Influence of the self-adhering strategy on microhardness, sorption, solubility, color stability, and cytotoxicity compared to bulk-fill and conventional resin composites.

OBJECTIVES: To analyze and compare, in vitro, the microhardness, sorption, solubility, color stability, and cytotoxicity of three types of resin composites: self-adhesive (SARC) (Dyad Flow (DF)/Kerr), bulk-fill (Filtek Bulk Fill Flow (FBF)/3 M ESPE), and conventional (Filtek Z350XT Flow (Z350)/3 M ESPE). MATERIALS AND METHODS: Thirty cylindrical specimens were prepared using a split metal mold (15 mm × 1 mm), divided into 3 groups (n = 10) according to the material used. Vickers hardness (VH) was calculated from three indentations (300gf/15 s) per specimen. The sorption and solubility were measured according to the ISO 4049:2009 specification after storing in distilled water for 7 days. The color of each resin composite was measured using a portable digital spectrophotometer according to the CIELAB system. After a 7-day immersion in coffee, the color variation (∆E) was calculated. Following the ISO 10993:2012, the cytotoxicity in Vero cells was evaluated through the MTT assay. The results were analyzed using the Kruskal-Wallis test to compare the studied groups. The Wilcoxon test was used to compare the assessments in each studied group. For cytotoxicity analysis, the data were compared by the ANOVA test (α = 0.05). RESULTS: DF showed the lowest VH (28.67), highest sorption (0.543 µg/mm3) and solubility (1.700 µg/mm3), and higher ∆E after 7 days of coffee immersion (p = 0.008). The resin composites studied were considered non-cytotoxic. CONCLUSIONS: The SARC presented inferior mechanical and physical-chemical properties than bulk-fill and conventional resin composites, with comparable cytotoxicity against Vero cells. CLINICAL RELEVANCE: The simplification of the clinical protocol of SARC can minimize the number of possible failures during the restorative technique. However, considering their inferior physical and mechanical properties, their coverage with materials of higher mechanical properties and physical-chemical stability should be considered.

The Use of Cone-Beam Computed Tomography in the Endodontic Treatment of a Maxillary Central Incisor With Two Roots: Case Report.

Atypical anatomy in the maxillary incisor is extremely rare, with only a few case reports describing these variations. Cone-beam computed tomography (CBCT) is an effective way to accurately diagnose anatomical disparities and determine the 3-dimensional location of roots and canals. The aim of this article is to report on the diagnosis and endodontic treatment of a rare case of a double-rooted maxillary central incisor, supported by CBCT scanning as a diagnostic imaging technique. Clinical examination of a 72-year-old patient who was referred for endodontic treatment of tooth No. 9 revealed a coronary fracture and no response to thermal sensitivity tests. Based on the periapical radiographs, the presence of anatomical variations was suspected. This prompted a CBCT scan for the acquisition of a more accurate diagnosis, and two roots were detected. This article details the successful endodontic treatment performed. The results demonstrate that in a case of abnormal anatomy in a maxillary incisor an effective diagnosis along with adequate treatment may allow for a favorable prognosis in the long term.

Evaluation of microhardness, sorption, solubility, and color stability of bulk fill resins: A comparative study.

BACKGROUND: Due to the increasing popularity of bulk fill resins, there is a concern that their components can be leached; this is because these are inserted in a single 4-5 mm increment. This in vitro study evaluated the microhardness, sorption, solubility, and color stability of three restorative bulk fill resins, namely: Filtek Bulk Fill (FBF), Tetric N-Ceram Bulk Fill (TNC), and Opus Bulk Fill (OBF). MATERIAL AND METHODS: Cylindrical samples were fabricated to be 15 mm in diameter and 1 mm thick (n = 10). For the microhardness test, three random indentations were formulated on the samples using a micro-durometer with a load of 300 gf for 15 s. Sorption and solubility were then evaluated (ISO 4049: 2009). Color stability was analyzed with a digital spectrophotometer three times (initially, after 24 h, and after 7 d) during immersion in coffee and distilled water (control). The Shapiro-Wilk test was applied to analyze normality. The Mann-Whitney and Kruskal-Wallis tests were used to compare the groups and the immersion solution, with a significance level of 5%. RESULTS: There were a significant difference in microhardness (p<0.001), with the FBF group showing a higher value compared to the other groups (56.38). The highest average of sorption scores was observed in the OBF group (16.9 µg / mm3), followed by FBF (16.8 µg / mm3) and TNC (11.3 µg / mm3). Solubility was lowest in the OBF group (-2.83 µg / mm3), with a significant difference (p = 0.031). There was also a significant difference after 24 h in the mean ∆E score of all groups (p<0.005). After one week of immersion, the group that pigmented most was OBF (p = 0.008). CONCLUSIONS: The three bulk fill resins had acceptable hardness, sorption, and solubility values. However, all groups showed a high pigmentation rate after 7 d of immersion in coffee. Key words:Bulk fill, color stability, composite resins, microhardness, solubility, sorption.

DSDapp use for multidisciplinary esthetic planning.

OBJECTIVES: Digital smile design (DSD) is useful in planning multidisciplinary esthetic treatments. However, DSD requires clinician training and skill to ensure its effective use. The Digital smile design application (DSDapp) was recently developed, to facilitate such planning. The objective of this study was to illustrate the use of the DSDapp for esthetic planning in a clinical case that included periodontal plastic surgery and ceramic laminate veneers. CLINICAL CONSIDERATIONS: An intraoral digital scan was performed, and a photograph was obtained using an iPad (frontal facial full smile). The images were analyzed using the DSDapp. All reference lines were inserted, and dental shapes predetermined by the app were superimposed on the photographs. A digital diagnostic wax-up was performed considering the plan created in the DSDapp. After 3D printing the wax-up, a mock-up transferred the planning to the oral cavity. Following this, the patient was referred to a periodontist for the periodontal plastic surgery. After the healing period, the teeth were prepared for computer-aided design/computer-aided modeling lithium disilicate ceramic laminate veneers. CONCLUSIONS: DSDapp use accelerated the initial planning steps. Smile planning can be performed during the clinical session with the patient's active participation. In addition, the DSDapp facilitated better communication within the multidisciplinary team. CLINICAL SIGNIFICANCE: The DSDapp relies more on intuition than on skill and training to execute the treatment plan. The DSDapp provides immediate feedback to the patient, offering greater predictability and helps monitor the planning through all the clinical stages.

Influence of different thermopolymerization methods on composite resin microhardness.

BACKGROUND: Additional heat polymerization in composite resins allows greater effective-ness of microhardness, flexural strength, fracture tough-ness, wear resistance, and increased color stability. MATERIAL AND METHODS: 150 composite resin specimens were made using a 4 mm diameter and 2 mm thick bipartite steel matrix. Five resins composed of different compositions were tested (Brilliant Everglow/Coltene, Filtek One BulkFill/3M, Filtek P60/3M, Filtek Z350XT/3M, Filtek Z250XT/3M), and for each of them three types of polymerization were tested: light curing only (n=50); photopolymerization + autoclave thermopolymerization (n=50) and photopolymerization + microwave thermopolymerization (n=50). Each specimen was submitted to three indentations by means of the Vickers microhardness test, applying a load of 300gf, associated with the time of 15s. Data were analyzed descriptively by means of statistics, standard deviation and coefficient of variation and inferentially by the F test (ANOVA) in the comparison between groups. The margin of error used in statistical test decisions was 5%. RESULTS: The highest vicker microhardness averages were from the Control group (light curing only) on P60 (82.16) and Z250 XT (79.61) resins. The lowest averages were all verified on Brilliant Everglow resin in all polymerization methods studied: Photopolymerization (37.32), with microwave (43.80) and autoclave (45.12), followed by Bulk Fill 3M resin, ranged from 52.23 to 59.15. CONCLUSIONS: Both autoclave and microwave thermopolymerization methods showed similar behavior on the microhardness of the composites studied. Considering the resin type, there was a varied behavior compared to thermopolymerization, which increased the microhardness values for Brilliant Everglow resins (Coltene) and Filtek One Bulkfill (3M) and decreased for Filtek P60, Filtek Z350XT and Filtek Z250XT resins. Key words:Dentistry, composite resins, polymerization.

In Vitro Evaluation of Physical and Mechanical Properties of Light-Curing Resin Cement: A Comparative Study.

OBJECTIVE: The aim of study was to evaluate in vitro the surface hardness, sorption, solubility, and color stability of three light-cured resin cements, namely RelyX Veneer (RLX), Variolink Veneer (VLK), and All Cem Veneer (ACV). MATERIALS AND METHODS: Cylindrical samples (15 × 1 mm) were made for each group using a metallic mold (n = 10). Vickers microhardness test was performed, and average hardness was calculated from three indentations (300 gf/15s) per sample. The sorption and solubility of the materials were evaluated according to ISO 4049:2009 based on three samples weighing: initial (m 1), after immersion in distilled water for 7 days (m 2), and final (after removal of all moisture [m 3]). The color change was observed using a digital spectrophotometer, at three different time points, baseline, 1 day, and 1 week of immersion in coffee and distilled water (control). STATISTICAL ANALYSIS: Shapiro-Wilk test was used to analyze the normality of the data, and groups were compared using Kruskal-Wallis and Mann-Whitney tests. A significance level of 5% was used. RESULTS: RLX showed the highest microhardness mean values (36.96 VHN), but higher sorption (23.2 µg/mm3) and solubility (2.40 µg/mm3), with statistically significant differences with the other groups. For color stability, higher ∆E was observed for the samples immersed in coffee (p = 0.009). The VLK resin cement presented statistically significant differences from the other groups, with higher color changes in coffee at 1 day (15.14) and after 1 week (23.65). CONCLUSION: RLX resin cement showed better hardness results. All materials tested performed satisfactorily for sorption and solubility according to ISO 4049:2009. All materials showed high-staining values after 1 week of immersion in coffee.

Evaluation of the effect of tooth polishing on color stability after in-office bleaching treatment / Avaliação do efeito do polimento dental na estabilidade de cor após tratamento clareador em consultório

Introduction: One of the most commonly used corrective methods for staining teeth is tooth bleaching. However, subclinical alterations may occur in the micromorphology of dental tissues during the bleaching procedure, such as increases in porosity and surface roughness. Consequently, dental enamel may become more permeable and susceptible to staining. Objective: To evaluate the influence of tooth polishing after in-office bleaching treatment on color stability. Material and method: Thirty-three extracted human molars were used. The teeth were cut in the mesiodistal direction to obtain two samples per tooth (total of 66). The samples were randomly divided into six groups (n=11). Before and after the bleaching treatment, the lightness of the samples and change in lightness (∆L) were determined with a digital spectrophotometer (Easy Shade). The samples were bleached with 35% hydrogen peroxide (three sessions weekly). Three groups were submitted to polishing with felt discs and polishing paste after each session. To simulate the oral conditions during the consumption of colored beverages, the samples were submitted to alternating cycles of immersion in staining solutions (coffee, red wine, and Coca Cola). Result: Polishing resulted in an increase of mean lightness of 4.49 in the red wine group, 2.73 in the coffee group, and 4.08 in the cola group. The difference was significant in the red wine group (p<0.022), but not in the coffee or cola group. Conclusion: Polishing after in-office bleaching using felt discs and polishing paste can reduce the degree of pigment impregnation in patient with red wine rich diet.

Introdução: Um dos métodos mais usados ​​para dentes pigmentados é o clareamento dental. Entretanto, alterações subclínicas podem ocorrer na micromorfologia dos dentes durante procedimentos de clareamento, como aumentos na porosidade e rugosidade superficial. Consequentemente, o esmalte dental pode se tornar mais permeável e suscetível a manchas. Objetivo: Avaliar a influência do polimento dentário após o clareamento em consultório na estabilidade da cor. Material e método: Trinta e três molares humanos extraídos foram utilizados. Os dentes foram cortados na direção mesiodistal para obter duas amostras por dente (total de 66). As amostras foram divididas aleatoriamente em seis grupos (n = 11). Antes e após o tratamento clareador, a luminosidade das amostras e a alteração da luminosidade (∆L) foram determinadas com um espectrofotômetro digital (Easy Shade). As amostras foram clareadas com peróxido de hidrogênio 35% (três sessões com intervalos de 7 dias). Três grupos foram submetidos a polimento com discos de feltro e pasta de polimento após cada sessão. Para simular as condições orais durante o consumo de bebidas pigmentadas, as amostras foram submetidas a ciclos alternados de imersão em soluções (café, vinho tinto e Coca Cola). Resultado: O polimento resultou em um aumento da luminosidade média de 4,49 no grupo vinho tinto, 2,73 no grupo café e 4,08 no grupo cola. A diferença foi significativa no grupo vinho tinto (p <0,022), mas não no grupo café ou cola. Conclusão: O polimento após clareamento em consultório usando discos de feltro e pasta polidora pode reduzir o grau de impregnação em pacientes com dieta rica em vinho tinto.

Multidisciplinary Approach to Smile Restoration: Gingivoplasty, Tooth Bleaching, and Dental Re-anatomization.

This article reports on the case of a patient who underwent a multidisciplinary treatment in smile design that entailed dental cosmetic techniques involving esthetic periodontal surgery, teeth bleaching, and re-anatomization of the upper incisors. The male patient presented with a chief complaint of an excessive gingival display while smiling, as well as small, darkened teeth with spaces between them. After diagnosis and patient consent, therapy began in the following stages: periodontal plastic surgery with probing, bleeding points delimitation, beveled incision, removal of the gingival band with periodontal curettes, and finishing with an electric scalpel. After 21 days following surgery, dental bleaching using a combined technique that included two sessions of in-office bleaching (35% hydrogen peroxide) and 2 weeks of at-home bleaching (carbamide peroxide 16% for 4 hours per day) was carried out, followed by dental re-anatomization using resin composite. Diagnostic waxing, mock-up, fabrication of a palatal silicone index, incremental sculpturing, and structuring the restoration of the palatal shell to the vestibular surfaces was then completed, followed by occlusal adjustment, finishing, and polishing. The multidisciplinary intervention was fundamental for the accomplishment of the proposed treatment that combined biological, functional, and esthetic concepts.

Escaneamento digital e prototipagem 3d para confecção de laminados cerâmicos: relato de caso clínico / Digital Scanning and 3D Prototyping for Ceramic Laminate Confection: Clinical Case

Introdução:lentes de contato dentais podem ser uma excelente opção para correção de cor, forma, tamanho e posicionamento dental. Entretanto é umtratamentoque requer várias etapas laboratoriais com riscos de distorções nas etapas de moldagem e vazamento do modelo. Desta forma, desadaptações dos laminados em boca podem ser frequentes.Objetivo:relatar um caso clínico de nove laminados cerâmicos em que foi empregado o escaneamento digital, troquelização virtual e prototipagem do modelo em 3D.Método:paciente do gênero feminino, 59 anos, buscou atendimento odontológico queixando-se de desproporcionalidade dentária ao sorrir. Ao exame clínico foi observada uma inclinação maxilar que causava aquela desarmonia. Foi proposta a confecção de laminados cerâmicos para compensar a discrepância óssea bem como melhorar forma, contorno e cromia dentária. Após planejamento digital, confecção do enceramento diagnóstico, mock up, e aceita do planejamento por parte da paciente, iniciaram-se os preparos dentários. Finalizada esta etapa, os dentes foram escaneados (Trios 3Shape), troquelizados e prototipados em impressora 3D. O modelo foi encaminhado ao laboratório que confeccionou as peças protéticas em dissilicato de lítio de forma injetada e maquiada. Por fim, foram realizadas as provas secas, úmidas, ajustes necessários e cimentação dos laminados com cimento resinoso fotopolimerizável.Conclusão:a tecnologia empregada se mostrou eficiente na resolução do caso, sendo uma técnica rápida, que causou pouco desconforto à paciente e oportunizou uma boa adaptação dos laminados cerâmicos (AU).

Introduction:laminates veneers can be an excellent choice for color correction, shape, size and dental positioning. However, it is a technique that requires several laboratory steps with risks of distortion in the molding and casting steps of the model. Thus, maladjustments of laminatesin the mouth may be frequent.Objective:to report a clinical case of nine ceramic laminates through the digital scanning, virtual punching and 3D prototyping of the model.Methods:A 59 years old woman showed up to dental clinic searched dental care complaining of dental disproportionality when smiling. At the clinical examination, a maxillary inclination was observed that caused disharmony. It was proposed the making of ceramic laminates to compensate the bone discrepancy as well as improve shape, contour and dental color. After the digital planning, preparation diagnostic wax-up, mock up, and acceptance of patient planning, the dental preparations were started. After this step, the teeth were scanned (Trios 3Shape), punched and prototyped in a 3D printer. The model was sent to the laboratory to do the prosthetic parts in lithium disilicate in an injected and makeup manner. At last, it were made the tests dry, wet, required adjustments finally cementation of the ceramic laminates with photopolymerizable resin cement. Conclusions:the technology employed was efficient in solving this case, being a fast technique, which caused little discomfort to the patient and provided a good adaptation of the ceramic laminates (AU).

Desgaste dentinário seletivo associado à pino de fibra de vidro: relato de caso / Selective Dentin Removal Associated to the Fiberglass pin: Case Report / Desgaste Dentinario Selectivo Asociado con Pin de Fibra de Vidrio: Reporte de Caso

Introdução:Pigmentação dentináriaintrínseca pode comprometer a estética do sorriso e causar constrangimento ao sorrir. Essas manchas podem ser resultado da presença de materiais restauradores na coroa após tratamento endodôntico, hemorragia intracoronária, decomposição de detritos intrapulpares, medicamentos de uso intracanal e materiais obturadores. Objetivo:relatar um caso clínico dedesgaste dentinário seletivo associado à restauração com resina composta e pino de fibra de vidro. Metodologia:paciente do gênero masculino, 23anos, buscou atendimento odontológico queixando-se depigmentaçãodentáriano incisivo central após tratamento endodôntico e restauração classe IV de resina composta escurecida. Constatada a normalidade do tratamento endodôntico, iniciou-se o tratamento. Foi removida com pontas diamantadas e acesso palatinotoda pigmentação que comprometia a estética do sorriso, bem como a restauração em resina composta de cor e forma insatisfatória.Na sequência, após isolamento absoluto, o canal foi desobturado preservando 4mm de material obturador apical. Foi realizada limpeza do conduto e coroa com pasta de pedra pomes e água, aplicação de ácido fosfórico 37% (15s em dentina e 30s em esmalte), lavagem com spray de água e ar e secagem. Foi aplicado na coroa e no conduto adesivo universal e remoção dos excessos com cones de papel absorvente e polimerização (20s). Na sequência, o canal foi preenchido com cimento resinoso dual, e o pino de fibra de vidro foi inserido com inserção única. Por fim, a restauração foi realizada com resina composta de cor compatível com o remanescente e posteriormente acabamento e polimento. Conclusões:O desgaste dentinário seletivo associado à restauração em resina composta com pino de fibra de vidro favoreceua devolução estética efuncional ao elemento dentário (AU).

Introduction: Intrinsic dentinal pigmentation can compromise the aesthetics of the smile and cause embarrassment when smiling. These spots may be the result of the presence of restorative materials in the crown after endodontic treatment, intracoronary hemorrhage, intrapulpal debris decomposition, intracanal medication and obturator materials. Objective:to report a clinical case of selective dentin removal associated with restoration with composite resin and fiberglass pin. Methodology:male patient, 23 years old, sought dental care complaining of dental pigmentation in the central incisor after endodontic treatment and restoration of class IV of darkened composite resin. Once the endodontic treatment was normal, the treatment was started. It was removed with diamond tips and palatine access all pigmentation that compromised the aesthetics of the smile, aswell as the restoration in composite resin of color and unsatisfactory form. Following, after absolute isolation, the canal was obturated preserving 4mm of apical obturator material. The flue and crown were cleaned with pumice paste and water, 37% phosphoric acid (15s in dentin and 30s in enamel),spray with water and air and drying. It was applied to the crown and the universal adhesive conduit and removal of excesses with absorbent papercones (20s)and polymerization. Subsequently, the channel was filled with dual resin cement, and the fiberglass pin was inserted with single insert. Finally, the restoration was carried out with composite resin of color compatible with the remainder and later finishing and polishing. Conclusions:Selective dentin removal associated with composite resin restoration with fiberglass pin favored aesthetic and functional return to the dental element (AU).

Introducción: La pigmentación intrínseca de la dentina puedecomprometer la estética de la sonrisa y causar vergüenza al sonreír. Estas manchas pueden deberse a la presencia de materiales restauradores en la corona después del tratamiento endodóntico, hemorragia intracoronaria, descomposición de escombros intrapulpales, fármacos intracanales y materiales obturadores.Objetivo:reportar un caso clínico de desgaste selectivo de dentina asociado con resina compuesta y fibra de vidrio. Metodología:un paciente masculino de 23 años buscó atención dental quejándose de pigmentación dental en el incisivo central después del tratamiento endodóntico y la restauración de clase IV de resina compuesta oscura. Una vez que se encontró la normalidad del tratamiento endodóntico, se inició el tratamiento. Se eliminó con puntas de diamante y acceso palatino a toda la pigmentación que comprometía la estética de la sonrisa, así como la restauración en resina compuesta de color y forma insatisfactorios. Luego, después del aislamiento absoluto, se limpió el canal conservando 4 mm de material obturador apical. El conducto y la corona se limpiaron con pasta de piedra pómez, aplicación de ácido fosfórico al 37% (15 segundos en dentina y 30 segundos en esmalte), se lavaron con agua y aire y se secaron. Se aplicó a la corona y al conducto adhesivo universal y se eliminó el exceso con conos de papel absorbente y polimerización (20 s). Posteriormente, el canal se llenó con cemento de resina dual y el pasador de fibra de vidrio se insertó con un solo inserto. Finalmente, la restauración se realizó con resina compuesta de un color compatible con el resto y posteriormente acabado y pulido.Conclusiones:el desgaste selectivo de la dentina asociado con la restauración de resina compuesta con pin de fibra de vidrio favoreció el retorno estético y funcional al elemento dental (AU).

Harmonização estética do sorriso ­ cirurgia periodontal, clareamento dental e fechamento de diastemas ­ relato de caso / Aesthetic harmonization of the smile ­ periodontal surgery, dental whitening, and diastema closure - case report

Este estudo teve por objetivo relatar um caso clínico de harmonização estética do sorriso com abordagem multidisciplinar integrada, envolvendo cirurgia plástica periodontal, clareamento dental associado e fechamento de diastema com resina composta aplicada diretamente pela técnica "mãos livres". Após anamnese, diagnóstico e aceita da proposta terapêutica, foi realizado o procedimento cirúrgico periodontal (gengivectomia, gengivoplastia e frenectomia labial superior). Após o período cicatricial, foi realizado clareamento dental associado com as técnicas de consultório (peróxido de hidrogênio 35% - 02 sessões) e supervisionado (peróxido de carbamida 10% - 08hs/dia - 02 semanas). O tratamento foi finalizado com restaurações adesivas diretas em resina composta à mão livre para o fechamento de diastema. A terapêutica adotada evidenciou a necessidade de conhecimento científico e habilidade técnica profissional para seu emprego; mostrou-se eficaz como alternativa acessível de tratamento; permitiu melhor equilíbrio da harmonia estética do sorriso e a satisfação do paciente (AU).

This study aimed to report a clinical case of aesthetic harmonization of the smile with an integrated multidisciplinary approach, involving periodontal plastic surgery, associated to dental whitening and diastema closure with composite resin applied directly by the "hands free" technique. After anamnesis, diagnosis, and acceptance of the therapeutic proposal, the periodontal surgical procedure was performed (gingivectomy, gingivoplasty, and upper labial frenectomy). After the healing period, dental bleaching associated with the office techniques (35% hydrogen peroxide - 02 sessions) was performed and supervised (carbamide peroxide 10% - 08hs/day - 02 weeks). The treatment was finished with free hands direct adhesive composite resin restorations for diastema closure. The therapy adopted evidenced the need for scientific knowledge and professional technical skills for its use. It proved to be effective as an accessible treatment alternative; allowed better balance of the smile aesthetic harmony and the satisfaction of the patient (AU).