Can non-carious cervical lesions depth affect clinical response in pain intensity and remaining dentin thickness?

Non-carious Cervical Lesions (NCCL) are dental tissue defects, non-related to caries, frequently observed in the dental practice. The aim of this study was to evaluate the effects of NCCL on dentin depth and thickness and the response to dental pain by means of clinical diagnostic tests. 86 teeth from 14 patients with NCCL were assessed by: depth of NCCL, clinical tests (evaporative stimulus, to detect pain levels of dentin hypersensitivity, cold thermal test to classify pulp health, percussive stimuli to evaluate the periradicular tissues and cone beam computed tomography (tomography to evaluate remaining dentin thickness (RDT). In terms of depth, the sample was divided into two groups: G1- teeth with NCCLs ≤1.0mm and G2- teeth with NCCLs between 1.1-2.0 mm. Dental pain data were compared by Mann-Whitney test and RDT by Student's t-test and correlations by the Pearson test (p<0.05). The depth of NCCL does not influence dental pain response to evaporative stimulus (p=0.129), cold thermal test (p = 0.125), vertical (p = 0.317) and horizontal (p = 0.119) percussion clinical diagnostic tests. However, G1 showed more RDT (p<0.001), and the correlation test showed that deeper NCCL presents smaller remaining dentin thickness (p=0.011/r=-0.273). In conclusion, tooth with NCCL up to 2mm-depth presents similar levels of pain for dentin hypersensitivity, pulp and periradicular tissue independent to NCCL depth, however, lesions with ≤1.0mm-depth showed greater RDT in tomographic findings.

Can non-carious cervical lesions depth affect clinical response in pain intensity and remaining dentin thickness?

Abstract Non-carious Cervical Lesions (NCCL) are dental tissue defects, non-related to caries, frequently observed in the dental practice. The aim of this study was to evaluate the effects of NCCL on dentin depth and thickness and the response to dental pain by means of clinical diagnostic tests. 86 teeth from 14 patients with NCCL were assessed by: depth of NCCL, clinical tests (evaporative stimulus, to detect pain levels of dentin hypersensitivity, cold thermal test to classify pulp health, percussive stimuli to evaluate the periradicular tissues and cone beam computed tomography (tomography to evaluate remaining dentin thickness (RDT). In terms of depth, the sample was divided into two groups: G1- teeth with NCCLs ≤1.0mm and G2- teeth with NCCLs between 1.1-2.0 mm. Dental pain data were compared by Mann-Whitney test and RDT by Student's t-test and correlations by the Pearson test (p<0.05). The depth of NCCL does not influence dental pain response to evaporative stimulus (p=0.129), cold thermal test (p = 0.125), vertical (p = 0.317) and horizontal (p = 0.119) percussion clinical diagnostic tests. However, G1 showed more RDT (p<0.001), and the correlation test showed that deeper NCCL presents smaller remaining dentin thickness (p=0.011/r=-0.273). In conclusion, tooth with NCCL up to 2mm-depth presents similar levels of pain for dentin hypersensitivity, pulp and periradicular tissue independent to NCCL depth, however, lesions with ≤1.0mm-depth showed greater RDT in tomographic findings.

Resumo Lesões Cervicais Não Cariosas (LCNC) são defeitos do tecido dentário, não relacionados à cárie, frequentemente observados na prática odontológica. O objetivo do estudo foi avaliar os efeitos da profundidade e espessura da dentina de LCNC na resposta à dor dentária por meio de testes de diagnóstico clínico. 86 dentes de 14 pacientes com LCNC foram avaliados por: profundidade da LCNC, testes clínicos (estímulo evaporativo, para detectar níveis de dor de hipersensibilidade dentinária, teste térmico frio para classificar a saúde pulpar, estímulos percussivos para avaliação do tecido perirradicular e tomografia computadorizada de feixe cônico (TCFC), para avaliação da espessura de dentina remanescente (EDR). Em termos de profundidade, a amostra foi dividida em dois grupos: G1- dentes com LCNCs ≤1,0mm e G2- dentes com LCNCs entre 1,1-2,0 mm. Os dados de dor dentária foram comparados pelo teste de Mann-Whitney e a EDR pelo teste t-Student e correlações pelo teste de Pearson (p <0,05). A profundidade da LCNC não influencia a resposta da dor dentária ao estímulo evaporativo (p = 0,129, teste térmico frio (p = 0,125), teste diagnóstico clínico de percussão vertical (p = 0,317) e horizontal (p = 0,119), porém o G1 apresentou maior EDR (p <0,001) e o teste de correlação mostrou que LCNC mais profunda apresenta menor EDR (p = 0,011 / r = -0,273). Conclusão: Dentes com LCNC de até 2mm de profundidade apresenta níveis semelhantes de dor para hipersensibilidade dentinária, pulpar e saúde perirradicular, independente da profundidade da LCNC. Entretanto, lesões com profundidade ≤1,0mmin apresentaram mais EDR nos achados tomográficos.

Influence of non-carious cervical lesions, bone attachment level, and occlusal load on the stress distribution pattern in maxillary premolars: finite element analysis

This study aimed to evaluate the influence of different bone attachment levels and occlusal loads on the stress distribution pattern of maxillary premolars with or without non-carious cervical lesion (NCCL), before and after restoration with composite resin by three-dimensional (3D) finite element analysis. From the healthy model, NCCL models were produced and the cavity was restored with composite resin. Models with vertical and horizontal bone loss were also made. For each model, three types of occlusal loads were simulated (100 N): vertical load (VL), buccal load (BL), and palatal load (PL). After processing the models, the data were obtained in MPa for the criteria of Maximum Principal Stress (for all structures) and Minimum Principal Stress (for cortical and medullary bones). Stress values were collected for a node on the cervical buccal surface (Maximum Principal Stress) and the buccal crestal bone (Minimum Principal Stress). As a result, the different bone attachment levels did not affect stress distribution at the amelodentinal junction. The buccal load promoted a higher concentration of compressive stress on the buccal bone surface and the palatal load resulted in greater tensile stress in the buccal cervical third of the tooth. The concentration of tensile stress in the buccal cervical third was exacerbated by the presence of NCCL and it was similar to the healthy and restored models. It can be concluded that stress concentration at the bone level does not depend on the presence or absence of NCCL and the restoration procedure but it is related to the type of occlusal load. However, the presence of NCCL promoted a higher stress concentration in the cervical region, especially when combined with oblique occlusal loads.

Influence of Tip Diameter and Light Spectrum of Curing Units on the Properties of Bulk-Fill Resin Composites.

OBJECTIVE: The aim of this study was to evaluate the influence of different light-curing units (LCUs) with distinct tip diameters and light spectra for activating bulk-fill resins. MATERIALS AND METHODS: The specimens (n = 10) were made from a conventional composite (Amaris, VOCO) and bulk-fill resins (Aura Bulk Fill, SDI; Filtek One, 3M ESPE; Tetric Bulk Fill, Ivoclar Vivadent) with two diameters, 7 or 10 mm, × 2 mm thickness. Following 24 hours of specimen preparation, the degree of conversion (DC) was evaluated using the Fourier-transform infrared unit. Knoop hardness (KHN) readings were performed on the center and periphery of the specimens. Data were assessed for homoscedasticity and submitted to one-way and three-way analysis of variance followed by the Tukey's and Dunnett's tests, depending on the analysis performed (α = 0.05). RESULTS: LCUs and specimen diameter significantly affected the DC. The Tetric Bulk Fill provided increased DC results when light-cured with Valo (54.8 and 53.5%, for 7 and 10 mm, respectively) compared with Radii Xpert (52.1 and 52.9%, for 7 and 10 mm, respectively). No significant differences in KHN results were noted for the conventional resin composite (Amaris) compared with LCUs (p = 0.213) or disc diameters (p = 0.587), but the center of the specimen exhibited superior KHN (p ≤ 0.001) than the periphery. CONCLUSION: The light spectrum of the multipeak LCU (Valo) significantly increased the DC and KHN of the bulk-fill resin composite with additional initiator to camphorquinone (Tetric Bulk Fill) compared with the monowave LCU (Radii Xpert). The tip size of the LCUs influenced the performance of some of the resin composites tested.

Effect of Interval Time between Corrosive and Abrasive Challenges on a Nanoparticulate Composite Resin.

OBJECTIVE: This study aimed to evaluate the effect of interval time after acidic beverage intake and brushing on roughness and hardness of resin composite. MATERIALS AND METHODS: Nanofilled resin composites were tested as per interval time (no interval, 15 or 30 minutes) between aging media (isotonic, sports drink) and brushing. Specimens (n = 9) were subjected to three cycles daily for 5 days with immersion in beverage followed by simulated brushing (585 strokes). The brushing (control) group was submitted only in brushing cycles. Roughness and microhardness were analyzed in the baseline and end of the experiment. Surface morphology was analyzed by using scanning electron microscopy (SEM). STATISTICAL ANALYSIS: Data were analyzed by one-way ANOVA and Tukey's honestly significant difference (α = 0.05). RESULTS: Roughness was higher in no interval group and lower in 30 minutes and control. The 15 minutes present no statistical difference between control, 30 minutes and no interval. The hardness not present difference between groups. The SEM showed the no interval more roughness than 15 and 30 minutes, control and baseline. CONCLUSION: The interval time between erosive and abrasive challenge is important to preserve the smoothness surface of composite resin.

The influence of customization of glass fiber posts on fracture strength and failure pattern: A systematic review and meta-analysis of preclinical ex-vivo studies.

OBJECTIVE: To perform a systematic review of the literature focused to evaluate in vitro function of prefabricated fiber posts with and without customization by additional auxillary fiber posts and composite resin on the fracture strength of wide or enlarged canals and the failure pattern. METHODS: Six databases were used as primary search sources (PubMed, Scopus, LILACS, SciELO, Science Direct, and Web of Science) and three databases (Open Grey, Open Thesis, and OATD) were used to partially capture the "grey literature". The research included laboratory studies that used human upper anterior teeth aiming to assess the fracture strength and failure pattern of different glass fiber post customizations by additional auxiliary fiber posts or composite resin. The search had no restriction of year, language, and publication status. The risk of bias of the studies was assessed from the criteria established in systematic reviews of laboratory studies. Standardized mean differences were calculated by comparing the mean fracture strengths of customized and non-customized posts. Pooled estimates were calculated by Glass' delta method using the random-effects model. Subtotal estimates were presented according to each type of relining procedure and an overall estimate was described considering all studies combined. RESULTS: The search provided 2291 results, from which six met the eligibility criteria and were included in the qualitative assessment of the review. Only three studies presented a moderate risk of bias. The meta-analysis results showed that the use of auxiliary posts produced higher mean fracture strengths than non-customized posts (SMD = 2.21; 95%CI: 0.74; 3.68), and it was more effective than the use of composite resin to reline the posts. CONCLUSION: Based on laboratories studies, even though has not been observed any difference to a statistically significant level on fracture strength and failure pattern of the customized and non-customized post, future studies should follow a standardized approach to implementation and reporting of data.

Ceramic veneers on teeth with non-carious cervical lesions: case report and finite element analysis / Facetas cerâmicas em dentes com lesões cervicais não cariosas: relato de caso e análise de elementos finitos

On ceramic veneers rehabilitation, teeth with non-carious cervical lesions (NCCLs), especially premolars, are often involved. Preparation to remove deep NCCLs may lead to excessive wear and a less conservative approach, which goes against the current principles of minimal wear and maximum preservation. However, no evidence exists indicating which technique could avoid excessive wear during the dental preparation for veneers associated with NCCL. Thus, this study aimed to present an aesthetic treatment with ceramic veneers and follow-up of 24 months of a patient with various levels of NCCL severity; and to evaluate various wear protocols for dental veneers associated with NCCL via Finite Element Analysis (FEA) to guide and justify the clinical decision of the clinical case described. A 37-year-old male patient presented for treatment with wear on the anterior teeth and with NCCLs of various severity degrees on the posterior teeth. The treatment chosen was rehabilitation with ceramic veneers on teeth 15 to 25. The best restorative approach for the NCCL teeth was evaluated via an FEA, simulating various protocols and lesion depths while also calculating the percentage of tooth structure loss. Restoring the premolar's deeper NCCL with a composite resin core, before a ceramic veneer impression, presented better mechanical behavior in FEA and less tooth wear. For the 1.0 mm NCCL, beveling the lesion promoted good stress distribution, less invasive wear and an easier clinical procedure, as it did not involve a previous restorative procedure. It could be concluded that the restorative decision for premolars with NCCLs that will receive veneers should consider the set biomechanical behavior and especially the tooth structure wear necessary. For the case report presented, after two years of follow-up, no changes from the immediate result were observed, indicating that the cause of the lesions was eliminated, and that the treatment was effective, at least in the short-term. For FEA analysis, restoring the deeper NCCL prior to ceramic veneer impression, presented better mechanical behavior and less tooth wear. For the 1.0 mm NCCL, beveling the margin of the lesion generated the same good results

Na reabilitação com facetas cerâmicas, dentes com lesões cervicais não cariosas (LCNC), especialmente pré-molares, estão frequentemente envolvidos. O preparo para remover a LCNC pode levar a um desgaste excessivo e a uma abordagem menos conservadora, o que vai contra os princípios atuais de mínimo desgaste e máxima preservação. Entretanto, não existem evidências indicando qual técnica pode evitar o desgaste excessivo durante o preparo para facetas associado com LCNC. Portanto, esse artigo tem dois objetivos principais: 1) apresentar um tratamento estético com facetas cerâmicas e acompanhamento de 24 meses de um paciente com vários níveis de severidade de LCNC e 2) avaliar vários protocolos de preparo para facetas cerâmicas associadas com LCNC por meio do Método de Elementos Finitos (MEF) para guiar e justificar a decisão clínica do caso clínico descrito. Um paciente de 37 anos, gênero masculino, compareceu para tratamento com desgaste nos dentes anteriores e com LCNC com vários graus de severidade nos dentes posteriores. Optou-se pela reabilitação com facetas cerâmicas nos dentes 15 a 25. A melhor abordagem restauradora para os dentes com LCNC foi avaliada por MEF, simulando vários protocolos e profundidades de lesão, além disso foi calculada a porcentagem de estrutura dental perdida. Restaurar a LCNC profunda de um pré-molar com um núcleo de resina composta, antes da moldagem para faceta cerâmica, apresentou melhor comportamento mecânico em MEF e menos desgaste dental. Para a LCNC de 1 mm, biselar a lesão promoveu boa distribuição de tensões, um desgaste menos invasivo e um procedimento clínico mais fácil, já que não envolveu um procedimento restaurador prévio. Pode-se concluir que a decisão restauradora para pré-molares com LCNC que irão receber facetas deve considerar o comportamento biomecânico do conjunto e, principalmente, o desgaste de estrutura dental necessário. Para o caso apresentado, após 2 anos de acompanhamento, nenhuma mudança foi observada, indicando que a causa das lesões foi eliminada, e que o tratamento foi efetivo, ao menos no curto prazo. Para MEF, restaurar a LCNC antes da moldagem para facetas, apresentou melhor comportamento mecânico e menor desgaste dentário. Para a LCNC de 1,0 mm, fazer o bisel na margem da lesão levou aos mesmos bons resultados.

Development of a fiber-reinforced material for fiber posts: Evaluation of stress distribution, fracture load, and failure mode of restored roots.

STATEMENT OF PROBLEM: The biomechanical behavior of post-restored roots with an experimental fiber-reinforced composite resin is unknown. PURPOSE: The purpose of this in vitro study was to investigate the biomechanical behavior of an experimental composite resin (3-mm short glass fiber incorporated in methacrylate matrix with filler particles) used to produce the custom post itself or to reline fiber posts. MATERIAL AND METHODS: Four testing groups (n=10) were created according to the root restoration method: FG, commercially available fiber post; FG+RC, fiber post relined with conventional composite resin; FG+EXP, fiber post relined with the experimental composite resin; and EXP, a custom post made of experimental composite resin. A three-dimensional finite element linear elastic analysis was performed by using geometric representations of groups, and the results were analyzed by von Mises (σvM) and maximum principal stress criteria. In sequence, 40 bovine incisors were assigned to these groups and subjected to a fracture load test (Instron 5965; 0.5 mm/min), and the failure mode was determined. RESULTS: The EXP group showed more homogeneous stress distribution for σvM. ANOVA and the Tukey honestly significant difference (HSD) tests showed significant differences (P<.001) in fracture load (mean ±standard deviation; different superscript letters indicate statistical difference): FG+EXP (669.5 ±107.7)A; FG (620.7 ±59.2)A; EXP (506.5 ±27.0)B; FG+RC (452.7 ±81.6)B. No differences were found for failure mode (P=.595). CONCLUSIONS: The experimental composite resin significantly increases fracture load when used to reline commercially available fiber posts and, irrespective of its use, presented lower stress concentration.

Influence of anterior load and restorative procedure on maxillary incisors with different cervical wear morphologies / Influência do procedimento restaurador e de contato anterior em incisivos superiores com diferentes morfologias de desgaste cervical

The aim of this study was to evaluate the influence of different anterior load type and restorative procedure on stress distribution of maxillary incisors with different noncarious cervical lesions (NCCLs) morphologies. Three-dimensional models of a maxillary incisor were generated. Beyond the sound model (SO), five NCCLs morphologies were simulated: shallow (SH), notched (NO), concave (CO), wedge-haped (WS) and irregular with dual center (IR' and IR"). Composite resin restoration of all the models was simulated (R). Two different anterior loads were applied: 100N on palatine middle third (ML) and 500 N on palatine incisal third (IL). The data were obtained in MPa using the Maximum Principal Stress and Von Mises criteria and the statistical analysis was performed (paired t-test with 95% confidence level). The IL provided higher compressive stress than ML, mainly on WS (-136.3MPa), IR" (-117.5) and NO (-71.1 MPa). The highest tensile stress found within the restored models was on NOR with IL (19,1 MPa). The Von Mises results showed higher stress concentration on non-restored and IL models (p<0.001). The anterior load type and restorative status were determinant factors on stress distribution pattern changes, whereas NCCLs morphologies had little influence in maxillary incisors.

O objetivo deste estudo foi avaliar a influência de diferentes tipos de contatos anteriores e procedimentos restauradores na distribuição de tensões de incisivos superiores com diferentes morfologias de lesões cervicais não-cariosas (NCCLs). Modelos tridimensionais de um incisivo central superior foram gerados. Além do modelo hígido (SO), foram simuladas cinco morfologias de NCCLs: rasas (SH), entalhadas (NO), côncavas (CO), em forma de cunha (WS) e irregulares com centro duplo (IR' e IR''). Restauração com resina composta em todos os modelos foi simulada (R). Dois contatos anteriores diferentes foram aplicadas: 100N no terço médio palatino (ML) e 500N no terço incisal palatino (IL). Os dados foram obtidos em MPa utilizando os critérios de Tensão Máxima Principal e de Von Mises e a análise estatística foi realizada (teste t pareado com nível de significância de 95%). A IL proporcionou maior estresse compressivo que ML, principalmente em WS (-136,3MPa), IR "(-117,5) e NO (-71,1 MPa). A maior tensão de tração encontrada nos modelos restaurados foi na NOR com IL (19,1 MPa). Os resultados de Von Mises mostraram maior concentração de estresse nos modelos não restaurados e IL (p <0,001). O tipo de contato anterior e a presença de restauração foram fatores determinantes nas alterações do padrão de distribuição de estresse, enquanto as morfologias dos NCCLs tiveram pouca influência nos incisivos superiores.

Influência do desequilíbrio oclusal na origem de lesão cervical não cariosa e recessão gengival: análise por elementos finitos / Influence of occlusal instability on the origin of non-carious cervical lesion and gingival recession: finite element analysis

Objetivo: avaliar o comportamento biomecânico de pré- -molar superior com presença de Lesões Cervicais Não Cariosas (LCNC) e submetido a três carregamentos oclusais distintos pelo método de elementos finitos tridimensional (3D). Material e método: nove modelos tridimensionais elásticos foram gerados, com propriedades ortotrópicas e isotrópicas: Hígido (H); LCNC não restaurada (LCNC) e LCNC restaurada com resina composta (RC); sendo todos estes modelos submetidos a três carregamentos: Axial (A), Oblíquo vestibular (V) e Oblíquo palatino (P). Os carregamentos tiveram intensidade de 150 N e a restrição de deslocamento foi realizada na base e lateral dos ossos cortical e medular. Os resultados foram gerados em tensão máxima e mínima principal. Resultados: O carregamento axial apresentou padrões de tensão mais favoráveis, independente da característica da região cervical. O carregamento palatino mostrou maior acúmulo de tensão de tração na região cervical vestibular e o carregamento vestibular resultou em maior tensão de compressão na tábua óssea vestibular. A presença de LCNC foi fator intensificador para o aumento da concentração de tensão na região cervical. A simulação da restauração com resina composta promoveu um comportamento biomecânico simular ao do hígido. Conclusões: que o carregamento palatino pode estar mais associado com a presença de LCNCs e o vestibular com a presença de recessão gengival. O ajuste oclusal e a restauração da LCNC são indicados para tornar o padrão de tensão mais favorável para o remanescente dentário.

Objective: to evaluate the biomechanical behavior of maxillary premolar with the presence of NCCL and submitted to three distinct occlusal loads, using the three-dimensional (3D) finite element analysis. Methods: nine three-dimensional elastic models were generated, with orthotropic and isotropic properties: Sound (H); Unrestored NCCL (NCCL) and NCCL restored with composite resin (RC); All models were submitted to three loads: Axial (A), Buccal (V) and Palataline (P). The loads intensity was 150 N and the displacement restriction was performed at the base and lateral of the cortical and medullary bones. The results were generated at maximum and minimum principal stress. Results: the axial loading presented more favorable stress pattern, independent of the characteristic of the cervical region. The palataline loading showed a greater concentration of tensile stress in the buccal cervical region and the buccal loading resulted in a higher compression stress in the buccal bone. The presence of NCCL was a relevant factor for increase concentration of stress in the cervical region. The simulation of the restoration with composite resin promoted a biomechanical behavior similar to that of the sound tooth. Conclusion that the palataline loading may be more associated with the presence of NCCLs and the vestibular with the presence of gingival recession. The occlusal adjustment and the restoration of NCCLs are indicated to produce the stress pattern more favorable for the dental remaining.

Relationship between noncarious cervical lesions, cervical dentin hypersensitivity, gingival recession, and associated risk factors: A cross-sectional study.

OBJECTIVES: The aim of this study was to evaluate the risk factors associated with noncarious cervical lesions (NCCLs), cervical dentin hypersensitivity (CDH), and gingival recession (GR), besides the relationship among these conditions in a specific Brazilian sample population. METHODS: 185 patients who attended the "Ambulatory Program for Rehabilitation of Patients with Noncarious Cervical Lesions and Cervical Dentin Hypersensitivity" were evaluated, and 5180 teeth were analyzed. The subjects filled out a form and a calibrated examiner performed the clinical exams to determine the presence of NCCLs, CDH, and GR. NCCLs were classified according to their morphology and depth, CDH levels were evaluated according to air stimuli response, and GRs were categorized according to Miller's classification. The association of the risk factors with NCCLs, CDH, and GR was determined with the Mann-Whitney U test and multiple linear regression. For the correlations, the Spearman test was used with a 95%-confidence level. RESULTS: The NCCLs, CDH, and GR distributions within the study were 88.1%, 89.1%, and 59.4%, respectively. Maxillary premolars were the most affected by all three conditions. A positive correlation was found between age, NCCLs, and GR; between NCCLs and CDH; CDH and GR; GR and NCCLs. Age, gender, oral hygiene, gastroesophageal diseases, and occlusal trauma were significantly associated with the presence of all three conditions. CONCLUSIONS: The NCCLs and GR distributions increased with age; NCCLs, CDH, and GR had positive correlation; the lesions' depth and morphology contributed to high levels of sensitivity and severity of recessions; age, gender, gastric disease, and occlusal trauma were relevant factors for the occurrence of NCCLs, CDH, and GR. CLINICAL SIGNIFICANCE: The increasing distribution of NCCLs, CDH, and GR is closely associated with people's lifestyles. Thus, it is important for the clinicians to recognize the etiological factors and their most relevant associations to prevent and control such alterations, in order to improve the population's quality of life.

Esthetic rehabilitation with minimally invasive feldspathic ceramic veneers: 30 months of clinical follow-up / Reabilitação estética com facetas em cerâmicas feldspáticas minimamente invasivas: 30 meses de acompanhamento clínico

Diastemas among maxillary incisors and gingival contour disharmony are common findings among patients in dental practice. Ceramic veneers are indicated for esthetic rehabilitation of anterior diastemas due their predictable results, optical characteristics, fracture resistance and tooth structure conservation. However, because it is a friable material and have a brittle behavior, fractures occurrences are related to trauma, oclusal overload, parafunctional habits and material fatigue. This article describes 30 months follow-up of an esthetic and functional rehabilitation diastemas closure using feldspathic veneers associated with periodontal surgery and a ceramic repair with composite resin. Gingivectomy and frenectomy needs were found and the surgical procedures performed guided by new anatomic aspects of the crowns. Mock-up was performed after waxing and reverse planning. All anterior teeth underwent minimally invasive preparation. Feldspathic ceramic veneers were made, tried using try in paste and luted with light-cure resin cement. After 24 months, a fracture occurred on the right maxillary canine veneer. The ceramic restoration repair was performed with nano-hybrid composite resin, after the conditioning with 5% hydrofluoric acid, 37% phosphoric acid and silane couple agent. The combination between ceramic veneers and gingivectomy enables to obtain conservative treatments and esthetic success. After six months of the repair, resulting 30 months of follow-up, the anterior restorations were aesthetically and functionally satisfactory.

Presença de diastemas entre os incisivos superiores e desarmonia do contorno gengival são achados comuns entre os pacientes atendidos na rotina clínica. Facetas cerâmicas são indicadas para reabilitação estética de diastemas anteriores devido a previsibilidade de resultados, características óticas, resistências à fratura e conservação de estrutura dentária. Entretanto, por este ser um material frágil e apresentar comportamento friável, fraturas podem estar relacionadas a episódios de trauma, sobrecarga oclusal, hábitos parafuncionais e fadiga do material. Este artigo descreve um acompanhamento clínico de 30 meses de reabilitação estética e funcional de fechamento de diastema utilizando facetas minimamente invasivas confeccionadas com cerâmicas feldspáticas associadas à cirurgia periodontal e necessidade de reparo da cerâmica com resina composta. A indicação de plastia gengival e frenectomia foram constatadas e o procedimento cirúrgico guiado pelo planejamento da nova anatomia das coroas dentárias. Todos os dentes anteriores superiores foram minimamente preparados. O mock-up foi realizado depois do enceramento e do planejamento reverso. Facetas em cerâmicas feldspáticas foram confeccionadas, a cor do cimento resinoso selecionada com pastas testes e a cimentação concluída com cimento de polimerização exclusiva física. Depois de 24 meses de acompanhamento, ocorreu fratura da faceta do canino superior direito. O reparo da restauração cerâmica foi realizado com resina nanohibrida, depois da cerâmica condicionada com ácido fluorídrico 5%, ácido fosfórico 37% e aplicação de agente de união silano. A combinação entre facetas cerâmicas e cirurgia de plastia gengival permite alcançar tratamento conservador e sucesso estético. Posteriormente seis meses do reparo, resultando em 30 meses de acompanhamento clínico, as restaurações anteriores permaneciam estética e funcionalmente satisfatórias.

Analysis of bleaching products associated with desensitizing agents in experimental whitening gel ­randomized clinical trial / Análise de produtos clareadores associados com agentes dessensibilizantes em gel clareador experimental ­ ensaio clínico randomizado

The objective of this clinical study was to determine the effect of adding desensitizing agents in homemade experimental whitening gel Carbamide peroxide 16%. 60 young patients were selected (between 18-28 years), who used randomly (by lottery) the whitening gel DA (with desensitizing agent) or whitening gel CO (without desensitizing agent) characterized as control of a double-blind study, ie the patient and the evaluator did not know the product that was being used. Teeth 15, 14, 13, 12, 11, 21, 22, 23, 24 and 25 were bleached. The guidelines of how to apply the bleaching agents were performed by an experienced and calibrated team, and the application accompanied by examiners in several phases. To measure the color we used a Visual Range Vita Classical through visual inspection by the evaluators and patient information. A comparative test regarding each individual stimulation caused by mechanical attrition and thermal probe with clinical test was done (air syringe) in order to verify the presence of sensitivity in three phases: before treatment, after 7 and 14 days. Data were collected using Visual Analogue Scale (VAS) adapted to four criteria: no pain, mild pain, moderate pain and severe pain. The correlation of the data x teeth sensitivity were obtained separately, and tabulated for further comparative analysis. The results showed that there was no difference between the groups in terms of bleaching effect. In the post-operative sensitivity test, the subjects who used the product without desensitizing showed higher levels of sensitivity in different types of teeth, regardless of sex or age. It was concluded that the addition of desensitizing agent in the carbamide peroxide 16% whitening gel produced less post-bleaching sensitivity index. We emphasize that from the teeth evaluated, the premolars showed higher sensitivity index, followed by the canines and incisors. There was no difference in the bleaching capacity of the products used, demonstrating that the addition of desensitizing did not affect the efficacy of the treatment.

O objetivo deste estudo clínico foi determinar o efeito da adição de agentes dessensibilizantes em gel clareador experimental caseiro Peróxido de Carbamida 16%. Foram selecionados 60 pacientes jovens (entre 18 a 28 anos), que utilizaram aleatoriamente (através de sorteio) o gel clareador DA (com dessensibilizante) gel clareador CO (sem dessensibilizante), caracterizado como grupo controle de um estudo duplo-cego, ou seja o paciente e o avaliador não conheciam o produto que estava sendo utilizado. Foram clareados os dentes 15, 14, 13, 12, 11, 21, 22, 23, 24 e 25. As orientações de como aplicar os agentes clareadores foram realizadas por uma equipe experiente e calibrada, e a aplicação acompanhada por examinadores em diversas fases. Para mensuração da cor foi utilizada uma Escala Visual Vita Clássica através de inspeção visual pelos avaliadores e informações dos pacientes. Foi feito um teste comparativo considerando cada estímulo individualmente provocado por atrito mecânico com sonda clínica e teste térmico (seringa de ar), a fim de verificar a presença de sensibilidade em três fases: antes do tratamento, após 7 e 14 dias. Os dados foram coletados utilizando Escala Visual Analógica (EVA) adaptada a quatro critérios: ausência de dor, dor leve, dor moderada e dor intensa. A correlação dos dados dentes x sensibilidade foram obtidos separadamente, e tabulados para posterior análise comparativa. Os resultados demonstraram que não existiu diferença entre os grupos em termos de efeito clareador. Já no teste de sensibilidade pós-operatória, os sujeitos que utilizaram o produto sem o dessensibilizante mostraram maiores níveis de sensibildade, em diferentes tipos de dentes, independente de gênero ou idade. Pode-se concluir que a adição do agente dessensibilizante no gel clareador peróxido de carbamida 16% gerou menor índice de sensibilidade pósclareamento. Destacamos que dentre os dentes avaliados, os pré-molares apresentaram maior índice de sensibilidade, seguido pelos caninos e incisivos. Não houve diferença na capacidade de clareamento dos produtos empregados, demonstrando que a adição do dessensibilizante não comprometeu a eficácia do tratamento.

Multidisciplinary treatment of congenitally missing maxillary lateral incisors: a case report / Tratamento multidisciplinar de agenesias de incisivos laterais superiors: relato de caso

Congenital tooth agenesis and tooth loss due to dental traumatism are some of the most common causes leading to rehabilitation of young patients with dental implants. The success of treating congenitally missing teeth with implant-supported prosthesis is no more guided only by osseointegration criteria. Nowadays the successful rehabilitation of these cases involves the adequate installation of dental implants with suitable prosthetic contour, color, and emergence profile closer to that found in natural dentition. Several treatment options are available for restoring patients with congenitally missing teeth such as maxillary lateral incisors. Fixed prosthodontics and orthodontics managements are considered acceptable treatment protocols. However, the gold standard rehabilitation of congenitally missing maxillary incisors is performed with implant-based prosthesis since no tooth wear neither extensive tooth movements are necessary. The present paper reports the treatment of a young adult woman with congenitally missing maxillary lateral incisors who underwent orthodontic treatment for improvement of teeth alignment and occlusal balance previous to dental implant surgery. This treatment also allowed appropriate space for the future lateral incisors crowns. Then, Morse-type conical implants were positioned and prosthetic abutments installed. Ceramic laminates were planned on central incisors in order to improve anterior aesthetics. All-ceramic crowns and laminates were made using lithium dissilicate-based ceramic (e-Max Press). The multidisciplinary association of orthodontic, implant and prosthetic techniques resulted in successful functional and aesthetic rehabilitation of the case, which was maintained after 1 year follow up.

Agenesias e perdas dentárias devido a traumatismos estão entre as principais causas de reabilitações de pacientes jovens com implantes dentários. O sucesso do tratamento de agenesias com implantes osseointegrados não se limita mais à osseointegração exclusivamente. Atualmente, o sucesso da reabilitação destes casos envolve a correta instalação de implantes que favoreçam a confecção de uma prótese com cor, forma e perfil de emergência o mais semelhante possível aos dentes naturais. Os cirurgiões-dentistas têm várias opções para tratar casos de agenesias como as de incisivos laterais superiores. Próteses fixas convencionais e movimentação ortodôntica são considerados protocolos de tratamento aceitáveis. Entretanto, agenesias de incisivos laterais superiores são reabilitadas satisfatoriamente com próteses sobre implantes uma vez que extensas movimentações ou desgastes dentários são necessários. O presente caso relata o tratamento de uma paciente jovem com agenesia dos incisivos laterais que havia feito tratamento ortodôntico para correção do posicionamento dentário e equilíbrio dental antes de se submeter à cirurgia para instalação de implantes. O tratamento ortodôntico também favoreceu a obtenção de espaço apropriado para instalação das coroas dos incisivos laterais. Posteriormente, implantes cônicos com plataforma protética tipo cone morse foram instalados e pilares selecionados. Laminados cerâmicos foram planejados para os incisivos centrais com objetivo de se promover um resultado final mais harmônico e estético. As coroas em cerâmica pura e laminados foram confeccionados com cerâmica a base de dissilicato de lítio (e.Max Press). A associação multidisciplinar entre tratamento ortodôntico, implantes e próteses sobre implantes resultou no sucesso funcional e estético da reabilitação do presente caso com acompanhamento clínico de uma ano.

Enxerto de tecido conjuntivo subepitelial otimizando a reabilitação oral com implantes osseointegrados / Connective tissue graft improving implant oral rehabilitation

A estética tem sido um fator indispensável, tanto no direcionamento quanto no desenvolvimento da Odontologia, assim como na Implantodontia. Além da boa qualidade e anatomia da prótese que substituirá o dente perdido, a aparência saudável e harmônica do tecido peri-implantar é preponderante no tratamento reabilitador final. A estratégia de substituição de dentes anteriores com próteses sobre implantes pode envolver procedimentos multidisciplinares. As técnicas cirúrgicas de plástica peri-implantar são amplamente aplicadas com previsibilidade naquelas situações clínicas que demandam volume, forma e qualidade dos tecidos moles ao redor dos implantes. Sob esse ponto de vista, o enxerto de tecido conjuntivo subepitelial tem sido empregado com alto índice de sucesso, para obtenção de estética, função e saúde da mucosa peri-implantar.

Substituição de implante perdido por peri-implantite e reabilitação multidisciplinar em 18 meses: acompanhamento de um ano / A 18-month multidisciplinary rehabilitation period for a dental implant replacement due to peri-implantitis – 1 year follow-up

O presente caso clínico relata a perda de um implante devido à peri-implantite, cuja ocorrência foi favorecida pelo mau posicionamento do mesmo. Dessa forma, a coroa e o implante foram removidos, por ausência de possibilidade de outro tratamento mais conservador. Com o auxílio de técnicas cirúrgicas de enxerto ósseo (autógeno e xenógeno), enxerto gengival (conjuntivo subepitelial), tratamento ortodôntico e confecção de novas próteses, a saúde e a estética da paciente foram restabelecidas. Para a substituição, foi utilizado um implante cone-morse, amplamente utilizado em áreas estéticas atualmente. O tratamento durou 18 meses, atingindo as expectativas da paciente. Concluiu-se que a abordagem multidisciplinar e a comunicação entre os profissionais são essenciais para o sucesso do tratamento, uma vez que a instalação de implantes, sem planejamento protético minucioso, pode resultar em uma quantidade inumerável de problemas e complicações, no que diz respeito aos resultados cirúrgicos e protéticos esperados.

This case reports on the loss of a dental implant due to peri-implantitis favored by its malpositioning. In this way, the defi nitive crown and implant were removed because a more conservative treatment was not possible. With the aid of surgical techniques as bone grafting (autogenous and xenogeneic), gingival grafts (subepithelial connective tissue), orthodontic treatment and fabrication of new prostheses, the health and esthetic aspects were retrieved. A new dental implant (Cone Morse type) was inserted as advocated for esthetic regions. After 18 months, patient expectations were achieved. It can be concluded that a multidisciplinary approach and communication among different specialists are fundamental for a successful treatment once incorrect implant placement can generate a myriad of problems and complications regarding the surgical and prosthetic expected outcomes.

Critical analysis of fiber post surface treatment: a review / Análise crítica do tratamento de superfície de pinos de fibra: uma revisão

The surface treatment of fiber posts influence the bonding between composite resin cements and intraradicular retainers, being relevant to the prognostic of teeth without coronal structure. This study aimed to evaluate the different fiber post surface treatment protocols described on literature. The search strategy included a review of PubMed/MEDLINE database using fiber post associated with adhesion; bonding; surface treatment; as keywords. Papers not comprehending English language; assessment of post surface treatment; or testing of materials and their physicmechanical properties were excluded. Studies about glass and quartz fiber post surface treatment were considered for this literature review. Among the 190 articles included, silane agent was the material most used (60.52%) for the surface treatment of fiber posts, followed by application of alcoholic solutions (38.29%), and primer and/or adhesive systems (36.84%). Sandblasting of post surface was mentioned in (17.89%), but it affected the physical and mechanical properties. Hydrogen peroxide was mentioned only in 5.78% and it was shown to result on adequate exposure of the glass fibers without damaging them. It was concluded that a consensus for fiber post surface treatment still not exist in the current literature. Among the protocols described, the one using hydrogen peroxide followed by application of silane seems the most promising, since it allows increased bond strengths without fiber damage.

O processo de tratamento da superfície de pinos pré-fabricados de fibra influencia na união entre cimentos resinosos e esses retentores intra-radiculares, sendo relevante para o prognóstico do tratamento restaurador de dentes sem remanescente coronário. Este estudo objetivou avaliar diferentes protocolos de tratamentos de superfície para pinos de fibra descritos na literatura. Como metodologia, realizou levantamento bibliográfico na plataforma PubMed/MEDLINE, com a palavras-chave fiber post associada à adhesion; bonding; surface treatment. Excluíram-se artigos não redigidos em inglês; que não trataram a superfície do pino; e testes de propriedades físicas-mecânicas. Estudos que trataram a superfície de pinos de fibra de quartzo ou vidro foram incluídos. Dentre os 190 artigos incluídos nesta revisão, o agente silano foi o material mais utilizado (60.52%) para tratamento de superfície de pinos de fibra, seguido pela aplicação de álcool (38.29%), e sistema adesivo (36.84%). O jateamento do pino foi mencionado em 17.89%, mas esta técnica resultou em alteração das propriedades físicas e mecânicas. O peróxido de hidrogênio foi mencionado em 5.78% dos manuscritos, entretanto este tratamento permite a adequada exposição das fibras sem danificá-las. Concluiu-se que não consta na literatura protocolo padrão do tratamento da superfície de pinos de fibra. Dentre os protocolos descritos, o protocolo utilizando peróxido de hidrogênio seguido da aplicação do silano aparece como o mais promissor, pois permite resistência de união aumentada sem promover danos as fibras.

Sports dentistry: a perspective for the future

Sports Dentistry (SD) acts in the prevention, maintenance and treatment of oral and facial injuries, as well as the collection and dissemination of information on dental trauma, beyond stimulus to research. Establishes as a duty for the dentist detect problems related to the athlete's stomatognathic system. This essay is based on the provided data from the literature related to SD, including definition, practice areas and research fields. To discuss the data, six areas were categorized: shares in sports dentistry; oral health of athlete; sports-related dental implications; dental-facial trauma; face shields; and mouthguards. The analyzed data show that the SD is still an underexplored field of action by dentists, but it is expanding, despite not being recognized specialty by the Federal Council of Dentistry, but the Brazilian Academy of Sports Dentistry has been created with a mission to show the real importance of Dentistry in sport. The dentist should be part of the group of professionals associated with the athlete to perform periodic checks in order to ensure oral health which may contribute to athletes´performance. When impact occurs, however, it would be possible reduce the severity of the impact related to injuries, by using helmets, masks, goggles, face shields and mouthguard. Additionally, it is imperative that dentists, sports coaching, athletes, and professional who work with athletes be aware of the benefits of incorporating SD as an important academic and professional subject.

Análise do desgaste de pontas diamantadas 1014 por meio de MEV / Wear analysis of espherical diamond burs 1014 under SEM

Pontas diamantadas são instrumentos rotatórios abrasivos utilizados rotineiramente na odontologia restauradora. Objetivou-se analisar e comparar a qualidade da impregnação dos grânulos de diamante e o desgaste sofrido pelas pontas, por meio de MEV. Utilizaram-se 60 pontas diamantadas do modelo 1014, de seis marcas comerciais nacionais: KG Sorensen, Microdont, Fava, Vortex, Option e Zeep. Após MEV prévia ao desgaste, as pontas diamantadas foram submetidas a três testes sequenciais de três minutos em bloco de reina composta (n=5) e em cerâmica à base de dissilicato de lítio (N=5), ao término de cada etapa foi realizada MEV. Houve perda e variação na forma dos grânulos de diamante para todas as marcas comerciais, o que ressalta a importância da substituição de instrumentos rotatórios na atividade clínica.

Diamond burs are abrasive rotary instruments routinely used in restorative dentistry. The aim of this study was to analyze and compare the quality of the diamond granules impregnation and the wear under SEM. Sixty diamond burs were used (#1014) from 6 brazilian manufacturers: KG Sorensen, Microdont, Fava, Vortex, Option and Zeep. After initial SEM assessment, the diamond burs were subjected to three sequential tests of 3 minutes in composite resin blocks (n=5) and lithium disilicate-based ceramics (N=5). The burs were evaluated for wear under SEM after each step. Loss and variation of the shape of diamond granules were observed for all trademarks, highlighting the importance of replacement of rotary instruments in clinical procedures.

Esthetic rehabilitation with laminated ceramic veneers reinforced by lithium disilicate.

Because of their predictable results and conservation of tooth structure, ceramic veneers are indicated for the esthetic treatment of anterior teeth with anomalous positions or appearance. The objective of this case report is to highlight the steps in dental rehabilitation using ceramic veneers reinforced by lithium disilicate. In this case the patient had diastemas between the mandibular incisors. After preliminary procedures, diagnostic models, waxing, and mock-up were completed, an impression was made with addition silicone, and the veneers were fabricated and cemented with light-cure cement. As a result, the esthetics and function expected by the patient were achieved. The use of ceramic veneers enabled a conservative and esthetically successful rehabilitation treatment.