Spectrophotometric evaluation of restorative composite shades and their match with a classical shade guide.

OBJECTIVES: The aim of this study was to verify the match between 5 shades of composites from different manufacturers with a shade guide and among the systems using a portable spectrophotometer. MATERIALS AND METHODS: Shade measurements were performed on specimens of Z350 XT (3M ESPE), Charisma Diamond (Heraeus Kulzer GmbH), Esthet X-HD (Dentsply Caulk), and Empress Direct (Ivoclar-Vivadent) for shades A1, A2, A3, B1, and C3 using a Vita Easyshade spectrophotometer (Vita Zahnfabrik) against a white background. Corresponding shades of Vitapan Classical (Vita Zahnfabrik) guide were measured likewise and shade variation (ΔE) was calculated based on International Commission on Illumination L*a*b* parameters. The ΔE of the composites in each shade was compared by one-way analysis of variance and Tukey's post hoc test (α = 0.05). RESULTS: All composites presented ΔE > 3.7 compared with the shade guide. Variation in shades A3, B1, and C3 was significantly different for all composites. ΔE of Z350 XT was significantly lower for A1 than for the other shades, whereas ΔE of Z350 XT and Charisma Diamond were significantly lower for A2 than for the other shades. CONCLUSIONS: No composite shade matched with the shade guide. Equivalent shades of the restorative composite from different manufacturers may show clinically noticeable ΔE.

Cerâmicas anteriores: como e quando indicá-las / Anterior ceramics: how and when to indicate

Desde a introdução do primeiro sistema bem-sucedido de cerâmica fundida a metal, há uma crescente demanda de restaurações cerâmicas, pois se trata de um material de grande propriedade estética, devido à disponibilidade de uma ampla gama de matizes e efeitos de translucidez. O desenvolvimento das cerâmicas levou a uma gama maior de indicações e transformou o desenho dos preparos clássicos de facetas em desenhos estendidos e orientados pelo defeito prévio do remanescente dental, as chamadas “facetas estendidas”. No entanto, mesmo que atualmente as facetas clássicas e estendidas possam ser soluções alternativas aos preparos para coroa total, elas não devem ser sempre a primeira escolha para todas as situações clínicas, porque vários fatores devem ser considerados antes da elaboração de um plano de tratamento. Portanto, fazer a escolha certa entre coroas, facetas clássicas e estendidas na dentição anterior para cada situação clínica é elemento-chave para um tratamento conservador e longevo. Neste artigo uma classificação de acordo com o conteúdo das cerâmicas odontológicas é descrita, e são abordadas importantes considerações baseadas em evidência, relacionadas ao plano de tratamento de reabilitações nos dentes anteriores com coroas e facetas cerâmicas...

Since the introduction of the first porcelain-fused-to-metal system, there has been a growing demand for ceramic restorations, since it is a material that provides good aesthetics, wide range of shades and translucency effects. The development of new reinforced ceramics has led to a broader range of indications and changed the conventional veneer preparations into extended defect-oriented preparation designs, the so called “extended veneers”. However, even though classical and extended veneers can be an alternative to full crown preparations, they should not always be the first choice for every clinical situations because several factors must be taken into consideration before elaborating a treatment planning. Therefore, making the right choice between all-ceramic crowns, conventional and extended veneers in the anterior dentition is key for a conservative and long-lasting treatment for each individual situation. This article describes a classification of the ceramic systems, addressing important evidence-based considerations regarding the treatment planning rehabilitation of the anterior dentition using all-ceramic crowns and veneers...

Direct or indirect composite veneers in anterior teeth: which method causes higher tooth mass loss? An in vitro study.

There is little information in the literature regarding the relationship between preparations made for direct and indirect veneers and the loss of tooth structure required for each technique. This in vitro study sought to quantify the different mass losses from preparation techniques used for direct and indirect veneers. Thirty artificial teeth were weighted using a digital balance and placed in a dental manikin in the position corresponding to the right maxillary central incisor. Five clinicians-all experts in esthetic dentistry-were asked to perform conventional preparations for both a direct composite resin veneer and an indirect ceramic veneer. After preparations, specimens were weighted again in the same digital balance. Teeth undergoing veneer preparations demonstrated a statistically significant mass loss compared to unprepared teeth. Indirect ceramic veneer preparations produced more mass loss than direct composite veneer preparations (P < 0.01).

Clareamento dental: como aproximar-se de uma abordagem baseada em evidências / Dental bleaching: how to move towards an evidence-based approach

O clareamento dentário é um procedimento que tem recebido especial atenção da Odontologia. Como qualquer prática na área da Saúde, é importante que a abordagem da temática seja baseada em evidências. No presente artigo, alguns aspectos relativos ao clareamento dental baseado em evidências foram ressaltados. Principalmente, destaca-se que uma prática baseada em evidências requer a conjunção da melhor evidência disponível, as habilidades clínicas do profissional e as preferências, crenças e atitudes dos pacientes deve nortear a abordagem. Em relação à segurança, as evidências apontam que o clareamento dental é absolutamente seguro. Quanto aos possíveis efeitos negativos do funo e dos corantes da dieta, as evidências não conseguem demonstrar claramente efeitos deletérios. Os estudos apontam que a otimização dos resultados acontece quando as abordagens caseira e de consultório são combinadas. Em relação aos efeitos adversos, recessão gengival não está associada ao clareamento, entretanto hipersensibilidade dentária acontece em mais de 50% dos casos. Assim, prover ao paciente as informações relativas ao que a literatura tem demonstrado é um dos pilares da boa prática clínica baseada em evidências...

Tooth whitening is a procedure that has received special attention of Dentistry. Like any practice in healthcare it is important that the thematic approach is evidence-based. In this article, some aspects of evidence-based tooth whitening were highlighted. First, it is emphasized that an evidence-based practice requires the conjunction of the best available evidence. Professional clinical skills and preferences as well as beliefs and attitudes of patients should guide the approach. Regarding security, evidence shows that tooth whitening is absolutely safe. In relations to the possible negative effects of smoking and dyes from the diet, the evidence does not clearly demonstrate deleterious effects. Studies indicate that optimal outcomes occur when at-home and in-office approaches are combined. Regarding side effects, gingival recession is not associated with tooth whitening, however tooth hypersensitivity occurs in over 50% of cases. Thus providing the patient with relative information concerning this literature has shown to be the cornerstone of good evidence-based clinical practice...

Clareamento de dentes tratados endodonticamente: uma revisão da literatura / Bleaching of root-filled teeth: a literature review

Na Odontologia contemporânea, a estética sofreu uma valorizaçãosignificativa, ganhando destaque e importância. Nesse contexto, a belezaé influenciada pelo contorno, forma, simetria, alinhamento e,principalmente, pela cor dos dentes. O clareamento de dentes anterioresdesvitalizados escurecidos tem se tornado uma terapia muito requisitada,uma vez que o escurecimento dos dentes é motivo de grande insatisfaçãopor parte dos pacientes. Esta revisão de literatura tem como objetivoanalisar os dados disponíveis na literatura sobre este assunto, uma vezque a associação entre o clareamento interno e a reabsorção radicularexterna cervical é uma questão que ainda gera dúvidas na práticaodontológica. O clareamento interno apresenta resultados esteticamentesatisfatórios, no entanto, apresenta como possível efeito colateral areabsorção radicular cervical externa, que prejudica ou até mesmoinviabiliza a permanência do elemento dental na cavidade bucal. Aetiologia da reabsorção radicular externa relacionada ao clareamento écomplexa, no entanto acredita-se que o agente clareador alcance ostecidos periodontais através dos túbulos dentinários, desnature a dentina,que passa a ser considerada um tecido imunologicamente diferente,sendo reconhecida como um corpo estranho e inicia uma reaçãoinflamatória que resulta na perda localizada de tecido dental. Outralimitação do clareamento de dentes tratados endodonticamente é arecidiva da cor, ainda pouco compreendida. Apesar do clareamento dedentes desvitalizados ter um alto índice de sucesso e de sua naturezaminimamente invasiva, os possíveis efeitos colaterais, tais como areabsorção cervical externa e a recidiva de cor devem ser levados emconsideração no momento de sua indicação.

In modern Dentistry, the smile aesthetics is more valuable every day,gaining importance and prominence. In this context, the beauty isinfluenced by contour, shape, alignment, symmetry and, specially, thecolor of the teeth. The bleaching of anterior endodontically treateddarkened teeth has become a therapy very requested in the clinicalpractice of Dentistry, because stained teeth is of great concern forpatients. This literature review has as objective to analyze the availabledata on this subject, since the association between internal bleaching andexternal cervical root resorption is an issue that still raises questions indental practice. The internal bleaching has aesthetic success, however,this procedure is associated with a risk of external root resorption, whichhinders or even makes impossible the maintenance of the tooth in the oralcavity. The etiology of the external root resorption related to the internalbleaching is complex, however it’s believed that the bleaching chemicalsdiffuse from the pulp chamber through patent dentinal tubules to thesurrounding periodontal tissues, denatures dentin, which starts to beconsidered as a tissue with immunological differences, starting, then, to berecognized as a strange body, resulting in an inflammatory reaction whichresults, then, in the located loss of tissue. Another limitation of the internalbleaching of root-filled teeth is the discoloration. In spite of this procedure’shigh success rate, the results are different from those seen at long-termfollow-up, that is, the color regression is a fact that must be studied andbetter understood.

The influence of different placement techniques on the microtensile bond strength of low-shrink silorane composite bonded to Class I cavities.

The aim of this in vitro study was to evaluate the microtensile bond strength (µTBS) of a low-shrink silorane-based composite (Filtek Silorane) and a methacrylate-based composite (Filtek Z250) to the bottom dentin of a Class I cavity using different placement techniques. Twelve third molars were used. Standard, box-type Class I cavities (6.0 x 4.0 x 2.5 mm) were prepared at the occlusal crown center, with the pulpal floor ending approximately at the midcoronal dentin. The teeth were then randomly divided into four groups, according to each placement technique: ZI--Filtek Z250 placed incrementally; ZB--Filtek Z250 placed in bulk; SI--Filtek Silorane placed incrementally; and SB--Filtek Silorane placed in bulk. Each restored third molar was subjected to microtensile bond testing after 24 hours of storage in distilled water at 37 degrees C. After storage, each molar was longitudinally sectioned in both axes to obtain rectangular sticks with an approximate 0.49 mm2 cross-sectional area. Data were analyzed by one-way ANOVA followed by a Tukey post hoc test (P = 0.05). After debonding, the failure modes were analyzed using a stereomicroscope. The ZI group (72.6 MPa) showed the highest µTBS, followed by the ZB group (60.2 MPa), while the SI (34.4 MPa) and SB (42.6 MPa) groups demonstrated statistically significant lower bond strengths. The type of placement technique did not influence the µTBS of silorane-based composites to the bottom dentin of Class I cavities. The methacrylate-based composite showed superior performance, regardless of the placement technique.

Inlay/onlay: estética, produtividade e longevidade clínica / Inlay/onlay: esthetics, productivity and c1inicallongevity

Este artigo apresenta uma discussão sobre os aspectos que influenciam a decisão de indicar restaurações tipo inlay/onlay e sobre os fatores que devem ser considerados para a seleção do material restaurador a ser utilizado, resina composta ou porcelana.

This article presents a discussion on the aspects that may influence the indication decision for inlay/onlay restorations, and on the factors that should be considered when selecting the restorative material to be used, composite resin or porcelain.

Avaliação clínica do efeito de duas técnicas de clareamento dental em consultório utilizando peróxido de hidrogênio / Clinical evaluation of the efectiveness of two in-office bleaching techniques using a hydrogen peroxide based product

O objetivo deste estudo foi avaliar in vivo o efeito da utilização das lâmpadas halógenas como catalisadoras de um gel à base de peróxido de hidrogênio a 37,5% utilizado para o clareamento dental em consultório. Treze pacientes foram submetidos ao tratamento clareador em consultório com peróxido de hidrogênio a 37,5% (Whiteness HP Maxx, FGM/ Joinvile, SC, Brasil). A arcada superior de cada paciente foi dividida, e então em um dos hemiarcos o tratamento clareador foi realizado com a aplicação do peróxido de hidrogênio associado à iluminação com lâmpada halógena e no outro hemiarco o peróxido de hidrogênio foi utilizado sem nenhuma fonte de luz. Fotografias pré e pós operatórias foram realizadas nas mesmas condições de iluminação e submetidas à análise através de um software para comparar o grau de clareamento obtido nos hemiarcos esquerdo e direito. Os dados foram analisados utilizando o teste t-student (p≤0.05). Os resultados mostraram que não houve diferença significativa no clareamento obtido quando as duas técnicas foram comparadas. Estes resultados possibilitaram concluir que a iluminação com lâmpadas halógenas não melhorou o resultado final da técnica de clareamento dental em consultório quando um gel à base de peróxido de hidrogênio a 37,5% foi utilizado.

Purpose: To clinically evaluate the capacity of a halogen curing-light to act as a catalyst of a 37.5% hydrogen peroxide based product used to lightening teeth.Materials and Methods: Thirteen human subjects had their upper-arches (premolar to premolar) bleached and evaluated. Split-arch design using centrals, laterals, canines and premolars on one side treated with bleach (Whiteness HP Maxx, FGM, Joinvile, SC/Brazil) plus light, was compared with contralateral teeth using bleach alone. Pre and pos-operatory pictures were taken under the same light conditions. Then the pictures were analyzed with commercial software to compare the degree of lightening obtained on the right and left cervical area of the upper central incisors. Data were analyzed using paired Student-T test (p≤0.05).Results: Pairs of means for brightness and RGB blue channel showed no statistically significance differences at baseline and immediately after the third session of bleaching, despite of the use of the halogen light for gel activation.Clinical significance: The halogen curing-light does not improve the final result of the in-office bleaching technique using a 37.5% hydrogen peroxide gel.

Nd:YAG laser influence on microtensile bond strength of different adhesive systems for human dentin.

OBJECTIVE: The purpose of this study was to investigate the influence of Nd:YAG on microtensile bond strength (microTBS) of different adhesive systems for human dentin. BACKGROUND DATA: Lasers have been widely used in dentistry. New adhesive systems with different chemical compositions are introduced every year, and it is important to investigate the bonding of new adhesive systems to dentin irradiated with laser. METHODS: The occlusal surfaces of third molars were removed to obtain flat dentin surfaces. The teeth were randomly divided into six groups. Each adhesive system was applied, according to manufacturers' instructions, to surface dentine with and without Nd:YAG laser irradiation (0.9 W, 15 Hz, 60 mJ per pulse). A block of composite resin was built over the adhesive layer. The specimens were sectioned to obtain 0.70 x 0.70 mm of transversal section. Twenty test specimens were selected for each group, and were then submitted to microTBS on a universal testing machine. RESULTS: According to Student's t-test, for Single Bond, there was no statistically significant difference without (49.32 MPa) and with (47.34 MPa) laser application (p = 0.60). For the Tyrian SPE/One Step Plus, microTBS value with laser (27.09 MPa) was statistically higher than without laser (19.13 MPa), as well as for Adper Prompt L-Pop (22.85 and 13.78 Mpa; p < or = 0.01). CONCLUSION: The application of Nd:YAG laser to dentin provided an increase in the bond strength values for the Tyrian SPE/One Step Plus and Adper Prompt L-Pop adhesive systems, but did not influence the bond strength values of the Single Bond adhesive system.