Case Report: a 5-Year Follow-up of Proximal Caries Lesion Diagnosis / Diagnóstico de Lesões Cariosas Proximais - Relato de Caso: 5 Anos de Acompanhamento

This clinical case was aimed at reporting and discussing diagnostic methods for early detection and preventive treatment of proximal carious lesions. The patient presented to the dental clinic seeking treatment of a problem she reported as being "dental caries". The patient's orthodontist diagnosed dental caries, by means of radiographic exam. There was no evidence of any proximal carious lesion in the intraoral examination. The bitewing radiographs presented a radiolucent area limited to enamel in the mesial of maxillary left-second-bicuspid. For the purpose of confirming the intraoral diagnosis, an immediate tooth separation was performed. The immediate separation was unable to provide sufficient access; thus, the slow separation approach was performed. After 24-hours, tooth separation of 1mm was obtained, providing enough access for clinical examination. The proximal areas were evaluated by transillumination and impression taking. During the visual inspection, an area of enamel staining was observed, with no roughness due to tactile inspection and the evaluation by transillumination and impression showed no cavitation. The following preventive treatment plan was endorsed: oral hygiene instructions with emphasis to the importance of flossing the proximal areas, and healthy dietary habits. After a 5-years period of follow-up, the enhanced oral hygiene and heathy dietary habits were observed. A clinical examination with immediate tooth separation and bitewing radiographs was performed and showed no cavitation. The combination of methods for detecting carious lesions in proximal surfaces was effective in obtaining a diagnosis of caries in the permanent dentition. The absence of cavitated lesions must be indicative of preventive treatment. (AU).

Este caso clínico objetivou relatar e discutir os métodos diagnósticos para detecção e tratamento preventivo de lesões cariosas proximais. A paciente procurou atendimento restaurador com queixa de cárie diagnosticada por exame radiográfico realizado após término de seu tratamento ortodôntico. Ao exame clínico não havia suspeita de lesão cariosa. A avaliação radiográfica revelou, na face mesial do dente 25, presença de área radiolúcida limitada à metade externa do esmalte. Para confirmação do diagnóstico realizou-se a separação interdentária imediata, porém como a mesma não permitiu adequada visualização foi realizada a separação mediata e após 24 horas obteve-se adequada separação (1 mm) para o exame clínico. Em seguida, a superfície proximal foi avaliada por transiluminação e moldagem. Durante a inspeção visual foi constatada área de manchamento do esmalte, com ausência de rugosidade pela inspeção tátil e a avaliação tanto por transiluminação da superfície proximal, quanto por moldagem revelou ausência de cavitação. Devido o diagnóstico obtido o seguinte tratamento preventivo foi indicado: reforço de higiene oral com ênfase na importância do uso do fio dental e hábitos dietéticos saudáveis. Após 5 anos de acompanhamento melhoria da higiene oral e hábitos dietéticos foram constatados. O exame clínico com separação interdentária imediata e exame radiográfico revelaram ausência de cavitação. Conclui-se que a combinação de métodos de detecção de lesões cariosas proximais foi efetivo no diagnóstico da cárie dentária na dentição permanente. O resultado deste relato de caso mostrou que a ausência de lesões cariosas cavitadas deve ser um indicativo de tratamento preventivo.(AU).

Bond strength of adhesive systems to sound and demineralized dentin treated with bioactive glass ceramic suspension.

OBJECTIVE: The objective of this study was to evaluate the effect of a Biosilicate®, associated with dentin adhesive system, on microtensile bond strength (µTBS) to sound and demineralized dentin. MATERIALS AND METHODS: Eighty sound-extracted molars had their middle occlusal dentin exposed. In forty teeth, dentin was artificially demineralized (pH cycling). Sound and demineralized dentin teeth were separated into four groups (n = 10), according to the substrate treatment before restoration: Group 1-total-etching adhesive Adper TM Single bond 2 (ASB) + Biosilicate®, Group 2-ASB (without Biosilicate®), Group 3-AdheSE self-etching adhesive system (AdSE) + Biosilicate®, and Group 4-AdSE (without Biosilicate®). Each tooth was restored with a hybrid composite and stored in water at 37 °C for 6 months. After water aging, teeth were cut in sticks (≈ 1 mm2 cross-sectional area) and all samples were submitted to µTBS test. The fracture modes of the samples were analyzed by stereomicroscopy. The representatively fractured samples were observed by scanning electron microscopy. Representative samples of each group were analyzed on energy dispersive X-ray spectrometry (EDX). The µTBS and Ca-P ratio values were analyzed by 2-way ANOVA, Bonferroni, and Tukey test, respectively, p < .05. RESULTS: ASB + Biosilicate® presented the highest µTBS values (p < .05), and lowest µTBS values (p < .05) were found in AdSE Group. There was no statistical difference (p < .05) on µTBS when substrates were compared, except for Group 2. The fracture pattern analysis showed prevalence of adhesive fractures in all groups. CONCLUSION: Biosilicate® enhanced bond strength of self-etching and etch-and-rinse adhesives to sound and demineralized dentin. CLINICAL RELEVANCE: Bioactive glass ceramic suspension could be recommended to be used to improve the dentin bond strengths of the total-etching and self-etching adhesives after acid-etching and priming.

Implantes de zircônia na odontologia: revisão de literatura / Zirconia dental implants - a review

Diante da crescente expectativa quanto à estética em Odontologia e da necessidade de tratamentos metal free para casos específicos em regiões estéticas, o uso de implantes cerâmicos tem se tornado objeto de estudo e investimentos desde a década de 70, tornando-se hoje uma possível alternativa aos implantes de titânio. Assim, o objetivo deste estudo foi sistematizar o conhecimento disponível a respeito de implantes dentários de zircônia, avaliando sua viabilidade na implantodontia e a capacidade deste material em responder às exigências mecânicas e biológicas. Uma busca eletrônica foi realizada por meio do banco de dados PubMed utilizando a combinação das seguintes palavras- -chave: "zirconia", "dental implant", "zirconia implant" e "zirconia dental implant", sem restrição de idioma ou data de publicação. Esta pesquisa resultou em 801 trabalhos de potencial interesse. A seleção de artigos para inclusão no estudo com restrição de acordo com o objetivo proposto levou a seleção de 85 artigos relevantes para a revisão de literatura deste trabalho. De acordo com essa revisão, os resultados das pesquisas a respeito do uso da zircônia como matéria base na fabricação de implantes são promissores, embora a documentação científica disponível seja limitada pelas poucas e curtas experiências clínicas, principalmente em termos de longevidade. Estudos biológicos, mecânicos e clínicos publicados até a data parecem indicar que a zircônia pode ser uma excelente opção para os implantes de titânio, principalmente pelas suas propriedades mecânicas, aparência estética e menor adesão bacteriana.

Due to increasing demand for higher aesthetic in dentistry followed by the necessity of metal free rehabilitation for specific cases in esthetic regions, the use of ceramic implants has been object of study since the 70's, becoming today a possible alternative to titanium implants. The aim of this study was to systematize the knowledge available of zirconia implants, evaluating their viability and the ability of this material to respond to the mechanical and biological requirements. An electronic search was performed using the PubMed database and the combination of the following keywords: "zirconia", "dental implant", "zirconia implant" and "zirconia dental implant", without restriction of language or publication date. Eighty five articles were considered relevant to this study and the selection was fulfilled according to the proposed objective. According to this review, the results of research on the use of zirconia as the base material in implant manufacturing are promising, although available scientific documentation is limited by the few short clinical experiences, especially in terms of longevity. Biological, mechanical, and clinical studies published to date suggest that zirconia may be an excellent choice for titanium implants, mainly because of their mechanical properties, aesthetic appearance and lower bacterial adhesion.

The effect of proanthocyanidins and chlorhexidine on the bond strength of glass fiber posts to root dentin.

In this study, the influence of different irrigant solutions applied before cementation on the bond strength (BS) of glass fiber posts to root dentin was evaluated. Thirty endodontically treated maxillary canines of similar length were selected and divided into 3 groups (n = 10) according to the irrigant solution used before post cementation: 1% sodium hypochlorite (NaOCl; control), 2% chlorhexidine (CHX), or a 6.5% grape seed extract (GSE) cross-linking agent. After cementation of the posts, the roots were transversely sectioned to create 2 discs (2 mm) for each of the root thirds: coronal, middle, and apical. These discs were submitted to push-out tests (0.5 mm/min) to evaluate the BS between the glass fiber posts and the root dentin. Statistical analysis was performed by a 2-way analysis of variance and a Tukey test (P < 0.05). The failure mode was evaluated in all specimens. Both the CHX and GSE groups presented significantly higher BS values than the control group in all root thirds (P < 0.05). The values of the GSE group were significantly higher than those of the CHX group in all thirds except the apical third (P < 0.05). In the control group, the BS value was highest in the cervical third. There was no significant difference in the BS values between the cervical and middle thirds when CHX was used (P > 0.05); however, the BS value diminished significantly in the apical third (P < 0.05). The highest BS value in the GSE group was found in the middle third. The results showed that the use of either GSE or CHX before adhesive cementation improved the BS of glass fiber posts to root dentin.

Avaliação comparativa dos níveis de desajustes marginais de pilares UCLAS calcináveis assentados sobre a plataforma de implantes e sobre pilar cônico em próteses fixas implantosuportadas / Comparative assessment of the levels of marginal misfits UCLAS calcinable pillars seated on the platform and on implant abutment conical

Este trabalho objetivou avaliar os níveis de desajustes marginais de infraestruturas metálicas em próteses fixas assentadas sobre pilar cônico pré-fabricado (estheticone) e diretamente sobre o hexagonal do implante. Foram obtidas quatro amostras de infraestruturas de próteses fixas fundidas em liga de Níquel-Cromo assentadas sobre análogos de implantes regulares e sobre análogos do pilar cônico. As infraestruturas foram distribuídas em dois grupos (n=2) experimentais. Os desajustes marginais verticais (µm) foram avaliados com o emprego de um microscópio mensurador digital. Cada amostra recebeu quatro marcações diametralmente opostas (mesial, distal, vestibular e lingual) e foram avaliadas três vezes em cada uma dessas superfícies com o parafuso de fixação devidamente adaptado. Para a análise estatística foi utilizado o teste de U Mann Whitney na correlação dos valores das quatro faces diametralmente opostas (mesial, distal, vestibular e lingual) de ambos os grupos. Ainda, utilizou-se o teste Kruskal-Wallis para correlacionar os valores obtidos entre os pilares empregados. Os resultados mostraram que não houve diferença estatisticamente significante no desajuste marginal entre os grupos comparados. Concluiu-se que não houve diferença no desajuste marginal de infraestruturas metálicas de próteses sobre implantes fundidas com ligas de Ni-Cr com UCLA assentados sobre pilar estheticone ou diretamente sobre o hexágono de um implante de plataforma regular (AU).

The objective of this work was to evaluate the levels of marginal mismatches of metallic infrastructures on fixed prostheses seated on the following types of platforms: pre-fabricated conical pillar (estheticone), pillar UCLA, and directly on the hexagonal of the implant. Samples of infrastructures of fixed prostheses made of nickel-chrome alloy and seated on similar regular implants and on similar conical pillar were used. The infrastructures were distributed in two experimental groups (pillar estheticone and direct pillar on the platform). For the evaluation of vertical marginal mismatches (µm), each sample was seated on its platform and observed with the aid of a digital measuring microscope. Each sample received four marks, diametrically opposite to each other (mesial, distal, vestibular, and lingual) and all samples were evaluated three times in each surface with the fixation screw properly adapted. The averages of these evaluations were obtained using U Mann Whitney and Kruskal-Wallis statistical tests. The result of the U Mann Whitney test,did not show significant statistical difference while Kruskal-Wallis test showed difference between the estheticone pillar and the UCLA pillar. The estheticone pillar showed lower mismatches averages than the UCLA pillar and, no significant statistical difference was observed in the comparison with the hexagonal platform of the implant (AU).

Prótese sobre implantes tipo protocolo associada à overdenture ­ relato de caso / Implant-supported protocol-type prosthesis associated with overdenture ­ case report

Como forma de tratamento para o edentulismo, a Odontologia dispõe de várias alternativas, como próteses totais convencionais mucossuportadas e as próteses sobre implantes. O tratamento com próteses implantossuportadas, por proporcionar maior retenção, tem sido a escolha da maioria dos profissionais e pacientes. Adicionalmente, esses tratamentos têm revolucionado a reabilitação oral por proporcionar melhor conforto, estética, eficiência mastigatória, confiança ao falar em público, resultando na melhora da qualidade de vida. Assim, o presente trabalho tem como objetivo relatar um caso clínico de um paciente do sexo masculino reabilitado inicialmente, após perca de todos os dentes remanescentes por doença periodontal grave, com próteses overdentures em ambos os arcos. Em seguida, devido à evolução de um quadro clínico de hiperplasia tecidual, a prótese superior foi substituída por prótese total fixa implantossuportada (AU).

Dentistry has several alternatives to treat edentulism, such as conventional and implantsupported prostheses. The treatment with implant-supported prostheses, by providing greater retention, has been the choice of the majority of professionals and patients. Additionally, these treatments have revolutionized oral rehabilitation since they provide better comfort, aesthetics, masticatory efficiency and public speaking confidence, which results in improved quality of life. Thus, the aim of this study is to report a clinical case of a male patient initially rehabilitated with overdentures in both arches. Then, due to the evolution of a clinical hyperplasic tissue, the superior prosthesis was replaced by implanted-supported fixed total prosthesis (AU).

Reabilitação de paciente com próteses implanto- suportadas imediata e mediata associada à prótese total convencional / Immediate loading in mandibular edentulous patient associated with maxillary conventional prosthesis û case report

O edentulismo é um problema de saúde pública que afeta indivíduos em diversas esferas de vida: fisiológica, psicológica e social. Para solucionar esse problema, a Odontologia dispõe de várias alternativas como próteses totais convencionais mucossuportadas e as próteses sobre implantes. A prótese implanto-suportada como alternativa para o tratamento do edentulismo apresenta resultados superiores quando comparada às próteses convencionais, pois tem a grande vantagem de proporcionar retenção através da fixação ao implante osseointegrado. A proposta de reabilitação com suporte de implantes tem revolucionado a Odontologia por proporcionar melhor conforto, eficiência na mastigação, estética superior, confiança ao falar em público e, portanto, melhora na qualidade de vida. Atualmente, há dois modelos de próteses aplicadas aos desdentados totais: sobredentaduras, que são as próteses totais móveis suportadas por implantes osseointegrados (overdenture Implanto-retidas) e próteses totais fixas designadas como protocolos fixos e/ou protocolo Brånemark. O presente trabalho tem como objetivo relatar um caso clínico de um paciente do sexo feminino reabilitado com prótese total convencional no arco superior e prótese total fixa implanto-suportada imediata e, posteriormente, mediata no arco inferior...

Edentulism is a public health problem that affects people in various spheres of life: physiological, psychological and social. To solve this problem, dentistry offers several alternatives such as conventional dentures and implant-supported prosthesis. The implant-supported prosthesis as an alternative for the treatment of tooth loss has higher results than conventional prostheses, due to the fact of providing retention through attachment to the osseointegrated implant. The proposal of rehabilitation through implant-supported prosthesis has revolutionized dentistry as it provides better comfort, efficiency in chewing, superior aesthetics, and security at public speaking, therefore, improving the quality of life. Currently, there are two models of prostheses applied to edentulous patients; overdentures that are mobile dentures supported by dental implants (Implant-retained overdenture) and fixed dentures designated as fixed protocols and /or Brånemark protocol. The aim of this study is to report a case of a female patient rehabilitated with conventional denture in the maxilla and implant-supported fixed denture immediate and subsequently mediate in the mandible...

Morphology of sealant/enamel interface after surface treatment with bioactive glass.

The purpose of this study was to analyze, by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM), the morphology of sealant/enamel interface after surface treatment with Biosilicate. Before pits and fissures sealing, the occlusal surfaces of 10 sound human molars were sectioned perpendicularly at the fissures in order to obtain three slices for each tooth. Slices were randomly assigned into three groups (n = 10) according to sealing protocol: Group 1- Acid etching + Biosilicate + glass ionomer-based sealant (Clinpro XT Varnish, 3M ESPE); Group 2- Acid etching + glass ionomer-based sealant (Clinpro XT Varnish, 3M ESPE); Group 3- No sealing. All slices were subjected to thermal cycling (5,000 cycles; 5-55°C; dwell time: 30s). Half of the slices from each group (n = 5) were analyzed by CLSM and the other half by SEM. Groups 1 and 2 were also submitted to EDS analysis and their data were evaluated by Two-Way ANOVA e Tukey's test (α=5%). EDS data analysis showed higher amounts of silicon (Si) ions than calcium (Ca) ions in Group 1 (P < 0.05); Group 2 presented higher amounts (P < 0.05) of Ca ions than Si ions. It may be concluded that the use of Biosilicate for surface treatment did not affect the morphology of glass ionomer-based sealant/enamel interfaces.