Digital smile design and mock-up technique for esthetic treatment planning with porcelain laminate veneers.

The use of digital tools offers a new perspective to daily clinical activities. The digital information serves as a starting point for a wax-up and intraoral mock-up, which is widely reported in literature as an objective and efficient communication tool among dentist, patient, and technician. This case report of a maxillary anterior rehabilitation demonstrates esthetic planning with the digital smile design (DSD) system and a direct mock-up technique. After preoperative photographs were obtained, digital planning was created using DSD. However, due to differences in virtual simulation, a direct mock-up with composite resin was performed. Porcelain laminate veneers using feldspathic ceramics were used to restore the anterior teeth. Many times, the DSD simulation is not enough for the patient to understand and observe the changes that will be performed on the anterior teeth. This combination of techniques can offer predictability to results as well increasing the patient expectation satisfaction.

CAD/CAM post-and-core using different esthetic materials: Fracture resistance and bond strengths.

PURPOSE: To evaluate the fracture resistance (FR), and push-out bond strengths (BS) of custom-made CAD/CAM post-and-cores manufactured with different esthetic materials. METHODS: 90 single-rooted extracted teeth were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three equal groups according to the material: hybrid ceramic Vita Enamic (HC); nano-ceramic resin composite Lava Ultimate (RC); and experimental epoxy-resin reinforced by glass-fiber (FG). The post-and-cores were manufactured using CAD/CAM and cemented using a self-adhesive resin cement (Rely X Unicem2). A subgroup of 30 specimens (n=10) was subjected to fatigue (1,000,000 cycles at 5 Hz) and then to the FR test. Another subgroup with 60 specimens was submitted to the BS test, with and without fatigue. Data were submitted to analysis of variance (FR - one-way ANOVA; BS - two-way ANOVA) and Tukey's test (α= 0.05). RESULTS: The FR values (mean±SD, in Newtons) were 414.5±83.9 (HC), 621.3±100.3 (RC), and 407.6±109.0 (FG), with RC showing significantly higher FR values (P< 0.05). For BS, there was no statistically significant difference among the materials, with and without fatigue (P> 0.05). The type of material used to obtain the CAD/CAM-customized post-and-cores had a significant effect on the FR, but not on the BS of the specimens. Fatigue did not influence the BS for the tested materials. CLINICAL SIGNIFICANCE: CAD/CAM custom-made esthetic post-and-cores showed good performance relative to fracture resistance and bond strength to root canal dentin walls. The CAD/CAM materials tested could be used as an alternative to restore wide flared root canals in esthetically compromised teeth.

In vitro microTBS of one-bottle adhesive systems: sound versus artificially-created caries-affected dentin.

This in vitro study aimed to evaluate a pH-cycling model for simulation of caries-affected dentin (CAD) surfaces, by comparing the bond strength of etch-and-rinse adhesive systems on sound and artificially-created CAD. Dentin substrates with different mineral contents and morphological patterns were created by submitting buccal bovine dentin to the following treatments: (1) immersion in artificial saliva during the experimental period (sound dentin, SD), or (2) induction to a CAD condition by means of a dynamic pH-cycling model (8 cycles, demineralization for 3 h followed by mineralization for 45 h). The bond strength of Excite or Prime and Bond NT adhesive systems was assessed using the microtensile bond strength (microTBS) test. Dentin microhardness was determined by cross-sectional Knoop evaluations. Resin-dentin morphology after the treatments was examined by scanning electron microscopy. SD produced significantly higher microTBS than CAD for both adhesives evaluated, without differences between materials. CAD exhibited lower microhardness than SD. Morphological analysis showed marked distinctions between SD and CAD bonded interfaces. Under the conditions of this study, differences in morphological pattern and dentin mineral content may help to explain resin-dentin bond strengths. The proposed pH-cycling model may be a suitable method to simulate CAD surfaces for bonding evaluations.

Effect of photoactivation systems and resin composites on the microleakage of esthetic restorations.

AIM: The aim of this study was to evaluate the influence of four photoactivation systems [quartz tungsten halogen (QTH), light-emitting diode (LED), argon ion laser (AL), and plasma arc curing PAC)] on cementum/dentin and enamel microleakage of Class II restorations using a microhybrid [Z250-3M ESPE] and two packable composites [(SureFil-Dentsply and Tetric Ceram HB-Ivoclair/Vivadent]. METHODS AND MATERIALS: Three hundred sixty "vertical-slot Class II cavities" were prepared at the mesial surface of bovine incisors using a 245 carbide bur in a highspeed handpiece. Specimens were divided into twelve groups (composite-photoactivation systems). Half of the specimens had the gingival margin placed in enamel (n=15) and the other half in cementum/dentin (n=15). Composites were inserted and cured in 2 mm increments according to manufacturers' recommended exposure times. After polishing, the samples were immersed in 2% methylene blue solution, sectioned, and evaluated at the gingival margins. Data were submitted to statistical analysis using the Kruskal-Wallis and Mann-Whitney tests. RESULTS: No significant differences were found among the photoactivation systems and among resin composites (p>0.05). Microleakage was not significantly affected by location (enamel vs. cementum/dentin, p>0.05). These findings suggested neither the photoactivation systems nor the resin composite types might have an effect on the microleakage at gingival margins Class II cavities.

Stability of dentin bond strengths using different bonding techniques after 12 months: total-etch, deproteinization and self-etching.

This study evaluated the influence of (1) different dentin treatments and (2) storage time on dentin shear bond strengths. Two hundred and twenty-five bovine incisors were collected, ground to expose a flat dentin surface and randomly divided into three groups according to dentin surface treatment: (1) Total etch + Single Bond; (2) Total etch + collagen depletion with 10% NaOCl + Single Bond and (3) No etch + experimental self-etching adhesive. Composite was applied to the treated surfaces using a 3 x 5 mm cylindrical Teflon matrix and was light-cured. Each group was further stratified in five subgroups according to storage time in water at 37 degrees C: 1 day, 7 days, 30 days, 6 months and 12 months. Shear bond strengths (SBS) were determined and expressed in MPa. Data was analyzed for statistical significance with two-way ANOVA and Tukey's test (p=0.05). No interaction was observed between surface treatment and storage time. Storage time did not significantly affect bond strengths. Statistically significant differences were observed among the different surface treatments. Single Bond applied after total-etch presented higher mean SBS when compared to the other surface treatment methods. Collagen removal negatively influenced SBS, and the experimental self-etching adhesive presented intermediate values.

Pulp revascularization of replanted immature dog teeth after treatment with minocycline and doxycycline assessed by laser Doppler flowmetry, radiography, and histology.

This study investigated the effect of topical antibiotic treatment on pulp revascularization in replanted teeth. Thirty-four immature teeth were selected from three young dogs. Baseline radiographs and laser Doppler flowmetry (LDF) readings were obtained. Specimens were randomly divided into four groups: Thirty-eight teeth were extracted, kept dry for 5 min, and either (Group 1) covered with minocycline mixture (G1, n = 11), (Group 2) soaked in doxycycline (G2, n = 11), or (Group 3) soaked in saline (G3-negative control, n = 6), and replanted. Teeth in Group 4 were not extracted (positive control, n = 6). Postoperative radiographs and LDF readings were obtained for 2 months after replantation. After sacrifice, the jaws were collected and processed for light microscopy. Pre- and postreplantation LDF readings and radiographs, and histologic findings were analyzed to assess revascularization. Pulp revascularization occurred in 91% (G1), 73% (G2), and 33% (G3) of the specimens. In conclusion, minocycline facilitates pulp revascularization in replanted immature teeth after replantation.

Influence of load cycling on marginal microleakage with two self-etching and two one-bottle dentin adhesive systems in dentin.

PURPOSE: To evaluate the influence of occlusal load cycling on cervical microleakage of proximal slot restorations located in dentin, using two self-etching and two one-bottle dentin adhesive systems. MATERIALS AND METHODS: 240 proximal slot cavities were prepared in 120 bovine teeth and divided into two groups, one with load cycling and one without. The groups were then subdivided into four subgroups according to the adhesive system used (Experimental EXL 547 Self-etching 3M, Clearfil SE Bond, Single Bond, and Optibond Solo Plus) and restored following the manufacturers' instructions. The teeth were then submitted to mechanical load cycling with a force of 80 N and a frequency of 5 Hz, simultaneously over both restorations of each tooth, for a total of 50,000 cycles per specimen. All specimens were subsequently immersed in a 2% methylene blue solution (pH 7.0), and sectioned to examine the extent of dye penetration under a stereomicroscope (40X). RESULTS: There was no statistically significant difference (p = 0.00002) between the loaded and unloaded teeth. However, a statistically significant difference was observed between the adhesive systems used. The experimental self-etching EXL 547 presented the lowest mean microleakage, but was only statistically significantly different from the Single Bond loaded and unloaded groups and the Clearfil SE Bond unloaded group. CONCLUSION: The application of 50,000 loading cycles did not affect the microleakage of the two self-etching and the two one-bottle adhesive systems evaluated. In vitro mechanical load cycling is an important factor to consider when evaluating the performance of adhesive systems under simulated masticatory conditions.

Using opaquers under direct composite resin veneers: an illustrated review of the technique.

UNLABELLED: In restorative dentistry direct composite resin materials can be used to conservatively resolve many esthetic problems. Opaque resins are often necessary to mask discolorations and/or dark backgrounds when restoring anterior teeth. This article presents a direct composite resin veneer technique using opaquers. Potential problems with the tone of restorations after the use of opaquers are discussed. Advantages, limitations, and the clinical technique are presented. Training, as well as attention to the technique, contributes to an acceptable result. CLINICAL SIGNIFICANCE: Resinous opaquers can be used as a valid adjunct to the direct composite resin veneer technique when conservatively restoring dark teeth.

Obturations postérieures en composite: nouvelle technique / Obturação posterior em resina composta: nova técnica

Les auteurs décrivent une technique originale d'obturation des dents postérieures avec une résine composite: une matrice occlusales et proximales, permet la reproduction rapide et précise de la morphologie originelle de la surface occlusale et des crêtes marginales de la dent dans le cas de restaurations de Classe II (occluso-proximales). Cette technique rend l'obturation des dents postérieures avec de la résine composite plus rapide. Elle réduit également la quantité de résine à éliminer lors de l'ajustement occlusal et limite le risque de réaliser une obturation à la morphologie inadéquate

Nonvital tooth bleaching: guidelines for the clinician / Clareamento de dente não vitalizado: guia para clínica odontológica

The combination of intracoronal and extracoronal bleaching represents a conservative treatment to restore esthetics and darkened or stained nonvital teeth. Notwithstanding the eventual risks and difficulties accompainying such technique, nonvital teeth often can be successfully lightened. This article presents a few guidelines for bleaching nonvital teeth as a clinical case to illustrate the indications and clinical protocol for the technique

Dupla moldagem: registro oclusal / Double impression for occlusal registration

Este trabalho apresenta duas técnicas de moldagem onde os hemi-arcos superior e inferior são moldados simultaneamente, ao mesmo tempo em que o registro inter-oclusal é realizado. A primeira técnica utiliza uma moldeira plástica descartável (Triple-Tray Premier) com material de moldagem Impregum (Espe/Premier), um poliéter, e na confecção dos modelos se confecciona um "oclusor", dispensando o uso do articulador. A segunda técnica utiliza uma moldeira metálica que se acopla a um articulador do tipo semi-ajustável (Gama II), empregando como material de moldagem uma silicona de adição, no caso o Provil. As duas técnicas racionalizam o procedimento da moldagem reduzindo o tempo de trabalho, economizando material de moldagem e a realização de um registro inter-oclusal precisão