Three-year clinical evaluation of universal adhesives in non-carious cervical lesions.

PURPOSE: To compare the performance of universal adhesives containing different monomers, namely 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and dipentaerythritol penta-acrylate monophosphate (PENTA), in the restoration of non-carious cervical lesions (NCCLs). METHODS: This was a randomized controlled clinical trial involving 63 subjects in need of restorations of 203 NCCLs. Notch-shaped lesions were restored with Kalore (GC Corporation) after application of Scotchbond Universal (SU) or Prime&Bond Elect (PBE) following the etch-and-rinse (ER) or self-etch (SE) technique. Restorations were assessed after 1 week, 18 and 36 months. Logistic regression was performed for each outcome separately with compound symmetric variance-covariance structure assumed to consider a correlation of restorations within subjects. All analyses were conducted using SAS 9.4 (SAS). RESULTS: 150 teeth in 41 subjects were assessed at 36 months. Three restorations in the PBE_SE group failed the retention criterium. Statistically significant differences were reached for the following comparisons: restorations with SU_SE were 75% less likely to maintain a score of Alfa for marginal discoloration than PBE_SE; restorations with PBE_SE were 83% less likely to maintain a score of Alfa for marginal adaptation than PBE_ER. CLINICAL SIGNIFICANCE: More than 20% of restorations restored with universal adhesives developed marginal degradation after 36 months. The impact of phosphoric acid on the restoration seems to be material-dependent.

Effect of Silanization on Microtensile Bond Strength of Different Resin Cements to a Lithium Disilicate Glass Ceramic.

AIM: This study evaluated the influence of a silane-coupling agent on the bond strength of a self-adhesive cement and a conventional resin cement to a lithium disilicate glass ceramic. MATERIALS AND METHODS: A total of eight ceramic blocks were fabricated and divided into four groups (n = 2). In groups 1 and 3, ceramic surfaces were etched with hydrofluoric acid 10% for 20 seconds, rinsed for 30 seconds, and air-dried. One layer of a silane agent was applied onto all ceramic specimens and air-dried for 30 seconds. In groups 2 and 4, ceramic surfaces were etched with hydrofluoric acid, rinsed, and air-dried without application of the silane-coupling agent. The ceramic blocks were bonded to a block of composite with a self-adhesive resin cement or with a conventional resin cement, according to the manufacturer's instructions. After 24 hours in distilled water at 37°C, the specimens were sectioned perpendicular to the bonding interface area to obtain beams with a bonding area of 0.8 mm(2) and submitted to a microtensile bond strength test at a crosshead speed of 0.5 mm/min. Data were statistically analyzed with one-way analysis of variance and the Games-Howell post hoc test (p = 0.05). Fractured specimens were examined under optical microscopy at 40x magnification. RESULTS: Silanization resulted in higher microtensile bond strength compared to groups without silane. No significant differences were found between the conventional resin cement and the self-adhesive resin cement with silane agent (p = 0.983), and without silane agent (p = 0.877). CONCLUSION: Silanization appears to be crucial for resin bonding to a lithium disilicate-based ceramic, regardless of the resin cement used. The self-adhesive resin cement performed as well as the conventional resin cement. CLINICAL SIGNIFICANCE: Applying one layer of a silane-coupling agent after etching the ceramic surface with hydrofluoric acid 10% enhanced the bond strength between resin cements and a glass ceramic.

Evaluation of microtensile bond strength of self-etching adhesives on normal and caries-affected dentin.

The purpose of this study was to evaluate the µTBS (microtensile bond strength) of currently available self-etching adhesives with an experimental self-etch adhesive in normal and caries-affected dentin, using a portable hardness measuring device, in order to standardize dentin Knoop hardness. Normal (ND) and caries-affected dentin (CAD) were obtained from twenty human molars with class II natural caries. The following adhesive systems were tested: Mega Bond (MB), a 2-step self-etching adhesive; MTB-200 (MTB), an experimental 1-step self-etching adhesive (1-SEA), and two commercially available one-step self-etching systems, G-Bond Plus (GB) and Adper Easy Bond (EB). MB-ND achieved the highest µTBS (p<0.05). The mean µTBS was statistically lower in CAD than in ND for all adhesives tested (p<0.05), and the 2-step self-etch adhesive achieved better overall performance than the 1-step self-etch adhesives.

Compósitos em incisivos lateriais conoides: ciência e arte / Composite resin restorations in peg-shaped lateral incisors: science and art

A presença de incisivos laterais conoides compromete a harmonia do sorriso. O presente artigo tem como objetivo apresentar um relato de caso de reanatomização de laterais conoides, com consequente fechamento dos diastemas anterossuperiores e restabelecimento de guia canina. Entre as opções de tratamento optou-se pela restauração direta com resina composta por apresentar-se como o método que melhor se adaptou às expectativas e anseios da paciente. Ao final, o processo resultou em um sorriso esteticamente agradável não somente em termos dentais, mas também com relação à face da paciente, proporcionando um aspecto harmonioso e natural ao sorriso...

Diastema and peg-shaped teeth may compromise patient’s smile harmony. This article presents a case report of reshaping peg-shaped lateral incisors and subsequent closure of the maxillary anterior spacing and reestablishment of the canine guidance. Among the treatment options, direct resin composite restoration was selected because it was the treatment that best adapted to the expectations and desires of the patient. An excellent result was achieved with an aesthetically pleasing smile not only in dental terms, but also in relation to the face of the patient...

Clareamento interno/externo para dentes desvitalizados / Inside/Outside bleaching of nonvital teeth

A alteração de cor dos dentes isolados pode impactar negativamente na autoestima dos indivíduos, portanto é necessária a seleção de um tratamento adequado para a resolução de cada caso. Este caso clínico objetivou demonstrar o tratamento de um dente isolado com descoloração dental mediante clareamento dental do tipo interno/externo. O procedimento consistiu na realização do tratamento clareador do tipo interno/externo no dente escurecido e tratamento clareador caseiro nos demais dentes. O resultado apresentou-se satisfatório, especialmente pelo fato de ser uma opção de tratamento conservadora, efetiva e de custo-benefício favorável, a qual permite que opções menos conservadoras, como coroas e facetas, possam ser realizadas futuramente, caso houver necessidade.

Single discolored tooth can impact negatively the self-esteem of the individual, therefore selecting the most appropriate treatment for the resolution of each case is necessary. The aim of this case report was to demonstrate the treatment of a single discolored tooth, through the inside/ouside bleaching technique. Treatment planning consisted in internal/external bleaching of the single discolored tooth and home bleaching technique of the other teeth. A satisfactory result was obtained, in addition to being a conservative, effective and cost-effective treatment option. This allows for less conservative options, such as crowns and veneers, to be performed in the future, if necessary.

Influence of surrounding wall thickness on the fatigue resistance of molars restored with ceramic inlay.

The purpose of this study was to evaluate the influence of buccal and lingual wall thickness on the fatigue resistance of molars restored with CAD/CAM ceramic inlays. Forty human third molars were selected and divided into 4 groups, according to the remaining surrounding wall thickness chosen for inlay preparation (n=10): G1, 2.0 mm; G2, 1.5 mm; G3, 1.0 mm; G4, 0.5 mm. All inlays were made from feldspathic ceramic blocks by a CAD/CAM system, and cemented adhesively. After 1 week stored in distilled water at 37 °C, the specimens were subjected to fatigue testing under the following protocol: 5Hz; pre-load of 200 N for 5,000 cycles, followed by increasing loads of 400, 600, 800, 1000, 1200 and 1400 N for 30,000 cycles each. The specimens were cycled until failure or completion of 185,000 cycles. The survival rate of the groups was compared using the Kaplan-Meier survival curves (p>0.05). All specimens withstood the fatigue protocol (185,000 cycles), representing a 100% survival rate. The Kaplan-Meier survival curves showed no difference between groups. It can be concluded that the remaining tooth wall thickness did not influence the fatigue resistance of molars restored with CAD/CAM ceramic inlays.

Prótese parafusada por lingual: uma alternativa protética para implantes vestibularizados: relato de caso clínico / Lingual screw-retained prostheses: an alternative solution for buccal positioned implants: a case report

A Implantodontia tem demonstrado que a colocação de implantes não é uma tarefa das mais difíceis. A dificuldade reside em posicionar os implantes adequadamente para instalação, de maneira que o clínico possa optar pelo melhor sistema de retenção, de acordo com sua opinião: parafusada, cimentada ou cimentada-parafusada. Os problemas gerados por implantes malposicionados têm trazido muitas complicações na hora de confeccionar as próteses. Na tentativa de ilustrar uma forma de resolução desses problemas, o presente trabalho descreve um caso clínico de prótese unitária parafusada por lingual. Na região do primeiro molar inferior esquerdo, um implante – que havia sido instalado com inclinação vestibular – teve sua posição corrigida por meio desse sistema de retenção de prótese. Assim, conferiu-se ao trabalho protético estética vestibular sem aparecimento de cinta metálica, estética oclusal semelhante à das coroas cimentadas e, ao mesmo tempo, reversibilidade.

Implantology has shown that the insertion of implants is not one of the most difficult task. The difficulty lies in properly positioning the implant to be installed so that the clinician can choose the best retention system, according to his opinion: screwed, cemented or screwed-cemented. The problems caused by misplaced implants have brought many complications at the time of manufacturing the prosthesis. In an attempt to illustrate one way of solving these problems, this paper describes a clinical case of a single crow prosthesis screwed by lingual. In the region of the lower left first molar, an implant - which had been installed with vestibular inclination - had its position adjusted by means of this prosthesis retention system. Thus, it was given to prosthetic work buccal aesthetics appearance without showing the metallic collar, occlusal esthetics similar to that of cemented crowns and, at the same time, reversibility.