Solução estética conservadora em paciente jovem com fluorose: clareamento e microabrasão: relato de caso / Conservative aesthetic solution in a young patient with fluorosis: whitening and microabrasion: case report

Introdução: a fluorose constitui uma patologia que afeta os dentes desencadeada pelo excesso de ingestão de flúor. Sua manifestação ocorre a nível de esmalte na presença de manchas ou defeitos anatômicos. Objetivo: relatar o manejo clínico de um paciente com fluorose tratado com procedimento minimamente invasivo. Relato do caso: paciente do sexo feminino, 18 anos, apresentando queixas estéticas clinicamente observadas na vestibular dos dentes, com diagnóstico de lesões fluoróticas. Foi executado protocolo de dessensibilização com Ultra EZ por 5 min e aplicação do Verniz (Enamelast Fluoride) previamente ao tratamento clareador. Foram realizados duas sessões de clareamento com peróxido de hidrogenio 35% (DMC) por 45 min com intervalo de sete dias entre elas. Imediatamente após a segunda sessão de clareamento, foi realizado microabrasão com pasta abrasiva Whitness RM (FGM) e taça de borracha com fricção por 20 segundos. Resultados: o tratamento clareador associado a técnica da microabrasão do esmalte demonstrou resultado estético favorável, microinvasivo e eficaz no tratamento da fluorose. Conclusão: a associação dos tratamentos resolveu o problema estético da paciente de forma rápida e segura, conservando a estrutura dentária.

Introduction: fluorosis is a pathology that affects teeth triggered by excess fluoride intake. Its manifestation occurs at the enamel level in the presence of stains or anatomical defects. Objective: to report the clinical management of a patient with fluorosis treated with a minimally invasive procedure. Case report: female patient, 18 years old, presenting aesthetic complaints clinically observed in the buccal of the teeth, with a diagnosis of fluorotic lesions. A desensitization protocol was performed with Ultra EZ for 5 min and Varnish (Enamelast Fluoride) was applied prior to the bleaching treatment. Two bleaching sessions were performed with 35% hydrogen peroxide (DMC) for 45 min, with an interval of seven days between them. Immediately after the second bleaching session, microabrasion was performed with Whitness RM abrasive paste (FGM) and a rubber cup with friction for 20 seconds. Results: The bleaching treatment associated with the enamel microabrasion technique demonstrated a favorable, microinvasive and effective esthetic result in the treatment of fluorosis. Conclusion: the combination of treatments solved the patient's aesthetic problem quickly and safely, preserving the dental structure.

Effect of different adhesive strategies and storage time on bond strength of bi-functional monomers to simulated endodontically-treated dentin.

Adhesive strategies were evaluated on the bond strength of bi-functional monomers bonded to endodontically-treated-dentin (ETD). Superficial dentin was removed on human molars. Teeth were immersed in 5 mL 2.5% NaOCl, followed by immersion in 5 mL 17% EDTA. Dentin surface impregnated with epoxy resin-based sealer was then divided four groups (n=10): Scotchbond Multi-Purpose (SBMP); Single Bond Universal (SBU); Optibond All-in-One (OPB); and Tetric-N-Bond Universal (TBU). After 24-h or 1-year-of-storage specimens were submitted to microtensile bond strength (µTBS) and failure classification. A confocal laser scanning microscope (CLSM) evaluated the hybrid layer formation. Two-way ANOVA and Tukey-HSD test were performed (α=5%). The µTBS did not present statistical differences among adhesive strategies after 24-h. Significant differences were found after 1-year-of-storage. CLSM analysis showed water infiltration and consequently degradation of the hybrid layer after 1-year-of-storage. The use of SBU universal adhesive on the self-etching mode on ETD produced more stable bond over the 1-year-of-storage.

Analysis of enamel/restoration interface submitted cariogenic challenge and fluoride release.

The treatment of high-risk patients still is a challenge. The understanding and development non-invasive, non-destructive, and non-ionizing techniques, can help to guide the treatment and the diagnosis of primary and recurrent caries. The present study evaluated the behavior of enamel/restoration interface after a cariogenic challenge by Fourier domain optical coherence tomography (FD-OCT), scanning electron microscopy (SEM) examination, and the fluoride release of the different restorative materials. Cavities (1.5 × 0.5 mm) were performed in enamel surface and divided into groups (n = 8): glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), and resin composite (RC). The samples were submitted to pH-cycling, and the solutions analyzed for cumulative fluoride by ion-analyzer. The morphology was analyzed by SEM through replicas. The optical attenuation coefficient (OAC) was calculated through exponential decay from the images generated by FD-OCT. Data were analyzed considering α = 0.05. OAC values increased for all groups after pH-cycling indicating demineralization (p < .05). Considering the remineralizing solution, RMGIC presented higher fluoride release rate, followed by GIC, while RC did not release any fluoride. Yet for the demineralizing solution, RMGIC and GIC released similar fluoride rates, overcoming RC (p < .05). Micrographs revealed no changes on the restorations margins, although enamel detachment was observed for RC and GIC after pH-cycling.

Irrigação ultrassônica passiva proporciona menor incidência de debris após preparo do espaço para o pino / Passive ultrasonic irrigation provides less debris after post space preparation

Objetivo: esse estudo avaliou a incidência de resíduos (debris) na dentina, no espaço preparado para pino de fibra, submetida a um dos seguintes protocolos de irrigação: água destilada (AD); hipoclorito de sódio a 2,5% (HS); hipoclorito de sódio a 2,5% mais EDTA a 17% (HSE); hipoclorito de sódio a 2,5% agitado com irrigação ultrassônica passiva (HSUS). Métodos: os canais radiculares de quarenta incisivos bovinos, com comprimento radicular de 17,0 mm, foram obturados pela técnica do cone único. Após sete dias, um espaço para o pino de fibra foi preparado com brocas de Largo #1 e #2 e broca DC2 (White Post; FGM). Os espécimes foram aleatoriamente distribuídos em quatro grupos (n = 10), de acordo com o protocolo de irrigação usado: AD; HS, HSE ou HSUS. As raízes foram clivadas longitudinalmente e obtidas imagens, em microscopia eletrônica de varredura (500X), da superfície dentinária dos segmentos radiculares cervical e apical do espaço preparado para pino de fibra. Escores foram atribuídos de acordo com a presença de debris. Resultados: no segmento cervical, HSE e HSUS apresentaram menor incidência de debris do que AD e HS (p < 0,05). No segmento apical, HSUS proporcionou a menor incidência de debris na dentina radicular (p < 0,05). Não houve diferença entre os demais protocolos de irrigação, tanto no segmento cervical quanto no apical (p > 0,05). Conclusões: o protocolo HSUS proporcionou menor incidência de debris sobre a superfície dentinária do espaço preparado para pino de fibra (AU).

Objective: The present study evaluated the residues (debris) incidence in dentin fiber post space submitted to irrigation protocols using distilled water (DW), 2.5% sodium hypochlorite (HS), 2.5 % sodium hypochlorite and 17% EDTA (HSE), or 2.5% sodium hypochlorite energized bypassive ultrasonic irrigation (HSUS). Methods: Forty bovine incisors root canals with standardized root length (17.0mm) were obturated using single cone technique and epoxyresin sealer. After 7 days, the fiber post space was prepared using # 1 and # 2 Largo burs, and DC2 (White Post; FGM).The specimens were randomly divided into four groups (n= 10), according to the irrigation protocol: AD; HS, HSE or HSUS. After 48 hours, the roots were sectioned. Cervical and apical segment images were obtained using scanning electron microscopy (500X). Scores were assessed according to debris presence. Results: In cervical segment, HSE and HSUS presented debris incidence lower than DW and HS (P <0.05). DW and HS or HSE and HSUS were similar to each other (P > 0.05). Conclusions: HSUS provided the lower debris incidence in dentin surface of the fiber post space (P < 0.05) (AU).