Facetas diretas em resina composta utilizando o fluxo digital para planejamento: relato de caso / Direct facets in composite resin using digital flow for planning: case report / Facetas directas en resina compuesta utilizando flujo digital para planificación: reporte de caso

Introdução:O aprimoramento das resinas compostas nos últimosanos em associação com a difusão de informações nas redes sociais tornou as facetas diretas tratamentos populares na dentística restauradora. No entanto, são procedimentos que exigem ampla destreza manual e conhecimento técnico. O fluxo digital através doescaneamento, enceramento digital e prototipagem 3D para construção de guias tem se tornado uma excelente alternativa para aumentar a previsibilidade e aumentar a longevidade destes trabalhos. Objetivo:Descrever o protocolo de confecção de facetas diretas em resina composta, através de um relato de caso, utilizando como auxílio o planejamento digital para confecção de modelo 3D, guia de silicone e paredes palatinas. Descrição do Caso:Paciente do gênero masculino, 43 anos, queixava-se do formato dos seus dentes. Ao exame clínico percebeu-se desgaste dental nos incisivos centrais e linha do sorriso levemente invertida. Após duas sessões de clareamento de consultório com Peróxido de hidrogênio (35%) e mockup direto com resina composta, foi realizada a moldagem e escaneamento do modelo de gesso no laboratório. O enceramento digital foi aprovado, o modelo 3D foi impresso para confecção da guia de silicone. Com auxílio da guia foram executadas facetas diretas nos elementos 13, 12, 11, 21, 22 e 23. Conclusão:O fluxo digital pode ser uma alternativa viável para minimizar as falhas na confecção de facetas diretas em resina composta (AU).

Introduction:The improvement of composite resins in recent years, together with information disseminated on social media, has made direct veneers popular treatments in restorative dentistry. However, these procedures require significant manual dexterity and technical knowledge. Digital work flow using scanning, digital wax-up and 3D prototyping for the construction of guides has become an excellent alternative to increase predictability and the longevity of these procedures. Objective:Describe the manufacturing protocol for direct composite resin veneers, using a case report and digital to construct the 3D model, silicone guide and palatine walls. Case description:Male patient, 43 years old, complained of the shape of his teeth. Clinical examination revealed tooth wear on the central incisors and a slightly inverted smile line. After two whitening sessions with hydroigen peroxide (35%) and direct mockup with composite resin, the plaster model was molded and scanned in the laboratory. Digital wax-up was approved, and the 3D model was printed to manufacture the silicone guide. With the help of the guide, the direct veneers were applied to elements 13, 12, 11, 21, 22 and 23.Conclusions:Digital flow may be a feasible alternative to minimize manufacturing flaws in direct composite resin veneers (AU).

Introducción: La mejora de las resinas compuestas en los últimos años, y la difusión de información en las redes sociales, ha popularizado las facetas directas en los tratamientos en odontología restauradora. Sin embargo, son procedimientos que requieren demasiado destreza manual y conocimientos técnicos. El flujo digital usando escaneo, encerado digital y prototipado 3D para la construcción de guías se ha convertido en una excelente alternativa para aumentar la previsibilidad y la longevidad de estos procedimientos. Objetivo: Describir el protocolo para la realización de carillas directas en resina compuesta, a través de un reporte de caso, utilizando el planeo digital como ayuda para la realización de un modelo 3D, guía de silicona y paredes palatinas. Descripción del caso: Paciente masculino, 43 años, se quejó de la forma de sus dientes. El examen clínico reveló desgaste dental en los incisivos centrales y una línea de sonrisa levemente invertida. Después de dos sesiones de blanqueamiento en consultorio con peróxido de hidrógeno (35%) y maqueta directa con resina compuesta, el modelo de yeso fue moldeado y escaneado en el laboratorio. El encerado digital fue aprovado, el modelo 3D fue impreso para hacer la guía de silicona. Con la ayuda de la guía se realizaron carillas directas en los elementos 13, 12, 11, 21, 22 y 23. Conclusiones: El fluxo digital puede ser una alternativa viable para minimizar fallas en la fabricación de carillas directas en resina compuesta (AU).

Use of Images and Clinical Experience to Calibrate Dental Surgeons for the Diagnosis of Molar Incisor Hypomineralization

ABSTRACT Objective: To evaluate an imaging protocol for use as a diagnostic and calibration tool for dentists before and after practical activity. Material and Methods: Thirty photos of children's teeth with or without changes in dental enamel were selected and evaluated by a group of experienced dentists previously calibrated to establish the diagnosis defined as the gold standard. After instructions, the images were shown to a group of postgraduate dentists for free identification of dental changes. Subsequently, a lecture on molar incisor hypomineralization (MIH) was carried out, and, at 14 days and all calibration was performed using the criteria previously. The retest was performed at 28 days. After experience in clinical activity in the following two weeks, the post-test was performed at 49 days. Data were analyzed using Cohen's kappa coefficient. Results: Theoretical learning on the subject showed low inter-examiner agreement when the diagnosis of defects was made from images obtained from intraoral photographs. After clinical practice, there was greater intra-examiner agreement. After theoretical training, dentists started to identify different types of enamel alteration, although with low agreement between them. Conclusion: Clinical experience in theoretical and imaging training favored the identification of defects. However, it is necessary to improve the protocol to establish a reliable and viable diagnostic method for calibration in MIH.

Smile Arc Esthetics in Middle-Aged Man from the Layperson's Perspective Via Eye-Tracking

Abstract Objective: To evaluate the perceptions of smile esthetics associated with variations in the vertical plane of the maxillary incisors in the smile arc using eye-tracking software. Material and Methods: An image of a 59-year-old Caucasian male model was adapted and edited to make three changes in the vertical plane, simulating a convex, straight, and reverse smile arc. Four areas of interest were inserted at the right and left eyes, nose, and mouth. Forty laypeople raters between 18 and 45 years of age participated of the study. Eye-tribe hardware and Ogama software were used to perform eye-tracking. Attractiveness and age-perception questions were also incorporated into the study. ANOVA test and Pearson's correlation coefficient, at p < 0.05. Results: The most observed AOI in images with convex, straight, and reverse smiles, as assessed using heatmaps and point maps, was the mouth, followed by the right eye. A significant difference for the eye (p=0.02) was found when comparing convex and reverse smiles, whereas a significant difference for the mouth was observed between the straight and reverse smiles (p=0.03). Conclusion: Convex and straight smile arcs were associated with equal levels of attractiveness; the reverse smile was less attractive. No significant difference was noticed regarding age perception and the smile arcs. However, the reverse smile recorded a more complete fixation time.

Accuracy of Dental Photography: Professional vs. Smartphone's Camera.

There is a scant literature on the accuracy of dental photographs captured by Digital Single-Lens Reflex (DSLR) and smartphone cameras. The aim was to compare linear measurements of plaster models photographed with DSLR and smartphone's camera with digital models. Thirty maxillary casts were prepared. Vertical and horizontal reference lines were marked on each tooth, with exception to molars. Then, models were scanned with the TRIOS 3 Basic intraoral dental scanner (control). Six photographs were captured for each model: one using DSLR camera (Canon EOS 700D) and five with smartphone (iPhone X) (distance range 16-32 cm). Teeth heights and widths were measured on scans and photographs. The following conclusions could be drawn: (1) the measurements of teeth by means of DSLR and smartphone cameras (at distances of at least 24 cm) and scan did not differ. (2) The measurements of anterior teeth by means of DSLR and smartphone cameras (at all distances tested) and scan exhibited no difference. For documentational purposes, the distortion is negligeable, and both camera devices can be applied. Dentists can rely on DSLR and smartphone cameras (at distances of at least 24 cm) for smile designs providing comparable and reliable linear measurements.

Trueness of ten intraoral scanners in determining the positions of simulated implant scan bodies.

Few investigations have evaluated the 3-dimensional (3D) accuracy of digital implant scans. The aim of this study was to evaluate the performance of 10 intraoral scanners (IOSs) (CEREC Omnicam, CEREC Primescan, CS 3600, DWIO, i500, iTero Element, PlanScan, Trios 2, Trios 3, and True Definition) in obtaining the accurate positions of 6 cylinders simulating implant scan bodies. Digital scans of each IOS were compared with the reference dataset obtained by means of a coordinate measuring machine. Deviation from the actual positions of the 6 cylinders along the XYZ axes and the overall 3D deviation of the digital scan were calculated. The type of IOSs and position of simulated cylindrical scan bodies affected the magnitude and direction of deviations on trueness. The lowest amount of deviation was found at the cylinder next to the reference origin, while the highest deviation was evident at the contralateral side for all IOSs (p < 0.001). Among the tested IOSs, the CEREC Primescan and Trios 3 had the highest trueness followed by i500, Trios 2, and iTero Element, albeit not statistically significant (p > 0.05), and the DWIO and PlasScan had the lowest trueness in partially edentulous mandible digital implant scans (p < 0.001).

Técnica minimamente invasiva em lesão branca hipoplásica: relato de caso / Minimally invasive technique in hypoplastic white injury: case report / Técnica minimamente invasiva en lesiónblancahipoplástica: caso clínico

Introdução:As manchas dentárias, dentre elas a hipoplasia do esmalte,corresponde a um dos motivos que fazem com que os pacientes busquem alterações no seu sorriso.O tratamento proposto deve ser sempre o mais conservador possível e buscar devolver a autoestima do paciente. Objetivo:Este trabalho objetivou apresentarum relato de caso clínico de paciente do sexo feminino, 26 anos, insatisfeita com a estética do seu sorriso por apresentar dentes escurecidos e hipoplasia de esmalte na face vestibular, em incisivo superior.Descrição do caso:Ao exame clínico foi observado escurecimento fisiológico e hipoplasia de esmalte no incisivo lateral superior esquerdo (22).O plano de tratamento proposto foi clareamento dental pela técnica associada (técnica de consultório + técnica caseira), remoção da mancha hipoplásica de formaminimamente invasiva e restauração em resina composta direta. Conclusões:Através de um correto diagnóstico, associado a uma técnica e seleção de material adequado, foi possível conseguir excelência estética com preservação de estrutura dentária sadia (AU).

Introduction:Dental stains, including enamel hypoplasia, correspond to one of the reasons that make patients seek changes in their smile. The proposed treatment should always be as conservative as possible and seek to restore the patient's self-esteem.Objective:This study aimedto present a clinical case report of a 26-year-old female patient, dissatisfied with the aesthetics of her smile as she had darkened teeth and enamel hypoplasia on the vestibular face, in anupper incisor. Case description:On clinical examination, physiological darkening and enamel hypoplasia were observedon the left upper lateral incisor (22). The proposed treatment plan was dental bleaching using the associated technique (In-office bleaching+ at-home bleaching), removal of the hypoplastic stain in a minimally invasive manner and restoration in direct composite resin.Conclusions:Through a correct diagnosis, associated with a technique and selection of suitable material, waspossible to achieve aesthetic excellence with preservation of healthy dental structure (AU).

ntroducción: Las manchas dentales, incluida la hipoplasia del esmalte, corresponden a una de lasrazones que hacenquelos pacientes busquencambios em susonrisa. El tratamiento propuestosiempredebe ser lo másconservador posible y tratar de restablecerla autoestima del paciente.Objetivo: Este estudio tuvo como objetivo presentarun informe de caso clínico de una paciente de 26 años de edad, insatisfechacon la estética de susonrisa, ya que habíaoscurecidolosdientes y la hipoplasia del esmalte en lasuperficie vestibular, en el incisivo superior.Descripcióndel caso: Enelexamen clínico, se observó oscurecimiento fisiológico e hipoplasia del esmalte en el incisivo lateral superior izquierdo (22). El plan de tratamiento propuestofueel blanqueamiento dental utilizando la técnica asociada (técnica de consultorio + técnica casera), eliminación de la mancha hipoplásica de maneramínimamente invasiva y restauraciónen resina compuestadirecta. Conclusiones: A través de un diagnóstico correcto, asociado con una técnica y selección de material adecuado, fueposible lograr laexcelencia estética conlapreservación de una estructura dental sana (AU).

Traumatic Dental Injuries Occurred in Primary Teeth and their Sequel Effects on the Developmental Permanent Successors: A Controlled Study

ABSTRACT Objective: To examine the types of traumatic dental injuries of the primary teeth (TDI-p) and the long-term sequelae on permanent dentition (LSP) comparing with a control group (CG). In addition, a questionnaire that measures parents' knowledge and awareness was used. Material and Methods: The trauma group (TG) consisted of permanent teeth following TDI-p exposed teeth, while the CG consisted of permanent teeth following unexposed teeth with TDI-p of the same patients. In total, 141 teeth were evaluated in 27 patients. Data concerning such as teeth, when TDI-p occurred, types of treatments and types of LSP were collected. Chi-square test was used for intergroup comparison for gender, type of trauma, LSP, age of trauma and parameters in the parental information questionnaire. Significance level was p<0.05. Results: A statistically significant difference was found in the analysis between TG and CG (p<0.001). The prevalence of LSP due to TDI-p was 29.6% and the prevalence of sequelae in CG was 7.4%. The most common LSP was enamel hypoplasia (14.8%). Parents were aware of the importance of TDI-p, and they had insufficient knowledge about its management. Conclusion: TDI-p can be considered a high-risk factor in the development of LSP. Also, the lack of knowledge in parents should be supported by software-based application systems to be developed.

Comparison of Bracket Position Accuracy with Different CAD/CAM Indirect Bonding Systems

ABSTRACT Objective To evaluate the accuracy of three different digital bracket positioning systems, comparing vertical, mesiodistal and buccolingual accuracy. Material and Methods The same case was sent to Orapix, Insignia, and Orthocad systems and the brackets were bonded to the malocclusion models.Damon 3 MX brackets were used with all systems and the brackets were bonded to the models with the same bonding protocol and materials. The comparison of the position of each single bracket was made with digital photography, and ImageJ software was used to find the length in pixels and then convert it to hundredths of a mm for vertical, mesiodistal and buccolingual displacement, compared to the setup. Results Insignia System reported the average higher vertical displacement (0.28 mm), compared with the other two appliances (0.22-0.23 mm), and showed the lowest average displacement for the mesiodistal and buccolingual positioning (0.14 and 0.07 mm, respectively).However, these slight bracket positioning variations between these bonding systems were not statistically different (p>0.05). Conclusion The three systems analyzed were shown to be accurate in positioning the brackets, and none of them was statistically better.

Difference in Orthodontic Patients' Perceptions of Essix and Hawley Retainers

Abstract Objective: To determine differences in how orthodontic patients perceive the aesthetics relating to the use of Essix and Hawley retainers. Material and Methods: Photographs of a female patient using an Essix retainer and a Hawley retainer, respectively, were assessed by 70 orthodontic patients aged between 21 and 55 years. All participants were provided with the same images of the two retainer types being worn and were asked to grade the aesthetics of each retainer using a visual analog scale. The significance of differences in orthodontic patient perceptions of aesthetics in the use of Essix and Hawley Retainers in the young adult and adult age groups were tested using the Mann-Whitney test with assumed significance p<0.01. Results: There were differences in participants' perceptions between the two retainers that were statistically significant, with responses varying between young adults aged 21 to 35 years and adults aged 36 to 55 years. According to the VAS, the two retainers' average scores in the total population are 82 for Essix Retainer and 60 for Hawley Retainer in both groups. Conclusion: The Essix retainer as a retention appliance is considered more aesthetically pleasing than the Hawley retainer among both young and middle-aged adults.

Novel methodology for measuring intraoral wear in enamel and dental restorative materials.

OBJECTIVES: To test the hypotheses that (a) the chairside/handheld dental scanner combined with a metrology software will measure clinical wear in vivo in agreement with measurements from X-ray computed microtomography and; (b) polished monolithic zirconia does not cause accelerated wear of opposing enamel. MATERIALS AND METHODS: Thirty single crowns were randomized to receive a monolithic zirconia or metal-ceramic crown. Two non-restored opposing teeth in the same quadrants were identified to serve as enamel controls. After cementation, quadrants were scanned using an intraoral dental scanner. Patients were recalled at 6-months and 1-year for re-scanning. Scanned images were compared using a metrology software to determine maximum vertical wear of teeth. The accuracy of the scanning measurements from this new method was compared with X-ray computed microtomography (micro-CT) measurements. Statistical analysis was performed using Mann-Whitney U test to determine significant differences between wear of enamel against zirconia, metal-ceramic or enamel. Linear regression analysis determined agreement between measurements obtained using intraoral scanning and micro-CT. RESULTS: Regression analysis demonstrated that there is a quantitative agreement between depth and volume measurements produced using intraoral scanning and the micro-CT methodologies. There was no significant difference between the wear of enamel against polished monolithic zirconia crowns and enamel against enamel. CONCLUSIONS: Intraoral scanning combined with a matching software can accurately quantify clinical wear to verify that monolithic zirconia exhibited comparable wear of enamel compared with metal-ceramic crowns and control enamel. Agreement between the intraoral scanner and the micro-CT was 99.8%. Clinical Trials.gov NCT02289781.

Solução estética multidisciplinar em dentes anteriores: relato de caso / Multidisciplinary aesthetic solution in previous teeth: case report / Solución estética multidisciplinariaem dientes anteriores: caso clínico

ntrodução:Pacientes com dentes curtos e ameias abertas, relatam muita insatisfação com seusorriso.A gengivoplastia, quando bem indicada, permite oaumento no tamanho da coroa dentária de forma a reduzir a necessidade de aumento incisal com resina composta. A reanatomização com resinas compostas para fechamento de ameias e aumentosincisais representa uma alternativa conservadora, pois trata-se de uma técnicaadesiva diretaque pode ser realizada sem nenhum desgaste dentário. Além disso é uma técnica reversível preferível para pacientes jovens. Objetivo:Apresentar um relato de caso clínico de paciente do sexo masculino, 22 anos, insatisfeito com o tamanho, cor e a forma dos seus dentes anteriores. Descrição do Caso:Ao exame clínico foi observado coroa curta, escurecimento fisiológico, espaços interdentais e desalinhamento das bordas incisais. O plano de tratamento proposto foi encaminhar para a gengivoplastia, clareamento dental pela técnica associada e reanatomização estética dos dentes anteriores com resinacomposta diretaestratificada com diferentescamadas e cores, e posterior texturização superficialdurante as fases de acabamento e polimento finais. Conclusões:Com a gengivoplastiae asrestaurações, obtivemos dentes reanatomizados, reproduzindo naturalidadede forma, textura e cor. Com planejamento e técnica adequada, foi possível restabelecer o sorriso comproporções, forma e naturalidade satisfatórias (AU).

Introduction:Patients with short teeth and open battlements, report a lot of dissatisfaction with their smile. Gingivoplasty, when properly indicated, allows for an increase in the size of the dental crown in order to reduce the need for incisal augmentation with composite resin. Resuscitation with composite resins for the closure of niches and incisal increases represents a conservative alternative, as it is a direct adhesive technique that can be performed without any dental wear. Furthermore, it is a preferable reversible technique for young patients.Objective:To present a case report of a 22-year-old male patient, dissatisfied with the size, color and shape of his anterior teeth.Case Description:The clinical examination showed a short crown, physiological darkening, interdental spaces and misalignment of the incisal edges. The proposed treatment plan was to refer to gingivoplasty, tooth whitening by the associated technique and aesthetic reanatomization of the anterior teeth with stratified direct composite resin with different layers and colors, and later surface texturing during the final polishing and finishing phases. Conclusions:With gingivoplastyand restorations, we obtained reanatomized teeth, reproducing natural form, texture and color. With proper planning and technique, it was possible to restore the smile with satisfactory proportions, shape and naturalness (AU).

Introducción: Los pacientes com dientescortos y almenasabiertas, informanmuchainsatisfaccióncom susonrisa. La gingivoplastia, cuando está indicada adecuadamente, permite un aumento em eltamaño de la corona dental para reducirlanecesidad de aumento incisalcon resina compuesta. La rstauración con resinas compuestas para elcierre de nichos y aumentos incisales representa una alternativa conservadora, ya que es una técnica adesiva directa que se puede realizar sinningún tipo de desgaste dental. Además, es una técnica reversiblepreferible para pacientes jóvenes. Objetivo: Presentar un informe de caso de un paciente masculino de 22 años, insatisfechocom eltamaño, el color y la forma de sus dientes anteriores.Descripcióndel caso:El examen clínico mostró una corona corta, oscurecimiento fisiológico, espaciosinterdentales y desalineación de los bordes incisales. El plan de tratamento propuesto era referirse a lagingivoplastia, elblanqueamiento dental mediante la técnica asociada y lareanatización estética de losdientes anteriores con resina compuestadirecta estratificada con diferentes capas y colores, y luego texturizar lasuperficie durante las fases finales de pulido y acabado. Conclusiones: Com lagingivoplasty yrestauracióndental, obtuvimosdientesreanatomizados, reproduciendo forma, textura y color naturales. Con una planificación y técnica adecuadas, fueposible restaurar lasonrisacon proporciones, forma y naturalidade satisfactorias (AU).

Protein Profiles of Individuals with Erosive Tooth Wear

Abstract Objective: To determine if protein profiles identified in saliva could be used to determine risk and severity of erosive tooth wear. Material and Methods: Three types of saliva sampling were performed to obtain saliva from 34 18-year old individuals that received regular dental check-ups, along with clinical status of the dentition and risk factor related to erosive tooth wear using the VEDE scale. Protein profiles in saliva were determined using electrophoresis and the calculation of the percentage of a specific band at a specific molecular weight in relationship to the total protein in that sample (% of total) using molecular weight standards. This quantification was repeated for each protein band across a range of molecular weights for each sample to test for association with erosive tooth wear status. Results: There were no differences in the number of detectable proteins sourced from the parotid gland, nor the unstimulated and stimulated whole saliva. Five out of the 34 individuals had no signs of erosive tooth wear despite an acidic diet and were more likely to have proteins with molecular weight smaller than 1 KDa (p=0.03). Conclusion: There is potential for the use of protein profiling to determine risks for erosive tooth wear.

Desempenho clínico de coroas monolíticas posteriores de cerâmica infiltrada por polímero: ensaio clínico controlado e randomizado duplo cego / Clinical performance of posterior monolithic polymer-infiltrated ceramic crowns: double-blind randomized controlled clinical trial

Objetivo: avaliar por meio de um ensaio clínico controlado, randomizado e duplo-cego, o desempenho clínico de coroas monolíticas unitárias posteriores confeccionadas em cerâmica infiltrada por polímero, bem como o impacto da reabilitação na satisfação estética e qualidade de vida dos pacientes. Materiais e Métodos: Um total de 20 pacientes que receberam 36 coroas foram incluídos neste estudo. Todos os pacientes assinaram o termo de consentimento livre e esclarecido (TCLE). Os dentes sob reabilitação foram alocados por meio de um sorteio simples entre os grupos: Grupo Controle: (LD- dissilicato de lítio) e grupo Experimental (PIC -Vita Enamic/Vita Zahnfabrik). Registros fotográficos, radiográficos e informações clínicas foram coletados antes, durante e após a reabilitação. As coroas foram avaliadas quanto à taxa de sobrevida clínica (Critérios de USPSH modificados), satisfação estética (escala visual analógica- EVA), qualidade de vida (Oral Impacts on Daily Performances -OIDP), e tipo de falhas (biológicas e técnicas). A coleta de dados foi realizada por um único examinador calibrado e cego para o tipo de material, nos tempos de seguimento T0 (antes do início do tratamento), T1 (1 mês), T2 (6 meses) e T3 (12 meses). O OIDP e os critérios de USPHS foram analisados descritivamente. A satisfação estética foi analisada com MannWhitney/Teste de Friedman/ pós-testes de Wilcoxon. A análise de sobrevivência foi feita usando Kaplan-Meier seguido do teste de log-rank. O nível de significância foi estabelecido em (5%). Resultados: 36 coroas foram colocadas em 20 pacientes com uma média de idade de 47.17 anos (±13,91), sendo 22 (56,4%) coroas do grupo controle (LD) e 14 (35,9%) para o grupo experimental (PIC). A análise de Kaplan-Meier revelou uma taxa de sobrevida de 83,5% para PIC e de 86,2% para LD sem diferenças significativas entre eles (P>0.05). Quatro falhas foram registradas, 2 em cada grupo, sendo dois descolamentos, uma de PIC após 1 mês e uma de LD após 6meses. Houve também uma fratura do dente (LD) e mobilidade grau III (PIC) após 12 meses de acompanhamento. Não houve diferença significativa na satisfação estética, entre o grupo controle e grupo experimental (Mann-Whitney - P>0.05). A satisfação estética foi significativamente maior após 1(T1), 6(T2) e 12(T3) meses quando comparado ao baseline (T0) (Teste de Friedman - P<0.05). A reabilitação com coroas unitárias impactou positivamente na qualidade de vida dos pacientes. Conclusão: Este estudo demonstra que coroas monolíticas unitárias de PIC apresentaram desempenho clínico, estético e um impacto positivo na qualidade de vida dos pacientes após 12 meses, similar ao LD (AU).

Objective: To evaluate, through a controlled, randomized and double-blind clinical trial, the clinical performance of posterior single monolithic crowns made ceramic infiltrated polymer, as well as the impact of rehabilitation on patients' aesthetic satisfaction and quality of life. Materials and Methods: A total of 20 patients who received 36 crowns were included in this study. All patients signed an informed consent form. The teeth under rehabilitation were allocated using a simple draw between the groups: Control Group: (LD- lithium disilicate) and Experimental group (PIC -Vita Enamic). Photographic, radiographic, and clinical information records were collected before, during, and after rehabilitation. The crowns were assessed for clinical survival rate (modified USPSH criteria), aesthetic satisfaction (visual analog scale - VAS), quality of life (Oral Impacts on Daily Performances - OIDP), and type of failures (biological and technical). Data collection was performed by a single examiner calibrated and blinded to the type of material, at the follow-up times T0 (before the start of treatment), T1 (1 month), T2 (6 months), and T3 (12 months). The OIDP and USPHS criteria were analyzed descriptively. Aesthetic satisfaction was analyzed with the Man-Whitney/Friedman test/Wilcoxon post-tests. Survival analysis was performed using Kaplan-Meier followed by the log-rank test. The level of significance was set at (5%). Results: 36 crowns were placed on 20 patients (17 women and 3 men) with a mean age of 47.17 years (± 13.91), with 22 (56.4%) crowns from the control group (LD) and 14 (35.9%) for the group experimental (PIC). The Kaplan-Meier analysis revealed a survival rate of 83.5% for PIC and 86.2% for LD with no significant differences between them (P>0.05). Four failures were recorded, 2 in each group, two detachments after 1(PIC) and 6 months (LD), a tooth fracture (LD), and grade III mobility after (PIC) 12 months of follow-up. There was no significant difference in aesthetic satisfaction between the control group and the experimental group (Mann-Whitney, P>0.05). Aesthetic satisfaction was significantly higher after 1 (T1), 6 (T2), and 12 (T3) months when compared to baseline (T0) (Friedman test - P <0.05). Rehabilitation with single crowns had a positive impact on patients' quality of life. Conclusion: This study demonstrates that single monolithic crowns of PIC presented a good clinical, aesthetic performance and a positive impact on patients' quality of life after 12 months, similarly to PIC (AU).

Comparisons between photographic equipment for dental use: DSLR cameras vs. smartphones / Comparações entre equipamento fotográfico para uso odontológico: câmeras DSLR vs. smartphones

Objective: to compare the image quality obtained by six cameras used for dental documentation, including four DSLR cameras and two smartphones with different sensor size. Methods: the equipment determined the groups: APSCcan18-55 ­ Sensor APS-C Canon (EOS T5i) + 18-55 mm lens; APSCcan100 ­ Sensor APS-C Canon (EOS T5i) + 100 mm macro lens; APSCnik18-55 ­ Sensor APS-C Nikon (D5100) + 18-55 mm lens; APSCnik100 ­ Sensor APS-C Nikon (D5100) + 100 mm macro lens; ip1/3" ­ iPhone with 1/3-inch sensor; ga1/2.6"- Galaxy with 1/2.6-inch sensor. Two set of images -"dental documentation" and "small objects"- were obtained. The photographs were evaluated by three groups: US, undergraduate students; DS, dentists; and DP, dentists with photography experience. Scores between 0 and 10 were assigned. The results were compared by RM Anova and Tukey (α = 0.05). Results: the highest overall scores were obtained with APSCnik100 (8.5). For "dental documentation", APSCcan18-55 and APSCnik18-55 showed the lowest values, even compared to ga1/2.6" (for US, DS and DP evaluators) and ip1/3" (for US evaluators). For "small objects", DSLRs resulted in higher mean values compared to smartphones for US and DS. Conclusions: DSLR cameras with 18-55 mm lens and no circular flash should not be used for documentation photographs. DSLR cameras, regardless of lens, are superior to smartphones for small objects photographs. (AU)

Objetivo: comparar a qualidade da imagem obtida por seis câmeras utilizadas para documentação odontológica, incluindo quatro câmeras DSLR e dois smartphones com diferentes tamanhos de sensor. Métodos: a divisão dos grupos foi realizada pelo tipo de equipamento: APSCcan18-55 - Sensor APS-C Canon (EOS T5i) + lente 18-55 mm; APSCcan100 - Sensor APS-C Canon (EOS T5i) + lente macro de 100 mm; APSCnik18-55 - Sensor APS-C Nikon (D5100) + lente 18-55 mm; APSCnik100 - Sensor APS-C Nikon (D5100) + lente macro de 100 mm; ip1 / 3 "- iPhone com sensor de 1/3 de polegada; ga1 / 2.6 "- Galaxy com sensor de 1 / 2,6 polegadas. Dois conjuntos de imagens ­ "documentação odontológica" e "pequenos objetos" ­ foram realizados. As fotografias foram avaliadas por três grupos de examinadores: estudantes de graduação (US); dentistas (DS); e dentistas com experiência em fotografia (DP). Foram atribuídas pontuações entre 0 e 10. Os resultados foram comparados por Anova e Tukey (α = 0,05). Resultados: os maiores escores foram obtidos com o APSCnik100 (8,5). Para "documentação odontológica", APSCcan18-55 e APSCnik18-55 apresentaram os menores valores. Para "objetos pequenos", as DSLRs resultaram em valores médios mais altos em comparação aos smartphones. Conclusões: as câmeras DSLR com lentes de 18 a 55 mm e sem flash circular não devem ser usadas para fotografias de documentação. As câmeras DSLR, independentemente da lente, são superiores aos smartphones para fotografias de objetos pequenos. (AU)

Quantification of maxillary dental midline deviation in 2D photographs: Methodology trial.

INTRODUCTION: Discrepancy of the upper dental midline to the facial midline plays an important role in smile aesthetic assessment. This study presents different reference points to quantify the deviation of upper dental midline to the facial midline in 2D frontal photographs. The aim was to find the most accurate, precise, and practical reference points to measure dental midline discrepancy in 2D photographs. METHODOLOGY: A modified headset with a protractor was developed in order to achieve photographs in nine standardised head positions. Six reference points were used to detect the facial midline in the 2D photographs (eyebrows "EB", inner-canthus of the eyes "ICE", alae of the nose "AN", columella "C", nasolabial folds "NLF", and the philtrum "PH"). The deviation of the maxillary dental midline from the facial midline was measured and compared with clinical measurements. STATISTICAL ANALYSIS: Standard deviations (SD), Root Mean Square Error (RMSE), Method of Moments' Estimator (MME), 2-way repeated measures ANOVA, and multi-level linear model were used to estimate the true errors. RESULTS: The different reference points responded significantly differently to changes in head position and all showed measurement errors, which increased with greater head rotation. Alae of the nose showed the least measurement error and the greatest precision in all head positions. CONCLUSION: The alae of the nose are the recommended reference points to identify the facial midline in order to quantify dental midline deviation from frontal photographs.

Class III Malocclusion: Missense Mutations in DUSP6 Gene

Objective: To determine the DUSP6 gene mutation in three generations of Malaysian Malay subjects having Class III malocclusion. Material and Methods: Genetic analyses of DUSP6 gene were carried out in 30 subjects by selecting three individuals representing three generations, respectively, from ten Malaysian Malay families having Class III malocclusion and 30 healthy controls. They were submitted Clinical Evaluation to clinical examination, lateral cephalometric radiographs, dental casts, and/ or facial and intra-oral photographs. Buccal cell was taken from each participant of Class III malocclusion and control groups. DNA extractions from buccal cell were carried out using Gentra puregene buccal cell kit. Bio Edit Sequence Alignment Editor software was used to see the sequencing result. Results: A heterozygous missense mutation c.1094C>T (p. Thr 365 Ile) was identified in DUSP6 gene in three members of one family with Class III malocclusion, whereas no mutation was found in the control group. Conclusion: Current study successfully identified a missense mutation in DUSP6 gene among one Malaysian Malay family affected by Class III malocclusion. The outcome of this study broadened the mutation spectrum of Class III malocclusion and the importance of DUSP6 gene in skeletal functions.

Variability of color matching with different digital photography techniques and a gray reference card.

STATEMENT OF PROBLEM: Color matching in restorative and prosthetic dentistry is important for the success of dental treatments, although communication with the dental laboratory remains subjective, and studies of the performance of objective communication methods are lacking. PURPOSE: The purpose of this study was to evaluate color differences (ΔE) and compare color luminosity (L*) values among different types of digital photography equipment used to document tooth color, with and without a gray reference card, and to determine whether the gray card could be used to standardize color assessment in dental photography. MATERIAL AND METHODS: Sixty photographs were made (n=10) using different equipment: a D7000 digital camera (Nikon Corp) with an 85-mm lens and wireless close-up flash (DC+WCF); close-up flash surrounded by 80 grams per square meter (gsm; specification of paper thickness) white printing paper (DC+WPP); ring flash (DC+RF); close-up flash attached to a dual-point rigid flash bracket (DC+DPRF); cross-polarizing filter attached to a close-up flash (DC+CPF); and iPhone 7 (I7). For all photographs, a gray reference card with known color values was positioned at the patients' mandibular teeth, acting as a parameter for the analysis of white-balanced digital photographs. Each photograph underwent white balance with the reference card and software. ΔE were obtained from each piece of equipment by comparing images with and without white balance (original photo) with software and the smallest ΔE achieved was used as the gold standard for comparisons of luminosity. Values of luminosity were subsequently obtained for the different equipment with and without white balancing the photographs; these values were compared using a general estimating equation with Huber-White standard error (α=.05). RESULTS: The use of a cross-polarizing filter was used as the gold standard for luminosity evaluation, as the smallest ΔE (3.4) among photographs were observed when those with and without white balance were compared. Luminosity results from the cross-polarizing filter method (DC+CPF) were not significantly different from those of the DC+DPRF (P=.73), DC+WPP (P=.106), and DC+WCF (P=.551) groups but were statistically different from DC+RF (P=.028) and I7 groups (P<.001). Use of a gray card was significant when a ring flash (P=.008) or the iPhone (P=.023) were used but not statistically significant for the other groups (P>.05). CONCLUSIONS: The use of a cross-polarizing filter results in more color-standardized photographs, while the ring flash system and the iPhone 7 result in less standardized photographs. The gray reference card had a significant effect when a ring flash system or iPhone 7 was used.

Interceptação da impacção de um incisivo permanente superior / Interceptive approach of impacted maxillary permanent incisor

Um dente impactado é aquele que não conseguiu irromper na cavidade oral, geralmente devido a fatores genéticos ou obstáculos mecânicos. Acredita-se que a sua etiologia esteja mais ligada a fatores locais, sendo conhecidas as maiores incidências: terceiros molares inferiores, caninos superiores, terceiros molares superiores, segundos pré-molares inferiores e superiores e os incisivos centrais superiores, nesta ordem. A impacção de incisivos superiores é encontrada no cotidiano dos profissionais que tratam de pacientes jovens, tornando essenciais os embasamentos técnico e teórico-científico para condutas a serem tomadas durante a fase de dentadura mista para a obtenção de um sorriso harmônico e do restabelecimento psicossocial dos pacientes. A abordagem ortodôntica interceptora é indicada para minimizar os danos e reabilitar a estética do sorriso. Assim, o objetivo deste artigo é trazer uma revisão de literatura sobre a impacção dentária e relatar a fase interceptora ortodôntica de um paciente que apresentava um incisivo central superior permanente impactado (AU).

Impacted tooth is characterized by the failure of its eruption in the oral cavity due to genetic factors or mechanical obstacles. It is believed that its etiology is mainly associated to local factors, with the highest incidence of impaction found in lower third molars, upper canines, upper third molars, second lower and upper premolars, and upper central incisors, in this sequence. Impaction of permanent upper incisors tends to be found in the daily life of professionals who treat young patients, demanding previous technical and theoreticalscientific knowledge for conducts to be taken to obtain a harmonic smile and psychosocial balance. The orthodontic interceptive approach is indicated to minimize damage and rehabilitate the smile aesthetics. Thus the aim of this article is to perform a literature review on dental impaction and to report a clinical case of the interceptive phase of a patient with an impacted permanent upper central incisor (AU).

Is it feasible to use smartphone images to perform telediagnosis of different stages of occlusal caries lesions?

The purpose of this study was to compare the performance of two different models of smartphone and a conventional camera with that of direct clinical examination in detecting caries lesions at different stages of progression in deciduous molars. The photographic equipment consisted of two smartphones (iPhone and Nexus 4) and a conventional macro camera setup. First, in the laboratory phase of the study, we compared the images of 20 exfoliated primary teeth having caries lesions at different stages. Then, in the clinical phase of the study, the images of 119 primary molars from fifteen children (3 to 6 years old) were used. All of the photographic images were taken using the previously described devices. In both groups, two examiners, blinded to the photographic equipment used, assessed the images independently on a computer screen, and classified them according to the International Caries Detection and Assessment System (ICDAS). The teeth were then examined directly by two other experienced examiners, and the consensus reached was considered the reference standard. Parameters of validity, such as percentage of correct answers, agreement with the reference standard, sensitivity, specificity and inter-examiner agreement (using the weighted kappa test) were calculated. The examiners performed similarly in both in vitro and in vivo studies. Inter-examiner reliability was approximately 0.7 for all the devices in the laboratory setting, and for the macro camera photography system in the clinical setting, but it was approximately 0.9 for the iPhone and Nexus images taken in vivo. With regard to the percentage of correct answers, the highest values were observed for sound and extensive caries lesions in both laboratory and clinical settings. The percentage of correct answers for initial and moderate lesions was particularly low in the clinical evaluation, irrespective of the camera devices used. Therefore, we concluded that photographic diagnosis using smartphone images is feasible and accurate for distinguishing sound tooth surfaces from extensive caries lesions; however, photographic images are not a good method for accurately detecting initial and moderate caries lesions.

Digital dental photography.

Photography has always been an integral part of dentistry. The journey goes back to the time when film photography was used only for documentation and referral purpose which has now evolved to digital photography. Its application in dental practice is simple, fast, and extremely useful in documenting procedures of work, education of patients, and pursuing clinical investigations, thus providing many benefits to the dentists and patients. The article describes the added benefits of digital dental photography over film photography, basic armamentarium for obtaining good photographs, and how digital dental photography is beneficial in the field of prosthodontics.