Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades / Atuação multidisciplinar em paciente com fissura lábio palatina: tratamento estético-funcional dento-facial de mais de duas décadas

Cleft lip and palate is a very common congenital defect in which embryonic facial processes do not achieve the ideal facial formation during their development which can cause malformation. Multiple dentistry specializations, especially oral and maxillofacial, orthodontics, oral rehabilitation and dental aesthetics are required in order to correct lip and oral cavity malformations by this congenital defect with the objective of functional and aesthetics improvement. The clinical case reported show the multidisciplinary approach in a patient with cleft lip and palate implementing an aesthetic and functional dentofacial rehabilitation. The case involves a 27-year-old female patient LCLG, Caucasian, with the presence of unilateral congenital cleft lip and palate on the left side, who started rehabilitative and reparative treatment at 3 months of age. She then started pediatric orthodontic treatment for angle class 3 crossbite correction at 7 years of age. After complete replacement of deciduous to permanent dentition at the age of 11, the patient started orthodontic treatment with a fixed appliance for several years and restorative treatment with composite resin reanatomize the anterior teeth due to agenesis of elements 22 and 25. After a few years when the resin restorations were no longer biologically favorable, an aesthetic rehabilitation treatment with ceramic laminates was planned through smile digital planning soon after completing the orthodontic treatment. This case report demonstrates that high aesthetic, functional and psychological expectations of a patient with congenital defect compromise throughout her life were met through a multidisciplinary dental treatment based on correct diagnosis and digital planning (AU)

A fissura labiopalatal é um defeito congênito muito comum, no qual os processos faciais embrionários não atingem a formação facial ideal durante o seu desenvolvimento, podendo causar malformações. Múltiplas especializações da odontologia, principalmente buco-maxilo-facial, ortodontia, reabilitação oral e estética dental são necessárias para corrigir as malformações labiais e da cavidade oral por esse defeito congênito com o objetivo de melhoria funcional e estética. O caso clínico relatado mostra a abordagem multidisciplinar em um paciente com fissura labiopalatal implementando uma reabilitação dentofacial estética e funcional. O caso envolve uma paciente do sexo feminino, 27 anos, LCLG, branca, com presença de fissura labiopalatal congênita unilateral à esquerda, que iniciou tratamento reabilitador e reparador aos 3 meses de idade. Após a substituição completa da dentição decídua pela permanente aos 11 anos de idade, a paciente iniciou tratamento ortodôntico com aparelho fixo por vários anos, e tratamento restaurador com resina composta para reanatomizar os dentes anteriores devido à agenesia dos elementos 22 e 25. Após alguns anos em que as restaurações em resina não eram mais favoráveis biologicamente, foi planejado um tratamento reabilitador estético com laminados cerâmicos através do planejamento digital do sorriso logo após a finalização do tratamento ortodôntico. Este relato de caso demonstra que as altas expectativas estéticas, funcionais e psicológicas de uma paciente com comprometimento de defeito congênito ao longo de sua vida foram atendidas por meio de um tratamento odontológico multidisciplinar baseado em diagnóstico correto e planejamento digital (AU)

Evaluación in vitro de la influencia de sistemas de pulimento intraoral en la rugosidad superficial de una cerámica odontológica después del ajuste / In vitro evaluation of the influence of oral intra polishing systems in the surface roughness of a ceramic dental after adjustment

El objetivo de este estudio fue evaluar tres métodos de pulimento de las superficies de una porcelana con la finalidad de producir superficies con menor rugosidad. Fueron confeccionados 40 especímenes en formato cilindros estandarizados de 5mm de diámetro y 2mm de altura con la porcelana IPS Empress 2. Posteriormente los especímenes fueron divididos en grupos y sus superficies fueron sometidos a técnicas de pulido diferentes. Cada espécimen fue analizado en el rugosímetro, y en cada espécimen se realizó tres mediciones a lo largo de su eje, dando como resultado la rugosidad promedio (Ra). Las medias de Ra fueron sometidas a los tests estadísticos de Anova y Tukey (p? 0,05). El Grupo A (Control - Glaseado) presentó la menor media de Ra (A=0,9190) que los demás grupos (B =2,879; C=2,897; D =3,468). En base a los datos obtenidos por este estudio se puede inferir que los sistemas de pulimento disminuyen la rugosidad superficial provocada por el ajuste oclusal en las cerámicas odontológicas. Entre tanto, esos conjuntos son incapaces de devolver la vitrificación de la superficie

The aim of this study was to evaluate three porcelain polishing systems used to raise smoother surfaces. 40 IPS Empress 2 cilindric specimens with 5mm of diameter and 2mm height. The specimens were divided in groups and polished with different systems. Each specimen has his surface by a perfilometer three times resulting the mean roughness of each specimen (Ra). The Ra mean was submitted to ANOVA and Tukey´s tests (p? 0,05). For the group A (Control - Glaze) was found smaller mean values of Ra (A=0,9190) compared to the other groups (B =2,879; C=2,897; D =3,468). Based on these results we´re able to imply that the used polishing systems reduces the surface roughness caused by occlusal adjustment. However the polishing systems are unable to restore the smoothness provided by the glaze

Temperature variation in pulp chamber during dental bleaching in presence or absence of light activation / Variação da temperatura na câmara pulpar durante o clareamento dental na presença ou ausência de fotoativação

Purpose: In addition to the chemical damage due to bleaching gels penetration into the pulp during pulp vitality dental bleaching, another possible aggressive factor could be the heat generated by the exothermal oxidation reaction of the bleaching gel, which may also be aggravated by the use of light activation. This study assessed the temperature variation in the pulp chamber in human teeth, using three different bleaching gels with or without LED light activation. Methods: Thirty human pre-molars were cut longitudinally to obtain buccal and lingual halves. The 60 specimens were divided into 3 groups, and the bleaching gel used varied as follows: 35% hydrogen peroxide (WHP); 37% carbamide peroxide (W) and 38% hydrogen peroxide (OX). Half of the specimens were submitted to bleaching with light activation and, the other half, without light activation. The light source used was the light emitting diode appliance (LED, 3-Light, Clean Line), and the intrapulpal temperatures were measured by using a digital thermometer. Data were analyzed by ANOVA and Tukey´s tests (alpha=5%). Results: The intrapulpal temperatures (in oC) were as follows: without light activation (WHP= 0.68b; W= 0.40b; OX= 0.48b); with light activation (WHP= 2.35a; W= 1.60a; OX= 1.80a ). Conclusion: LED light activation of bleaching gels increased the temperature in the pulp chamber, but did not achieve the critical temperature value of 5.5 oC.

Objetivo: Além da agressão química devido à penetração dos géis clareadores na polpa durante o clareamento de dentes com vitalidade pulpar, outro possível fator agressor pode ser o calor gerado pela reação de oxidação exotérmica do gel clareador, que pode também ser agravada pela fotoativação. Este estudo avaliou a variação da temperatura na câmara pulpar de dentes humanos, utilizando-se três diferentes géis clareadores, com ou sem fotoativação.Metodologia: Trinta pré-molares humanos foram cortados longitudinalmente para obtenção de duas metades: vestibular e lingual. Os 60 espécimes foram divididos em 3 grupos e os agentes clareadores utilizados variaram como segue: peróxido de hidrogênio 35% (WHP), peróxido de carbamida 37% (W) e peróxido de hidrogênio 38% (OX). Metade dos espécimes foi submetida ao clareamento com fotoativação e, a outra metade, sem fotoativação. A fonte de luz utilizada foi o aparelho à base de diodo emissor de luz (LED, 3-Light, Clean Line) e as temperaturas foram medidas por um termômetro digital. Os dados foram analisados por análise de variância e teste de Tukey (alfa=5%).Resultados: Os resultados de temperatura foram: sem fotoativação (WHP= 0.68b; W= 0.40b; OX= 0.48b); com fotoativação (WHP= 2.35a; W= 1.60a; OX= 1.80a).Conclusão: A fotoativação dos géis clareadores com LED contribuiu para um maior aumento de temperatura na câmara pulpar, mas não se atingiu a temperatura crítica de 5,5oC.

Effect of different finishing times on surface roughness and maintenance of polish in nanoparticle and microhybrid composite resins.

The objective of the study was to evaluate the effect of immediate polishing, after 24 h and after 1 week, on the surface roughness of two micro-hybrid resins (Esthet-X; Opallis) and one nanoparticle resin (Filtek Z350), as well as verifying maintenance of the polish after 1 year, simulated by means of thermal cycling. Forty-three specimens of each material were made and divided into a control group and three experimental groups. The control group specimens received no surface treatment. Group 1 received finishing with an extra-fine diamond drill and posterior polishing with the systems Enhance and PoGo, immediately after polymerization. Group 2 received the same procedures; however, these were carried out after 24 h of storage. Group 3 received the surface treatment after 7 days of storage. After that, the surface roughness was evaluated by a profilometer. After the initial reading, the specimens were submitted to thermal cycling for 10,000 cycles. After thermal cycling, a new roughness reading was taken. The results showed a higher roughness value for the resin Esthet-X, and the resins Opallis and Z350 presented the same roughness values. As regards the time when polishing was performed, specimens polished immediately after polymerization presented higher roughness values in comparison with the other two periods. After thermal cycling, the statistical analysis showed that the Opallis resin polish had been maintained, whereas for the other two resins, there was a significant reduction in surface smoothness. The surface roughness was influenced by the material and also by the period of polishing; the surface roughness of all tested materials were at a clinically acceptable level.

In vitro assessment of chemical activation efficiency during in-office dental bleaching.

PURPOSE: This study compared five types of chemical catalyzing agents added to 35% hydrogen peroxide gel, with regard to their capacity of intensifying in-office dental bleaching results. METHODS: One-hundred and twenty bovine incisors were used, of which the crowns and roots were cut in the incisor-apical direction, to acquire the dimensions of a human central incisor. The specimens were sectioned in the mesiodistal direction by means of two longitudinal cuts, the lingual halves being discarded. The vestibular halves received prophylaxis with a bicarbonate jet, ultrasound cleaning and acid etching on the dentinal portion. Next, the specimens were stored in receptacles containing a 25% instant coffee solution for two weeks. After the darkening period, initial measurement of the shade obtained was taken with the Easy Shade appliance, which allowed it to be quantified by the CIELab method. The samples were divided into six groups, corresponding to the chemical activator used: a) none (CON); b) ferric chloride (CF); c) ferrous sulphate (SF); d) manganese gluconate (GM); e) manganese chloride (CM); f) mulberry root extract (RA). Each group received three 10-minute applications of the gels containing the respective activating agents. Next, a new shade measurement was made. RESULTS: The Analysis of Variance and Tukey tests (alpha = 5%) showed statistically significant differences for the shade perception values (p = 0.002). Groups GM, CM and RA showed significantly higher means than the control group. CONCLUSION: The presence of some chemical activators is capable of resulting in a significant increase in tooth shade variation.

A scanning electronic microscopy study of the action of different desensitizing agents on bovine dentin.

This study sought to use scanning electronic microscopy (SEM) to evaluate the dentinal tubule occlusion potential of different desensitizing agents. Ten slices of bovine dentin were divided into six fragments, cleaned (using ultrasound), and etched for 15 seconds with a 35% phosphoric acid solution. All but one of the groups received a different desensitizing agent; the sixth group served as a control and received no additional treatment. After the agents were applied, the dentin specimens were analyzed by SEM and scores were assigned based on the extent of tubular obliteration. Only three agents demonstrated tubular sealing that was significantly different from that of the control group.

Restabelecimento da estética e função em paciente portador de bulimia nervosa: relato de um caso clínico / Recovering aesthetic and function for a patient with bulimia nervosa: clinical case report

Um desgaste dental severo na presença de periodonto sadio apresenta alterações impares no diagnóstico, plano de tratamento, metodologia reabilitadora e controle do paciente. Entretanto, uma reabilitação sistematizada e integrada levará a um prognóstico favorável e adequado. A bulimia nervosa representa doença psicossomática, favorecendo a dissolução das estruturas duras do órgão dental, levando ao aparecimento de sensibilidade e a uma aparência antiestética, além de perda de dimensão vertical devido a um desgaste rápido da estrutura dental. Este artigo ilustra a reconstrução de uma dentição severamente desgastada, por ocorrência de bulimia nervosa, associando restabelecimento da dimensão vertical de oclusão e uso de coroas cerâmicas puras e restaurações metálicas fundidas

Shear bond strengths of a ceramic system to alternative metal alloys.

STATEMENT OF PROBLEM: The success of metal-ceramic restorations is influenced by the compatibility between base metal alloys and porcelains. Although porcelain manufacturers recommend their own metal systems as the most compatible for fabricating metal-ceramic prostheses, a number of alloys have been used. Purpose This study evaluated the shear bond strength between a porcelain system and 4 alternative alloys. MATERIAL AND METHODS: Two Ni-Cr alloys: 4 ALL and Wiron 99, and 2 Co-Cr alloys: IPS d.SIGN 20 and Argeloy NP were selected for this study. The porcelain (IPS d.Sign porcelain system) portion of the cylindrical metal-ceramic specimens was 4 mm thick and 4 mm high; the metal portion was machined to 4x4 mm, with a base that was 5 mm thick and 1 mm high. Forty-four specimens were prepared (n=11). Ten specimens from each group were subjected to a shear load on a universal testing machine using a 1 mm/min crosshead speed. One specimen from each group was observed with a scanning electron microscope. Stress at failure (MPa) was determined. The data were analyzed with a 1-way analysis of variance (alpha=.05). RESULTS: The groups, all including IPS d.Sign porcelain, presented the following mean bond strengths (+/-SD) in MPa: 4 ALL, 54.0+/-20.0; Wiron, 63.0+/-13.5; IPS d.SIGN 20, 71.7+/-19.2; Argeloy NP, 55.2+/-13.5. No significant differences were found among the shear bond strength values for the metal-ceramic specimens tested. CONCLUSION: None of the base metal alloys studied demonstrated superior bond strength to the porcelain tested.