etch-and-rinse and a self-etch adhesive system. For both adhesives, bonding to sound dentin (SD) showed that the microtensile bond strength (µTBS) values of SD, CAD, and CID were SD > CAD > CID (P < 0.05). Knoop microhardness number mean values followed the same trend. Adhesive systems were not able to totally penetrate into CAD and CID, forming more irregular resin-dentin interdiffusion zones and atypical resin tags than SD. The tested in vitro pH-cycling caries model allowed the evaluation of specific dentin substrate alterations in response to µTBS. The type of dentin and its histological structure played an important role in etch-and-rinse and self-etch bonding, as lower µTBS values were attained in CAD and CID.

Protocolo clínico para restaurações cerâmicas associadas a implantes em área estética / Clinical protocol for ceramic restorations combined with implants in aesthetic areas

A otimização dos resultados estéticos e funcionais em reabilitações implantos suportadas depende da sofisticação dos procedimentos técnicos, das condições teciduais adjacentes às restaurações, e da perfeita integração entre os elementos que compõem o sorriso. Para tanto, deve-se despender tempo e concentração durante a fase de planejamento do caso clínico, em caráter multidisciplinar. O presente artigo traz uma sequência de passos clínicos importantes para um diagnóstico correto, e para um plano e uma sequência de tratamento adequados, destacando a importância da instalação de implantes em um posicionamento tridimensional adequado, dentro do conceito de cirurgias guiadas pela restauração final - planejamento reverso. Além disso, o artigo aborda técnicas úteis para a preservação, o aumento e/ou a manipulação dos tecidos perimplantares, fundamentais ao alcance da estética e da estabilidade dos implantes no longo prazo.

Aesthetic and functional outcomes in dentistry depend on technical procedures, on the conditions of the tissues adjacent to restorations, and on the integration of ali the components of a smile. With this in mind, the dental team must invest time and focus during the planning phase of the clinical case, with a multidisciplinary approach. This article presents a sequence of clinical steps for a correct diagnosis, treatment plan and sequence, stressing the importance of installing implants in a correct three-dimensional position, within the concept of surgery guided by the final restoration - Restoration Driven. In addition, this article discusses useful techniques for the preservation, enhancement and/or manipulation of perimplantar tissues, which are essential to obtaining long term implant aesthetics and function.

Freqüência clínica dos biótipos periodontais considerando o formato geométrico dos incisivos centrais superiores / Clinical frequency of periodontal biotypes among different geometric forms of maxillary incisors

O objetivo deste estudo clínico foi avaliar a freqüência dos biótipos periodontais, considerando os diferentes formatos geométricos dos incisivos centrais superiores, através de parâmetros anatômicos dentários e gengivais. Quarenta voluntários foram agrupados de acordo com a forma dos incisivos centrais superiores (ICS, n = 10): retangular (grupo 1), triangular (grupo 2), quadrado (grupo 3) ou oval (grupo 4). Para cada voluntário, foi determinado o biótipo periodontal através de consenso entre 3 examinadores calibrados e foram medidos: o comprimento (CC) e a largura (LC) da coroa; a razão entre a largura e o comprimento da coroa (PLC); a altura do ponto de contato entre os ICS (APC); a distância entre os zênites gengivais dos ICS (ZG1); a distância entre os zênites gengivais do incisivo central e do incisivo lateral superiores (ZG2); a altura da papila entre os ICS (AP1); e a altura da papila entre o incisivo central e o incisivo lateral superiores (AP2). Os dentes quadrados obtiveram os menores valores de comprimento coronário (9,36 ± 0,97, p = 0,0012) e a maior proporção entre a largura e o comprimento da coroa (0,93 ± 0,06, p = 0,0001), quando comparados aos dos demais grupos. Os dentes triangulares apresentaram significativamente a maior distância (8,44 ± 0,89, p = 0,0438) considerando o parâmetro ZG2. O biótipo periodontal fino/festonado foi predominante no total de voluntários desse estudo (60%), e mais freqüente em indivíduos com dentes retangulares. Voluntários com dentes quadrados apresentaram maior freqüência de periodonto plano e espesso (60%), embora o teste exato de Fisher não tenha encontrado diferenças estatisticamente significantes entre os grupos.

The aim of this clinical study was to evaluate the frequency of periodontal phenotypes among different geometric forms of maxillary central incisors. Some clinical parameters such as tooth and papillae dimension, localization of contact points and distances between gingival vertices were also evaluated. Forty patients were selected and divided into 4 groups (n=10) according to geometric form of maxillary central incisors: rectangular (group 1), triangular (group 2), squared (group 3) or ovoid (group 4). Squared teeth showed the lowest coronal length values (9.36±0.97; p=0.0012 and the highest coronal width/length ratio (0.93±0.06; p=0.0001), when compared to the other groups. Thin and scalloped gingival phenotype was predominant in this clinical study (60%), and was frequent in groups 1, 2 and 4. In contrast, squared teeth (group 3) presented predominantly thick and plan gingiva. Nevertheless, Fisher’s exact test did not found any statistical difference among groups.

Prevalência e severidade da cárie e fluorose em escolares e pré-escolares de um município de médio porte sem água fluoretada / Prevalence and severity of dental caries and fluorosis in school children and preschool children in a medium size city without fluoridated water

O objetivo deste estudo foi verificar a prevalência e severidade da cárie e de fluorose em pré-escolares e escolares do município de Rio das Pedras, SP, município de médio porte, sem água fluoretada até o ano de 2001. Foram analisados os dados do Levantamento Epidemiológico em Saúde Bucal do Estado de São Paulo, coletados em 1998. A amostra foi composta de 165 crianças de 5 e 6 anos e 574 crianças de 7 a 12 anos, de ambos os sexos, sorteadas em escolas públicas e privadas da zona urbana. Foram utilizados os índices ceod e CPOD para cárie e o índice de Dean para a fluorose dentária, segundo os critérios da OMS (1997). Os resultados mostraram ausência de fluorose, porém elevada prevalência de cárie em ambas as faixas etárias: apenas 23% dos pré-escolares e 27,5% dos escolares estavam livres de cárie, com uma média de CPOD de 4,8 aos 12 anos, sendo assim, estes resultados ficaram distantes das metas da OMS para o ano de 2000. Portanto, a alta prevalência de cáries encontrada nos escolares e pré-escolares do município de Rio das Pedras sugere a necessidade de se adotar medidas preventivas e educativas em saúde bucal no município.

The purpose this study was to determine the prevalence and severity of dental caries and fluorosis in preschool children and school children in the city of Rio das Pedras, São Paulo, Brazil, where the fluordation public water supply began in the year 2001. The data used were those obtained in the 1998 epidemiologic dental survey carried out in the State of São Paulo. The study population consisted of 5 and 6-yr-old children (n = 165) and 7-12-yr-old children (n = 574), male and female, enrolled in public and private school located in the urban area. DMF-T Index, def-t Index, WHO criteria for caries diagnostic and Dean Index for fluorosis was used. The results demonstrated flurosis absence, however prevalence of dental caries was higher in all ages groups deciduous and permanent dentition both. Percentage of caries-free preschool was 23% and caries-free school children were 27.5%. Mean DMF-T was 4.8 at age 12. The WHO goal for the year 2000 of a mean DMFT index no more than 3 ate the age of 12 years and 50 percent 5 years of children caries-free was not achieved in this population. The high prevalence of dental caries found in school children and preschool children in the city of Rio das Pedras suggests a need for oral health education and preventive programs.

Contratação de polimerização: estratégias para minimizar seus efeitos em restaurações diretas / Polymeration shrinkage: strategies to minimize its effects on direct restorations

O objetivo deste estudo é revisar a literatura sobre as estratégias clínicas para minimizar os efeitos adversos da contração de polimerização dos compósitos, dentre elas, a forma de inserção da resina composta, o uso de materiais intermediários com propriedades elásticas e as técnicas de fotoativação. De acordo com a literatura, a combinação de mais de uma estratégia parece ser o método mais eficiente para garantir o sucesso clínico das restaurações diretas. Além disso, o julgamento crítico do adequado emprego dos compósitos pode influenciar o resultado final do tratamento restaurador.

Adhesive systems and secondary caries formation: Assessment of dentin bond strength, caries lesions depth and fluoride release.

OBJECTIVES: The present study evaluated the microtensile bond strength and caries formation on adhesive/dentin interfaces before and after dynamic chemical formation of secondary caries. METHODS: Restorations were prepared on the dentin surface of 80 bovine incisors using four adhesive systems: two fluoride-free (Single Bond and Clearfil SE Bond) and two fluoride containing (Optibond Solo Plus and Clearfil Protect Bond). The restored teeth were then sectioned into multiple slabs that were further trimmed at the bonded interface to a cross-sectional area of 1 mm2. Half of the slabs were subjected to secondary caries formation using a pH cycling model (treated groups); while the other half was used as the control group (no pH cycling). The specimens designated for bond strength evaluation were subjected to microtensile bond strength test (muTBS). Caries lesions formation was assesses by polarized light microscopy at different depths from the adhesive-dentin bonded interface. The fluoride ion concentration was evaluated using the de/remineralization solutions (De/Re). RESULTS: No differences in muTBS were observed among the adhesive systems in both the control and treated conditions. Secondary caries significantly reduced the values of muTBS for all adhesives (p<0.05). Optibond Solo Plus presented the lowest caries formation at 5 microm depth. Fluoride concentrations present in the De/Re were less than 0.03 ppm, regardless of the adhesive system tested. SIGNIFICANCE: Bond strength values significantly decreased after in vitro secondary caries formation. Fluoride present in adhesive systems is not capable of inhibiting secondary caries or maintaining bond strength values following caries formation.

Photosensitization of in vitro biofilms by toluidine blue O combined with a light-emitting diode.

In natural ecosystems, micro-organisms grow preferentially attached to surfaces, forming matrix-enclosed biofilms. The aim of this study was to determine photodestruction levels in biofilms after subjecting them to photodynamic therapy. Biofilms of Streptococcus mutans, S. sobrinus, and S. sanguinis were grown on enamel slabs for 3, 5 or 7 d. Both the number of viable micro-organisms and the concentration of water-insoluble polysaccharides were analysed, and mineral loss (DeltaZ) analyses were performed on the enamel slabs. The antimicrobial potential of toluidine blue O (0.1 mg ml(-1)), associated with 85.7 J cm(-2) of a light-emission diode, was evaluated on the viability of 5-d biofilms. Both the number of micro-organisms and the concentration of water-insoluble polysaccharide increased with the age of the biofilms. A significant reduction ( approximately 95%) in viability was observed for S. mutans and S. sobrinus biofilms following photosensitization, with a > 99.9% reduction in the viability of S. sanguinis biofilms. In conclusion, a biofilm model was shown to be suitable for studying changes in bacterial numbers and enamel mineralization and for demonstrating the potential value of photosensitization in the control of in vitro biofilms.

Chemical or microbiological models of secondary caries development around different dental restorative materials.

This study evaluated artificial secondary caries around restorative materials, induced by means of chemical or microbiological models. The following materials were used randomly to restore 130 dental blocks: (1) zinc-oxide eugenol-free temporary filling: Coltosol (Coltène/Whaledent Inc.; n = 30), (2) silver amalgam: Permite C (SDI Limited, n = 20), (3) composite resin: Filtek Z250 (3M ESPE; n = 20), (4) glass-ionomer cement: Fuji II (GC America Inc.; n = 20), (5) resin-modified glass ionomer: Vitremer (3M ESPE; n = 20), and (6) polyacid modified resin: Dyract AP (Dentsply; n = 20). Ten specimens of Group 1 were kept in humidity, and had no carious formation (NC). Ten specimens of each group were submitted to pH cycling (CG, n = 60), and the others were immersed in a medium containing Streptococcus mutans and sucrose (BG, n = 60). Mineral content was determined by microhardness assessment, and lesion depth was measured in polarized light photomicrographs. In the chemical model (CG), mineral content values in the vicinities of restoration were high for Groups 5 (75.7 +/- 11.9), 4 (70.8 +/- 14.2), and NC (95.4 +/- 3.8); intermediate for Groups 1 (55.8 +/- 18.5), 6 (45.6 +/- 11.0), and 2 (44.3 +/- 11.2); and reduced for Group 3 (34.7 +/- 9.7). In the microbiological model (BG), results were similar to CG, although there was less demineralization. The highest lesion depths were found for Groups 3 (182.3 +/- 33.2) in CG and 6 (126.5 +/- 42.8) in BG, when compared to Group 5 (114.6 +/- 26.0 and 56.2 +/- 33.2, respectively). In both models of caries induction, ionomeric materials showed a superior cariostatic effect when compared to the other restorative materials.

In vitro evaluation of caries inhibition promoted by self-etching adhesive systems containing antibacterial agents.

This study evaluated the cariostatic effect of antibacterial self-etching adhesive systems, by means of an in vitro bacterial caries model. Seventy-five prepared bovine slabs were randomly divided into groups (n=15): (1) unbonded composite, no carious challenge (UNB-NC); (2) unbonded composite, carious challenge (UNB-C); (3) Clearfil SE Bond, no antibacterial agent (CSE); (4) Protect Bond, containing MDPB and fluoride (PB); and (5) Reactmer Bond, fluoride-releasing (RB). All preparations were restored with Filtek Z-250. Groups (2)-(5) were submitted to a medium containing Streptococcus mutans (ATCC-- 25175) for 5 days, and Group (1) was kept in a noninoculated medium. Insoluble polysaccharides present in tooth biofilms were quantified, Knoop hardness (KHN) was measured on the enamel adjacent to restorations, and standard 35-mm polarized light photomicrographs were taken as illustrations. Polysaccharide and Knoop hardness results were analyzed with the use of ANOVA, with a split-split-plot statistical design for KHN. Except for Group (1), all groups showed similar caries formation. Biofilm over PB restorations showed the smallest amounts of polysaccharides (14.37 microg/mg), and CSE showed the highest amounts (20.87 microg/mg). All self-etching systems tested were unable to inhibit secondary caries in a bacterial model simulating a high caries challenge, even though there was reduced glucan synthesis provided by the adhesive system containing MDPB and fluoride.

Fluoride-releasing capacity and cariostatic effect provided by sealants.

This study evaluated the effect of sealants on enamel demineralization, focusing on physical protection of the sealed enamel and fluoride protection of the adjacent unsealed enamel. Occlusal fissures with areas measuring 12 mm2 were delimited in 48 extracted molars, randomly divided into 4 groups (n =12): 1) no sealing; 2) sealing with a resin-modified glass-ionomer (Vitremer, 3M ESPE); 3) sealing with a fluoride-releasing composite sealant (Clinpro Sealant, 3M ESPE); and 4) sealing with a non-fluoridated composite sealant (Concise, 3M ESPE). A 4-mm2 window was outlined on the buccal enamel for analysis of fluoride uptake. Following treatment, groups 2, 3 and 4 were subjected to 5-days of pH-cycling, while group 1 was kept in a moist environment at 37 degrees C. Fluoride uptake was assessed by dental biopsy, and the amount of fluoride released to the cycling solutions was determined by ion analysis. Enamel demineralization around the sealants was evaluated by cross-sectional micro-hardness analysis. Group 2 showed higher levels of fluoride release (P < 0.01) and uptake by enamel (P < 0.05), and lower levels of demineralization (P < 0.05) than groups 3 and 4. Group 3 exhibited reduced demineralization on unsealed enamel and provided fluoride uptake in a distant enamel area, while group 4 did not.

Microleakage at the composite-repair interface: effect of different surface treatment methods.

This study evaluated microleakage at the composite-repair interface after using different methods of surface treatment. Eighty resin composite specimens (Filtek Z250, 3M Dental Products) aged in artificial saliva for three months were divided into four groups (n=20) according to the following surface treatment methods: untreated control-no roughening or abrasion of the surface; roughening with diamond burs; jet prophylaxis with sodium bicarbonate particles and air abrasion with 50 microm aluminum oxide particles. Each method was examined using scanning electron microscopy (SEM) to evaluate changes in surface topography. All groups were then etched with 37% phosphoric acid, coated with a bonding agent (Single Bond, 3M Dental Products) and received new resin applications. The samples were then thermocycled (800 cycles/5 degrees C to 55 degrees C [+/- 2]) and immersed in 2% methylene blue buffered dye solution (7.0 pH) for four hours. Three examiners measured the extent of microleakage in a stereoscope microscope using four representative scores. For all experimental groups, no significant difference in repair microleakage was identified by the Kruskal-Wallis test (p>0.05). Therefore, different testing methods of surface treatment showed the same effect on dye penetration along the repair interface.

Diagnóstico de lesões cariosas em superfície oclusal / Occlusal caries diagnosis

A redução na prevalência mundial da doença cárie e as alterações no seu padrão de desenvolvimento e aspecto clínico têm tornado ainda mais complexo o seu diagnóstico. Uma vez que os indivíduos podem apresentar níveis de atividade e severidade da doença associados a manifestações clínicas sutis ou mesmo subclínicas, deve-se atentar para um diagnóstico precoce e individualizado, que permita a instituição de medidas conservativas ao invés das invasivas. A desmineralização cariosa no sistema de fóssulas e fissuras é crítica, em função da microanatomia da superfície oclusal, o que, juntamente com a localização, dificulta a percepção visual de alterações nessa região. Métodos diagnósticos complementares têm sido desenvolvidos para auxiliar a detecção e o monitoramento de tais lesões, embora forneçam informações estáticas, as quais não devem ser consideradas isoladamente. A associação entre o exame clínico-anamnésico e alguns exames complementares permite determinar, individualmente, o risco, a atividade e a severidade da doença, além de caracterizar as lesões cariosas já estabelecidas. Reunindo-se essas informações, torna-se mais fácil decidir a terapêutica adequada