Nature-mimicking layering with composite resins through a bio-inspired analysis: 25 years of the polychromatic technique.

OBJECTIVES: For decades, the dental community has discussed which materials would be the ideal substitutes for lost tooth structure. Initially, the biomimetic approach advocated that feldspathic ceramics would be the material of choice for enamel. However, given the complexity of obtaining excellent dental technicians and the financial cost, are composite resins a suitable replacement? The optical properties with opalescence and fluorescence effects, as well as this material's high fracture toughness, indicate it as a long-lasting restorative material. However, because this material depends on the operator's expertise, knowledge of layering techniques and the selection of each material for the different layers is required. Thus, knowledge of the polychromatic technique through a bioinspired approach is necessary to obtain results of life-like restorations. This article aims to review the polychromatic layering technique (PLT), considering the optical and mechanical properties of dentin and enamel and correlating these properties with current composite resins to guide clinicians in selecting the most suitable restoratives for their clinical challenges. CLINICAL CONSIDERATIONS: The polychromatic layering technique is revisited, cross-referencing the properties of dentin and enamel with current composite resin restoratives and their biomimetic properties. The effectiveness and predictability of the PLT are corroborated in clinical cases of varying degrees of difficulty requiring different layering strategies. CONCLUSION: After the bio-inspired analysis, using nature as a model to be understood and followed, it is possible to note how the polychromatic technique remains current and viable in mimicking nature, providing esthetic and natural results in the layering of composite resins. CLINICAL SIGNIFICANCE: Composite resins effectively replicate the optical and mechanical characteristics of natural dentin and enamel through the bioinspired approach presented by the polychromatic layering technique.

The Influence on Fracture Resistance of Different Composite Resins and Prefabricated Posts to Restore Endodontically Treated Teeth.

Recent formulations of resin-based composites have incorporated different combinations of materials. However, the mechanical and bonding behavior of these materials with intraradicular posts are unclear. This study aimed to evaluate the effect of light-cure and dual-cure resin composite posts on the fracture resistance of endodontically-treated teeth. Materials and Methods: Ninety extracted human upper canines were selected and randomly divided into nine groups (n=10): (G1) endodontically treated teeth without endodontic posts; (G2) glass-fiber post cemented with glass-ionomer cement; (G3) endodontic post by dual-cure composite resin (Rebilda DC); (G4) endodontic post by dual-cure composite resin (Cosmecore); (G5) endodontic post by dual-cure composite resin (Bis-Core); (G6) endodontic post by light-cure composite resin; (G7) glass-fiber post customized with flowable composite resin; (G8) glass-fiber post cemented with light-cure composite resin; (G9) glass-fiber post cemented with self-adhesive resin cement. After the post insertion, all specimens were subjected to mechanical (250,000 cycles) and thermocycling (6000 cycles, 5 °C/55 °C) and immediate loading at 45 degrees in a universal testing machine until fracture. The data were analyzed by one-way ANOVA and multiple comparisons using the Fisher LSD Method (p < 0 05). Results: The mean failure loads (±SD) for the groups ranged from 100.7 ± 22.6 N to 221.9 ± 48.9 N. The G1 group (without endodontic posts) had a higher fracture strength than all experimental groups (p < 0.001). Conclusions: Within the limitations, the light- and dual-cure post technique did not present lower fracture resistance values as compared to the conventional glass-fiber post.

Influência da qualidade das próteses totais na prevalência de disfunção temporomandibular / Influence of quality of total prostheses on the prevalence of temporomandibular disorder

Introduction Temporomandibular disorder (TMD) involves the mastication and temporomandibular articulation muscles. Completely toothless patients with prostheses should be thoroughly assessed since edentulism causes damage that can lead to TMD onset. Objective This study aims to assess the effect of the technical quality of total prostheses (TPs) on TMD occurrence in patients with bimaxillary TPs. Material and method 154 patients responded to a questionnaire to obtain personal data, information regarding prostheses, anamnestic index for TMD, and the prosthesis quality index. Result Of the 154 patients examined, 64 (41.6%) had no TMD, 61 (39.6%) had mild TMD, 23 (14.9%) moderate, and only 6 (3.9%) showed severe TMD. As for the quality of total prosthesis, 78 (50.6%) completely toothless individuals had satisfactory TPs while 76 (49.4) presented unsatisfactory prostheses. Regarding the time using total prosthesis, around 50% of individuals with up to 10 years use presented some degree of TMD and 70% of individuals with over 10 years presented TMD. Conclusion Considering the methodology used and the population studied, we conclude that the quality of the TPs did not influence the incidence of TMD.

Introdução A disfunção temporomandibular (DTM) é uma desordem que envolve os músculos da mastigação e da articulação temporomandibular. Pacientes desdentados totais e que utilizam protéses requerem uma avaliação criteriosa, já que o edentulismo leva a prejuízos que podem contribuir para o aparecimento de DTM. Objetivo O objetivo deste presente estudo foi avaliar o efeito da qualidade técnica das próteses totais (PTs) na incidência de DTM em pacientes portadores de PTs bi-maxilares. Material e método Foi aplicado um questionário a 154 pacientes contendo os dados pessoais, o histórico das próteses, o índice anamnésico para DTM e o índice de qualidade de prótese. Resultado Dos 154 pacientes examinados, 64 (41,6%) estavam livres de DTM, 61 (39,6%) possuíam DTM leve, 23 (14,9%), moderada e apenas 6 (3,9%) mostravam DTM severa. Quanto à qualidade da prótese total, 78 (50,6%) desdentados totais portavam PTs satisfatórias e 76 (49,4) estavam com próteses insatisfatórias. Quanto ao tempo de uso da prótese total, cerca de 50% dos indivíduos com até 10 anos de uso apresentaram algum grau de DTM e 70% dos indivíduos com mais de 10 anos acusaram a presença de DTM. Conclusão Considerando-se a metodologia empregada e a população estudada, pôde-se concluir que a qualidade das PTs não influenciou na presença de DTM.

Spectrophotometric analysis of dental bleaching after bonding and debonding of orthodontic brackets.

INTRODUCTION: The aim of this study was to evaluate the bleaching effect after aging simulation in teeth submitted to bonding and debonding of orthodontic brackets. MATERIALS AND METHODS: For this study, 90 human premolars were selected, and randomly divided into 6 groups: control, bleaching, and other 4 groups submitted to bleaching after bonding and debonding brackets using different methods. Color measurement of sample through the CIE L*a*b* system was performed in three moments: T1 - after brackets debonding, T2 - after staining cycling, and T3 - after bleaching. For evaluation of results among the components L*, a* and b*, the two criteria analysis of variance and the multiple comparison Tukey test (p < 0.05) were used. RESULTS: Statistically significant difference was observed among the groups submitted to brackets bonding and debonding through self-conditioning adhesive system and tungsten drill, also the control and bleaching groups between the moments T1 e T2. CONCLUSION: Bonding and debonding brackets methods tested in this study showed influence on the sample color change, and after the tooth bleaching process, only the group without brackets previous bonding achieved the color value presented before the staining and aging of samples in the brackets absence.

Push-out bond strength of fiberglass posts cemented with adhesive and self-adhesive resin cements according to the root canal surface.

Evaluating the bond strength of fiberglass posts cemented with different resin cements. MATERIALS AND METHODS: Seventy freshly extracted roots of healthy human canines were endodontically treated and prepared to receive fiberglass posts. The roots were randomly divided into seven groups: (G1) RelyX ARC, (G2) Enforce, (G3) BisCem, (G4) Duo-Link, (G5) Cement Post, (G6) Variolink II, and (G7) RelyX U200. After post cementation, the specimens were sectioned perpendicularly to the root axis using a high-speed diamond disc, totaling 340 specimens. The strength values obtained in the push-out test were submitted to two-factor ANOVA and Tukey test (p = 0.05). RESULTS: The root thirds (p = 0.001) and the type of cement (p = 0.001) influenced the bond strength values. The relation between these two factors was also significant (p = 0.011). CONCLUSIONS: The bond strength of self-adhesive resin cements was significantly higher as compared to other cements. Besides the cervical third in roots cemented with conventional cements types presented the highest bond strength values (p < 0.05).

Mechanical Degradation of Different Classes of Composite Resins Aged in Water, Air, and Oil.

A significant deterioration of the properties can drastically compromise the survival rate of restorative materials. The aim of this study was to assess flexural strength and hardness of three composite classes: hybrid composite resin (HCR), nanoparticulate composite resin (NCR), and silorane-based composite resin (SBCR). One hundred specimens were prepared for hardness testing by using a split metallic mold measuring 10 mm in diameter and 2 mm deep. Twenty specimens were prepared for each restorative material, randomly assigned for storage in air, distilled water, or mineral oil. After intervals of 24 hours, 30, 60, 90, and 120 days, hardness and flexural strength tests were initially compared in two levels: "storage medium" and "time" within each material group. A two-way analysis of variance was performed (p<0.05) on the variables "material" and "storage time" (p<0.05). The HCR showed to be stable with regard to the evaluation of flexural strength and hardness (p<0.05). A significant reduction occurs for the NCR in comparison to the other groups (p<0.05). The NCR presented the lowest values of hardness and flexural strength kept on water over time. The characteristics of material showed a strong influence on the decrease of the mechanical properties analyzed.

Color stability of conventional and bulk fill composite resins / Estabilidade cromática de resinas convencionais e resinas bulk fill

ABSTRACT Objective: This study compared the color stability of different dental composite resins after prolonged exposure to a coffee solution. Methods: Sixty-four cylindrical discs (10 mm diameter x 2 mm thickness) were prepared using 8 different dental composite resins (n=8, per group). The specimens were first immersed in artificial saliva for 24 h followed by immersion in a coffee solution for 14 days. The assessment of chromatic variation (ΔE) was performed with the aid of a Vita Easyshade Advanced spectrophotometer (VITA Zahnfabrik, Bad Sackingen, Germany). The color of each specimen was calculated based on the L*, a* and b* coordinates of the CIELab system. Results: Grandio SO had the lowest average chromatic variation (ΔE=7.77) after immersion in coffee solution. Durafill VS, Grandio and Z350 XT (ΔE=8.58; ΔE=9.52; ΔE=10.39, respectively) showed similar chromatic variation, with no statistical difference in relation to Grandio SO. However, the other dental composite resins evaluated showed statistically higher values of ΔE compared to Grandio SO, and Enamel HRi (ΔE=20.56) demonstrated the highest chromatic variation. Conclusion: The Bulk Fill and hybrid composite resins from the same manufacturer (Micerium, Avegno, Italy) showed greater chromatic variation than the other composite resins tested. Grandio SO (Voco, Cuxaven, Germany) had the lowest ΔE variation.

RESUMO Objetivo: Comparar diferentes resinas compostas em relação á estabilidade de cor após exposição prolongada em solução de café. Métodos: Sessenta e quatro discos cilíndricos (10mm x 2mm) foram confeccionados a partir de 8 diferentes marcas comerciais de compósitos (n= 8 por grupo); os espécimes foram imersos em saliva artificial, e posteriormente em café, sendo por conseguinte feita a avaliação da variação cromática (ΔE), utilizando espectrofotômetro Vita Easyshade Advanced (VITA Zahnfabrik, Bad Sackingen, Germany). O padrão de cada espécime foi medido examinando as coordenadas L*, a* e b* do sistema CIELab. Resultados: A resina composta Grandio SO apresentou a menor média de variação cromática (ΔE= 7,77) após a imersão em solução de café. Semelhantemente, a variação cromática das resinas compostas Durafill VS, Grandio e Z350 XT (ΔE=8,58; ΔE=9,52; ΔE=10.39) que não apresentaram diferença estatística. Todavia, as demais resinas compostas avaliadas apresentaram valores estatisticamente maiores de ΔE em relação a resina Grandio SO, sendo que a resina Enamel HRi (ΔE= 20,56) apresentou a maior variação cromática registrada. Conclusão: As resinas da categoria bulk fill e as resinas híbridas produzidas pelo mesmo fabricante (Micerium, Avegno, Itália) tiveram alterações cromáticas superiores às demais resinas testadas sendo que a resina GrandioSO (Voco, Cuxaven, Alemanha) foi a que apresentou menor alteração de ∆E.

Reconstruction of the Alveolar Buccal Bone Plate in Compromised Fresh Socket after Immediate Implant Placement Followed by Immediate Provisionalization.

OBJECTIVE: The aim of this clinical report was to reestablish the buccal bone wall after immediate implant placement. The socket defect was corrected with autogenous bone, and a connective tissue graft was removed from the maxillary tuberosity to increase the thickness, height, and width of the buccal bone and gingival tissue followed by immediate provisionalization of the crown during the same operation. CLINICAL CONSIDERATIONS: A 66-year-old patient presented with a hopeless maxillary left central incisor with loss of the buccal bone wall. Atraumatic, flapless extraction was performed, and an immediate implant was placed in the extraction socket followed by preparation of an immediate provisional restoration. Subsequently, immediate reconstruction of the buccal bone plate was performed, using the tuberosity as the donor site, to obtain block bone and connective tissue grafts, as well as particulate bone. Finally, immediate provisionalization of the crown followed by simple sutures was performed. Cone-beam computed tomography and periapical radiographs were taken before and after surgery. After 4 months, the final prosthetic crown was made. After a 2-year follow-up, a satisfactory aesthetic result was achieved with lower treatment time and morbidity. CONCLUSION: This case demonstrates the effective use of immediate reconstruction of the buccal bone wall for the treatment of a hopeless tooth in the maxillary aesthetic area. This procedure efficiently promoted harmonious gingival and bone architecture, recovered lost anatomical structures with sufficient width and thickness, and maintained the stability of the alveolar bone crest in a single procedure. CLINICAL SIGNIFICANCE: If appropriate clinical conditions exist, immediate dentoalveolar restoration may be the most conservative means of reconstructing the buccal bone wall after immediate implant placement followed by immediate provisionalization with predictable healing and lower treatment time.

Parafusamento transverso em prótese sobre implante: aspectos inovadores no design e na aplicação do sistema / Cross-pinning in implant-supported prosthesis: innovative design and approach

Reabilitações com próteses implantossuportadas são usadas frequentemente para resolver casos de edentulismo. Elas podem ser retidas por de meio de parafusos ou agentes de cimentação. No entanto, nos casos de alinhamento inadequado dos implantes ou fragilidade pelo desenho final da estrutura protética, o sistema de parafusamento convencional não pode ser utilizado. Um método alternativo para se manter a reversibilidade da peça protética é o parafusamento transverso. Este consiste em um sistema tubo/parafuso de dimensões reduzidas que possibilita o parafusamento em uma área palatina ou lingual. Entretanto, aperfeiçoamentos nos sistemas existentes comercialmente eram necessários para se suprirem dificuldades como custo, técnica de confecção e dimensões dos componentes. O presente artigo apresenta o desenvolvimento de um produto adequado para este método, para suprir as desvantagens dos sistemas anteriores, apresenta a técnica de confecção clínica e laboratorial, e discute os aspectos fundamentais no planejamento desse sistema...

Implant-supported prostheses are frequently used in oral rehabilitation to solve cases of edentulism. They may be screw-retained or cement-retained. However, sometimes conventional screw-retained systems can not be used in cases of improper alignment of implants or compromised structural integrity of the prosthesis. An alternative method to maintain reversibility of the rehabilitation is cross-pinning. This system consists of a tube/screw with reduced dimensions which enables screwing in a palatal or lingual area. However, improvements in the commercially existing systems have been necessary to overcome difficulties such as costs, manufacturing technique and component dimensions. This paper presents the development of an appropriate product for this method, allowing to overcome the disadvantages of previous systems and analyzes the clinical and laboratory steps discussing the fundamental aspects of planning when using this system...

Clinical application of adhesive systems - a critical review: biomimetic approach / Revisão crítica da aplicação clínica dos sistemas adesivos: abordagem biomimética

The various functions and clinical applications of adhesive systems have become a fundamental part of restorative treatment. The biggest challenge for such systems is to provide adequate adhesion to the different tissues, which can be very diverse in nature. When choosing the appropriate adhesive system, the dentist should be familiar with the origin, composition, action mechanism and method of application of each system. The commercially available products and their high technical status have made it possible for the clinician to develop a philosophy of maximum tissue preservation, optimized esthetics, up-to-date concepts and procedures and full function of the restored element, compatible with biomimetic theory. The literature describes the superior qualities of results obtained with three-step total etching adhesives and the use of chlorhexidine as a factor to increase longevity. Future perspectives include the use of ethanol, inactivating agents of enzymes released in the adhesive process and the action of agents that act upon the dentin matrix.

As diversas funções e aplicabilidades clínicas dos sistemas adesivos os tornaram parte fundamental da terapêutica restauradora. O desafio maior destes sistemas está em prover qualificada adesão aos diferentes tecidos uma vez que estes são muito distintos em sua constituição. Para que essa escolha seja feita corretamente o dentista deve conhecer a origem, composição, mecanismo de ação e modo de aplicação de cada sistema. Os produtos disponíveis e o estado técnico, alcançados atualmente, tem possibilitado aos clínicos o desenvolvimento de uma filosofia de máxima conservação tecidual, estética otimizada, atualização de condutas e conceitos bem como função plena do elemento dental restaurado compatíveis com uma filosofia biomimética. A literatura vigente apresenta superioridade de resultados com adesivos de condicionamento total de três etapas, uso de clorexidina como fator de aumento da longevidade e perspectivas futuras que incluem trabalhos com o uso de etanol, agentes inativadores enzimas liberadas no processo adesivo e a ação de agentes que atuem na malha dentinária.

Effect of Carbamide Peroxide on the Push-out Bond Strength of Different Composition Glass-Ionomer Cement to Root Canal Dentin when used as Cervical Barrier.

AIM: To evaluate the effect of 37% carbamide peroxide on the bond strength of conventional or resin-modified glass-ionomer cements when used as a cervical barrier in endodontically-treated teeth. MATERIALS AND METHODS: After root canal instrumentation and obturation, 40 specimens of the cement-enamel junction were obtained after transversal root canal sectioning from human extracted canines. The root canal specimens were standardized and filled with the following materials (n = 10, each group): G1: zinc phosphate (control), G2: Ketac glass-ionomer, G3: vitrebond glass-ionomer or G4: GC GL glass-ionomer. After 24 hours, the specimens were subjected to an application of 37% carbamide peroxide for 21 days, changed each 7 days and stored in an artificial pulp chamber. The specimens were then submitted to push-out bond strength testing with an electromechanical test machine (EMIC) and the failure mode in each specimen was analyzed with confocal microscopy (LEXT). RESULTS: G3 and G4 showed higher bond strengths values than the other groups (p < 0.05), and were similar to each other (p > 0.05). G1 showed the lowest bond strength value (p < 0.05). CONCLUSION: Glass-ionomer cements showed higher bond strength values than the zinc phosphate cement, and resin-modified glass-ionomer cements presented the highest push-out values to root canal dentin (GC, GL and Vitrebond). CLINICAL SIGNIFICANCE: Glass ionomer cements are recommended to use as cervical barrier materials before the internal dental bleaching, but its efficiency is questionable.

Matriz Bertholdo/Ricci/Barrotte (BRB): uma simplificação de técnica para obtenção de guia de estratificação com compósitos / Bertholdo/Ricci/Barrotte (BRB) matrix: a simplified technique for obtaining a copmposite layering guide

A estratificação de resinas compostas por meio de métodos sofisticados pode ser facilitada pela técnica denominada Matriz Lingual, em que uma guia é confeccionada em elastômero, por meio da moldagem de uma superfície palatina, previamente encerada ou esculpida em um ensaio restaurador intraoral. Essa técnica apresenta muitas vantagens, facilitando a estratificação, a construção anatômica e as fases de acabamento e polimento. Porém, em algumas situações clínicas, o desenrolar das etapas para se obter essa matriz pode ser moroso ou até mesmo inviável. Visando a facilitar a obtenção de tal aparato, uma técnica foi idealizada para permitir significativa redução do tempo clínico. Tal matriz, denominada Matriz BRB, é amplamente discutida de maneira didática e clínica neste artigo, que apresenta suas vantagens em casos em que é imperativo o uso de guia para realização de uma estratificação controlada. A simplicidade dessa abordagem, bem como a redução do tempo clínico e de custos financeiros, a torna viável em clínica cotidiana

Advance layering composite resins can be facilitated by a technique called “Lingual Matrix”, where a guide is made of elastomer by molding a previously waxed tooth or sculpted in an intraoral test drive restoration. This technique has many advantages to sophisticated layering, facilitating stratification, anatomic construction and the stages of finishing and polishing. However, in some clinical situations, the unfolding of the steps to obtain this matrix can be time consuming or even infeasible. To facilitate the achievement of this apparatus, a technique was idealized allowing significant reduction in clinical time. This matrix, called the “BRB Matrix” is widely discussed in a didactic and clinical manner in this article, presenting its advantages in clinical cases where it is imperative to use guide for conducting a controlled layering. The simplicity of this approach, as well as reduced clinical time and financial costs turn it feasible in an everyday clinical practice

Esthetic and function improvement by direct composite resins and biomimetic concept.

AIM: This case report describe a resin layering restorative technique based on biomimetic concept to improve esthetics in a patient with dental defects that affected both enamel and dentin in anterior teeth. BACKGROUND: Severe structural defect in anterior teeth compromises esthetics and it is a high challenge to become the defect imperceptible after the restoration. CASE DESCRIPTION: A clinical sequence of applying different composite resin layers allowed the reproduction of the interaction between hard dental tissues and the restorative material. CONCLUSION: This technique achieved a satisfactory final esthetic outcome, preserving sound teeth structure and at same time, improved the quality of life of the young patient. CLINICAL SIGNIFICANCE: The utilization of the biomimetic concept to increase a disharmonic smile with dental defects is based in a conservative approach, which reached a satisfactory and esthetic outcome.

Análise metalográfica do titânio puro submetido à soldagem laser Nd: YAG e TIG / Metallographic analysis of pure Ti submitted to Nd: YAG laser and TIG welding

Introdução: Os métodos de soldagem mais utilizados em Odontologia não podem ser aplicados ao titânio puro e às suas ligas em função da alta reatividade do titânio com elementos atmosféricos; dessa forma, o mesmo não deve ser soldado por processo comum. Objetivo: O objetivo deste trabalho foi avaliar a característica metalúrgica do titânio comercialmente puro sem solda e submetido aos processos de soldagem a laser e TIG. Material e Método: Foram confeccionados 15 corpos de prova em titânio comercialmente puro, cinco para cada condição, na forma de hastes cilíndricas, obtidas por fundição odontológica, sob atmosfera de gás argônio e vácuo, com calor produzido por um arco voltaico, com a injeção do titânio sob vácuo-pressão. Três grupos foram formados I: soldagem a laser; II: soldagem TIG, e III: sem solda. Os corpos de prova do grupo I e II foram seccionados ao meio e soldados por TIG e por laser, respectivamente; o grupo III foi mantido sem corte e sem solda, como controle. A análise metalográfica foi realizada sob aumentos de 50×, 100× e 200×, em microscópio. Resultado: Pelos resultados obtidos nas micrografias, o titânio comercialmente puro apresentou uma morfologia de grãos equiaxiais da fase α, o cordão de solda a laser apresentou estrutura martensítica e, na TIG, microestrutura Widmanstätten. Conclusão: A microestrutura martensítica é condizente com a alta taxa de resfriamento proveniente do processo de soldagem a laser. As estruturas martensítica e Widmansttäten são mais refinadas quando comparadas à microestrutura do metal base.

Introduction: The welding method most commonly used in dentistry can not be applied to pure titanium and its alloys and its alloys due to high reactivity of titanium with the atmospheric elements must not be welded by common process. Objective: This study surveyed the characteristics of commercially pure titanium metal intact samples and those laser weld and tungsten inert gas weld. Material and Method: Fifteen cylindrical rods were developments by using brass rods are patterns. The samples were invested in casings, subjected to thermal cycles, and positioned in a plasma arc-welding machine under argon atmosphere and vacuum, and titanium was injected under vacuum/pressure. Three groups were formed I: laser welding, II, III and TIG welding, without welding. The bodies of the test piece in group I and II were cut in half and welded by TIG and laser, respectively, and group III was maintained intact as control. The metallographic analysis was performed under magnification 50×, 100× and 200× microscope. Result: The results obtained in the micrographs, the commercially pure titanium showed an equiaxed grain morphology of α phase, the laser weld bead showed martensitic structure and TIG Widmanstätten microstructure. Conclusion: Martensitic microstructure is in agreement with the high cooling rate from the laser welding process. Martensitic and Widmansttäten structures are more refined when compared to the microstructure of the base metal.

O design inteligente e a estratificação biomimética em restaurações diretas posteriores: consolidando a era pós-amálgama / Rational design and biomimetic layering of posterior composite restorations: consolidating the postamalgam era

No campo da dentística restauradora, muitas conquistas têm sido alcançadas, principalmente em relação à crescente conscientização dos pacientes quanto à possibilidade de se obterem restaurações mais funcionais e estéticas. O grande dilema tem sido como raciocinar clinicamente com esses novos conceitos, ou seja, modificar a abordagem antiga, que era baseada na ausência da verdadeira união. Quais conceitos clássicos devem permanecer vigentes nesse novo contexto? Mimetizar, em ciência, envolve permitir a cópia de um modelo que, na área odontológica, sem dúvida, é o dente intacto. Este artigo aborda a associação desse conceito com a técnica e a seleção dos materiais na prática clínica.

The increased awareness of patients for more functional and esthetic restorations led to a number of archievements that occurred in Restorative Dentistry. A major concern is how to clinically thinking on these new concepts, changing the old approach which was based on the lack of true adhesion. Which classical concepts should be maintained in this new context? Mimicking in science, involves a process of copying a model that, in the dental field, is in most cased an intact tooth. This article discusses the association of this concept with the technique and selection of materials in clinical practice.

Transformação cosmética de caninos em incisivos laterais: uma abordagem sistemática / Cosmetic transformation of canines in lateral incisors: a systematic approach

A agenesia de dentes do grupamento anterossuperior é de fácil percepção pelo leigo por afetar a estética do sorriso, sendo esse o motivo principal da busca por tratamento nesses casos. Atualmente, as diferentes opções de tratamento ampliam as possibilidades clínicas mas também trazem dúvidas e discussões sobre qual abordagem seria a ideal. O objetivo desse estudo foi avaliar, por meio da execução de um caso clínico, os parâmetros de importância no planejamento da transformação de caninos em incisivos laterais pelo uso da técnica restauradora direta com resinas compsotas. om a avanço das propriedades mecânicas, das cores e técncias de estratificação dos materiais compósitos atuais, resultados altamente estéticos e mais duráveis podem ser conquistados. Em casos de agenesia de incisivos laterais e reposicionamento de cabninos, a reanatomização com resinas compostas em incisivos laterais é um procedimento viável e com previsibilidade de resultados quando um método multidisciplinar e racional de trabalho é utilizado pela equipe odontológica

Agenesis of upper anterior teeth is easily observed by laypeople because it affects the smile esthetics, which is the main reason for seeking treatment in such cases. Currently,the different treatment options expand the clinical possibilities but also carry doubts about which approach would be ideal. The objective of this study was to evaluate through the execution of a clinical case, the parameters of importance in planning the transformation of canine teeth in lateral incisors when using the direct restorative technique with composite resins. With the enhancement of mechanical properties, colors and layering techniques of composite materials, highly esthetic results can be achieved in a more durable fashion. In agenesis cases of lateral incisors and canine repositioning, sculpturing of the new anatomy with those composites is a feasible procedure with predictable results if a multidisciplinary approach and rational work is used by the dental team.

Prótese total fixa em função imediata confeccionada em resina composta indireta / Indirect composite, resin fixed prostheses for immediate dental implant loading

Os implantes osseointegrados em função imediata estão sendo muito utilizados no tratamento reabilitador de pacientes desdentados totais por ser um procedimento seguro e de alta previsibilidade. No entanto, a viabilidade e o sucesso de tratamentos com implantes osseointegrados em função imediata são definidos por fatores como número de implantes, sua distribuição e esplintagem, redução das cargas laterais e contatos oclusais excessivos. As resinas compostas indiretas modificadas por vidro possibilitam a construção de uma prótese altamente estética, associada à resistência satisfatória e a melhor dissipação das forças durante o carregamento oclusal. Este artigo apresenta um caso de prótese total fixa mandibular implantossuportada em função imediata confeccionada em resina composta indireta.

Immediate functioning of osseointegrated implants has been widely employed in edentulous patients due to its safety and high predictability. However, viability and success of immediate-loaded implants is defined by factors such as number of implants, distribution and splinting, as well as reduction of oblique loads and excessive occlusal contacts. The indirect composite resin-modified glass enable building of a highly aesthetic prosthesis, combining satisfactory resistance and better force dissipation on occlusal loading. This article describes a resin composite, mandibular fixed prosthesis on osseointegrated implants in immediate function.

Dificuldades relatadas por estudantes de odontologia diante de procedimentos relacionados à periodontia / Problems reporterd by dental students about procedures related to periodontics

Objetivo: O presente trabalho teve por objetivo avaliar as principais dificuldades relatadas por estudantes do último ano do curso de Odontologia na execução de procedimentos periodontais básicos e cirúrgicos. Métodos: Um questionário proposto com 24 questões, sendo 14 referentes a procedimentos periodontais básicos e 10 a procedimentos cirúrgicos foi aplicado em 45 alunos de graduação com trabalhos envolvendo tais procedimentos durante as atividades práticas da Disciplina de Clínica Integrada, disciplina obrigatória da grade curricular do curso, ministrada aos alunos do último ano. Os alunos foram questionados quanto à percepção individual de dificuldades quanto a execução dos diversos passos referentes aos tratamentos avaliados. O grau de dificuldade individual foi determinado segundo a escala Likert em 0 = nenhuma, 1  =  leve, 2  =  moderada, 3 =  alta e 4 = muito alta. Aplicou-se a análise exploratória dos dados obtidos e adicionalmente, o grau de dificuldade foi dicotomizado em nenhuma a leve (escores 0 e 1) e moderada a muito alta (escores 2 a 4). Resultados: Com relação ao tratamento periodontal básico, a sondagem do nível ósseo foi o procedimento com maior quantidade de alunos em dificuldade (57,5%). Para as dificuldades relatadas por estudantes relacionadas às etapas de uma cirurgia periodontal apenas os procedimentos relacionados a anestesia e remoção de sutura não apresentaram relatos de dúvidas. Conclusão: O procedimento cirúrgico periodontal foi o que envolveu maior prevalência de dúvidas relatadas de forma moderada a muito alta, sendo a indicação da técnica cirúrgica adequada, a etapa com a maior porcentagem de dúvidas (66,6%) entre os graduandos (AU).

Objective: This study aimed at evaluating the difficulties reported by last-year dentistry course students regarding basic and surgical periodontal procedures. Methods: A proposed questionnaire with 24 questions, 14 related to basic periodontal procedures and 10 to surgical procedures, was applied to 45 undergraduate students with jobs involving these procedures, during the practical activities of the Integrated Clinic Discipline, a compulsory subject in the curriculum of the course, taught to last-year students. Students were asked about their own perceptions of the difficulties in implementing the various steps related to the treatments. The degree of individual difficulty was determined according to the Likert scale: 0 = none, 1 = mild, 2 = moderate, 3 = high, 4 = very high. Exploratory analysis of data was applied, and the difficulty level was also dichotomized into none to mild (scores 0 and 1) and moderate to very high (scores 2­4). Results: Regarding the basic periodontal treatment, bone level probing was the procedure with the highest number of student difficulties (57.5%). As for the difficulties reported by students regarding the stages of periodontal surgery, only the procedures related to anesthesia and suture removal had no report of doubts. Conclusion: Periodontal surgery was the procedure involving the most prevalent questions reported as moderate to very high, and the indication for the most suitable surgical technique was the stage with the highest percentage of questions (66.6%) among the undergraduates (AU).

Prevalência de sinais e sintomas de disfunção craniomandibular em pacientes desdentados totais (com dimensão vertical restabelecida e diminuída) e pacientes dentados naturais / Prevalence of signs and symptoms of craniomandibular disorders in edentulous patients with the vertical dimension correctly established and reduced vertical dimension and dentate patients

O presente estudo procurou avaliar a prevalênica de sinais e sintomas de Disfunção Craniomandibular (DCMs) em três grupos específicos de pacientes: Grupo A1- Pacientes desdentados totais com a dimensão vertical corretamente estabelecida (constituído por 74 indivíduos); Grupo A2- Pacientes desdentados totais com a dimensão vertical diminuída (constituído por 80 indivíduos); Grupo B- Pacientes dentados com a dimensão vertical preservada (constituído por 61 indivíduos). Os sintomas foram avaliados através de índice anamnésico e os sinais estudados foram à sensibilidade muscular e articular à palpação, os sons articulares e os hábitos parafuncionais.Associação estatisticamente significante foi constatada para o índice anamnésico (prevalente em A2 e B), o número de regiões sensíveis à palpação muscular (prevalente em A2), os hábitos parafuncionais (prevalente em B) e os sons articulares (prevalente em B). Pode-se concluir que a dimensão vertical pode ser um fator contribuinte ou até mesmo perpetuante da disfunções craniomandibulares.