A conservative full-mouth ceramic rehabilitation for a severely worn dentition.

There is a constantly growing prevalence of tooth wear in dentistry. The present case report describes a rehabilitation through ceramic restorations of a severely worn dentition based on a conservative intervention, adequate restorative material selection, and adhesive bonding strategies. A 36-year-old patient with a mainly esthetic complaint presented with signs of tooth wear caused by erosion and attrition. Preparations were performed guided by the diagnostic planning. The full-mouth rehabilitation, combined with the correction of the vertical dimension of occlusion, was split into quadrants, and lithium disilicate partial restorations were fabricated. The proposed rehabilitation was based on the maximal preservation of the remaining tooth structure and the adequate selection of restorative materials and adhesive bonding strategies.

Fractal analysis is a useful tool for evaluating prostate tissue remodeling caused by ethanol consumption and androgen therapy.

Alcohol has been widely consumed for centuries and is linked to the aggravation of diseases. Several studies have shown that excessive consumption of ethanol results in morphophysiological changes in the male reproductive system. One of the effects of ethanol is the decrease in testosterone concentration and hormonal therapies are an alternative to minimize the changes resulting from chronic alcoholism. Qualitative studies were commonly carried out to evaluate the male histopathological alterations resulting from ethanol consumption, being necessary quantitative and non-subjective techniques. This study analyzes the importance of fractal analysis as a useful tool to identify and quantify tissue remodeling in rats submitted to ethanol consumption and hormone therapy with testosterone. Prostate of animals submitted to chronic ethanol consumption showed tissue disorganization, which was confirmed by an increasing of fractal dimension. Regarding the prostatic stroma, collagen fractal dimension and quantification revealed lower values in animals that were only submitted to androgen therapy. Thus, we can conclude that the fractal analysis was a useful tool to quantify tissue changes caused by ethanol consumption and androgen therapy.

Correlation between patient complaint, temporomandibular disorder diagnosis and mandible head morphology

The aim of this study was to evaluate the correlation between patient complaints, clinical diagnosis of temporomandibular disorder (TMD) based on the diagnostic criteria for TMD, and morphology of the mandibular condyle obtained by cone-beam computed tomography (CB-CT). Data were collected from 40 patients. The anatomy of the mandibular condyle was assessed using CB-CT, the diagnosis of TMD according to diagnostic criteria for TMD, and patients' complaints was registered at the appointment. Data were explored and all statistical references were completed in bicaudal tests, with 95% confidence level (α=0.05). The Chisquared test was used with Bonferroni correction (z-tests). Main complaints found were grouped as muscular, articular, muscular and articular, or headache and articular symptoms. Clinical diagnosis of TMD involved myalgia, local myalgia, myofascial pain, myofascial pain with reference, myofascial pain with arthralgia, arthralgia, or disc displacement with reduction. At least one joint showed condylar flattening, erosion, sclerosis, or osteophytes. No correlation was observed between main complaints, clinical diagnosis, and morphology of the mandibular condyle in all comparisons. The findings suggest that due to the absence of clinical and morphological correlation, CB-CTs should be requested only in specific cases, when doubt remain after careful TMD diagnosis, to avoid their over-indication(AU)

The Influence of Post System Design and Material on the Biomechanical Behavior of Teeth with Little Remaining Coronal Structure.

PURPOSE: To evaluate the influence of different post systems on the biomechanical behavior of teeth with a severe loss of remaining coronal structure. MATERIALS AND METHODS: Fifty standardized bovine teeth (n = 10 per group) were restored with: cast post-and-core (CPC), prefabricated metallic post (PFM), parallel glass-fiber post (P-FP), conical glass-fiber post (C-FP), or composite core (no post, CC). The survival rate during thermomechanical challenging (TC), the fracture strength (FS), and failure patterns (FP) were evaluated. Finite element models evaluated the stress distribution after the application of 100 N. RESULTS: All specimens survived TC. Similar FS was observed among post-containing groups. Groups P-FP and CC presented 100% repairable fractures. The von Mises analysis showed the maximum stresses into the root canal in groups restored with metallic posts. Glass-fiber posts and CC presented the maximum stresses at the load contact point. Glass-fiber groups showed lower stresses in the analysis of maximal contact pressure; CPC led to the highest values of contact pressure. The modified von Mises (mvM) stress in dentin did not show differences among groups. Moreover, mvM values did not reach the dentin fracture limit for any group. CONCLUSIONS: The type of intracanal post had a relevant influence on the biomechanical behavior of teeth with little remaining coronal structure.

Tratamento de sequela cirúrgica com explantação de implantes mal posicionados associado à reimplantes e regeneração óssea guiada em região posterior de mandíbula / Treatment of surgical sequel with explanation of poorly positioned implants associated to reimplants and guided bone regeneration in mandible posterior region

O presente trabalho teve como objetivo obter, a partir da técnica de regeneração óssea guiada (ROG), aumento ósseo vertical e horizontal, proporcionando a osseointegração dos implantes dentários inseridos, atingindo o sucesso desejado do tratamento. Para a realização da regeneração óssea guiada, utilizou-se parafusos de titânio inseridos no osso nativo, que serviu como estrutura para a inserção do mineral de osso bovino desproteinizado (Bio-Oss, Geistlich/DBBM), o qual foi estabilizado por uma membrana reabsorvível de colágeno (Bio-Guide, Geistlich), fixada por parafusos de cobertura sobre os implantes. Exames tomográficos foram realizados antes e após a realização da técnica descrita para análise dos resultados. Através deste trabalho, concluiu-se que a regeneração óssea guiada pode ser considerada uma técnica eficaz, a qual mostra resultados positivos referentes ao aumento ósseo tridimensional (AU).

The aim of this study was to obtain vertical and horizontal bone augmentation through guided bone regeneration (GBR) technique, providing osseointegration of inserted dental implants, achieving the desired treatment success. For guided bone regeneration, titanium screws were inserted in the native bone, that served as a structure for the insertion of deproteinized bovine bone mineral (Bio-Oss, Geistlich/DBBM) stabilized by a collagen membrane (Bio-Guide, Geistlich), and fixed by cover screws on the implants. For the analysis of the results, tomographic examinations were performed before and after the described technique. Through this study it could be concluded that guided bone regeneration can be considered an effective technique, showing positive results regarding the three-dimensional bone increase (AU).

Conhecimento dos cirurgiões dentistas sobre o uso de anestésicos locais em pacientes: diabéticos, hipertensos, cardiopatas, gestantes e com hipertireoidismo / Knowledge of surgeons dentists about the use of local anesthetics in patients: diabetic, hypertension, heart disease, pregnant women and with hyperthyroidism

Anestésicos locais, contendo ou não vasoconstritores, são utilizados para realização da maioria dos procedimentos odontológicos. Porém, seu uso inadequado, principalmente em casos de alteração sistêmica, pode acarretar sérios riscos para a saúde do paciente. O objetivo deste estudo foi avaliar o nível de conhecimento dos cirurgiões dentistas (CDs) com relação à utilização de anestésicos locais, frente à pacientes especiais com diabetes, hipertensão, cardiopatias, gestantes e pacientes com hipertireoidismo. O estudo teve um delineamento quantitativo do tipo transversal com dados coletados através de questionário adaptado pela equipe como único instrumento para coleta de dados. Os dados foram submetidos à análise estatística descritiva e inferencial. De 200 participantes, 17% eram acadêmicos formandos em odontologia, e, dentre os formados, a maioria (34 %) tinha de 1 a 5 anos ou de 6 a 10 anos (16%) de formação. Do total de participantes graduados, 43% não possuíam especialização e 57% eram especialistas. Os resultados demostraram baixa taxa de acertos global (62%) entre os participantes. Quanto as categorias de pacientes especiais, observamos bom nível de conhecimento sobre o uso de anestésicos em pacientes diabéticos (79%), hipertensos (73%) e nível razoável para gestantes (65%) e pacientes com hipertireoidismo (62%). Entretanto, 60% erraram as questões relacionadas a cardiopatias. Ademais, foi insuficiente o percentual daqueles que afirmaram aferir a P.A no início dos atendimentos (45%), assim como, daqueles que consideram-se preparados para atender pacientes especiais (36%). Concluiu-se que o nível de conhecimento dos CDs relacionado ao atendimento de pacientes especiais é insuficiente havendo diferença significativa entre especialistas e clínicos(AU)

Local anesthetics, with or without vasoconstrictor are used to perform the vast majority of procedures in dentistry. However, improperly use it can lead to serious risks to patient's health, especially if it has some systemic disorders. The aim of this study was evaluate the level of dentistry's knowledge about use of local anesthetics in special-needs patients with diabetes, hypertension, heart disease, pregnant and patients with hyperthyroidism. The study was a quantitative cross-sectional design and the data were collected through a questionnaire adapted by the team as the only tool for data collection. Data were subjected to descriptive and inferential statistical analysis. Of the total 200 participants, 17% were students from the last year of Odontology (17%), most had 1-5 years of graduation (34%) or 6-10 years of graduation (16%). Of the total graduated participants, 43% were non-specialist and 57% were specialists. The results show a low overall hit rate (62%) among all participants. Among the special-needs patients' categories we observed a good level of knowledge about the use of anesthetics in patients with diabetes (79%) and hypertension (73%) and reasonable level for pregnant (65%) and patients with hyperthyroidism (62%). However, 60% erred issues related to heart disease. It was also lower the percentage who said measure BP (blood pressure) before start all treatment (45%) and who claimed to feel prepared to attend special-needs patients (36%). It was concluded that dentistry knowledge level regarding the care of special-needs patients is insufficient and has significant difference between non-specialist and specialists(AU)

Resin cements formulated with thio-urethanes can strengthen porcelain and increase bond strength to ceramics.

OBJECTIVES: The use of thio-urethane oligomers has been shown to significantly improve the mechanical properties of resin cements (RCs). The aim of this study was to use thio-urethane-modified RC to potentially reinforce the porcelain-RC structure and to improve the bond strength to zirconia and lithium disilicate. METHODS: Six oligomers were synthesized by combining thiols - pentaerythritol tetra-3-mercaptopropionate (PETMP, P) or trimethylol-tris-3-mercaptopropionate (TMP, T) - with di-functional isocyanates - 1,6-Hexanediol-diissocyante (HDDI) (aliphatic, AL) or 1,3-bis(1-isocyanato-1-methylethyl)benzene (BDI) (aromatic, AR) or Dicyclohexylmethane 4,4'-Diisocyanate (HMDI) (cyclic, CC). Thio-urethanes (20 wt%) were added to a BisGMA/UDMA/TEGDMA organic matrix. Filler was introduced at 60 wt%. The microshear bond strength (µSBS), Weibull modulus (m), and failure pattern of RCs bonded to zirconia (ZR) and lithium disilicate (LD) ceramics was evaluated. Biaxial flexural test and fractographic analysis of porcelain discs bonded to RCs were also performed. The biaxial flexural strength (σbf) and m were calculated in the tensile surfaces of porcelain and RC structures (Z = 0 and Z = -t2, respectively). RESULTS: The µSBS was improved with RCs formulated with oligomers P_AL or T_AL bonded to LD and P_AL, P_AR or T_CC bonded to zirconia in comparison to controls. Mixed failures predominated in all groups. σbf had superior values at Z = 0 with RCs formulated with oligomers P_AL, P_AR, T_AL, or T_CC in comparison to control; σbf increased with all RCs composed by thio-urethanes at Z = -t2. Fractographic analysis revealed all fracture origins at Z = 0. CONCLUSION: The use of specific thio-urethane oligomers as components of RCs increased both the biaxial flexural strength of the porcelain-RC structure and the µSBS to LD and ZR. CLINICAL SIGNIFICANCE: The current investigation suggests that it is possible to reinforce the porcelain-RC pair and obtain higher bond strength to LD and ZR with RCs formulated with selected types of thio-urethane oligomers.

Fibrina rica em plaquetas e piezocirúrgico em comparação com instrumento rotatório convencional e coágulo em cirurgia de terceiros molares inferiores impactados: relato de caso

Objetivo: avaliar os resultados pós-operatórios em cirurgias de terceiros molares inferiores impactados com um desenho split mouth. Em um dos lados, foi utilizada fibrina rica em plaquetas (PRF) e piezocirúrgico, no lado oposto, foi realizada osteotomia rotatória convencional e coágulo. Foram avaliados a relação entre as duas técnicas de osteotomia, o tempo cirúrgico e a gravidade das sequelas no pós-operatório, incluindo dor, edema, trismo e reparo. Relato de caso: este trabalho apresenta um relato de caso clínico como projeto-piloto de uma série de casos clínicos. Os terceiros molares inferiores indicados para extração, foram pareados pela classificação de Pell e Gregory, sendo divididos em: grupo A (hemiarco direito), utilizando o piezocirúrgico e PRF, e grupo B (hemiarco esquerdo), seguindo os padrões tradicionais com brocas rotatórias e coágulo. As exodontias foram realizadas em um único momento pelo mesmo cirurgião-dentista. O piezocirúrgico, comparado à técnica convencional, demonstrou menor dor pós-operatória pela escala de VAS, além de diminuir o número de analgésicos consumidos e reduzir significativamente o trismo após 72 horas da cirurgia. Em contrapartida, o seu tempo cirúrgico foi superior ao da técnica convencional. Considerações finais: conclui-se que o uso de piezocirúrgico e PRF obteve melhores resultados nas condições pós-operatórias com relação a dor, edema e reparo. Porém, o tempo cirúrgico foi maior que a osteotomia convencional e coágulo. Sendo assim, o presente estudo mostrou que a piezocirurgia e a utilização combinada de PRF têm efeitos positivos nos resultados pós-operatórios, após a exodontia de terceiro molar impactado.