Effect of simulated brushing on surface roughness and wear of bis-acryl-based materials submitted to different polishing protocols.

BACKGROUND: Provisional materials must have enough strength to withstand masticatory loads without suffering deformation or fracture, and their surfaces must have good finishing and polishing characteristics to reduce biofilm accumulation. Thus, the purpose of this study was to investigate the best polishing protocol for different bis-acryl composite resins in comparison with a conventional resin composite and a self-curing acrylic resin aiming to obtain a smooth restoration surface and resistance to wear. MATERIAL AND METHODS: One hundred and four samples (15 mm length x 5 mm width x 4 mm depth) were prepared and divided into four groups according to the material tested: Protemp 4 and Structur 3 bis-acryl composite resins, Dencor self-curing acrylic resin, Filtek Z350XT conventional composite resin. The polishing procedures were performed with Sof-Lex Pop-On discs or Sof-Lex spirals and abrasion procedures were performed on a brushing machine. The surface roughness was analyzed at three periods (initial, post-polishing and post-brushing) and the wear was evaluated after simulated brushing. The results were submitted to ANOVA followed by the Tukey (α = 0.05). RESULTS: Filtek Z350XT groups showed the lowest values of initial surface roughness followed by Structur 3, Protemp 4 and Dencor groups. After polishing and simulated brushing, Filtek Z350XT groups also presented the lowest roughness values, followed by bis-acryl groups (Structur 3 and Protemp 4) and Dencor groups demonstrated the highest surface roughness. Sof-Lex Pop-On discs system exhibited lower roughness values for all groups. CONCLUSIONS: Sof-Lex Pop-On discs system promoted the best polishing for all groups. Overall, Filtek Z350XT groups presented lower results for both roughness and wear for all periods evaluated, followed by Protemp 4 and Structur 3, meanwhile Dencor groups presented the highest roughness and wear values for all periods. Key words:Acrylic resin, bis-acryl, brushing, composite resin, polishing, roughness, wear.

Assessment of a conservative approach for restoration of extensively destroyed posterior teeth.

OBJECTIVE: Extensive restorations in posterior teeth always bring doubts to the clinicians regarding the best protocol, mainly when structures of reinforcement were lost. OBJECTIVE: This study aimed to evaluate the effect of beveling on the fracture resistance and pattern of class II (MOD) restored teeth. METHODOLOGY: Ninety human premolars were randomly assigned into 9 groups: CTR (control/sound); NC (cavity preparation, non-restored); RU (restored, unbeveled); RTB (restored, entire angle beveling); RPB (restored, partial/occlusal beveling); EC (endodontic access/EA, non-restored); EU (EA, unbeveled); ETB (EA, entire angle beveling); EPB (EA, partial/occlusal beveling). Teeth were restored with Esthet X resin composite and stored in distilled water for 24 h before the inclusion in PVC cylinders. The axial loading tests were performed with 500 kgF at 0.5 mm/min crosshead speed until fracture of the specimens. Fracture resistance and pattern were accessed and data were analyzed using one-way ANOVA and Tukey's HSD test (α=0.05). RESULTS: Mean (±SD) failure loads ranged from 136.56 (11.62) to 174.04 (43.5) kgF in the groups tested without endodontic access. For endodontically accessed teeth, fracture resistance ranged from 95.54 (13.05) to 126.51 (19.88) kgF. Beveling of the cavosurface angle promoted the highest fracture resistance values (p<0.05) and prevented catastrophic fractures. CONCLUSIONS: Cavosurface angle beveling is capable of improving fracture resistance and pattern for both endodonticaly accessed and non-accessed teeth.

Assessment of a conservative approach for restoration of extensively destroyed posterior teeth

Abstract Extensive restorations in posterior teeth always bring doubts to the clinicians regarding the best protocol, mainly when structures of reinforcement were lost. Objective This study aimed to evaluate the effect of beveling on the fracture resistance and pattern of class II (MOD) restored teeth. Methodology Ninety human premolars were randomly assigned into 9 groups: CTR (control/sound); NC (cavity preparation, non-restored); RU (restored, unbeveled); RTB (restored, entire angle beveling); RPB (restored, partial/occlusal beveling); EC (endodontic access/EA, non-restored); EU (EA, unbeveled); ETB (EA, entire angle beveling); EPB (EA, partial/occlusal beveling). Teeth were restored with Esthet X resin composite and stored in distilled water for 24 h before the inclusion in PVC cylinders. The axial loading tests were performed with 500 kgF at 0.5 mm/min crosshead speed until fracture of the specimens. Fracture resistance and pattern were accessed and data were analyzed using one-way ANOVA and Tukey's HSD test (α=0.05). Results Mean (±SD) failure loads ranged from 136.56 (11.62) to 174.04 (43.5) kgF in the groups tested without endodontic access. For endodontically accessed teeth, fracture resistance ranged from 95.54 (13.05) to 126.51 (19.88) kgF. Beveling of the cavosurface angle promoted the highest fracture resistance values (p<0.05) and prevented catastrophic fractures. Conclusions Cavosurface angle beveling is capable of improving fracture resistance and pattern for both endodonticaly accessed and non-accessed teeth.

Recuperando o guia incisal de um paciente com bruxismo: Relato de caso / Recovering the incisal guidance of a patient with bruxism: Case report

O objetivo do presente relato de caso clínico foi descrever a reabilitação estética e funcional dos incisivos anteriores superiores de um paciente com bruxismo. Paciente do gênero masculino, 23 anos de idade, bruxoma, procurou tratamento para os dentes anteriores superiores devido aos diastemas dentários e também por causa dos comprimentos reduzidos dos incisivos centrais superiores. Para isso, foi realizada a gengivoplastia e osteotomia na região dos incisivos centrais superiores com o objetivo de melhorar as posições dos contornos gengivais e aumentar o comprimento desses dentes. Após 90 dias, o clareamento dentário foi realizado. Depois de 1 mês as facetas de resina composta foram confeccionadas nos incisivos centrais superiores. Durante o tratamento as necessidades e perspectivas do paciente foram levadas em consideração para alcançar o sucesso clínico. Após a conclusão dos procedimentos, o resultado final foi satisfatório. Portanto, um plano de tratamento integrado se mostrou de extrema valia, principalmente quando o paciente é devidamente esclarecido das opções disponíveis de tratamento e colabora com o mesmo.

The objective of the present case report was to describe the aesthetic and functional rehabilitation of the upper anterior incisors of a patient with bruxism. A 23-year-old male patient, with bruxism, sought treatment for his upper anterior teeth due to diastemas and reduced lengths of the upper central incisors. The gingivoplasty and osteotomy were performed in the region of the upper central incisors to improve the positions of the gingival contours and increase the length of these teeth. After 90 days, teeth whitening was performed. After 1 month the composite resin veneers were made in the upper central incisors. During treatment, the needs and perspectives of the patient were considered to achieve clinical success. The treatments were finalized, and the final result was satisfactory. Therefore, an integrated treatment plan proved to be extremely important, especially when the patient is adequately informed of the available treatment options and collaborates with the treatment.

Two-year clinical evaluation of resin composite in posterior teeth: A randomized controlled study.

BACKGROUND: Clinical evaluations as fundamental method to prove the efficiency of restorative materials. AIM: This study evaluated the clinical performance of restorative systems during 2 years of clinical service. MATERIALS AND METHODS: This study assessed the clinical performance of restorative systems (Filtek Z250 and P60), during 2 years of clinical service, using the US Public Health Service system. The randomized and double-blind study comprising thirty volunteers. The restorations were evaluated at baseline, 6, 12, and 24 months. It was used the following criteria: marginal discoloration (MD), marginal integrity (MI), superficial texture (ST), wear (W), postoperative sensitivity (PS) and recurrent caries (RC). RESULTS: Statistic analysis was performed using Fisher's and McNemar's exact tests and Pearsons's Chi-square in a significance level of 5%. The results at baseline and 24 months for Group I were: MD - 100, 100%; MI - 100, 88.6%; ST - 100, 94.3%; W - 100, 94.3%; PS - 100, 100%; RC - 100, 100%, of alpha scores; Group II: MD - 100, 97.1%; MI - 100, 91.4%; ST - 100, 94.3%; W - 100, 91.4%; PS - 100, 100%; RC - 100, 100%, of alpha scores. It was observed no statistical difference in the evaluated criteria and period. CONCLUSIONS: After 24 months of evaluation, both restorative systems exhibited acceptable clinical performance.

Endocrown with Leucite-Reinforced Ceramic: Case of Restoration of Endodontically Treated Teeth.

A common problem encountered by dentists is the restorative treatment of nonvital teeth. When the pulp chamber presents appropriate conditions for retention, the endocrown is indicated. This monolithic, ceramic adhesive restoration is singularly used yet warrants wider recognition and use. The endocrown allows preservation of the tooth structure and is minimally invasive. Currently, this treatment option, of a core buildup and full coverage restoration, reduces tooth structure excessively. This treatment presents not only functional limitations but also aesthetic concerns. Recently, the VITA-PM9 system, a leucite-reinforced glass ceramic, has been increasingly used in a variety of clinical situations due to its satisfactory physical-mechanical and aesthetic properties. Therefore, the present study describes a case of surgical restoration of a nonvital tooth using the endocrown technique and the VITA-PM9.

Abordagem multidisciplinar na restauração de um dente posterior extensamente destruído - relato de caso / Extensive posterior tooth restoration with a multidisciplinary approach - case report

Entre os tipos mais frequentes de restaurações dentárias, destacam-se as restaurações dos tipos compostas e/ou complexas em dentes posteriores, sendo comum a perda de uma ou mais cúspides, necessitando de uma abordagem multidisciplinar. No contexto atual da Odontologia minimamente invasiva, as resinas compostas têm destaque importante, pois possibilitam a substituição de restaurações insatisfatórias sem sacrificar excessivamente as estruturas dentárias sadias. Esta característica importante permite a realização de restaurações extensas em dentes desvitalizados. Este relato de caso clínico objetiva descrever uma técnica restauradora de um dente posterior envolvendo uma abordagem multidisciplinar (periodontia, endodontia e dentística restauradora), apresentando e discutindo a sequência dos procedimentos adotados. Neste caso clínico foi realizada uma cirurgia periodontal com intuito de possibilitar a posterior restauração direta em resina composta, associada a um retentor intrarradicular reforçado com fibra de vidro. Dessa forma, com a evolução das técnicas e materiais disponíveis para os clínicos gerais e especialistas, esta abordagem possibilita a devolução da estética e da função em um pequeno número de sessões clínicas, com custo reduzido quando comparado aos tratamentos restauradores indiretos.

Complex or composite posterior teeth restorations are among the most common types, and the loss of one or more cuspids is very frequent and often requires a multidisciplinary approach. Within the context of minimally invasive Dentistry, composite resins are widely used since they allow the replacement of unsatisfactory restorations, avoiding excessive wear of the healthy tooth structure. This enables extensive restorations in devitalized teeth. This report aims to describe a restoration technique applied on a posterior tooth through multidisciplinary approach (periodontics, endodontics and restorative dentistry), presenting and discussing the adopted procedures. In this clinical case, a periodontal surgery was performed in order to allow the subsequent direct composite resin restoration associated with an intra-radicular fiber post. Thus, with the evolution of techniques and materials available to the general practitioner and specialists, direct restorations allow aesthetical and functional restoration with a small number of clinical sessions with a lower cost when compared to indirect restorations.

Use of restorative materials for direct and indirect restorations in posterior teeth by Brazilian dentists

Introduction: Often, dentists perform procedures aiming at more esthetical than long-term clinical performance of restorations. Objective: To evaluate the prevalence of use of different direct and indirect restorative materials in posterior teeth. Material and methods: In 2004, a questionnaire was applied to 486 dentists living at five geographical regions of Brazil. The dentists answered a questionnaire containing four questions, in which they reported the most widely used restorative material for direct (amalgam, composite resin, and glass ionomer) and indirect restorations (gold, silver, and copper/aluminum alloys, indirect resin composites, and ceramics) and specified the reason for using the material type selected. Results: In 2004, amalgam was the direct restorative material most used by dentists at almost all regions, except from South region, where resin composite was the most used. Esthetics was the main reason stated for the use of resin composites. As for indirect restorations, metallic restorations were the most used in Northeast (77.8%). No differences were found regarding the material type use between metallic and aesthetic materials at North, Southeast and Center-West regions. At South region, esthetic restorations were the most used. Conclusion: Despite the limitations of this present study, direct and indirect metallic restorations were the most common materials in 2004.

Cleidocranial dysplasia case report: remodeling of teeth as aesthetic restorative treatment.

Cleidocranial dysplasia (CCD), is an autosomal dominant disorder with a prevalence of 1 in 1,000,000 individuals. It is generally characterized by orofacial manifestations, including enamel hypoplasia, retained primary teeth, and impacted permanent and supernumerary teeth. The successful treatment involving a timing intervention (orthodontic-maxillofacial surgeons-restorative) is already described. However, the restorative treatment might improve the aesthetic final result in dentistry management for patients with cleidocranial dysplasia. Objective. Therefore, this clinical report presents a conservative restorative management (enamel microabrasion, dental bleaching, and direct composite resin) for aesthetic solution for a patient with CCD. Clinical Considerations. The cosmetic remodeling is a conservative, secure, and low cost therapy that can be associated with other procedures such as enamel microabrasion and dental bleaching to achieve optimal outcome. Additionally, the Golden Proportion can be used to guide dental remodeling to improve the harmony of the smile and the facial composition. Conclusions. Thus, dentists must know and be able to treat dental aesthetic problems in cleidocranial dysplasia patients. The intention of this paper is to describe a restorative approach with the cosmetic remodeling teeth (by grinding or addicting material) associated with enamel microabrasion and dental bleaching to reestablish the form, shape, and color of smile for patients with cleidocranial dysplasia.

O que o cirurgião-dentista que pratica a Odontologia deve saber a respeito do amálgama dentário / What the dentist should know about dental amalgam

Muitas organizações não governamentais, cientistas, docentes, dentistas, médicos, ativistas e advogados tem trabalhado incansavelmente para legislar sobre o fim do amálgama como material restaurador odontológico, cujos artigos e opiniões contribuem para incentivar a “terceira guerra” contra o amálgama. O UNEP concluiu as discussões sobre um acordo internacional, a Convenção de Minamata sobre o Mercúrio, que tem como objetivo reduzir os impactos ambientais significativos para a saúde devido … poluição atmosférica por mercúrio e inclui disposições que tratam de diversos produtos que contêm esse elemento químico. Alguns desses produtos deverão ser banidos a partir de 2020. As restaurações de am álgama não foram atingidas pela proibição, no entanto, o tratado sugere algumas disposições relativas … diminuição gradual de uso desse material, sem exigir medidas proibitivas ou prazo de banimento. Segundo o recente relatório do UNEP de 2013, as maiores fontes antropogônicas (atividades humanas) de contaminação ambiental pelo mercúrio estão associadas … mineração artesanal de ouro, … queima de carvão, produção de cimentos, metais ferrosos e não ferrosos. A quantidade de vapor liberado das restaurações de amálgama pela cremação para a atmosfera por ano em escala mundial não chega a atingir 1% do total emitido pelos demais setores de poluição. Com relação a possíveis vapores provocados por resíduos de amálgama, não existe nenhum dado registrado até 2013 pelo UNEP. Nos sistemas aquáticos pode-se encontrar a forma mais tóxica de mercúrio, o metilmercúrio ou orgânico, que pode se acumular nos peixes e mamíferos marinhos consumidos pelos seres humanos; além disso, neste ambiente o mercúrio inorgânico, não tóxico, e o elementar, menos tóxico, podem ser transformados no metilmercúrio. A maior parte da exposição humana aos riscos … saúde devido ao mercúrio ocorre a partir do consumo de alimentos como peixes marinhos e/ou de água doce.

Many non-governmental organizations, scientists, professors, physicians, dentists, lawyers and activists have been working tirelessly to legislate on the end of amalgam as a dental restorative material, their articles and opinions contribute to encourage the “third war” against amalgam. The UNEP concluded discussions on an international agreement, the Minamata Convention on Mercury, which aims to reduce the health impacts due to environmental impacts due to air pollution by mercury, and includes provisions dealing with various products containing this chemical element. Some of these products may be banned by 2020. Amalgam fillings were not affected by the ban, however, the treaty suggests some provision for gradual reduction of use of this material, but without requiring prohibitive measures or a term of banishment. According to the recent report of UNEP (2013), the largest anthropogenic sources (human activity) of environmental mercury contamination are associated with gold mining, burning of coal and cement, ferrous and nonferrous metals production. The amount of vapor released annually to atmosphere from cremation of amalgam does not reach 1% of the total issued by other sectors of pollution. Regarding possible vapor caused by amalgam residues, there is no data recorded until 2013 by UNEP. In aquatic ecosystems the most toxic form of mercury, methylmercury or organic mercury, can be found, it can accumulate in fish and marine mammals that are consumed by humans, also in this environment the inorganic mercury (non-toxic) and the elemental mercury (less toxic) can be converted into methylmercury.

Endocrown: avaliação da resistência dos cimentos dentários / Endocrown: assessment of resistance of dental cements

O sistema endocrown está sendo cada vez mais usado para restaurações de dentes posteriores com coroas amplamente destruídas e visa uma máxima preservação de estruturas dentais remanescentes. O tipo de cimentação usado nesses casos é fundamental para o sucesso clínico, já que o cimento é usado para selar a interface dente/restauração unindo-os por algum tipo de interação, seja ela mecânica e/ou química. O objetivo dessa pesquisa foi avaliar qual cimento é mais resistente quando submetidos ao teste de tração. Foram analisados três tipos de cimentos: Fosfato de zinco, ionômero de vidro e resinoso dual. Os testes foram realizados em próteses confeccionadas em resina acrílica e cimentadas em dentes bovinos previamente preparados de forma padronizada. Quando submetidos ao teste de ANOVA, o cimento resinoso dual e o fosfato de zinco apresentaram as maiores médias. Esta proximidade de resultados estimula maiores estudos com a cimentação de Endocrown com cimento convencional

The Endocrown system is being increasingly used for posterior restorations with crowns widely destroyed and aims for maximum preservation of remaining tooth structure. The type of cement used in these cases is crucial for clinical success, since the cement is used to seal the interface tooth/restoration joining them for some kind of interaction, whether mechanical and/or chemical. The purpose of this study was to evaluate which cement is more resistant when submitted to tensile test. Were analyzed three types of cements: zinc phosphate, glass ionomer, and resinous dual. The tests were performed in prostheses made of indirect composite resin and cemented in bovine teeth previously prepared in a standardized manner. When submitted to ANOVA test, the dual resin cement and zinc phosphate presented the highest means. This closeness results encourages further studies with cementation Endocrown with conventional cement

Endocrown para o tratamento de dentes despolpados / Endocrown: an alternative treatment for pulpless teeth

Um dos problemas odontológicos mais vivenciados pelos cirurgiões dentistas refere-se ao tratamento restaurador de dentes despolpados. Nessas situações, a retenção para o material restaurador é normalmente crítica. Quando a região da câmara coronária apresenta condições adequadas para os princípios de retenção podem-se empregar as coroas tipo Endocrown. No entanto, atualmente, este tipo de tratamento se torna não apenas um problema funcional, mas também estético. Dessa forma, o objetivo deste trabalho é apresentar uma sequência operatória para restaurar um dente posterior despolpado utilizando uma coroa Endocrown para restabelecer a função e a estética

One of the most common problems faced by the dentists is the restorative treatment of pulpless teeth. In these situations the retention for the restorative material is usually critic. When the pulp chamber presents appropriate conditions for the retention the Endocrown type crown can be used. However, nowadays, this type of treatment becomes not only a functional problem, but also an aesthetic one. In that way, the aim of this work was to present an operative sequence to restore a non vital tooth using Endocrown to reestablish aesthetics and function

Influence of different surface treatments on the shear bond strength of a methacrylate resin composite repaired with silorane-based resin

Introduction: When repairs are needed in restorations made with methacrylate-based resin composites, the clinician still has doubts whether it is possible to use a silorane-based material and which is the best procedure. Objective: To evaluate the shear bond strength between a methacrylate-based resin composite and a silorane-based material using different surface treatments. Material and methods: Eighty flat bases made with methacrylate resin composite (Filtek Z350 XT) were prepared (n = 8). The bases were stored into water at 37°C for one week. Ten groups were evaluated: G1 (control - no repair); G2 (surface grinding, washing, drying, adhesive and repair with Filtek Z350 XT); G3 (surface grinding, washing, drying, adhesive and repair with silorane - Filtek P90); G4 (surface grinding, washing, drying, adhesive, silane and repair with Filtek Z350 XT); G5 (surface grinding, washing, drying, application of silane, adhesive and repair with silorane - Filtek P90). All groups were kept at 37°C for 24 h in either water (G1 to G5) or ethanol (G6 to G10). The results were analyzed with one-way ANOVA and Tukey test (α = 0.05). Results: There were significant differences between groups (p < 0.001). Only repairs made with silane and Z350 XT (G4 = 46.2 ± 12.9; G9 = 48.1 ± 16.3) resulted in values similar to controls (G1 = 59.2 ± 15.8; G6 = 62.3 ± 15.9) (p = 0.33). The smallest value occured when the repair was performed with silane and silorane-based based and stored into ethanol (G10 = 29.9 ± 12.4). The storage media had little influence on the results. Conclusion: The silorane-based resin composite was not effective for repair of the methacrylate-based material.

Staining susceptibility of methacrylate and silorane-based materials: influence of resin type and storage time

Introduction: The color stability of composite resins is a fundamental factor in their clinical behavior. Objective: To evaluate the color stability of composite resins of different colors exposed to a cola-based soft drink after different storage periods. Additionally, three methacrylate-based materials and one silorane-based material were evaluated. Material and methods: Specimens of three methacrylate-based materials (Opallis EA3, DA3 and T-Neutral; Filtek Supreme XT A3E, A3D and CT; 4 Seasons A3 Enamel, A3 Dentin and High Value) and one silorane-based material (Filtek P90 A3) were prepared, light-cured for 40 s, and manually polished with Sof-Lex discs. Samples were stored for 1 h, 24 h or 7 days. The color was evaluated by CIE-Lab system before and after immersion for 10 min in a cola-based soft drink. Color variation (ΔE) was calculated from individual values of L*, a* and b*, being considered imperceptible when < 1, clinically acceptable when ≤ 3.3, and clinically inacceptable when higher than 3.3. Data were evaluated by two-way Anova and Dunnett's T3 tests (α = 0.05). Results: There were differences among the resins (p < 0.001), with an interaction effect being also observed (p < 0.001). Storage time was not significant (p = 0.246). P90 showed a ΔE smaller than one unit at all studied times. Supreme XT CT and 4 Seasons High Value showed higher ΔE, but not above the critical value of 3.3. The only material that showed ΔE higher than 3.3 was Opallis DA3 after 1 h of storage. Conclusion: The silorane-based composite resin showed smaller ΔE at the times studied.

Conservative approach to restore the first molar with extensive destruction: A 30-month follow-up.

The available options for restoring multiple surface cavities are: amalgam, composite resin, or indirect restorations. Adhesive system and intradentinal pin-retained composite resin restorations should have a similar performance to pin-retained amalgam, regarding resistance to support occlusal forces. Polymerization shrinkage is a major concern when performing direct posterior composite resin restorations and the incremental insertion technique can provide less stress and outstanding margin behavior. Intradentinal pins can potentially enhance composite resin's retention, while reducing gaps caused by polymerization shrinkage. This article reports a clinical case involving an extensive restoration on a posterior tooth with cusp loss that was successfully treated using an intradentinal pin and direct nano-hybrid composite resin restoration.

Laminados cerâmicos na finalização dos tratamentos clínicos integrados / Laminate veneers and multidisciplinary management

de solucionar. Nestes casos, uma abordagem multidisciplinar éfundamental. Má posição dentária e margem gengival sem umcontorno adequado, normalmente, apresentam problema estético efuncional. Assim, um tratamento ortodôntico e periodontal paraadequação prévia é fundamental para o sucesso do tratamentoreabilitador. Além disso, cuidados e paciência durante todo otratamento são essenciais tanto por parte do profissional como porparte do paciente. Recentemente, os laminados cerâmicos têm sidoamplamente utilizados em dentes anteriores. Adicionalmente, essetratamento tem sido mais conservador quando comparado às coroastotais. Portanto, o presente trabalho demonstra por meio de um casoclínico, a associação da ortodontia, periodontia e dentística norestabelecimento do sorriso com laminados cerâmicos, de formaeficiente, conservadora e com resultados estéticos satisfatórios.

Some clinical cases are more complex. In these situations, amultidisciplinary approach is essential. Malposition dental and gingivalmargin without an adequate contour usually have functional andaesthetic problem. Thus, an integrated orthodontic-periodonticrestorativeapproach may enhance the aesthetic results whenprosthetic therapy itself is not feasible. Additionally, care and patiencethroughout treatment are essential for both the professional and thepatient's part. Recently, ceramic laminate veneers have been widelyused in anterior teeth. Additionally, this treatment has been moreconservative. Therefore, this article presents integrated orthodontics,periodontics and restorative smile solution.

The efficacy of acid etching for removing contamination in layered dental restorations.

Contamination between incremental layers of a composite resin restoration can occur during surgical procedures. The present study sought to evaluate how two decontamination treatments affected the shear bond strength between layers of a saliva-contaminated composite resin surface. Forty disks of a nanohybrid composite resin were prepared and divided into four groups (n = 10). The surfaces of all specimens (except for samples in Group 1, the positive control) were contaminated with human saliva. For the negative control samples (Group 2), no decontamination was performed. For Group 3 samples, acid etching was performed and adhesive was applied. For Group 4, surfaces were roughened with a diamond bur prior to acid etching and adhesive application. The specimens were submitted to a shear bond strength test, and the data were analyzed using one-way ANOVA and Tukey tests (α = 0.05). No significant differences were detected between the mean shear bond strengths of samples in Groups 1, 3, and 4 (p < 0.05). Shear bond strength was significantly reduced in Group 2 samples (p < 0.05). Acid etching and the application of adhesive improved shear bond strength, producing values similar to those in the positive control group.

Free-hand stratification with composite resins for the closure of anterior diastema

Introduction: Dental diastemas are common findings at dental clinics. This clinical situation produces discomfort in many patients and its solution is difficult to many professionals. Silicone guides, made from waxed casts, have been used to assist the stratification of resin composites in cases of dental diastemas. This technique, however, does not necessarily need to be used as protocol in all situations. Objective: To demonstrate the stratification technique without silicone guides. Case report: The present study reports a case of stratification technique for anterior diastemas closure without silicone guide. Conclusion: The closure of diastemas can be quickly and easily performed using composite resins without the need of previously manufacturing silicone guides.

56-month clinical performance of Class I and II resin composite restorations.

OBJECTIVE: This study evaluated the 56-month clinical performance of Class I and II resin composite restorations. Filtek P60 was compared with Filtek Z250, which are both indicated for posterior restorations but differ in terms of handling characteristics. The null hypothesis tested was that there is no difference in the clinical performance of the two resin composites in posterior teeth. MATERIAL AND METHODS: Thirty-three patients were treated by the same operator, who prepared 48 Class I and 42 Class II cavities, which were restored with Single Bond/Filtek Z250 or Single Bond/Filtek P60 restorative systems. Restorations were evaluated by two independent examiners at baseline and after 56 months, using the modified USPHS criteria. Data were analyzed statistically using Chi-square and Fisher's Exact tests (a=0.05). RESULTS: After 56 months, 25 patients (31 Class I and 36 Class II) were analyzed. A 3% failure rate occurred due to secondary caries and excessive loss of anatomic form for P60. For both restorative systems, there were no significant differences in secondary caries and postoperative sensitivity. However, significant changes were observed with respect to anatomic form, marginal discoloration, and marginal adaptation. Significant decreases in surface texture were observed exclusively for the Z250 restorations. CONCLUSIONS: Both restorative systems can be used for posterior restorations and can be expected to perform well in the oral environment.