The "Phase Down" of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

ABSTRACT Objective: To guide professionals about the criteria for replacing amalgam restorations and inform them about the new guidelines regarding the use/indication of this (amalgam) material after the Minamata Convention - COP-4. Material and Methods: The articles were selected from the databases (PubMed, Scielo, Bireme), and relevant articles on the subject between the years 2003-2021 were selected. Recently, social media have been flooded with dental treatments that aim to perform restorations only with composite resins or other types of esthetic material and completely replace all dental amalgam restorations, irrespective of their time in place, size, and functionality. Results: Although improperly, it has been noted that this information reaches patients, and they are led to believe in the inaccurate data that is passed on, such as, for example, (that amalgam leads to) permanent contamination by mercury, causing systemic problems and the loss of the tooth. Conclusion: The "phase down" of amalgam in research and teaching has previously been observed in several countries worldwide; however, its use is still necessary given particular circumstances, which, theoretically, make it a material with exact indication.

Is the computed tomography exam important for planning mini-implant installation?

Background: Mini-implants are devices used to provide absolute and temporary anchorage for tooth movement. Objectives: The present study was carried out to compare the use of periapical radiographs and computed tomography (CT) for planning mini-implants performed by orthodontists. Material and Methods: Five radiographs and five CT scans of premolars and molars regions. These were analyzed by ten Orthodontists. Initially (T1), the evaluators indicated the preferred location for the insertion of a mini-implant, as well as the diameter and length of the device, using only a periapical radiograph. After 30 days (T2), the same evaluation was performed. Sixty days later (T3), the orthodontists reassessed the radiographs in association with the CT scans. Finally, after 90 days (T4), the evaluation was performed with the same exams. The comparison of the chosen diameter and length of the mini-implants was performed using the Student's t-test. The evaluation of the chosen insertion sites was analyzed by the Wilcoxon test. For both tests, the level of significance was 5%. The kappa concordance test was also performed for the intra- and inter-examiner evaluations. Results: The results of the study showed substantial or perfect intra-examiner and reasonable to perfect inter-examiner agreement. Considering the length and diameter of the mini-implants, no statistical difference was found between the groups. Regarding the insertion site, more than 20% of the treatment plans were changed when the CT scan was associated. Conclusions: The results showed that the association of a CT scan with radiography frequently leads the professional to change the insertion point for the installation of mini-implants. Key words:Orthodontic anchorage procedures. Mini Dental Implants. Bone Screws. Cone-beam computed tomography. Periapical radiography.

Assessment of influence of LED curing units used on microhardness of resin-modified glass ionomer sealants

Aim: Resin modified glass ionomer (RMGI) is class of material that can be used as sealant for preventing and arresting the progression of caries in pits and fissures. As these are hybrid materials, their properties can be affected by factors related to the polymerization process. Therefore, this study aimed to evaluate the influence of different generations of LED curing units (Elipar DeepCure-L and VALO Grand) on Knoop microhardness values (KHN) of RMGI sealants (Clinpro XT and Vitremer). Methods: Forty cylindrical specimens (6mm ø x 1 mm high) were prepared according to the manufacturer's instructions and divided into four groups (n=10) according to the type of RMGI and LED used. The KHN of the top surface of each sample was calculated 7 days after light-curing. Data were submitted to two-way ANOVA (α = 0.05). Results: Vitremer had higher KHN values than Clinpro XT after using both LEDs (p<0.0001), but especially when light-cured with the use of VALO Grand (p<0.0001). Whereas the KHN value of Clinpro was not influenced by the LED device (p>0.05). Conclusions: Top surface microhardness values of RGMI sealants were affected by both material composition and generations of LED curing units used. Third generation LED curing units seemed to be more efficient for the polymerization of RMGI-based sealants

TEAM BASED LEARNING: EXPERIENCE REPORT IN THE SUBJECT OF INTEGRATED CLINIC IN DENTISTRY GRADUATION / APRENDIZAJE BASADO EN EQUIPOS: RELATO DE EXPERIENCIA EN LA ASIGNATURA DE CLÍNICA INTEGRADA EN LA GRADUACIÓN EN ODONTOLOGÍA / TEAM BASED LEARNING: RELATO DE EXPERIÊNCIA NA DISCIPLINA DE CLÍNICA INTEGRADA NA GRADUAÇÃO EM ODONTOLOGIA

The present work aims, through an experience report, to describe the planning, execution and development of concepts related to subjects already taught in the Dentistry course, using TBL as a teaching methodology. At first, in a classroom setting, students individually answered questions selected by the professors of previous ENADE tests. All questions chosen had a clinical and interdisciplinary nature. After preliminary correction by teachers, without disclosing the results, students were divided into small groups to debate each of the questions and answers they chose, reaching consensus for the presentation of a single answer by the group. The interpretation of the results, as well as the comparison of group and individual scores, allowed us to infer that the TBL was very useful in the learning process and in the assessment of academic training. Students exercised their communication, argumentation and persuasion skills, improving their interaction with peers, with teachers and personal performance. Teachers and students were able to interact in a playful way, in addition to understanding the level of assimilation of previous content and its possible application in the subject to be studied. The teachers' understanding of the students' level of knowledge facilitated patients selection to be treated, ensuring technical excellence and satisfaction of the entire service delivery chain.

El presente trabajo tiene como objetivo, a través de un relato de experiencia, describir la planificación, ejecución y desarrollo de conceptos relacionados con materias ya impartidas en la carrera de Odontología, utilizando como metodología de enseñanza el TBL. En un primer momento, en un ambiente de aula, los estudiantes respondieron individualmente preguntas seleccionadas por los profesores de pruebas anteriores de ENADE. Todas las preguntas escogidas tenían un carácter clínico e interdisciplinario. Luego de la corrección preliminar de los docentes, sin revelar los resultados, los estudiantes se dividieron en pequeños grupos para debatir cada una de las preguntas y respuestas elegidas, llegando a un consenso para la presentación de una sola respuesta por parte del grupo. La interpretación de los resultados, así como la comparación de puntuaciones grupales e individuales, permitió inferir que el TBL fue de gran utilidad en el proceso de aprendizaje y en la evaluación de la formación académica. Los estudiantes ejercitaron sus habilidades de comunicación, argumentación y persuasión, mejorando su interacción con sus pares, con los docentes y su desempeño personal. Docentes y alumnos pudieron interactuar de manera lúdica, además de comprender el nivel de asimilación de los contenidos previos y su posible aplicación en la materia a estudiar. La comprensión de los profesores sobre el nivel de conocimiento de los estudiantes facilitó la selección de los pacientes a ser tratados, asegurando la excelencia técnica y la satisfacción de toda la cadena de prestación de servicios.

O presente trabalho tem como objetivo, por meio de um relato de experiência, descrever o planejamento, a execução e o desenvolvimento de conceitos relativos a disciplinas já ministradas no curso de Odontologia, utilizando o TBL como metodologia de ensino. Em um primeiro momento, no cenário de uma sala de aula, os estudantes respondiam individualmente questões selecionadas pelos docentes de provas anteriores do ENADE. Todas as questões escolhidas tinham cunho clínico e interdisciplinar. Após a correção preliminar dos professores, sem divulgação dos resultados, os alunos eram divididos em pequenos grupos, para debater cada uma das questões e respostas que eles elegiam, entrando em consenso para a apresentação de uma única resposta do grupo. A interpretação dos resultados, bem como a comparação das pontuações em grupo e individuais, permitiu inferir que o TBL foi bastante útil ao processo de aprendizagem e na avaliação da formação dos acadêmicos. Os estudantes exercitaram suas habilidades de comunicação, argumentação e convencimento, melhorando sua interação entre pares, com os docentes e desempenho pessoal. Os docentes e discentes conseguiram interagir de forma lúdica, além de entender o nível de assimilação dos conteúdos prévios e sua possível aplicação na disciplina a ser cursada. O entendimento dos professores do grau de conhecimento dos alunos facilitou a seleção dos pacientes a serem atendidos, garantindo excelência técnica e satisfação de toda a cadeia de prestação de serviços

Evaluation of resin composite staining by beverages with acid pH / Avaliação do manchamento de resinas compostas por bebidas de pH ácido

ABSTRACT Introduction: Composite resins are an extensively used esthetic material that has excellent adaptation, reproduces the characteristics of the tooth structure and is suitable for the conditions of the oral environment. However, this material is also very susceptible to staining due to pigmentation coming from the diet and habits of the patient. Objectives: To evaluate the staining of two brands of composite resin, one nanoparticle and a nanohybrid type (Filtek Z350XT® and IPS Empress Direct®), in direct contact with the acid pH of beverages. Methods: In total 40 specimens were made, 20 of each type of resin studied. After being inserted into a Teflon matrix and light activated, the samples were removed, stored in containers with 2 ml of artificial saliva and kept in the refrigerator. Every day 20 of these samples were placed in direct contact with 2 ml Gatorade, and the other 20 samples, in 2 ml of wine, each set for 30 minutes. After 30 minutes, the acid pH substances were removed, and 2 ml of artificial saliva was again placed in the container. This process was repeated every day for 10 days. Results: The results showed that the nanoparticle resin (Filtek Z350XT) was more susceptible to staining than the nanohybrid type (Empress Direct®) when in contact with the wine. When wine and Gatorade were compared, the solution with higher staining capacity was shown to be wine. Conclusion: The two resins tested were susceptible to staining in a 10-day period. Mottling and more staining was visibly detected after samples were immersed in the solution with the higher pH, and nanoparticulate resin was more susceptible to staining.

RESUMO Introdução: As resinas compostas são altamente utilizadas por serem um material estético, com excelente adaptação, reproduz as características da estrutura dental e se adequa ao meio bucal. Porém, este material é muito susceptível à pigmentação por corantes vindos da dieta e de hábitos do paciente. Objetivos: Avaliar o manchamento de duas marcas comerciais de resina composta: Nanoparticulada e Nanohíbrida, em contato direto com bebidas de pH ácido (Filtek Z350XT® e IPS Empress Direct®). Métodos: Foram confeccionados 40 corpos de prova, 20 de cada tipo de resina estudada, depois de inseridas em matriz de teflon e fotoativados, os corpos de prova foram removidos, armazenados em recipientes com 2ml de saliva artificial e mantidos na geladeira. Diariamente 20 dos mesmos eram colocados em contato direto com 20mL Gatorade e os outros 20mL de vinho durante 30 minutos cada. Passados os 30 minutos, as substâncias de pH ácido eram retiradas e novamente, 2 mL de saliva artificial eram colocadas no recipiente. Este processo foi repetido todos os dias durante 10 dias. Resultado: Os resultados mostraram que a resina nanoparticulada (Filtek Z350XT®) é mais susceptível ao manchamento que a nanohíbrida (Empress Direct®) quando em contato com o vinho. Quando comparados vinho e Gatorade, a solução com maior teor de manchamento é o vinho. Conclusão: As duas resinas testadas foram sensíveis ao manchamento num período de 10 dias, esse manchamento foi visivelmente detectado, a solução com o pH mais elevado manchou mais e a resina nanoparticulada é mais susceptível ao manchamento.

Relato de experiência no ensino da Dentística com base em metodologias ativas de ensino-aprendizagem: gamificação e práticas lúdicas / Experience report in teaching Dentistry based on active teaching-learning methodologies: gamification and ludic practices

O presente estudotem por objetivo demonstrar umprocesso de ensino-aprendizagemna graduação odontológica de cunho lúdicoe engajamento do estudante, no momentoem que ocorre a transição no ensino dasdisciplinas, destacando-se:do ciclo básico;percorrendo oambiente laboratorial;até o atendimento clínico aospacientes, para além do mero treinamento técnico.Prevalece noensino superioro aprendizadofragmentadopordisciplinas e áreas de especializaçãoenota-se uma ausência de conexãoentre ospropósitoslaboratorialeclínico. A aplicação de duas ferramentas, com o aporte dasMetodologias Ativas de Ensino-Aprendizagem(MAEA), converteu-seem umrelato de experiência de ensino da exitosoda Dentística,a saber: (1) demonstração tridimensional da formação de cavidades com materiaisacessíveis, com base napinturacom tinta guache das paredes cavitáriase ângulos de macromodelos de gesso,representando preparosintracoronário e extracoronárioparcial (onlay);e(2) gamificação, por meio de quebra-cabeçadeprojeçãodeimagem dos diferentestipos de preparos cavitários.O uso de recursos com basenas MAEAdemonstrou resultados promissores, interconectandoáreas de ensino da dentística, vistas como dicotômicas, teórica e prática, ensinosbásico e clínico, assimcomo promovendoo despertar, a adesão e o desenvolvimento de habilidades manuaisdo estudante (AU).

The aim of this study was to demonstrate a teaching-learning process of a ludic nature and student engagement, in a dental graduation course, at a time when the transition in the teaching of subjects is taking place. The basic cycle will be highlighted by walking through the laboratoryenvironment. Even the clinical care of patients will be considered beyond the level of mere technical training. In higher education, learning fragmented by subjects and areas of specialization prevails, and there is no connection between laboratory and clinical purposes. The application of two tools, with the contribution of Active Methods of Teaching and Learning (AMTL), became a report of successful teaching experience in Dentistry, namely: (1) three-dimensional demonstration of the formation of cavities with accessible materials, based on painting the cavity walls and angles of plaster macromodels with gouache paint, representing intracoronal and partial extracoronal (onlay) preparations; and (2) gamification, by means of projecting the images of puzzle of different types of cavity preparations. The use of resources based on the AMTL has shown promising results, by interconnecting areas of teaching dentistry, seen as dichotomous, theoretical and practical, basic and clinical teaching, as well as promoting the awakening, adherence and development of students' manual skills (AU).

Influência do selamento de superfície na rugosidade e microdureza de compósitos dentais antes e após o clareamento dental / Influence of the surface sealing on the roughness and microhardness of dental composites before and after dental bleaching

O objetivo deste estudo foi avaliar a rugosidade de superfície e microdureza Knoop de compósitos microhíbrido e nanoparticulado, selados ou não, antes e após o clareamento dental. Vinte amostras foram confeccionadas (5 mm x 2 mm) e fotopolimerizadas usando um LED, com irradiância de 1390 mW/cm2. As amostras foram divididas em 4 grupos (n = 5) de acordo com o tipo de compósito e selamento ou não da superfície. Após a polimerização foi realizado o polimento das amostras com discos de óxido de alumínio, em seguida, aplicado o selante de superfície de acordo com os grupos experimentais. A rugosidade de superfície média (Ra) foi avaliada com um perfilômetro e a microdureza utilizando um indentador Knoop com carga de 10 g durante 10 s. Foram realizadas duas leituras (L1 e L2); a leitura L1 foi feita 24 h após a confecção das amostras e L2 após a aplicação do agente clareador. Os resultados obtidos foram submetidos a ANOVA e teste de Tukey (a = 0,05). O clareamento não afetou a microdureza Knoop e rugosidade de superfície, e a aplicação do selante reduziu apenas a microdureza. A manutenção dos menores valores de dureza para os grupos selados após o tratamento clareador indica a manutenção deste material

Physicochemical properties of enamel after microabrasion technique

AIM: This study aimed to evaluate the enamel microhardness, surface roughness, and chemical composition after microabrasion technique, followed by polishing and different immersion times in artificial saliva. Materials and methods: Ninety enamel blocks (25mm2) from bovine incisors were divided into two groups (G1 and G2), and then subdivided in five subgroups (n = 9) according to their microabrasion treatment and polishing with a diamond paste: 35% phosphoric acid and pumice (H3PO4+Pum) and polishing; just H3PO4+Pum; 6.6% hydrochloric acid and silica (HCl+Sil) and polishing; just HCl+Sil; and control (no treatment). For G1, roughness and microhardness analyses were performed before (L1) and after (L2) microabrasion. After 15 (L3) and 30 (L4) days of immersion in artificial saliva, microhardness analysis was also performed. After (L4) analysis, the specimens were subjected to SEM analysis. G2 was used for the chemical analysis using energy dispersion testing (EDS). The data was subjected to statistical analysis (α = 5%). For roughness, L2 presented higher values than L1, except for the polished groups. For microhardness, L2 presented higher values than L1, except for unpolished groups. The L3 and L4 did not differ and were higher than L1. RESULTS: No changes were observed in the phosphorus concentrations of the microabrasioned enamel. However, the specimens treated with HCl+Sil were observed as having decreased calcium and increased chlorine and silica on the EDS test. Conclusion: Microabrasion followed by polishing and immersion in artificial saliva for 15 days is enough to increase the microhardness of microabrasioned enamel surfaces, although the microabrasion procedure can alter the mineral content of the enamel.

Clareamento dentário associado à aplicação de fosfopeptídio de caseína-fosfato de cãlcio amorfo (CPP-ACP): relato de caso / Association between dental bleaching and application of casein phosphopeptide - amorphous calcium phosphate (CPP-ACP): Clinical report

Com a valorização da Odontologia Estética, o clareamento dentário se tornou um procedimento de rotina na prática clínica. Atualmente, as variações da técnica são em relação à análise de cor (por escala visual ou espectrofotometria), às formas de aplicação (gel, líquido, pó/líquido, tiras clareadoras) e protocolos (externo ou interno), e a minimização dos seus efeitos colaterais,como a sensibilidade. Paciente de 23 anos, do sexo masculino,encontrava-se insatisfeito com a tonalidade amarelada de seus dentes, principalmente do incisivo inferior (41). Ao exame clínico, essa diferença de cor pôde ser constatada e, em exame radiográfico, pôde-se verificar alterações no espaço pericementário do elemento 41, decorrente de trauma ortodôntico. Instituiu-se o tratamento endodôntico desse dente, seguido de procedimentos clareadores externos nos demais dentes e procedimento clareador interno no elemento 41. Em seguida, foi preconizada a aplicação da pasta de caseína fosfato de cálcio amorfo, por meio de moldeiras individuais. A análise de cor foi realizada por meio da escala Vita® e do espectrofotômetro CM-700d previamente e após o clareamento, e após aplicação da pasta. A associação de técnicas clareadoras, como no presente caso, se mostrou efetiva para o restabelecimento estético do sorriso do paciente, dentro das suas expectativas.Com a valorização da Odontologia Estética, o clareamento dentário se tornou um procedimento de rotina na prática clínica. Atualmente, as variações da técnica são em relação à análise de cor (por escala visual ou espectrofotometria), às formas de aplicação (gel, líquido, pó/líquido, tiras clareadoras) e protocolos (externo ou interno), e a minimização dos seus efeitos colaterais, como a sensibilidade. Paciente de 23 anos, do sexo masculino, encontrava-se insatisfeito com a tonalidade amareladas, como no presente caso, se mostrou efetiva para o restabelecimento estético do sorriso do paciente, dentro das suas expectativas

With the appreciation of the esthetic treatment, the dental bleaching became a daily procedure in clinical practice. Currently, the technique variations are in relation to the color analysis (by visual shade or spectrophotometry),to the application forms (gel, liquid, liquid/powder) and protocols (vital or non-vital bleaching), and to minimizing their collateral effects, as the sensibility. A 23-years-old patient, male, presented himself unsatisfied with the color of his teeth, especially in the lower incisor (#41). On the clinical evaluation, this alteration could be perceived and, on the radiographic exam, alterations in the pericemental space could be observed, probably due to the orthodontic trauma. It was indicated the endodontic treatment to the element 41 and after vital bleaching and non-vital bleaching in this tooth. Then, the application of casein phosphopeptide-amorphous calcium phosphate was recommended by means of individual appliances. The color analysis was made by means of Vita® shade guide and of spectrophotometer CM-700d before and after bleaching, and after the use of the paste. The association of the bleaching techniques, as in this case, was effective in restoring patient's esthetic smile, according to his expectations.

Microabrasão do esmalte: comparação de técnicas através de relatos de casos clínicos / Enamel microabrasion: Comparison of thechniques through case reports

Atualmente, com a grande quantidade de informação e disponibilidade de produtos fluoretados no mercado, utilizados para prevenção de cárie, tem-se observado um grande aumento na taxa de manchamentos por fluorose e, dessa forma, maior procura dos pacientes por tratamentos estéticos e novas técncias d remoção de manchas do esmalte pelos cirurgiões dentistas. O objetivo desse trabalho é apresentar dois relatos de caso clínico sobre remoção dse manchas de fluorose, nos quais foram utilizados diferentes materiais a fim de comparar sua efetividade através da avaliação de seus resultados. No primeiro caso utilizaou-se ácido clorídrico a 6,6 pr cento associado a carbeto de silício como abrasivo: e, no segundo, ácido fosfórico a 37 por cento associado a pedra-pomes. oram observados resultados clínicos satisfatórios para ambos os materiais empregados.

Currently, with the vast amount of information and availability of fluoridated products on market, used to prevent caries, it has seen a large increase of fluorosis staining of teeth, thus the demand of patients for esthetic treatments. The aim of this paper is to present two clinical case reports about fluorosis staining removal. Different materials were used to compare its effectiveness by results evaluation. In the first case we used hydrochloric acid 6.6% associated with silicon carbide abrasive, and in the second phosphoric acid 37% mixed with pumice. Satisfactory clinical results were observed for both materials used.

Esthetic and functional rehabilitation via reattachment of dental fragments.

Anterior teeth fractures are frequently encountered in clinical practice. The reattachment of dental fragments, if possible, is a conservative and effective technique, which is utilized in this case. This case presentation concerns an 18-year-old male patient with a root-crown fracture of the left maxillary central incisor, which involves the periodontal biologic space. The treatment was the reattachment of the dental fragment with a composite resin and adhesive, in association with periodontal surgery. The reattachment technique described in this case report is simple, but it provides long-lasting esthetics and improved function via a very conservative approach.

Effects of mouthwashes on Knoop hardness and surface roughness of dental composites after different immersion times.

The aim of this in vitro study was to evaluate the effect of different mouthwashes on superficial roughness and Knoop hardness of two resin composites. Eighty specimens (6 mm Ø and 2 mm height) were prepared and divided into eight experimental groups (n = 10) according to the resin composites (4 Seasons and Esthet X), and storage solutions (G1 - Distilled water; G2 - Colgate Plax Overnight; G3 - Colgate Plax Alcohol Free; and G4 - Colgate Plax Whitening). The initial hardness and roughness readings (T1) were measured and then the specimens were stored in 2 mL of mouthwash for 12 h (T2) and 24 h (T3). The data were analyzed with repeat-measures two-way ANOVA and Tukey's test (α = 5%). Regardless of the type of solution and time of exposure, there was no statistical difference for roughness between the resins (p = 0.44). G4 and G8 presented higher roughness means than G1, G3, G5 and G7, after 12 and 24 hours of immersion. For Knoop microhardness analysis, there was a significant reduction for all groups after 12 hours and 24 hours. We conclude that the mouthwashes containing hydrogen peroxide and/or alcohol decrease the microhardness of the resins tested; however, the mouthwash containing hydrogen peroxide had a higher deleterious effect on roughness.

Effects of mouthwashes on Knoop hardness and surface roughness of dental composites after different immersion times

The aim of this in vitro study was to evaluate the effect of different mouthwashes on superficial roughness and Knoop hardness of two resin composites. Eighty specimens (6 mm Ø and 2 mm height) were prepared and divided into eight experimental groups (n = 10) according to the resin composites (4 Seasons and Esthet X), and storage solutions (G1 - Distilled water; G2 - Colgate Plax Overnight; G3 - Colgate Plax Alcohol Free; and G4 - Colgate Plax Whitening). The initial hardness and roughness readings (T1) were measured and then the specimens were stored in 2 mL of mouthwash for 12 h (T2) and 24 h (T3). The data were analyzed with repeat-measures two-way ANOVA and Tukey's test (α = 5 percent). Regardless of the type of solution and time of exposure, there was no statistical difference for roughness between the resins (p = 0.44). G4 and G8 presented higher roughness means than G1, G3, G5 and G7, after 12 and 24 hours of immersion. For Knoop microhardness analysis, there was a significant reduction for all groups after 12 hours and 24 hours. We conclude that the mouthwashes containing hydrogen peroxide and/or alcohol decrease the microhardness of the resins tested; however, the mouthwash containing hydrogen peroxide had a higher deleterious effect on roughness.