Tooth preparation for ceramic veneers: when less is more.

Historically, preparations for ceramic veneers have varied from extremely aggressive to a minimal reduction or a lack of preparation. Today, we are moving toward minimally invasive dentistry with the philosophy that less is more. Less tooth reduction means more adhesion and clinical longevity. What must be considered when performing minimally invasive preparations is that in a significant number of cases the dental element will receive a veneer that will modify its final contour. This is quite common in cases of conoid teeth, diastemas or loss of dental structure by abrasion, erosion or attrition. The aim of this article is to present a step-by-step protocol to achieve conservative preparations for ceramic veneers, called the mock-up driven technique. This technique takes into account the final contour desired for the veneer, and results in considerably less invasive dental preparations.

Tratamento do bruxismo com toxina botulínica tipo A ­ relato de caso / Treatment of bruxism with botulinum toxin type A ­ case report

O presente trabalho tem o objetivo de relatar o caso de uma paciente diagnosticada com bruxismo do sono, a qual foi tratada com aplicação de toxina botulínica tipo A. A paciente SBL, 53 anos, compareceu ao consultório odontológico queixando-se de fortes dores faciais e cefaleia matutina. A paciente fazia uso de placa semiflexível para dormir, a qual foi imediatamente substituída por uma placa rígida de acrílico, ajustada de acordo com os critérios de oclusão mutuamente protegida. Devido à dificuldade da paciente em aderir ao uso da placa, optou-se pelo tratamento com toxina botulínica tipo A. O medicamento foi injetado em três pontos do músculo masseter, bilateralmente, na quantidade de 5U em cada ponto. No quinto dia após a aplicação, os primeiros sinais clínicos do efeito do medicamento foram percebidos pela paciente, que foi instruída a suspender o uso da placa miorrelaxante. No retorno de 30 dias, a sensibilidade positiva à palpação do masseter e articulação temporomandibular não estava mais presente. A paciente relatou extrema satisfação com o tratamento, considerando o procedimento indolor e sem efeitos adversos. A frequência das dores reduziu consideravelmente. O tratamento com toxina botulínica mostrou-se eficaz, pouco invasivo e livre de efeitos colaterais, devendo ser considerada uma importante opção para o controle da dor muscular e prevenção dos desgastes dentários em pacientes bruxômanos (AU).

This study aims to report the case of a patient diagnosed with sleep bruxism, who was treated with botulinum toxin type A. Patient SBL, 53 years old, reported strong facial pain and headache during the morning. The patient had been using a semi-flexible splint to sleep, which was immediately replaced by a rigid acrylic splint, adjusted according to the criteria of mutually protected occlusion. Due to patient difficulty to adhere to splint use, the option for the treatment was botulinum toxin type A. The drug was injected in three points of the masseter muscle, bilaterally, 5U at each point. On the fifth day after application, the first clinical signs of drug effect were noticed by the patient, who was instructed to discontinue the use of the occlusal splint. After thirty days, the positive sensitivity of the masseter muscle palpation and temporomandibular joint were not present. The patient reported extreme satisfaction with the treatment, considering it painless and without side effects. The frequency of pain reduced considerably. The treatment with botulinum toxin was effective, minimally invasive, and free of side effects and should be considered an important option for the control of muscle pain and prevention of tooth wear in patients with bruxism (AU).

Fechamento de diastema com restaurações cerâmicas ultraconservadoras / Midline diastema closurewithultra-conservativeceramicrestorations

A literatura sugere diferentes abordagens para o fechamento de diastemas, as quais podem incluir tratamento ortodôntico, restaurador, ou a combinação de ambos. O presente trabalho tem o objetivo de relatar, por meio de um caso clínico, uma abordagem ultraconservadora para o fechamento de diastema entre incisivos centrais superiores com fragmentos cerâmicos. Os fragmentos cerâmicos û facetas parciais sem preparo - quando corretamente indicados para fechamento de diastema podem ser considerados uma excelente opção, pois aliam os benefícios da Odontologia minimamente invasiva, como a máxima preservação da estrutura dentária, às vantagens dos sistemas cerâmicos. A cerâmica mimetiza ao máximo as estruturas naturais dos elementos dentários, sendo uma excelente opção para suprir as diversas deficiências da resina composta.

The literature suggests different approaches for closing diastema, which may include orthodontic treatment, restorative treatment, or a combination of both. This study aims to report a clinical case, an ultra-conservative method to close adiastema between the maxillary central incisors with ceramic fragments. Ceramic fragments ûunprepared partial veneers - when properly indicated for diastema closure may be considered an excellent option since it combines the benefits of minimally invasive Dentistry, such as the maximum preservation of dental structure, to the advantages of ceramic systems. Ceramic can mimic natural teeth structure and is an excellent option to make up the various shortcomings of the composite resin.

Reproducibility, Reliability, and Validity of Fuchsin-Based Beads for the Evaluation of Masticatory Performance.

PURPOSE: Rehabilitation of masticatory function is inherent to prosthodontics; however, despite the various techniques for evaluating oral comminution, the methodological suitability of these has not been completely studied. The aim of this study was to determine the reproducibility, reliability, and validity of a test food based on fuchsin beads for masticatory function assessment. MATERIALS AND METHODS: Masticatory performance was evaluated in 20 dentate subjects (mean age, 23.3 years) using two kinds of test foods and methods: fuchsin beads and ultraviolet-visible spectrophotometry, and silicone cubes and multiple sieving as gold standard. Three examiners conducted five masticatory performance trials with each test food. Reproducibility of the results from both test foods was separately assessed using the intraclass correlation coefficient (ICC). Reliability and validity of fuchsin bead data were measured by comparing the average mean of absolute differences and the measurement means, respectively, regarding silicone cube data using the paired Student's t-test (α = 0.05). RESULTS: Intraexaminer and interexaminer ICC for the fuchsin bead values were 0.65 and 0.76 (p < 0.001), respectively; those for the silicone cubes values were 0.93 and 0.91 (p < 0.001), respectively. Reliability revealed intraexaminer (p < 0.001) and interexaminer (p < 0.05) differences between the average means of absolute differences of each test foods. Validity also showed differences between the measurement means of each test food (p < 0.001). CONCLUSIONS: Intra- and interexaminer reproducibility of the test food based on fuchsin beads for evaluation of masticatory performance were good and excellent, respectively; however, the reliability and validity were low, because fuchsin beads do not measure the grinding capacity of masticatory function as silicone cubes do; instead, this test food describes the crushing potential of teeth. Thus, the two kinds of test foods evaluate different properties of masticatory capacity, confirming fushsin beads as a useful tool for this purpose.

Aplicação da toxina botulínica tipo A na correção do sorriso gengival / Application of botulinum toxin type A in a correction of gummy smile

O presente trabalho tem o objetivo de relatar o caso de uma paciente diagnosticada com sorriso gengival, a qual foi tratada com aplicação de toxina botulínica tipo A. Paciente do gênero feminino, 23 anos, procurou atendimento odontológico relatando insatisfação com a quantidade de gengiva exposta durante o sorriso. O diagnóstico foi de sorriso gengival com origem no excesso de crescimento vertical da maxila. O tratamento com cirurgia ortognática, indicado quando há desarmonia do sorriso devido a um problema ósseo, foi prontamente rejeitado pela paciente. Assim, sugeriu-se a aplicação da toxina botulínica tipo A com o objetivo de relaxar os músculos elevadores do lábio superior e da asa do nariz e os elevadores do lábio superior (músculos ELSAN), diminuindo a faixa de gengiva exposta ao sorrir. No terceiro dia após a aplicação, os primeiros sinais clínicos do efeito do medicamento foram percebidos pela paciente, a qual relatou efeito máximo após 14 dias. A mesma relatou extrema satisfação com o tratamento, considerando o procedimento indolor e sem efeitos adversos. Consultas de retorno foram realizadas com 15, 90, 120 e 150 dias. Aos 120 dias, o efeito do tratamento ainda estava presente. No último retorno, constatou-se o fim da ação do medicamento e retorno à situação inicial. Desta maneira, a toxina botulínica tipo A mostrou-se como uma alternativa de tratamento eficaz, simples e minimamente invasiva para o sorriso gengival de origem óssea (excesso de crescimento vertical da maxila) (AU).

This study aims to report the case of a patient diagnosed with gummy smile, who was treated with botulinum toxin type A. A female patient, 23 years old, sought dental care reporting dissatisfaction with the amount of gum exposed during smile. The diagnosis was gummy smile with origin in excess of vertical maxillary growth. The orthognathic surgery treatment indicated, when there is smile disharmony due to a bone problem, was promptly rejected by the patient. Thus, it was suggested the application of botulinum toxin type A in order to relax the upper lip levator muscles and the bridge of the nose and upper lip lifts (ELSAN muscles), reducing the gum strip exposed to smile. On the third day after application, the first clinical signs of drug effect was noticed by the patient, who reported maximum effect after 14 days. The patient reported extreme satisfaction with treatment, considering the painless and without side effects procedure. Return visits were conducted with 15, 90, 120, and 150 days. After 120 days, the treatment effect was still present. In the final examination, there was the end of the action of the drug and return to starting position. It was concluded that the botulinum toxin type A has proved to be an alternative effective, simple and minimally invasive treatment for gummy smile of bone origin (excessive vertical maxillary growth) (AU).

Esthetic Rehabilitation of the Smile with No-Prep Porcelain Laminates and Partial Veneers.

Rehabilitation of patients with anterior conoid teeth may present a challenge for the clinician, especially when trying to mimic the nature with composite resins. This clinical report exemplifies how a patient with conoid upper lateral incisors was rehabilitated with minimally invasive adhesive restorations. Following diagnostic wax-up and cosmetic mock-up, no-prep veneers and ceramic fragments (partial veneers) were constructed with feldspathic porcelain. This restorative material presents excellent reproduction of the optical properties of the dental structure, especially at minimal thicknesses. In this paper, the details about the treatment are described. A very pleasing outcome was achieved, confirming that minimally invasive adhesive restorations are an excellent option for situations in which the dental elements are healthy, and can be modified exclusively by adding material and the patient does not want to suffer any wear on the teeth.

The relationship between occlusal support and maxillary development: An animal study.

OBJECTIVE: To test the hypothesis that maxillary development may be affected by occlusal support. MATERIALS AND METHODS: The sample was composed by Wistar rats (5 weeks old) divided into three groups: Control (n = 10), extraction of mandibular molar teeth - left side (n = 10), extraction mandibular molar teeth - left and right sides (n = 10). The rats were sacrificed 8 weeks postextraction. Cone beam computed tomography scan images were taken for posterior measurement of maxillary length and width. Data were analyzed by one-way analysis of variance (Tukey test as post-hoc test). RESULTS: Maxillary length was significantly shorter (P < 0.005) in both groups after tooth extraction. No difference was observed regarding maxillary width and body weight. CONCLUSION: Reduced occlusal support may impair the development of the maxilla in rats.

Conventional Complete Denture in Patients with Ectodermal Dysplasia.

Ectodermal dysplasia is described as heritable conditions that involve anomalies of structures derived from the ectoderm, including hypodontia. In the cases of edentulous young patients, who did not finish their craniofacial growth, treatment with conventional complete denture is a suitable alternative. The aim of this study was to report a case of mandibular edentulism treated with conventional complete denture in a thirteen-year-old patient diagnosed with hidrotic ectodermal dysplasia. Typical features, such as frontal bossing, depressed nasal bridge, protuberant lips, scarce hair, and brittle nails, were visualized during the extraoral examination. The intraoral inspection and radiographic analysis revealed oligodontia, dental malformation, and prolonged retention of deciduous teeth at maxilla and total edentulism at mandible. A conventional complete denture was planned and constructed following the same steps of technique as recommended in adults. Although this option is not a definitive treatment, the patient and his parents were satisfied with his improvement in chewing and speech, as well as with the aesthetic benefits.

O emprego do mock-up na Odontologia: trabalhando com previsibilidade / The use of mock-up in Dentistry: working with predictability

A Odontologia baseada em evidência engloba a necessidade de resultados previsíveis nos diversos tratamentos odontológicos, o que, consequentemente, deve conduzir a uma relação de confiança entre o paciente e o cirurgião dentista. O objetivo do presente trabalho é descrever, através de três casos clínicos, a técnica do mock-up e discutir no decorrer do manuscrito sua importância como ferramenta de diagnóstico e planejamento do tratamento reabilitador estético. Através domock-up, assegura-se o atendimento às expectativas estéticas do paciente em relação ao futuro tratamento, bem como resguarda o profissional de possíveis intercorrências. Esta técnica é bastante simples e eficiente, permitindo a visualização tridimensional do tratamento definitivo. Assim, o mock-up determina a previsibilidade dos resultados ao atuar como guia das decisões terapêuticas...

The evidence-based Dentistry encompasses the need for predictable results in the various dental treatments, which should therefore lead to a relationship of trust between patient and dentist. The objective of the present work was to describe through three clinical cases, the technique of mock-up and discuss throughout the manuscript its importance as a diagnostic and planning tool for aesthetic rehabilitation treatment. Through the mock-up, it can to ensure compliance the aesthetic expectations of the patient regarding the future treatment and protect the professional of possible complications. This technique is very simple and efficient, allowing three-dimensional visualization of definitive treatment. Thus, mock-up determines the predictability of results by guiding the therapeutic decisions...

Changes in patient satisfaction and masticatory efficiency during adaptation to new dentures.

Because adapting to new conventional dentures is highly variable, there is uncertainty as to how long dissatisfied patients should wait before choosing a treatment with dental implants. The authors investigated whether changes in patient satisfaction and masticatory efficiency may be observed between 3 and 6 months after the insertion of new conventional complete dentures. The study included 24 edentulous patients requiring new complete dentures. Masticatory efficiency and patient satisfaction were evaluated at 3 and 6 months post-insertion. Masticatory efficiency was evaluated through the colorimetric method, with the beads as the artificial test food. A method for quantifying overall satisfaction of complete-denture wearers was used. Subjects were asked to respond to questions with three-grade answers concerning 12 factors: chewing, tasting, speech, esthetics, pain, fit, retention, and comfort (maxillary and mandibular evaluations were done for each of the last four factors). The results of patient satisfaction and masticatory efficiency at 3 and 6 months post-insertion were compared using the paired-samples t test (α = 0.05). Significant reductions in mandibular pain (P less than 0.05) and improvements in mandibular fit (P less than 0.05) were observed at 6 months. No difference was found for patient overall satisfaction, chewing, tasting, speech, maxillary pain, esthetics, maxillary fit, retention, comfort, and masticatory efficiency. The authors concluded that reduction in pain and improvements in adaptation of the lower denture may be observed between 3 and 6 months after insertion of new conventional complete dentures. This period of adaptation should be considered before choosing a treatment with dental implants.

The influence of mandibular ridge anatomy on treatment outcome with conventional complete dentures.

Since prognostic indicators are likely to take on increasing importance as a diagnostic tool for selection of patients for implant provision, this study investigated the influence of the shape and resiliency of the mandibular alveolar ridge on the retention and stability of conventional complete dentures. Ninety- three edentulous patients wearing both maxillary and mandibular conventional complete dentures composed the sample. Data were collected regarding shape and resiliencyof the mandibular residual ridge. Dentures were assessed for retention and stability using an objective and reproducible tool.The associations between the clinical characteristics of the mandibular alveolar ridge and denture retention and stability were analyzed using chi-square and Fisher exact tests (a = 0.05). A significant association between ridge shape and denture stability (p < 0.05) was found, while ridge resiliency was significantly associated to denture retention (p < 0.001). Based on the results, mandibular ridge shape and resiliency influenced the retention and stability of conventional complete dentures.

The influence of mandibular ridge anatomy on treatment outcome with conventional complete dentures

Since prognostic indicators are likely to take on increasingimportance as a diagnostic tool for selection of patients forimplant provision, this study investigated the influence of theshape and resiliency of the mandibular alveolar ridge on theretention and stability of conventional complete dentures. Ninety-three edentulous patients wearing both maxillary andmandibular conventional complete dentures composed the sample.Data were collected regarding shape and resiliencyof themandibular residual ridge. Dentures were assessed for retentionand stability using an objective and reproducible tool.The associationsbetween the clinical characteristics of the mandibularalveolar ridge and denture retention and stability were analyzedusing chi-square and Fisher exact tests (α = 0.05). A significantassociation between ridge shape and denture stability (p < 0.05)was found, while ridge resiliency was significantly associated todenture retention (p < 0.001). Based on the results, mandibularridge shape and resiliency influenced the retention and stabilityof conventional complete dentures...

Bilateral balanced articulation: science or dogma?

For more than a hundred years, it has been supposed that canine guidance should be avoided in conventional complete dentures, since it would result in denture instability. Thus, bilateral balanced articulation has been held by many authors as fundamental for treatment success. However, randomized clinical trials have shown that balanced articulation is not as important as previously thought. The issue about which occlusal concept is the most appropriate for individual needs is clinically and economically relevant for both the dentist and dental technician. Therefore, the purpose of this study is to provide an evidence-based update on complete denture occlusion. Clinical Relevance: The issue about which occlusal concept is the most appropriate for individual needs is clinically and economically relevant.

A importância da placa estabilizadora no tratamento do bruxismo e cefaleia matinal - relato de caso / The importance of the stabilization splint in the treatment of bruxism and morning headaches - case report

Este estudo teve como objetivo relatar um caso de bruxismo e cefaleia matinal, o qual foi tratado com placa estabilizadora para impedir o desgaste dentário e reduzir a dor orofacial de origem muscular. A paciente procurou a disciplina de Clínica Integrada com queixa de dores de cabeça e na face frequentes logo ao acordar. Após anamnese, exame físico intraoral e palpação muscular, a paciente foi diagnosticada com cefaleia matutina e dor facial de origem muscular relacionadas com bruxismo noturno (atividade parafuncional). Como tratamento, foi proposta a confecção de uma placa estabilizadora para uso noturno. No primeiro retorno após uma semana, a paciente relatou melhora na cefaleia matutina, e após um mês, os sintomas praticamente desapareceram. A mesma foi instruída a continuar usando a placa para dormir com o objetivo de proteger seus dentes de um desgaste maior, mesmo que as dores cessassem ompletamente. Recomendou-se retorno após 3 meses para acompanhamento dos sinais e sintomas. Apesar da inexistência de tratamento curativo, o tratamento com placa estabilizadora apresenta-se como uma importante opção terapêutica no controle da dor muscular e prevenção dos desgastes dentários.

This study aimed to report a clinical case of bruxism and morning headaches in which the patient was treated with a stabilization splint to prevent tooth wear and reduce muscular orofacial pain. The patient complained of frequent headaches and facial pain upon waking. After anamnesis, intraoral examination, and muscle palpation, the patient was diagnosed with morning headaches and muscular orofacial pain caused by nocturnal bruxism (parafunctional activity). The patient was treated with a stabilization splint for nocturnal use. One week after the insertion of the splint, the patient reported relief in morning headache, and after a month the symptoms had almost completely disappeared. The patient was instructed to keep using the splint to sleep in order to prevent tooth wear, even if the pain ceased completely. An appointment at 3 months post-insertion was scheduled for follow-up of signs and symptoms. Despite the lack of curative treatment for sleeping bruxism, the stabilization splint therapy is an important therapeutic option for pain control and prevention of tooth wear

Reproducibility of a silicone-based test food to masticatory performance evaluation by different sieve methods.

The aim of this study was to evaluate the reproducibility of the condensation silicone Optosil Comfort® as an artificial test food for masticatory performance evaluation. Twenty dentate subjects with mean age of 23.3±0.7 years were selected. Masticatory performance was evaluated using the simple (MPI), the double (IME) and the multiple sieve methods. Trials were carried out five times by three examiners: three times by the first, and once by the second and third examiners. Friedman's test was used to find the differences among time trials. Reproducibility was determined by the intra-class correlation (ICC) test (α=0.05). No differences among time trials were found, except for MPI-4 mm (p=0.022) from the first examiner results. The intra-examiner reproducibility (ICC) of almost all data was high (ICC≥0.92, p<0.001), being moderate only for MPI-0.50 mm (ICC=0.89, p<0.001). The inter-examiner reproducibility was high (ICC>0.93, p<0.001) for all results. For the multiple sieve method, the average mean of absolute difference from repeated measurements were lower than 1 mm. This trend was observed only from MPI-0.50 to MPI-1.4 for the single sieve method, and from IME-0.71/0.50 to IME-1.40/1.00 for the double sieve method. The results suggest that regardless of the method used, the reproducibility of Optosil Comfort® is high.

Association between prosthetic factors and temporomandibular disorders in complete denture wearers.

OBJECTIVE: The purpose of this study was to investigate the prevalence of temporomandibular disorders (TMD) in denture wearers and the association between prosthetic factors and this condition. BACKGROUND: There is no consensus about the relationship between prosthetic factors and TMD among denture wearers. MATERIALS AND METHODS: The sample was composed of 92 patients wearing both maxillary and mandibular complete dentures. The Research Diagnostic Criteria for TMD (RDC/TMD) were adopted for patient examination. Objective evaluation of denture quality was determined by analysis of retention and stability of mandibular denture, interocclusal distance, articulation and occlusion. Association between denture quality and TMD diagnosis was analysed using chi-square and Fisher's exact tests. RESULTS: 37.4% of the patients presented TMD. Denture quality was not significantly associated with the presence of TMD: mandibular retention (p = 0.466); mandibular stability (p = 0.466); interocclusal distance (p = 0.328); centric relation (p = 0.175); and balanced occlusion (p = 0.56). CONCLUSION: Within the scope of this case-controlled cross-sectional study, no robust association between prosthetic factors and TMD was found.

The influence of mandibular ridge anatomy on treatment outcome with conventional complete dentures. / The influence of mandibular ridge anatomy on treatment outcome with conventional complete dentures.

Since prognostic indicators are likely to take on increasing importance as a diagnostic tool for selection of patients for implant provision, this study investigated the influence of the shape and resiliency of the mandibular alveolar ridge on the retention and stability of conventional complete dentures. Ninety- three edentulous patients wearing both maxillary and mandibular conventional complete dentures composed the sample. Data were collected regarding shape and resiliencyof the mandibular residual ridge. Dentures were assessed for retention and stability using an objective and reproducible tool.The associations between the clinical characteristics of the mandibular alveolar ridge and denture retention and stability were analyzed using chi-square and Fisher exact tests (a = 0.05). A significant association between ridge shape and denture stability (p < 0.05) was found, while ridge resiliency was significantly associated to denture retention (p < 0.001). Based on the results, mandibular ridge shape and resiliency influenced the retention and stability of conventional complete dentures.

Incisivos Laterais Conóides: Otimização Estética Através do Uso de Resina Composta Direta / Connoid lateral incisors: esthetics optimization using direct composite resin

Na odontologia est�tica moderna, a realiza��o de reanatomiza��es de dentes con�ides apresenta-se como op��o de t�cnica para obten��o de um sorriso harm�nico. Nesse contexto, o avan�o dos materiais odontol�gicos diretos, como as resinas compostas e sistemas adesivos, permite a realiza��o desse procedimento de maneira simples e eficaz, quando comparado a outras t�cnicas dispon�veis. O presente trabalho mostra, atrav�s de um caso cl�nico, a possibilidade da realiza��o de um correto diagn�stico, planejamento e tratamento restaurador est�tico conservador, utilizando a resina composta como material restaurador direto, solucionando as anomalias de maneira simples, r�pida e econ�mica para o paciente.

In modern esthetic dentistry, recontouring peg-shaped teeth is an alternative technique for obtaining a harmonious smile. In this context, the advancement of direct dental materials, such as resin composites and adhesive systems, allows this procedure to be performed simply and efficiently, when compared with other available techniques. Through a clinic case, this study shows the possibility of achieving a correct diagnosis, planning and conservative aesthetic restorative treatment using composite resin as direct restorative material, thus solving quickly and cost effectively the teeth anomalies.