Multidisciplinary approach for anatomical correction and diastema closure with laminates veneers: a clinical report / Abordagem multidisciplinar para correção anatômica e fechamento de diastemas com facetas laminadas: relato de caso clínico

Objective: multidisciplinary treatment has become increasingly common in dental offices and this treatment strategy is based on the achievement of a healthy, harmonious, and pleasant smile. In addition, the development of new ceramic systems and the possibility of making indirect restorations with a low thickness, such as laminates veneers, allowed combining highly satisfactory aesthetic properties, preserving the dental structure through minimally Invasive technique. Case report: this paper describes a multidisciplinary approach involving periodontics and restorative dentistry for the successful, functional, and aesthetic treatment in an adult patient. The digital smile design was performed as a guide to plan the clinical case considering factors such as tooth inclination and position, golden proportion, tooth size and shape. Discussion: based on these concepts, the present work reports, through a clinical case, the restoration of aesthetics and function with ceramic laminates veneers in lithium disilicate, in the case of anatomical correction and diastema closure. Conclusion: overall, the multidisciplinary treatment plan demonstrated to have greater advantages both for the aesthetics and function of the patient, as well as for the work team. During the 24-month follow-up, this case presented great functional and aesthetics results. (AU)

Introdução: o tratamento multidisciplinar tornou-se cada vez mais comum nos consultórios odontológicos, sendo uma estratégia baseada no tratamento da obtenção de um sorriso saudável, harmonioso e agradável. Além disso, o desenvolvimento de novos sistemas cerâmicos e a possibilidade de fazer restaurações indiretas com baixa espessura, como facetas laminadas, permitiram combinar propriedades estéticas altamente satisfatórias, preservando a estrutura dentária com o mínimo desgaste. Caso clínico: este artigo descreve uma abordagem multidisciplinar envolvendo Periodontia e Odontologia restauradora para um tratamento funcional e estético em um paciente adulto. O desenho digital do sorriso foi realizado como um guia para planejar o caso clínico, considerando fatores como inclinação e posição do dente, proporção áurea, tamanho e formato do dente. Discussão: com base nesses conceitos, o presente trabalho relata, através de um caso clínico, a restauração estética e funcional com laminados cerâmicos em dissilicato de lítio para correção anatômica e fechamento de diastemas. Conclusão: em geral, o plano de tratamento multidisciplinar demonstrou ter maiores vantagens tanto para a estética e função do paciente, quanto para a equipe de trabalho. Durante os 24 meses de acompanhamento, esse caso apresentou ótimos resultados funcionais e estéticos. (AU)

Delayed Light Activation Improves Color Stability of Dual-Cured Resin Cements.

PURPOSE: To evaluate the color change caused by post-irradiation conversion (ΔE24h and ΔE8 days ) and artificial aging (ΔEAGING ) of resin cements light activated through ceramics of different opacities immediately and 6 minutes after manipulating the material. MATERIALS AND METHODS: Resin cement disks (Allcem and LuxaCore) were light activated through ceramics (without ceramic, e.max HT, LT, and MO) immediately and 6 minutes after the manipulation (n = 10). Spectrophotometry was used to evaluate ΔE24h and ΔE8 days after 37˚C-dry-dark-storage for 24 hours and 8 days, and ΔEAGING after 60˚C-water-storage for 24 hours. Data were analyzed with three-way ANOVA and Tukey's HSD (α = 0.05). RESULTS: Regarding the post-irradiation color change, significant differences were found between the cements (p < 0.0001), light activation protocols (p = 0.037), and ceramics (p < 0.001). The immediate activation (16.2 ± 0.1) showed lower ΔE values than the delayed activation (16.5 ± 0.1). Ceramics influenced the ΔE values as follows: MO (14.0 ± 1.2) < LT (14.9 ± 1.2) ≈ HT (15.4 ± 1.2) < control (21.2 ± 1.2). Regarding ΔEAGING , significant differences were found between cements (p < 0.001), light activation (p = 0.006), and ceramics (p < 0.001). The delayed activation (8.4 ± 0.1) showed lower values than the immediate activation (8.9 ± 0.1). Ceramic spacers influenced ΔEAGING as follows: control (5.6 ± 0.2) < MO (6.6 ± 0.2) < HT (11.0 ± 0.2) ≈ LT (11.5 ± 0.2). CONCLUSION: The delayed light activation resulted in increased color stability, while the ceramic interposition resulted in lower color stability.

Titanium dioxide nanotubes addition to self-adhesive resin cement: Effect on physical and biological properties.

OBJECTIVES: This study has investigated the influence of Titanium dioxide nanotubes (TiO2-nt) addition to self-adhesive resin cement on the degree of conversion, water sorption, and water solubility, mechanical and biological properties. METHODS: A commercially available auto-adhesive resin cement (RelyX U200™, 3M ESPE) was reinforced with varying amounts of nanotubes (0.3, 0.6, 0.9wt%) and evaluated at different curing modes (self- and dual cure). The DC in different times (3, 6, 9, 12 and 15min), water sorption (Ws) and solubility (Sl), 3-point flexural strength (σf), elastic modulus (E), Knoop microhardness (H) and viability of NIH/3T3 fibroblasts were performed to characterize the resin cement. RESULTS: Reinforced self-adhesive resin cement, regardless of concentration, increased the DC for the self- and dual-curing modes at all times studied. The concentration of the TiO2-nt and the curing mode did not influence the Ws and Sl. Regarding σf, concentrations of both 0.3 and 0.9wt% for self-curing mode resulted in data similar to that of dual-curing unreinforced cement. The E increased with the addition of 0.9wt% for self-cure mode and H increased with 0.6 and 0.9wt% for both curing modes. Cytotoxicity assays revealed that reinforced cements were biocompatible. SIGNIFICANCE: TiO2-nt reinforced self-adhesive resin cement are promising materials for use in indirect dental restorations. Taken together, self-adhesive resin cement reinforced with TiO2-nt exhibited physicochemical and mechanical properties superior to those of unreinforced cements, without compromising their cellular viability.

In Vitro Evaluation of Dentin Hydraulic Conductance After 980 nm Diode Laser Irradiation.

BACKGROUND: Dentin hypersensitivity treatments are based on the physical obliteration of the dentinal tubules to reduce hydraulic conductance. The aim of the present study is to evaluate the hydraulic conductance of bovine root dentin after irradiation with a 980-nm diode laser, with or without associated fluoride varnish. METHODS: Sixty bovine root dentin specimens were divided into six groups (n = 10 in each group): G1, G3, and G5 (0.5 W, 0.7 W, and 1 W diode laser, respectively); G2, G4, and G6 (fluoride varnish application + 0.5 W, 0.7 W, and 1 W diode laser, respectively). The dentin hydraulic conductance was evaluated at four time periods with a fluxmeter: 1) with smear layer, 2) after 37% phosphoric acid etching, 3) after the treatments, and 4) after 6% citric acid challenge. After the dentinal fluid flow measurements, specimens were also evaluated for mineral composition using energy dispersive X-ray spectroscopy (EDS). RESULTS: Analysis demonstrated a better result with increased irradiation power (P < 0.001), especially if the diode laser irradiation was associated with the application of fluoride varnish (P < 0.001), ensuring a greater reduction in permeability. Considering the groups treated only with laser irradiation, the 1 W group was superior when compared with the 0.5 W and 0.7 W irradiated groups immediately after treatment (P < 0.001). After citric acid testing, all groups showed similar results, except when comparing the 1 W groups with the 0.5 W groups (P = 0.04). EDS results of the irradiated groups showed an increase in the proportion of calcium and phosphorus ions, which demonstrates a superficial composition modification after laser treatments. CONCLUSION: Laser irradiation of exposed dentin promoted significant reduction in the dentin hydraulic conductance, mainly with higher energy densities and association with fluoride varnish.

Prosthetic rehabilitation and management of an MTA-treated maxillary central incisor with root perforation and severe internal resorption.

Root canal perforation and root resorption are challenging clinical conditions to correctly diagnose and treat, especially when they occur in anterior teeth. This clinical report describes the computed tomography findings, endodontic treatment, prosthetic rehabilitation, and clinical outcome of an iatrogenic root perforation and internal resorption in a maxillary central incisor. The case management consisted of endodontic retreatment, periodontal surgery, and prosthetic rehabilitation. Gray mineral trioxide aggregate (MTA) was used to fill the resorption space and seal the perforation. The prosthetic treatment was performed with glass fiber-reinforced dowels and all-ceramic crowns. No signs or symptoms, including discomfort, pain, or esthetic defects were observed in 30 months of follow-up.

Network structures of Bis-GMA/TEGDMA resins differ in DC, shrinkage-strain, hardness and optical properties as a function of reducing agent.

OBJECTIVES: To evaluate the influence of different tertiary amines on degree of conversion (DC), shrinkage-strain, shrinkage-strain rate, Knoop microhardness, and color and transmittance stabilities of experimental resins containing BisGMA/TEGDMA (3:1wt), 0.25wt% camphorquinone, 1wt% amine (DMAEMA, CEMA, DMPT, DEPT or DABE). Different light-curing protocols were also evaluated. METHODS: DC was evaluated with FTIR-ATR and shrinkage-strain with the bonded-disk method. Shrinkage-strain-rate data were obtained from numerical differentiation of shrinkage-strain data with respect to time. Color stability and transmittance were evaluated after different periods of artificial aging, according to ISO 7491:2000. Results were evaluated with ANOVA, Tukey, and Dunnett's T3 tests (α=0.05). RESULTS: Studied properties were influenced by amines. DC and shrinkage-strain were maximum at the sequence: CQ