Effect of nanofibers as reinforcement on resin-based dental materials: A systematic review of in vitro studies.

This systematic review provides an update on the effect of nanofibers as reinforcement on resin-based dental materials. A bibliographic search was conducted in MEDLINEPubMed, Embase, Web of Science, Scopus, BVS (LILACS, BBO e IBECS), Cochrane, LIVIVO, and gray literature (BDTD) to identify relevant articles up to May 2021. In vitro studies that evaluated and compared the mechanical properties of nanofibers resin-based composite materials, were eligible. No publication year or language restriction was applied, and methodological quality was assessed using two methods. In a total of 6100 potentially eligible studies, 81 were selected for full-text analysis and 35 were included for qualitative analysis. Of the 35 included studies, a total of 29 studies evaluated the flexural strength (FS) of the materials. These groups were distinguished according to the resin-based materials tested and nanofiber types. Most of the studies evaluated materials composed of glass fibers and demonstrated higher values of FS when compared to resin-based materials without nanofibers. The incorporation of nanofibers into resin-based dental materials improved the mechanical properties compared to resin-based materials without nanofibers, suggesting better performance of these materials in high-stressbearing application areas. Further clinical studies are required to confirm the efficacy of resin-based materials with nanofibers.

Efeito de diferentes protocolos fotoativadores e espessura dos incrementos na dureza de resinas Bulk fill / Effect of lightcure protocols and increment thickness in the hardness of Bulk fill composites

As resinas Bulk fill surgiram com o intuito de facilitar a restauração de cavidades profundas. A fotoativação adequada é extremamente importante para que a resina bulk fill ofereça propriedades mecânicas satisfatórias e, longevidade na restauração. Este estudo avaliou a influência da espessura do incremento na microdureza Knoop (KHN) de três resinas bulk fill (n = 5). Cinquenta amostras foram divididas de acordo com o material (Filtek Z250, Filtek One Bulk Fill e Filtek Bulk Fill Flow), espessura (2mm e 4 mm) e tempo de fotoativação (20 e 40s) - Z2502mm20s, Z2502mm40s, One2mm20s, One2mm40s, One4mm20s, One4mm40s, Flow2mm20s, Flow2mm40s, Flow4mm20s e Flow4mm40s. As análises KHN foram realizadas no topo e na base de cada amostra. Os dados foram submetidos à ANOVA a 1 critério e ao Teste de Tukey (p< 0,05). A média e desvio padrão (+/-) dos seguintes grupos foram (Z2502mm20s) 0,85 (+/- 0,01); (Z2502mm40s) 0,92 (+/- 0,01); (One2mm20s) 1,05 (+/- 0,08); (One2mm40s) 0,95 (+/- 0,04); (One4mm20s) 0,93 (+/- 0,04); (One4mm40s) 0,97 (+/ - 0,04); (Flow2mm20s) 0,92 (+/- 0,05); (Flow2mm40s) 0,89 (+/- 0,04); (Flow4mm20s) 0,79 (+/- 0,04) e (Flow4mm40s) 0,90 (+/- 0,03). Os grupos da Filtek One Bulk apresentaram um valor significativamente maior, demonstrando uma polimerização suficiente mesmo na base de incrementos com 4 mm. Concluiu-se que o aumento na espessura do incremento de resinas bulk fill não afetou negativamente a fotoativação(AU)

Bulk fill composites emerged, allowing the restoration of deep cavities easily. Appropriate lightcuring is crucial to bulk fill composite presents satisfactory mechanical properties and restoration longevity. This study evaluated the influence of thickness increment on Knoop microhardness (KHN) of three dental bulk fill composites (n=5). Fifty samples were divided according to composite (Filtek Z250, Filtek One Bulk Fill and Filtek Bulk Fill Flow), thickness (2mm and 4 mm) and time lightcuring (20 and 40 s) - Z2502mm20s, Z2502mm40s, One2mm20s, One2mm40s, One4mm20s, One4mm40s, Flow2mm20s, Flow2mm40s, Flow4mm20s e Flow4mm40s. KHN analysis were performed on the top and the base of each specimen. Data were subjected to one-way ANOVA and Tukey test (p< 0,05). The mean and standard deviation (+/-) of following groups were (Z2502mm20s) 0,85(+/-0,01); (Z2502mm40s) 0,92(+/- 0,01); (One2mm20s) 1,05(+/-0,08); (One2mm40s) 0,95(+/-0,04); (One4mm20s) 0,93 (+/-0,04); (One4mm40s) 0,97(+/-0,04); (Flow2mm20s) 0,92(+/- 0,05); (Flow2mm40s) 0,89(+/-0,04); (Flow4mm20s) 0,79(+/-0,04) e (Flow4mm40s) 0,90(+/-0,03) Filtek One Bulk groups present significantly higher value, demonstrating sufficient polymerization even on the base of 4 mm increments. It was concluded that the increase in the thickness increment of Bulk fill composites did not negatively affect the lightcure(AU)

Physical and surface properties of a 3D-printed composite resin for a digital workflow.

STATEMENT OF PROBLEM: Information related to the optical and surface properties, including health compatibility, surface roughness, and esthetics, of 3D-printed dental materials is scarce. PURPOSE: The purpose of this in vitro study was to compare the physical and surface properties of a 3D-printed resin with those of materials used for interim restorations. MATERIAL AND METHODS: A 3D-printed resin (PR) (NextDent C&B MFH; 3D Systems), an autopolymerizing interim material (BA) (Protemp 4; 3M ESPE), and a composite resin (Z350) (Filtek Z350XT; 3M ESPE) were tested for degree of color change (ΔE) (n=7) at different timepoints-24 hours after polishing/baseline (P0), 8 days after polishing (P1), and after artificial aging in water at 60 °C for 24 hours (P2)-by using a CIELab-based colorimeter; flexural strength (σ) (n=10) with a 3-point bend test; Knoop hardness (H) (n=8); and surface roughness (Ra) (n=7) with a profilometer. All specimens were polished 24 hours after polymerization, except for the additional group for surface roughness (BA) without polishing (BANP). A statistical analysis was performed by using 2-way repeated-measures ANOVA followed by the Fischer test for ΔE and 1-way ANOVA followed by the Fisher test for microhardness and surface roughness (α=.05). RESULTS: The Z350 showed the highest values for σ and H, followed by PR. BA showed the lowest results for both tests (P<.05). Considering roughness, the Z350 showed similar values to those of BA but lower than PR; PR showed similar roughness when compared with BA. PR showed the highest color variation among the groups at all timepoints, followed by BA. The Z350 was the most color stable material at all timepoints. CONCLUSIONS: The 3D-printed composite resin had adequate mechanical and surface properties for an interim restorative material. It has the potential to be a low-cost workflow in dentistry, although its color stability could be a concern for long-term use.

Influence of Modulated Photo-Activation on Shrinkage Stress and Degree of Conversion of Bulk-Fill Composites.

This study aimed to evaluate the polymerization properties of bulk-fill materials (low and high-viscosity) by using high-intensity continuous light and intermittent photo-activation in terms of polymerization shrinkage stress and degree of conversion (DC). The following Bulk-fill and Conventional nanofilled resin composites were evaluated: Filtek Z350XT Flow (3M/ESPE), SureFil SDR Flow (Dentsply), Filtek Bulk Fill Flow (3M/ESPE), Filtek Z350XT (3M/ESPE) and Filtek Bulk Fill Posterior (3M/ESPE). A LED device (DB 685, Dabi Atlante) was used for both protocols: continuous uniform and intermittent photo-activation (light-on and light-off cycles) with identical radiant exposure (14 J/cm2). The polymerization shrinkage stress (n=6) was evaluated by inserting a single increment of 12 mm3 between two stainless steel plates (6×2 mm) adapted to a Universal Testing Machine (UTM), at different times. Measurements were recorded after photo-activation. The degree of conversion was evaluated by Fourier transformed infrared spectroscope (FTIR) with an attenuated total reflectance (ATR) accessory (n=5). Data were analyzed by three-way ANOVA and Tukey's HSD (α=0.05) tests. Bulk Fill Posterior presented higher shrinkage stress values when photo-activated with the intermittent technique (p<0.05). The intermittent photo-activation increased the degree of conversion for the low-viscosity bulk-fills (p<0.05). Therefore, the use of modulated photo-activation (intermittent) must be indicated with caution since its use can influence the shrinkage stress and degree of conversion of composites, which varies according to the resin formulations.

Influence of modulated photo-activation on shrinkage stress and degree of conversion of bulk-fill composites

Abstract This study aimed to evaluate the polymerization properties of bulk-fill materials (low and high-viscosity) by using high-intensity continuous light and intermittent photo-activation in terms of polymerization shrinkage stress and degree of conversion (DC). The following Bulk-fill and Conventional nanofilled resin composites were evaluated: Filtek Z350XT Flow (3M/ESPE), SureFil SDR Flow (Dentsply), Filtek Bulk Fill Flow (3M/ESPE), Filtek Z350XT (3M/ESPE) and Filtek Bulk Fill Posterior (3M/ESPE). A LED device (DB 685, Dabi Atlante) was used for both protocols: continuous uniform and intermittent photo-activation (light-on and light-off cycles) with identical radiant exposure (14 J/cm2). The polymerization shrinkage stress (n=6) was evaluated by inserting a single increment of 12 mm3 between two stainless steel plates (6×2 mm) adapted to a Universal Testing Machine (UTM), at different times. Measurements were recorded after photo-activation. The degree of conversion was evaluated by Fourier transformed infrared spectroscope (FTIR) with an attenuated total reflectance (ATR) accessory (n=5). Data were analyzed by three-way ANOVA and Tukey's HSD (α=0.05) tests. Bulk Fill Posterior presented higher shrinkage stress values when photo-activated with the intermittent technique (p<0.05). The intermittent photo-activation increased the degree of conversion for the low-viscosity bulk-fills (p<0.05). Therefore, the use of modulated photo-activation (intermittent) must be indicated with caution since its use can influence the shrinkage stress and degree of conversion of composites, which varies according to the resin formulations.

Resumo O presente estudo teve como objetivo avaliar as propriedades de polimerização de materiais bulk-fill (baixa e alta viscosidade) utilizando luz contínua de alta intensidade e fotoativação intermitente em relação ao estresse de contração de polimerização e grau de conversão (DC). As seguintes resinas compostas Bulk-fill e nanohíbridas convencionais foram avaliadas: Filtek Z350XT Flow (3M/ESPE), SureFil SDR Flow (Dentsply), Filtek Bulk Fill Flow (3M/ESPE), Filtek Z350XT (3M/ESPE) e Filtek Bulk Fill Posterior (3M/ESPE). Um dispositivo de LED (DB 685, Dabi Atlante) foi utilizado nos dois protocolos: fotoativação contínua e intermitente contínua (ciclos de liga e desliga) com exposição idêntica (14 J/cm2). A tensão de contração de polimerização (n=6) foi avaliada através da inserção de um incremento único de 12 mm3 entre duas placas de aço inoxidável (6×2 mm) adaptadas a uma Máquina de Ensaio Universal (UTM), em tempos diferentes. As medições foram registradas após a fotoativação. O grau de conversão foi avaliado por FTIR-ATR (n=5). Os dados foram analisados ​​pelos testes ANOVA a três fatores e teste de Tukey (α=0,05). A resina Bulk Fill Posterior apresentou maiores valores de tensão de contração quando fotoativadas com a técnica intermitente (p<0,05). A fotoativação intermitente aumentou o grau de conversão nas resinas bulk-fill de baixa viscosidade (p<0,05). Portanto, o uso de fotoativação modulada (intermitente) deve ser indicado com cautela, uma vez que seu uso pode influenciar a tensão de contração e o grau de conversão dos compósitos, o que varia de acordo com as formulações da resina.

Management of dental caries guided by the ICDAS-LAA: a 28-month follow-up.

Dental caries is a significant oral health issue and public health concern. Currently conceptualized as a dynamic and multifactorial process, caries is a continuum of disease stages, during which tooth damage may be reversed or controlled, depending on lesion progression. The International Caries Detection and Assessment System, when used in conjunction with the Lesion Activity Assessment (ICDAS-LAA), reflects the dynamic caries process and allows the classification of cavitated lesions according to their severity and progression, which is essential to selecting the appropriate treatment. This case report describes the diagnosis and treatment of a patient who had caries in the past and in whom old lesions remained untreated. The ICDAS-LAA was used to assess caries accurately and guide treatment decisions. The patient maintained a dietary journal for 2 weeks to help establish her risk of developing caries. Treatment involved a minimally invasive dentistry approach, which consisted of remineralization via fluoride applications, placement of a composite resin restoration, microabrasion, and periodic maintenance. During the 28-month follow-up period, rigorous control of caries risk factors was achieved, and the results were satisfactory, demonstrating the effectiveness of the ICDAS-LAA in diagnosing and managing carious lesions.

Effect of a resin-modified glass-ionomer with calcium on enamel demineralization inhibition: an in vitro study.

We assessed the effect of a new coating material based on resin-modified glass-ionomer with calcium (Ca) in inhibiting the demineralization of underlying and adjacent areas surrounding caries-like lesions in enamel. The measures used were surface hardness (SH) and cross-sectional hardness (CSH). Thirty-six bovine enamel specimens (3 × 6 × 2 mm) were randomly allocated into three groups (n = 12): No treatment (NT); resin-modified glass-ionomer with Ca (Clinpro XT Varnish, 3M ESPE) (CL), and fluoride varnish (Duraphat, Colgate) (DU). The specimens were subjected to alternated immersions in demineralizing (6 h) and remineralizing solutions (18 h) for 7 days. SH measurements were conducted at standard distances of 150, 300, and 450 µm from the treatment area. CSH evaluated the mean hardness profile over the depth of the enamel surface and at standard distances from the materials. The energy-dispersive X-ray spectroscopy analysis was conducted to evaluate the demineralization bands created on the sublayer by % of calcium (Ca), phosphorus (P), and fluoride (F). Ca/P weight ratio was also calculated. Based on SH and CSH measurements, there was no difference between groups at the distances 150 µm (p = 0.882), 300 µm (p = 0.995), and 450 µm (p = 0.998). Up to 50 µm depth (at 150 µm from the treatment area), CL showed better performance than DU ( p< 0.05). NT presented higher loss of Ca and P than CL and DU (p < 0.05). There was no significant difference in the % of F ion among the three groups. The new coating material was similar to F varnish in attenuating enamel demineralization.

Effect of a resin-modified glass-ionomer with calcium on enamel demineralization inhibition: an in vitro study

Abstract We assessed the effect of a new coating material based on resin-modified glass-ionomer with calcium (Ca) in inhibiting the demineralization of underlying and adjacent areas surrounding caries-like lesions in enamel. The measures used were surface hardness (SH) and cross-sectional hardness (CSH). Thirty-six bovine enamel specimens (3 × 6 × 2 mm) were randomly allocated into three groups (n = 12): No treatment (NT); resin-modified glass-ionomer with Ca (Clinpro XT Varnish, 3M ESPE) (CL), and fluoride varnish (Duraphat, Colgate) (DU). The specimens were subjected to alternated immersions in demineralizing (6 h) and remineralizing solutions (18 h) for 7 days. SH measurements were conducted at standard distances of 150, 300, and 450 µm from the treatment area. CSH evaluated the mean hardness profile over the depth of the enamel surface and at standard distances from the materials. The energy-dispersive X-ray spectroscopy analysis was conducted to evaluate the demineralization bands created on the sublayer by % of calcium (Ca), phosphorus (P), and fluoride (F). Ca/P weight ratio was also calculated. Based on SH and CSH measurements, there was no difference between groups at the distances 150 µm (p = 0.882), 300 µm (p = 0.995), and 450 µm (p = 0.998). Up to 50 µm depth (at 150 µm from the treatment area), CL showed better performance than DU ( p< 0.05). NT presented higher loss of Ca and P than CL and DU (p < 0.05). There was no significant difference in the % of F ion among the three groups. The new coating material was similar to F varnish in attenuating enamel demineralization.

Tratamento estético por meio de restaurações diretas em resina composta para hipocalcificação de esmalte: 18 meses de controle clínico / Aesthetic treatment through direct composite resin restorations for enamel hypocalcification: 18 months of clinical control

Atualmente, tem se tornado rotina a busca por procedimentos que realcem o sorriso. Neste contexto, técnicas de clareamento dental, microabrasão, restaurações diretas em resina composta, bem como indiretas em cerâmica, são abordagens viáveis para restabelecer alterações do esmalte na região anterior. O objetivo deste caso clínico é relatar uma alternativa de tratamento às lesões de mancha branca extensa em dentes anteriores, compatíveis com hipocalcificação de esmalte, em uma paciente jovem, por meio de restaurações diretas em resina composta. Devido à profundidade e extensão das lesões, restaurações utilizando a técnica de inserção incremental foram realizadas, uma vez que proporcionam menor contração volumétrica do material. Além disso, a estratificação com compósitos para dentina, esmalte e translúcido garantiu a obtenção de um resultado estético harmônico. Após o controle clínico de 18 meses, foi possível verificar que as restaurações apresentavam-se satisfatórias, ausência do comprometimento da interface adesiva, necessitando apenas de repolimento para manutenção do brilho superficial. Desta maneira, na atual Odontologia de mínima intervenção, a abordagem com resina composta foi uma alternativa restauradora estética, conservadora e eficaz para o tratamento de lesões de hipocalcificação de esmalte na região anterior (AU).

Nowadays, the search for procedures that highlight the smile has become routine. In this context, dental bleaching, microabrasion, direct composite resin restorations techniques, as well as indirect ceramics resin are viable approaches to reestablish enamel alterations in the anterior region. The objective of this clinical case is to report an alternative treatment for lesions of extensive white spot in anterior teeth, compatible with enamel hypocalcification in a young patient with direct composite resin restorations. Due to lesions depth and extent, restorations using the incremental insertion technique were performed, as they provide less volumetric contraction of the material. In addition, the stratification with composites for dentin, enamel and translucent established a harmonious aesthetic result. After clinical control of 18 months, it was possible to verify that the restorations were satisfactory, there was absence of adhesive interface deterioration, only requiring repolishing to maintain the superficial brightness. So in the current minimal intervention Dentistry the composite resin approach was an aesthetic, conservative and effective restorative alternative for treatment of enamel hypocalcification lesions in anterior region (AU).

Clinical performance of the composite resin veneers: the minimally invasive approach / Desempenho clínico de facetas de resina composta: uma abordagem minimamente invasiva / Desempeño clínico de las carillas de resina compuesta: un enfoque mínimamente invasivo

Minimally invasive approach lead composite resin veneers restorations as a conservative and alternative treatment option, with the aim to improve the aesthetics anterior dentition. Clinically, this treatment reducing the clinical time and has a lower cost than indirect technique. In addition, new resin composite was developed to support the clinician to make more natural restorations. The present case report aim to evaluated the clinical performance of direct composite veneer technique was restored with 100% supra-nano spherical filler composite. A 39-year-old female, searched for restorative treatment of anterior teeth, which were unaesthetically altered. In the clinical examination, it was observed color alterations in maxillary left and right incisors and canines due to use of medicines, and bruxism. The treatment plan included an in-office dental bleaching, removal of inadequate anterior restorations and confection of composite veneers restorations. The dental bleaching was performed with hydrogen peroxide 35% activated by LED/laser in two sessions. Those restorations were performed using supra-nano spherical resin-based composite, color A1 for dentin and enamel, with direct composite laminate veneer technique. After six-month follow-up, the restorations presented good clinical aspect, absence of biofilm accumulation and abrasive wear. Therefore, direct veneer restorations may be alternative treatment for anterior teeth esthetic problems, suggesting a promising performance of these new composites(AU)

A abordagem minimamente invasiva torna as facetas de resina composta conservadoras e opção de tratamento alternativo para melhorar a estética da dentição anterior. Clinicamente, esse tratamento reduz o tempo operatório e tem um custo menor que a técnica indireta. Além disso, uma nova resina composta foi desenvolvida para ajudar o clínico a fazer restaurações mais naturais. O presente relato de caso tem como objetivo avaliar o desempenho clínico da técnica direta de faceta de resina composta de preenchimento 100% supra-nano-esférico. Paciente de 39 anos, sexo feminino procurou o tratamento restaurador dos dentes anteriores, que foram alterados inesteticamente. No exame clínico foram observadas alterações de cor nos incisivos superiores, esquerdo e direito, e caninos devido ao uso de medicamentos e bruxismo. O plano de tratamento incluiu clareamento dentário em consultório, remoção de restaurações anteriores inadequadas e confecção de facetas de resina composta. O clareamento dental foi realizado com peróxido de hidrogênio a 35% ativado por LED / laser em duas sessões. Essas restaurações foram realizadas utilizando resina composta supra-nano-esférica, cor A1 para dentina e esmalte, com técnica direta de laminado composto. Após seis meses de acompanhamento as restaurações apresentaram bom aspecto clínico, ausência de acúmulo de biofilme e desgaste abrasivo. Portanto, facetas diretas de resina composta podem ser um tratamento alternativo para problemas estéticos de dentes anteriores, sugerindo um desempenho promissor desses novos compósitos(AU)

El abordaje mínimamente invasivo hace que las facetas de resina compuesta conservadoras y opción de tratamiento alternativo para mejorar la dentición anterior estética. Clínicamente, este tratamiento reduce el tiempo clínico y tiene un costo menor que la técnica indirecta. Además, un nuevo compuesto de resina fue desarrollado para ayudar al clínico a hacer restauraciones más naturales. El presente relato de caso tiene como objetivo evaluar el desempeño clínico de la técnica directa de faceta de resina compuesta de relleno 100% supra-nano-esférico. Paciente de 39 años, sexo femenino buscó el tratamiento restaurador de los dientes anteriores, que fueron alterados intemporal. En el examen clínico se observaron alteraciones de color en los incisivos superiores, izquierdo y derecho, y caninos debido al uso de medicamentos y bruxismo. El plan de tratamiento incluyó blanqueamiento dental en consultorio, remoción de restauraciones anteriores inadecuadas y confección de facetas de resina compuesta. El blanqueamiento dental fue realizado con peróxido de hidrógeno al 35% activado por LED / láser en dos sesiones. Estas restauraciones se realizaron utilizando resina compuesta supra-nano esférica, color A1 para dentina y esmalte, con técnica directa de laminado compuesto. Después de seis meses de seguimiento las restauraciones presentaron buen aspecto clínico, ausencia de acumulación de placa dental y desgaste abrasivo. Por lo tanto, las facetas directas de resina compuesta pueden ser un tratamiento alternativo para problemas estéticos de dientes anteriores, sugiriendo un desempeño prometedor de estos nuevos compuestos(AU)

Influence of light activation of simplified adhesives on the shear bond strength of resin cements to a leucite-reinforced ceramic.

OBJECTIVE: This study aims to evaluate the influence of the light activation of simplified adhesives on the shear bond strength of resin cements to a glass-ceramic. Three factors were evaluated: (1) cement in two levels (light cured and dual cured); (2) adhesive in two levels (Single Bond 2 and Single Bond Universal), and (3) light activation in two levels (yes or no). MATERIALS AND METHODS: Thirty-two 1-mm thick slices of a leucite-reinforced glass-ceramic (IPS Empress CAD) were divided into eight groups according to adhesive (Single Bond 2 or Single Bond Universal), cement (AllCem Veneer or AllCem), and light activation of the adhesive before application of the cement (yes or no). Ceramic surfaces were etched for 60 s with 5% hydrofluoric acid, and adhesives were applied. Four cement cylinders were made over each ceramic slice (n = 16) and then submitted to shear bond strength tests. STATISTICAL ANALYSIS: Data were analyzed with three-way ANOVA and Tukey (α = 0.05). RESULTS: There were significant differences between adhesives (P < 0.0001) and no differences between cements (P = 0.0763) and light activation (P = 0.4385). No interaction effect occurred (P = 0.05). Single Bond 2 showed higher bond strength than Single Bond Universal. CONCLUSIONS: The light activation of the adhesive before the application of the resin cement did not influence the bond strength.

Understanding the interaction of resin composite with light for predictable aesthetic results in anterior teeth: A case report / Compreensão da interação das resinas compostas com a luz para resultados estéticos previsíveis em dentes anteriores: Relato de caso

This case report illustrates a conservative technique for reintervention on anterior composite restorations in a young patient with composite veneers. The treatment incorporated the use of photos and digital planning to establish a harmonious smile design. In order to conserve the dental tissues, existing resin composites restorations in maxillary anterior teeth were carefully removed to minimize enamel reduction, followed by a study of color and shade of teeth considering factors such as hue, chroma, luminosity, opacity, translucency and light effects. Eight direct veneers were built up with resin composite taking the optical properties of the material into account and their influence on the thickness of the layers that create specific light effects when superimposed on each other. To obtain excellent results with a predictable working protocol, nanohybrid composite systems facilitate good aesthetics, avoiding more invasive treatment in an economic manner.(AU)

O presente relato de caso ilustra uma técnica conservadora para a re-intervenção em restaurações diretas de resina composta em pacientes jovens. O tratamento consistiu em fotos e planejamento digital para obtenção de um desenho digital do sorriso individual e harmonioso. De acordo com os princípios de máxima conservação da estrutura dentária, as restaurações existentes nos dentes superiores anteriores foram criteriosamente removidas para minimizar a redução do esmalte, seguido do estudo de cor e sombra dos dentes considerando fatores como matiz, croma, valor, opacidade, translucidez e efeitos de luz. Oito facetas diretas foram realizadas em resina composta considerando as propriedades ópticas do material e a influência destas na espessura das camadas de resina para criar efeitos de luz singulares quando sobrepostas. Para a execução de uma odontologia estética e consciente, em associação a um protocolo de trabalho previsível, os sistemas de resinas compostas nanohibridas possibilitam resultados estéticos satisfatórios, evitando tratamentos mais invasivos de maneira economicamente viável.(AU)

Estratégias para o aumento da previsibilidade na abordagem multidisciplinar da Odontologia estética / Strategies to increase predictability in cosmetic dentistry multidisciplinary approach

O planejamento estético multidisciplinar traz conceitos de excelência na resolução de casos complexos e desafiadores em Odontologia. O presente relato de caso clínico aborda os princípios, indicações e técnica operatória para a resolução estética de dentes escurecidos, com restaurações extensas insatisfatórias e pigmentadas e arranjo periodontal desarmônico, através de uma abordagem interdisciplinar guiada. O planejamento estético digital foi delineado para orientação do enceramento diagnóstico e confecção de guia cirúrgico para a gengivoplastia. Os dentes anteriores foram clareados e considerando a condição dos mesmos após remoção das restaurações insatisfatórias foram propostas restaurações cerâmicas indiretas, uma faceta unitária no elemento 11 e um laminado cerâmico no elemento 12. Diante do resultado alcançado, revela-se importante a correta indicação e a utilização de estratégias clínicas que guiem os procedimentos operatórios no objetivo de prover conservadorismo e biomimetismo (AU).

The multidisciplinary aesthetic planning brings excellence concepts in the resolution of complex and challenging cases in dentistry. This case report addresses the principles, indications and the surgical technique for aesthetic resolution of darkened teeth, with extensive unsatisfactory and pigmented restorations, and disharmonious periodontal arrangement through a guided interdisciplinary approach. Digital aesthetic planning was designed to guide the wax-up diagnosis and to make surgical guide for gingivoplasty. Anterior teeth whitening was performed and considering their condition after removal of the unsatisfactory restorations, indirect ceramic restorations were proposed, a unitary ceramic veneer (11) and a laminate veneer (12). Considering the result achieved, it is important to consider the correct indication and the use of clinical strategies that guide the surgical procedures in order to provide conservatism and biomimicry (AU).

Evaluation of the anti-caries effect of a glass ionomer sealant and a fluoride varnish / Avaliação do efeito anticárie de um selante ionomérico e um verniz fluoretado

Objetivo: O objetivo deste estudo in vitro foi avaliar a perda mineral do esmalte bovino tratados com um selante ionomérico e um verniz fluoretado após ciclagem de pH, por meio da analise da microdureza de superfície do esmalte e seccional, além da avaliação da composição química de superfície por análise quantitativa em espectroscopia de energia dispersiva (EDS). Métodos: Trinta e seis blocos de esmalte bovino após polimento e análise da composição superficial em EDS, foram submetidos a analise da microdureza superficial e sequencialmente divididos aleatoriamente divididos em três grupos em função do tratamento empregado (n=12): G1) Clinpro XT-Varnish (3M-ESPE), G2) Duraphat (Colgate-Palmolive) e G3) Sem tratamento. Os espécimes foram submetidos à ciclagem de pH por sete dias. Posteriormente, a análise em EDS e microdureza superficial final foi realizada, onde para microdureza em distâncias padronizadas em relação ao material de tratamento, bem como a análise da microdureza longitudinal em distâncias padronizadas da superfície externa do esmalte. Resultados: A análise em EDS demonstrou que para o G3 a perda de cálcio e fósforo foi significativamente maior do que para o G1 e G2 após a ciclagem de pH, já para o íon flúor não houve diferenças significativas entre os grupos nas duas condições. A microdureza de superfície e longitudinal do esmalte nos permite inferir que maiores valores de dureza foram evidenciadas para G1 e G2 do que para G3, nas diferentes distâncias do material. Conclusão: Considerando as limitações deste estudo concluímos que ambos materiais testados foram capazes de inibir parcialmente a desmineralização do esmalte submetido a um modelo dinâmico de ciclagem de pH.(AU)

Objective: The aim of this in vitro study was to evaluate the mineral loss of enamel treated with a glass ionomer-based sealant and a fluoride varnish after pHcycling, through the analysis of the microhardness of the enamel as well as the evaluation of Ca/P/F ratio by Energy-dispersive X-ray spectroscopy analysis (EDS). Methods: Thirty six bovine enamel blocks were analyzed for microhardness and randomly assigned to one of the following three treatment groups (n = 12): G1 ­ Clinpro XT Varnish (3M-ESPE); G2 ­ Duraphat (Colgate - Palmolive); or G3 ­ No treatment. The specimens were subjected to pH- cycling for 7 days. Subsequently, they were analyzed by EDS, and the final evaluations of the microhardness at standard distances from the treatment material as well as the cross-sectional microhardness at standard distances from the outer surface of the enamel were performed. Results: The EDS findings revealed that, in G3, the loss of calcium and phosphorus was significantly higher than G1 and G2 after pH-cycling; however, there were no significant differences in the initial and final fluoride ion concentrations among the three groups. The values of the surface microhardness and crosssectional microhardness in G1 and G2 were higher than those in G3, at different distances of the materials. Conclusion: Within the limitations of this study, it may be concluded that both the evaluated materials were able to partially inhibit enamel demineralization when subjected to a dynamic pH-cycling model.(AU)

Multidisciplinary esthetic approach for multiple anterior diastema: 36-month clinical performance / Abordagem estética multidisciplinar para múltiplos diastemas anteriores: desempenho clínico de 36 meses

The presence of diastema, between anterior teeth, distorts a pleasing smile by concentrating the observer’s attention on the spaces. The patient’s needs and expectations must be considered in the process of treatment planning to ensure satisfaction with the treatment out comes. There are many forms of therapy that can be used for diastema closure. A carefully developed diagnosis, which includes a determination of the causal element sand advanced treatment planning, allows the mostappropriate treatment to be selected for each case. The aim of this paper is to present a multidisciplinary approach as a solution to multiple diastemata in the anterior region using gingival tissue recontouring and direct adhesive restorations, with minimumwear of the dental structure, after the orthodontic intervention, discussing the minimal intervention toobtain imperceptive and aesthetic final restoration. Thirty-six months after the treatment was carriedout, the final aesthetic was maintained with all dental element details and gingival tissue harmony, without recurrence of periodontal pockets and the preservation of the tooth color and shape...

A presença de diastemas, entre dentes anteriores, distorce um sorriso agradável, concentrando a atenção do observador para os espaços. As necessidades e expectativas do paciente devem ser consideradas no processo de planejamento para garantir a satisfação no resultado do tratamento. Existem muitas formas de tratamento que podem ser utilizadas para o fechamento de diastemas. Um diagnóstico desenvolvido cuidadosamente, que inclui a determinação dos elementos causais e planejamento avançado do tratamento, permite as eleção do tratamento mais adequado para cada caso. O objetivo deste artigo é apresentar uma abordagem multidisciplinar como solução para diastemas multiplos na região anterior usando o recontorno gengival e restaurações adesivas diretas, com mínimo desgaste da estrutura dental, após a intervenção ortodôntica discutindo a intervenção mínima para a obtenção de restaurações finais estéticas e imperceptiveis. Trinta e seis meses após o tratamento foi avaliado, a estética final foi mantida com os detalhes do elemento dental e harmonia tecido gengival, sem recorrência de bolsas periodontais e preservando a cor e forma dos dentes...

Reabilita‡Æo est‚tica de diastema m£ltiplo anterior com resina composta – controle cl¡nico de sete meses / Aesthetic rehabilitation of multiple anterior diastemas using composite resin – seven months recall

A busca por padrães est‚ticos ideais contribuiu para o advento de procedimentos restauradores que possibilitam a mimetiza‡Æo do natural e a introdu‡Æo do conceito de harmonia do sorriso atendendo …s exigˆncias dos pacientes. A presen‡a de diastemas anteriores m£ltiplos constitui um desafio … Odontologia, tendo em vista o aspecto negativo que agrega a despropor‡Æo do sorriso e a est‚tica facial. Sendo assim, o presente caso objetiva descrever a t‚cnica operat¢ria do fechamento de diastemas em resina composta atrav‚s de embasamento te¢rico cient¡fico para a resolu‡Æo do caso. O caso descrito relata a reabilita‡Æo est‚tica de diastemas anteriores por meio de procedimentos restauradores diretos em resina composta promovendo a preserva‡Æo da estrutura dent ria, mimetiza‡Æo do natural, restabelecimento das corretas propor‡ães dentais e redu‡Æo do tempo cl¡nico necess rio, alcan‡ando resultados est‚ticos de excelˆncia. A realiza‡Æo de uma t‚cnica padronizada e bem fundamentada em resina composta para o fechamento de diastemas proporciona resultados cl¡nicos est‚ticos satisfat¢rios e previs¡veis.

The indreasing serach for aesthetic standards has collaborated for the advent of restorative procedures that allow a natural apearence and has lauched concept of harmonic smile, meeting patients’ expectations. Considered as a negative aspect of smile and facial aesthetics the presence of multiple anterior diastemas is very chalenging. This case report aims to describe the technique of the diastema closure with composite resin considering the scientific literature for the resolution of the case. In this study the is described the aesthetic rehabilitation of anterior distaemas through of direct restorative procedures with composite resin and preservation of tooth structure, mimicking natural teeth, reestablishment of dental proportions and reduced clinical time, achieving excellent aesthetic results. The implementation of a standardized and wellgrounded technique using composite for diastema closure provides clinical and aesthetic satisfactory and predictable results.

Proteínas morfogenéticas ósseas: mecanismo de ação e aplicabilidade clínica / Bone morphogenetic proteins: action mechanism and clinical applicability

Os avanços tecnológicos e os inúmeros achados biológicos que a ciência proporciona oferecem importantes conhecimentos e opções de tratamentos ao cirurgião-dentista, principalmente no campo dos materiais para enxerto, através da identificação de substâncias com capacidade de desempenhar a função desejada sem induzir toxicidade tecidual, gerando respostas celulares benéfcas que venham a otimizar a terapia proposta. Dentre estes materiais, as proteínas morfogenéticas ósseas (BMPs), pertencentes ao grupo dos fatores de crescimento beta TGF-β,vem ganhando grande destaque nas pesquisas, pois são capazes de induzir a neoformação tecidual. O presente trabalho propôs a discussão sobre o mecanismo de ação das BMPs, a fm de explicar sua aplicabilidade clínica e as perspectivas futuras na Odontologia.