Desensitizing Agent Previously Applied During In-Office Bleaching: A Double-Blind Randomized Clinical Trial

Abstract Objective: To compare the clinical effect of two desensitizing agents used before the application of a bleaching gel based on 35% hydrogen peroxide (HP). Material and Methods: 30 patients were selected, and two desensitizing agents with different mechanisms of action were applied: Fluorine Neutral 2% (FN), which acts by blocking dentinal canaliculi while Potassium Nitrate 5% with 2% Sodium Fluoride (PN/SF) that acts in nerve transmission and blockade. Desensitizers were used before the application of 35% HP. For whitening, three clinical sessions were performed, with an interval of seven days, with three applications of the bleaching gel for 15 minutes, totaling 45 minutes/session. Tooth sensitivity (TS) was assessed with the numerical analog scale, and a spectrophotometer was used to obtain the color variation (ΔE). ΔE were submitted to ANOVA and Tukey test (p<0.05), and TS data were submitted to a two-way ANOVA analysis. Results: For sensitivity experience, the Tukey test indicated differences between PN/SF and the placebo I, but there was no statistically significant difference between FN and the placebo II. The TS was lower when the desensitizing gel was used during the bleaching procedure compared to after treatment, regardless of the desensitizing agents. Conclusion: PN/SF before in-office tooth bleaching can reduce TS intensity, and the use of desensitizing gel before bleaching did not affect the bleaching efficacy.

The in vitro effect of solutions with or without sugar in dental bleaching.

The interaction of bleaching technique (in-office or at-home) and solutions (deionized distilled water with and without sugar, red wine with and without sugar, coffee with and without sugar) on the effectiveness of in vitro dental bleaching was evaluated. Hydrogen peroxide (HP) 37.5% gel was used for in-office bleaching, 3 applications of 8 min each, 3 sessions with an interval of 7 days. At-home bleaching was performed with 10% Carbamide peroxide (CP), 2 h/day, for 30 days. The enamel vestibular surfaces (n = 72) were subjected daily to test solutions for 45 min, washed with distilled water for 5 min and stored in artificial saliva. The enamel color analysis was performed with a spectrophotometer through color variation (ΔE) and luminosity variation (ΔL). Roughness analysis was performed by atomic force microscopy (AFM) and scanning electron microscopy (SEM). Enamel composition was determined by energy dispersive X-ray spectrometry (EDS). The results were submitted to one-way analysis of variance (ANOVA) for ΔE, ΔL and EDS and two-way for AFM. For ΔE and ΔL there was no statistically significant difference. An increase in roughness was observed on the surface when exposed to a sugar-water solution for at-home bleaching and a lower concentration of Ca and P in the deionized water solution with sugar. Solutions containing or not sugar did not influence the bleaching potential, however the presence of sugar in the water solution increased the surface roughness with CP.

Surface roughness evaluation and whitening efficiency on tooth enamel after using whitening toothpaste: a randomized double-blinded study

The aim of this randomized double-blinded study was to evaluate the enamel surface roughness and color change after one month of whitening toothpaste use and the color stability obtained 1 month after its interruption. 30 volunteers were divided into 3 groups (n = 10) corresponding to the dentifrices: 1) Colgate Total 12 Clean Mint (TD) (Control), 2) Colgate Luminous White (LW) and 3) Sensodyne Whitening Extra Fresh (SB). The volunteers were impression with addition silicone to obtain an epoxy resin replica of the upper central incisor for the initial surface roughness evaluation using a profilometer and the initial color of the incisors and canines was evaluated with a spectrophotometer after one week of wash-out. After 1 month, the color of the central incisors and canines was measured again, and the volunteers were molded to obtain a second replica to the final roughness analysis. Data were submitted to ANOVA-one way (p≤0.05). The results showed that there was no statistical difference between the dentifrices for color difference and surface roughness for all the studied conditions. It was possible to conclude that the whitening dentifrices used in this study were not able to alter the initial color of the teeth and did not cause changes in the surface roughness of enamel.

Ellagic acid on the quality of the adhesive interface of class I composite resin restorations after aging

To evaluate the effect of ellagic acid on the inhibition of matrix metalloproteinase by analyzing the quality of the adhesive interface with bond strength measures in periods of 24 hours and six months of storage. Method: 40 healthy human third molars were prepared with class I cavities (5x4x3mm). The teeth were divided into four experimental groups: Group 1- without application of ellagic acid and storage time of 24 hours; Group 2- with ellagic acid/24 hours; G3- without ellagic acid/six months; Group 4- with ellagic acid/six months. Then, the cavities were restored with Single Bond Universal adhesive and Z350 composite resin, with and without the previous application of ellagic acid. Subsequently, hourglass-shaped specimens were obtained and subjected to the bond strength (BS) test (n = 10) in a universal testing machine. The bond test was performed after 24 hours and six months of storage. For the standard evaluation (n = 3) the samples were infiltrated with silver nitrate and placed in a developing solution for analysis in a Scanning Electron Microscope (SEM). The data obtained were analyzed with the Kruskal-Wallis non-parametric test, showing a statistically significant difference. Results: The highest bond strength values were found for the 24-hour groups followed by the groups with six months of storage. For nano-infiltration, groups G1 and G2 showed lower infiltration than groups G3 and G4. Conclusion: The previous application of ellagic acid did not affect the BS of the adhesive interface of the adhesive system analyzed, regardless of storage time.

Effects of desensitizing products on the reduction of pain sensitivity caused by in-office tooth bleaching: a 24-week follow-up.

OBJECTIVE: To clinically assess the effect of desensitizing gels and dentifrices on the reduction in pain sensitivity and color variation during tooth bleaching. METHODOLOGY: A total of 108 volunteers were randomly separated into the following groups of n=12: GT/S-glycerine and thickener/sucralose; NF/S-potassium nitrate and sodium fluoride/sucralose; NA/S-potassium nitrate and arginine/sucralose; GT/AC-glycerine and thickener/arginine and calcium carbonate; NF/AC-potassium nitrate and sodium fluoride/arginine and calcium carbonate; NA/AC-potassium nitrate and arginine/arginine and calcium carbonate; GT/PN-glycerine and thickener/potassium nitrate; NF/PN-potassium nitrate and sodium fluoride/potassium nitrate; and NA/PN-potassium nitrate and arginine/potassium nitrate. Sensitivity was assessed with the numerical analogue scale, and color variation (ΔE) was measured with a spectrophotometer. The sensitivity values obtained were subjected to a multivariate analysis of variance (MANOVA) and color variation values were subjected to a randomized analysis of variance (p<0.05). RESULTS: The NF/AC, NA/AC, NF/PN, and NA/PN groups presented lower sensitivity values and reduced sensitivity compared to those of the other groups throughout the clinical sessions. None of the groups showed sensitivity at the 24-week assessment. Statistically, no significant difference were observed in the color values among the groups four weeks after the beginning of bleaching (p=0.074). Additionally, the color assessment of all groups was statistically similar four weeks (p=0.084) and 24 weeks (p=0.118) after the beginning. CONCLUSION: Our results indicate that adding NF/S, NA/S, NF/AC, and NA/AC desensitizers to tooth bleaching protocols reduces pain sensitivity without affecting its effectiveness.

Influence of cavo superficial enamel acid-etching on the microtensile bond strength of low-shrinkage composite resin / Influência do condicionamento ácido do ângulo cavo superficial na resistência adesiva de restaurações em um compósito de baixa contração de polimerização

Introduction: To prevent the shrinkage stresses produced during polymerization, composite resins of low polymerization shrinkage were developed. Objective: To evaluate the microtensile bond strength in class I cavities restored by acid-etching the cavosurface angle and with composite resins indicated for posterior teeth. Material and method: 48 healthy molars were selected and divided into six groups (n = 8), considering that the cavosurface enamel of three groups was etched with 35% phosphoric acid. The teeth were restored with the Clearfil SE Bond adhesive system and Filtek Z350 XT, Empress Direct, and Charisma Diamond composite resins, which were light-cured for 40 seconds. After 24 hours, the teeth were taken to a cutting machine, which produced sections in the buccolingual and mesiodistal directions. This resulted in toothpicks of 0.9×0.9 mm that were taken to the universal testing machine for the microtensile bond strength test. Statistical analysis was performed with ANOVA and Tukey's test (p < 0.05). Result: There was no statistically significant difference between the groups evaluated. Conclusion: Acid-etching the cavosurface angle did not affect the performance of restorations, probably due to the adhesive system used.

Introdução: Com o intuito de se evitar as tensões geradas durante a contração de polimerização das resinas compostas, foram desenvolvidas as resinas compostas de baixa contração de polimerização. Objetivo: Avaliar a resistência à microtração em cavidades classe I restauradas com tratamento ácido do ângulo cavo superficial e resina composta indicada para dentes posteriores. Material e método: Foram selecionados 48 molares hígidos que foram divididos em 6 grupos (n=8), sendo que 3 desses tiveram o esmalte cavo superficial condicionado com ácido fosfórico a 35%. Os dentes foram restaurados com o sistema adesivo Clearfil SE Bond e as resinas compostas Filtek Z350 XT, Empress Direct e Charisma Diamond, fotoativadas por 40 segundos. Após 24 horas, os dentes foram levados para máquina de corte, na qual foram realizados cortes no sentido vestíbulo-lingual e no sentido mésio-distal obtendo - se palitos de 0,9×0,9 mm que foram levadas para a máquina de ensaio universal para a realização do teste de microtração. Para análise estatística foi realizado análise de variância e teste de Tuckey (p < 0,05). Resultado: Não houve diferença estatística significante entre os grupos avaliados. Conclusão: O condicionamento ácido do ângulo cavo superficial não influenciou no desempenho das restaurações provavelmente devido ao sistema adesivo utilizado.

O efeito do tabagismo na ocorrência da cárie dentária: uma revisão de literatura / The effect of smoking on the occurrence of dental caries: a literature review

Introdução: A cárie dentária é a doença bucal mais prevalente no mundo, sendo uma das mais estudadas há anos. Diversos fatores estão envolvidos em seu desenvolvimento, alguns de forma direta, outros indiretamente. O hábito de fumar considerado como contribuinte para diversas patologias bucais, como doença periodontal, câncer oral e atualmente relacionado com a doença cárie. Objetivo: Analisar a associação do tabagismo com a ocorrência da cárie dentária. Materiais e Métodos: Este trabalho tratou-se de um estudo de revisão de literatura sobre os efeitos do tabagismo na cárie dentária onde as informações foram obtidas a partir de 61 artigos científicos em português, inglês, espanhol e francês, consultados em bases de dados online, com disponibilidade na íntegra, que apresentavam coerência com a temática e com data de publicação entre 2008 e 2019. Foram excluídas da pesquisa, publicações cujos títulos e/ou objetivos não possuíam ligação direta com a temática ou que fugiam do objeto de estudo. Resultados: Os resultados da literatura mostraram que fumantes têm risco aumentado de desenvolver cárie dental em comparação com não fumantes. A nicotina é apontada como o componente do tabaco responsável pelo aumento da proliferação bacteriana dentro do biofilme dental. Além disso os biofilmes tornam-se mais compactos e resistentes em presença dessa substância. Conclusão: A comunidade científica tem mostrado que a nicotina é um dos fatores modificadores para o desenvolvimento da doença, sendo necessárias mais trabalhos nesse âmbito para elucidar essa questão.

Introduction: Dental caries is the most prevalent oral disease in the world, being one of the most studied for years. Several factors are involved in its development, some directly, others indirectly. The habit of smoking has been considered as a contributor to several oral pathologies, such as periodontal disease, oral cancer and currently has been related to caries disease. Objective: To analyze the association between smoking and the occurrence of dental caries. Materials and Methods: This work was a study of literature review on the effects of smoking on dental caries where the information was obtained from 61 scientific articles in Portuguese, English, Spanish and French, consulted in online databases , with full availability, which were coherent with the theme and with publication date between 2008 and 2019. Publications whose titles and / or objectives did not have a direct link with the theme or which escaped the object of study were excluded from the research. Results: Results in the literature have shown that smokers are at increased risk of developing dental caries compared to non-smokers. Nicotine is identified as the tobacco component responsible for the increase in bacterial proliferation within the dental biofilm. In addition, biofilms become more compact and resistant in the presence of this substance. Conclusion: The scientific community has shown that nicotine is one of the modifying factors that contributes to the development of the disease, requiring further research in this area to further clarify this issue.

Effects of desensitizing products on the reduction of pain sensitivity caused by in-office tooth bleaching: a 24-week follow-up

Abstract Objective To clinically assess the effect of desensitizing gels and dentifrices on the reduction in pain sensitivity and color variation during tooth bleaching. Methodology A total of 108 volunteers were randomly separated into the following groups of n=12: GT/S-glycerine and thickener/sucralose; NF/S-potassium nitrate and sodium fluoride/sucralose; NA/S-potassium nitrate and arginine/sucralose; GT/AC-glycerine and thickener/arginine and calcium carbonate; NF/AC-potassium nitrate and sodium fluoride/arginine and calcium carbonate; NA/AC-potassium nitrate and arginine/arginine and calcium carbonate; GT/PN-glycerine and thickener/potassium nitrate; NF/PN-potassium nitrate and sodium fluoride/potassium nitrate; and NA/PN-potassium nitrate and arginine/potassium nitrate. Sensitivity was assessed with the numerical analogue scale, and color variation (ΔE) was measured with a spectrophotometer. The sensitivity values obtained were subjected to a multivariate analysis of variance (MANOVA) and color variation values were subjected to a randomized analysis of variance (p<0.05). Results The NF/AC, NA/AC, NF/PN, and NA/PN groups presented lower sensitivity values and reduced sensitivity compared to those of the other groups throughout the clinical sessions. None of the groups showed sensitivity at the 24-week assessment. Statistically, no significant difference were observed in the color values among the groups four weeks after the beginning of bleaching (p=0.074). Additionally, the color assessment of all groups was statistically similar four weeks (p=0.084) and 24 weeks (p=0.118) after the beginning. Conclusion Our results indicate that adding NF/S, NA/S, NF/AC, and NA/AC desensitizers to tooth bleaching protocols reduces pain sensitivity without affecting its effectiveness.

Conservative Substitution of Fractured Ceramic Onlays Using Self-Adhesive Cement: Case Report / Substituição Conservadora de Onlays Cerâmicas Fraturadas Utilizando Cimento Autoadesivo: Relato de Caso

The advances in bonding of ceramics and self-adhesive resin cements to tooth structure make this treatment a feasible alternative to restore posterior teeth. This case report described the removal of two fractured onlays and the fabrication of new lithium disilicate onlays cemented with self-adhesive resin cement. The rationale for various choices in this treatment protocol is detailed with reference to the pertinent literature. It is concluded that the clinical success of the technique depends on the correct identification of the case for which this treatment is appropriate and on the successful execution of the clinical steps involved. (AU)

Os avanços na adesão de cerâmicas e cimentos resinosos autoadesivos à estrutura dentária tornam este tratamento uma alternativa viável para restaurar os dentes posteriores. Ester relato de caso descreveu a remoção de duas onlays fraturadas e confecção de novas onlays de dissilicato de lítio cimentadas com cimento resinoso auto-adesivo. A justificativa para várias escolhas neste protocolo de tratamento é detalhada com referência à literatura pertinente. O sucesso clínico da técnica depende da correta identificação do caso para o qual este tratamento é adequado e da execução bem-sucedida das etapas clínicas envolvidas. (AU)

Effects of desensitizing dentifrices on the reduction of pain sensitivity caused by in-office dental whitening: a double-blind controlled clinical study.

Objective: The purpose of this study was to clinically evaluate the influence of desensitizing dentifrices applied through a plastic tray on reducing the pain sensitivity and color variation caused by in-office dental whitening and to evaluate differences among such dentifrices through a controlled double-blind clinical study. Materials and methods: A prospective study was conducted with 48 individuals between 18 and 30 years without gender distinction. For the dental whitening, 35% hydrogen peroxide was used in three clinical sessions. After each whitening session, the volunteers used a plastic tray containing one of the dentifrices (sucralose- S, sodium fluoride - SF, arginine and calcium carbonate - ACC, and 5% potassium nitrate - PN) for 4 hrs during the night. The evaluation of the sensitivity associated with the use of the plastic tray in each whitening session was performed using the analog numerical scale with scores from 0 to 10. The color variation (ΔE) was determined with a spectrophotometer. The pain sensitivity data were submitted to the multivariate analysis of variance with repeated measurements and a Lambda Wilks test (p<0.05). To analyze the color variation, a one-way ANOVA was applied (p<0.05). Results: The ACC and 5% NP groups showed a reduction in sensitivity in relation to the other groups (p<0.05). There was a reduction in sensitivity after placement of the tray with dentifrice. The color evaluation associated with the dentifrice showed no difference (p=0.9186). Conclusion: The use of desensitizing dentifrices with ACC or 5% NP in a plastic tray was effective for the reduction of pain sensitivity, and the use of a desensitizing dentifrice did not decrease the effectiveness of whitening.

Estudo in vitro da morfologia dos canais radiculares do primeiro pré-molar inferior, utilizando tomografia computadorizada de feixe cônico / In vitro study of mandibular first premolar root canals morphology using cone-beam computed tomography

Introdução: o tratamento endodôntico objetiva limpar e modelar o sistema de canais radiculares. O preparo químico-mecânico e a obturação tridimensional (3D) do sistema de canais radiculares são baseados no conhecimento da anatomia dentária interna. As radiografias convencionais e periapicais digitais apresentam limitações na definição da imagem, devido à anatomia 3D do elemento a ser tratado, que é compactada em uma imagem bidimensional. A tomografia computadorizada de feixe cônico (TCFC) é, atualmente, um interessante instrumento para análises anatômicas, devido à precisão volumétrica e ausência de sobreposição de estruturas. Métodos: foram analisados, in vitro, sessenta e quatro (n = 64) primeiros pré-molares inferiores humanos extraídos por indicação terapêutica. Em seguida, foram feitos protótipos com gengiva artificial de silicone, posicionando-se os elementos de forma semelhante a arcadas, para serem geradas as imagens de TCFC e analisadas por um endodontista experiente. O número de canais por raiz foi quantificado em cada elemento dentário e suas configurações anatômicas foram descritas seguindo a classificação de Vertucci. Resultados: foram encontrados 59% de canais Tipo I (n = 38); 0% do Tipo II (n = 0); 9% do Tipo III (n = 6); 6% do Tipo IV (n = 4); 16% do Tipo V (n = 10); 3% do Tipo VI (n = 2); 5% do Tipo VII (n = 3); 0% do Tipo VIII (n = 0) e 2% do Tipo C-shaped. Conclusão: as imagens de TCFC revelam em 3D a anatomia dentária interna, permitindo o planejamento da terapia endodôntica e um mapeamento detalhado da morfologia interna. O conhecimento dessa microanatomia viabiliza uma maior previsibilidade na realização do tratamento, assim como no seu prognóstico, e possibilita melhorar a descontaminação de áreas anatômicas complexas (AU).

Introduction: Endodontic treatment aims to clean and shape the root canal system. Chemomechanical preparation and tridimensional (3D) filling of the root canal system are based on knowledge of internal dental anatomy. Conventional and periapical digital radiographs present limitations in image definition due to the tridimensional anatomy of the tooth to be treated. The 3D anatomy is compressed in a two-dimensional image. Cone-beam computed tomography (CBCT) is currently an interesting tool for anatomical analysis because of volumetric precision and absence of overlapping structures. Methods: A total of 64 (sixty-four) human mandibular first premolars were extracted for therapeutic recommendation. Then prototypes were manufactured with artificial gingiva made of silicone, positioning the teeth in a format similar to the arches. They were subjected to CBCT examination and analyzed by an experienced endodontist. The number of canals per root was quantified for each tooth, and their anatomical configurations were described following Vertucci's classification. Results: The following were found: Type I (n = 38) 59%; Type II (n = 0); Type III (n = 6) 9%; Type IV (n = 4) 6%; Type V (n = 10) 16%; Type VI (n = 2) 3%; Type VII (n = 3) 5%; Type VIII (n = 0) and C-shaped 2%. Conclusion: CBCT image reveals tridimensional anatomy on the basis of which endodontic therapy is planned. It maps internal morphology in detail. Knowledge of micro-endodontics allows for greater predictability in treatment as well as prognosis, in addition to improving decontamination of complex anatomical areas.

Evaluation of Finishing/Polishing Techniques on Low-Shrink Posterior Restorative After Mechanical Cycling / Avaliação de Técnicas de Acabamento/Polimento em Restaurações Posteriores de Baixa Contração Após Ciclagem Mecânica

The aim of this study was to evaluate the surface roughness of a silorane and methacrylate-based composite resins subjected to different finishing/polishing techniques. Twelve disk specimens were prepared from each composite resin: P90®, Z350® and Charisma, divided into 12 groups according to the finishing/polishing technique: no finishing/polishing (control); finishing with 1112 FF diamond burs; finishing with 1112 FF diamond burs associated to Enhance/Pogo; finishing with 1112 FF diamond burs associated to Enhance/Pogo/Polishing/Poli I and II pastes/Fotogloss. After initial readouts of surface roughness, the specimens were subjected to mechanical cycling (1.200.000 cycles) and immediately subjected to final roughness readouts. Surface roughness means was statistically analyzed by ANOVA and Tukey-Kramer test (α=0.05). SEM images were realized after finishing/polishing and after mechanical cycling. The P90 composite showed surface roughness values similar to other investigated composites. However, significant difference was observed in finishing/polishing techniques. The diamond burs group showed the highest surface roughness differing from the other composite resins (α < 0.05). Enance/Pogo showed the lowest results, which presented no difference compared to the polishing paste group (α > 0.05). The low-shrink posterior restorative showed similar surface roughness when compared to dimethacrylate composite resins and suitable to posterior restorations. (AU).

O objetivo deste estudo foi avaliar a rugosidade superficial de resinas compostas à base silorano e metacrilato submetidas a diferentes técnicas de acabamento/polimento. Foram preparadas 12 amostras de disco de cada resina composta: P90®, Z350® e Carisma, divididas em 12 grupos de acordo com a técnica de acabamento / polimento: sem acabamento / polimento (controle); acabamento com ponta diamantada 1112 FF; acabamento com ponta diamantada 1112 FF associada a Enhance / Pogo; acabamento com ponta diamantada 1112 FF associada a Enhance / Pogo / Polishing / Pastas Poli I e II / Fotogloss. Após as leituras iniciais da rugosidade da superfície, os espécimes foram submetidos a ciclos mecânicos (1.200.000 ciclos) e submetidos imediatamente a leituras de rugosidade final. As medias de rugosidade superfícial foram analisadas estatisticamente por ANOVA e teste de Tukey-Kramer (α = 0,05). As imagens de MEV foram realizadas após o acabamento / polimento e após a ciclagem mecânica. O compósito P90 mostrou valores de rugosidade superficial semelhantes a outros compósitos investigados. Tough, mostrou diferença significativa nas técnicas de acabamento / polimento. O grupo de pontas damantadas apresentou maior rugosidade superficial que diferiu das outras resinas compostas (α <0,05). Enance / Pogo mostrou os menores resultados, que não apresentaram diferença em relação ao grupo de pasta de polimento (α> 0,05). O material restaurador posterior de baixa contração apresentou rugosidade superficial semelhante quando comparado as resinas compostas de dimetacrilato e são restaurações adequadas para região posterior. (AU).

Minimally invasive aesthetic rehabilitation in composite resin: report of two clinical cases / Reabilitação estética minimamente invasiva em resina composta: relato de dois casos clínicos

Patient demand looking for the perfect smile has been steadily growing in the last few years. Thus, these two case reports discuss some ultra-conservatives approach to achieve good esthetic results. In the first case the clinical protocol of a restorative approach is described, the cosmetic remodeling of the teeth and in the second case, the replacement of extensive unsatisfactory composite restorations. The treatment planning was based on diagnostic waxing and the making of mock-up in both cases. Teeth bleaching were also performed before restoration. To conclude, these conservative relative therapies with composite resin restorations provide an ultra-minimally invasive protocol with excellent esthetic appearances and fuction, especially for young people. (AU)

A demanda do paciente que procura o sorriso perfeito tem crescido constantemente nos últimos anos. Assim, esses dois relatos de casos clínicos discutem uma abordagem ultraconservadora para alcançar bons resultados estéticos. No primeiro caso é descrito o protocolo clínico de uma abordagem restauradora, a remodelação cosmética dos dentes e, no segundo caso, a substituição de restaurações compostas extensas insatisfatórias. O planejamento do tratamento baseouse em enceramento diagnóstico e a confecção de mock-up. O clareamento dos dentes foi realizado antes da restauração. Para concluir, essas terapias relativas conservadoras com restaurações de resina composta fornecem um protocolo ultra minimamenteinvasivo com excelentes aparências estéticas. (AU)

Resolution of a fluorosis case through the association of minimally invasive techniques: microabrasion and tooth bleaching

Color changes may interfere with smile balance and they represent a clinical challenge to dentists. Dental fluorosis originates from intrinsic factors and it is a disorder of enamel formation during the phase of teeth development, resulting in the change of enamel color. This clinical case report aimed to present the resolution of a case of dental fluorosis through the association of minimally invasive techniques, namely microabrasion and tooth bleaching. A 27-year-old male patient sought the dental clinic of the School of Dentistry of Piracicaba (FOP - UNICAMP, Brazil) presenting striped and symmetrical white stains and generalized chromogenic biofilm. After anamnesis and clinical examination, the patient was diagnosed with fluorosis stains. Initially, adequacy of the oral environment was performed with prophylaxis and supragingival scraping. Then, the enamel microabrasion technique was performed with 6% hydrochloric acid associated with silicon carbide (Whiteness RM - FGM) and supervised at-home bleaching was performed with 16% carbamide peroxide (Whiteness Simple 16% - FGM). In conclusion, the treatment performed reestablished the aesthetics and harmony of smile color with minimally invasive procedures without causing tooth sensitivity

Minimally invasive approach to diastema closure using lithium disilicate porcelain veneers: clinical report / Abordagem minimamente invasiva para fechamento de diastema usando laminados cerâmicos de dissilicato de lítio: relato clínico

Objective: Numerous advances in dentistry techniques and material have allowed patients to have not only a functional but also an aesthetic smile in a conservative way. This case report describes a treatment with ceramic laminates to solve the aesthetic problems of an 18-year-old male dissatisfied with his smile. Following the correct protocols, using minimally invasive abrasions, ceramic laminates, and strong adhesion between porcelain and dental enamel can provide predictable results and clinical longevity through follow-up. (AU)

Objetivo: Devido aos inúmeros avanços das técnicas e materiais odontológicos tem sido possível proporcionar ao paciente não só a função, mas também a estética do sorriso de maneira minimamente invasiva. Esse relato de caso descreve o tratamento com laminados cerâmicos para resolver problemas de um paciente de 18 anos gênero masculino insatisfeito com o seu sorriso. Seguindo os protocolos corretamente, utilizando desgastes minimamente invasivos, laminados cerâmicos, e forte adesão entre a porcelana e o esmalte dental, é possível obter resultados previsíveis e longevidade clínica mediante acompanhamento. (AU)

Influence of whitening dentifrices and mechanical brushing on color change and surface roughness of bulk fill resins

The use of whitening dentifrices during oral hygiene may cause surface modifications such as color change (ΔE) and increase surface roughness (Ra) of composite resin. Aim: This study aimed to evaluate the effect of whitening dentifrices and mechanical brushing on color change and surface roughness of Bulk Fill (Filtek Bulk Fill - F) and (Aura Bulk Fill - A) composite resins. Materials and methods: Sixty cylindrical specimens were fabricated of each composite resin. After initial color evaluations (Konica Minolta CM-700d), with D65 standard illuminant, and the surface roughness (Surfcorder SE 1700, Kosalab), the specimens were assigned (n=10) according to the whitening dentifrice used: True White (T), Colgate Total 12 Professional Whitening (D), Luminous White Advanced (L). Specimens were submitted to mechanical brushing (10,000 cycles); new color and surface roughness evaluations were taken. Data were analyzed by ANOVA, Duncan test and Dunnet test were used to identify differences between groups (α=5%). Results: The results showed that the tooth brushing time promoted a significant increase in ΔE of the FT group. The FD group exhibited intermediate values of ΔE and was similar to all groups tested. There was a significant increase in the surface roughness of the AD and AT groups after the mechanical tooth brushing. Conclusion: The results showed no significant changes were observed in surface roughness for F groups after toothbrushing. It be concluded that the color change and surface roughness of the composite resins after toothbrushing are dependent on the interaction between the composition of the composite resin and the characteristics of the dentifrice

Influence of enamel acid-etching on mechanical properties and nanoleakage of resin composite after aging

The aim of this study was to evaluate how acid-etching of the cavosurface enamel in Class I resin composite restorations influences the bond strength to the pulpal wall and the restoration, Knoop microhardness and nanoleakage after thermomechanical aging. For this research 76 fresh human molars were selected and restored with Silorane or Clearfil SEBond/Z350XT composite divided in 4 groups (Silorane system restored with or without enamel cavosurface acid-etching and Clearfil SEBond/Z350XT with or without enamel cavosurface acid-etching). To induce artificial aging, samples were subjected to thermomechanical cycling through 200,000 and thermal cycling between 5 and 55 °C with 30 second filling and 15-second drainage steps. Microhardness and microtensile bond strength were evaluated in 32 teeth (n=8) each and nanoleakage evaluation was performed in 12 teeth (n=3). Samples restored by Clearfil SEBond/Z350 XT without cavosurface acid-etching showed significantly lower microtensile bond strength results. The resin composite Z350XT presented higher values of Knoop microhardness. It was observed little or no infiltration for Silorane groups and moderate infiltration for Clearfil SE Bond groups. Acid-etching of the cavosurface enamel during restoration procedure with Clearfil Se Bond resulted in a stronger bond after thermomechanical cycling. Silorane groups showed less infiltration than Clearfil SE Bond groups (AU)

Knowledge and conduct of public health system dentist about atraumatic restorative treatment / Conhecimento e conduta dos cirurgiões-dentistas da estratégia saúde da família sobre tratamento restaurador atraumático

Objective: To evaluate the knowledge and conduct of dentists of the Public Health System (Family Health Strategy – FHS) regarding Atraumatic Restorative Treatment (ART). Material and method: A census survey was conducted and all FHS dentists from the urban area of the city of Teresina, Piauí, Brazil were visited in their workplaces and invited to participate in this study. Data collection was carried out between July and October, 2014 through self-administered questionnaires. For statistical analysis the chi-square test with a significance level of 5% and the linear association test were applied. Result: One hundred and eighty-three professionals participated in the study (with a response rate of 89.7%), mostly women (71.0%), aged twenty to thirty-nine years (49.2%), with twenty or more years’ experience since graduation (45.9%), working only in the public service (70.5%), and with expertise in the clinical area (44.3%). Most of them believe in ART (82.7%) and 95.8% of them apply it (of those, 58.9% apply it only in public service). The professionals’ individual knowledge of ART was measured and most of them have correct information regarding the treatment. The knowledge level evaluation was significantly associated with age and time since graduation (p<0.05). Conclusion: Most of the dentistsworking in the public health system of Teresina, Piauí, Brazil have a good knowledge of and show positive behavior towardentists ART, but improvement is needed regarding the technique and its correct indication.

Objetivo: Avaliar o conhecimento e conduta dos Cirurgiões-Dentistas (CD) da Estratégia Saúde da Família (ESF) sobre o Tratamento Restaurador Atraumático (ART). Material e método: A amostra foi censitária e todos os CD da ESF da zona urbana da cidade de Teresina – PI foram visitados em seus locais de trabalho e convidados a participar do estudo. Questionários autoaplicáveis foram utilizados como técnica de coleta de dados. Para as análises estatísticas aplicou-se o teste qui-quadrado com nível de significância de 5% e o teste de associação linear. Resultado: Participaram do estudo 183 profissionais, a maioria do sexo feminino (71,0%), na faixa etária de 20 a 39 anos (49,2%), com vinte ou mais anos de formados (45,9%), que tem apenas o serviço público como vínculo empregatício (70,5%), e especialização em área clínica (44,3%). A maioria acredita no ART (82,7%) e a realiza (95,8%), apenas no serviço público (58,9%). O conhecimento individual dos profissionais sobre ART foi mensurado e a maioria apresenta informações corretas sobre o tratamento. Houve associação significativa do autorrelato de conhecimento de ART com a faixa etária, o tempo de formado e a titulação dos participantes. A avaliação do nível de conhecimento teve associação significativa com a faixa etária e tempo de formado. Conclusão: A maioria dos Cirurgiões-Dentistas da Estratégia Saúde da Família de Teresina, Piauí, Brasil possui um bom conhecimento e conduta positiva em relação ao ART, mas necessita de aprimoramento com relação à técnica e sua correta indicação.

Caries, Toothbrushing Habits, and Fluoride Intake From Toothpaste by Brazilian Children According to Socioeconomic Status.

PURPOSE: The purpose of this study was to evaluate the prevalence of dental caries, toothbrushing habits, fluoride intake, and factors associated with the use of toothpaste in Brazilian children according to socioeconomic status (SES). METHODS: A cross-sectional observational study was conducted with 148 three- to four-year-olds of both low and high socioeconomic status. Data collection consisted of administering a questionnaire to guardians, brushing to determine fluoride intake, and examining the children's teeth to evaluate dental caries. RESULTS: In this study, 42 percent of children from high SES and 2.7 percent of children from low SES used toothpaste without fluoride or with a concentration below 1,000 ppm F. Fluoride intake was associated with SES, frequency of brushing, the amount of toothpaste used, and the concentration of fluoride present in toothpastes (P<0.05). Low SES children had a higher fluoride intake during brushing (0.045 mg F/kg body weight/day), compared to high SES children (0.023 mg F/kg body weight/day). Unlike low SES children (68.9 percent), all high SES children were caries free. CONCLUSIONS: A lower socioeconomic status was associated with a higher prevalence of dental caries and a higher intake of fluoride from toothpaste.