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OBJECTIVE: This study aims to evaluate the effects of exposure time and irradiance on the dentin bonding properties (microtensile bond strength (µTBS) and nanoleakage (NL)) of the Clearfil Universal Bond Quick (CUQ) adhesive and Scotchbond Universal Adhesive (SBU) immediately and after 2 years of water storage. MATERIAL AND METHODS: Hence, 128 human molars were randomly assigned to 16 groups based on adhesive strategy, irradiance/exposure times, and storage time for each universal adhesive tested. The adhesives were applied using the etch-and-rinse and self-etch strategies and were light-cured using four different irradiance/exposure times: 1400 mW/cm2 for 5 s (1400 × 5), 1400 mW/cm2 for 10 s (1400 × 10), 3200 mW/cm2 for 5 s (3200 × 5), and 3200 mW/cm2 for 10 s (3200 × 10). Then, each sample was restored and sectioned into a resin-dentin bonded stick to be tested for µTBS and NL (immediately and after 2 years of water storage). The mean µTBS and NL of all resin-dentin bonded sticks from the same hemi-tooth (factor time) were statistically analyzed using a three-way ANOVA and Tukey's test (a = 0.05). RESULTS: Despite a significant decrease in the µTBS values for all groups after 2 years of water storage, the 3200 × 5 group showed higher µTBS values, whereas the 3200 × 10 group showed lower µTBS values for both universal adhesives tested. Although a significant increase in the NL values was observed for all groups after 2 years of water storage, the 3200 × 10 group showed higher NL values than the other groups (p < 0.001). CONCLUSION: Results indicate that light-curing the adhesive layer with 14-16 J/cm2 led to an improvement in the stability of the resin-dentin adhesive interface. A longer exposure time (10 s) coupled with a higher irradiance (3200 mW/cm2) resulted in a greater degree of degradation of the adhesive interface. CLINICAL SIGNIFICANCE: To guarantee better stability of the adhesive interface, clinicians could be preferred a light-cured universal adhesive layer with 14-16 J/cm2. Higher irradiances should be avoided.

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OBJECTIVE: The aim of this study was to evaluate the diagnostic ability of dental undergraduate students to detect horizontal and oblique root fractures (ORFs) using different imaging techniques. MATERIALS AND METHODS: Nine teeth were selected and randomly divided in three groups in order to create a fracture line without fragments separation: control (without fracture), horizontal root fracture (HRF), and ORF. The root fracture was created using perpendicular force and was confirmed by transillumination. A model with two adjacent teeth was created, and different imaging techniques were performed: conventional periapical radiograph; mesially and distally shifted periapical radiographs; cone-beam computer tomography (CBCT). Twenty students that had participation on dental trauma clinic at the year of 2019 were invited to identify root fractures by a five-point scale: (i) fracture definitely not present, (ii) fracture probably not present, (iii) uncertain whether fracture is present or not, (iv) fracture probably present, and (v) fracture definitely present. Data were analyzed by Kappa test for agreement evaluation. RESULTS: Comparing each student to the gold standard, there was a variation in reproducibility and performance from poor to substantial (0.042-0.667). Reproducibility values ranged from poor to good for all periapical radiographs both in the diagnosis of ORF (-0.33-0.667) and in HRF (0-1). CONCLUSIONS: In CBCT images, the students' ability was lower in HRF detection in comparison with the oblique ones. The students showed limited capacity to diagnose root fractures; however when CBCT was used, the performance was more satisfactory than when periapical radiographs were used.

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PURPOSE: To evaluate the influence of the Er,Cr:YSGG laser with or without the 5% fluoride varnish on the acid resistance of dentin after erosive challenge. METHODS: 36 incisors were selected and sectioned, obtaining 72 specimens of 4 mm × 4 mm and randomly divided into eight groups (n = 9). In G1: application of Er,Cr:YSGG (0.1W; 5Hz, air 55%); G2: laser (0.25W; 5Hz, air 55%); G3: fluoride varnish + laser (0.1W; 5Hz, air 55%); G4: fluoride varnish + laser (0.25W, 5Hz, air 55%); G5: fluoride varnish + laser (0.1W; 5Hz, without air); G6: fluoride varnish + laser (0.25W, 5Hz, without air); G7: fluoride varnish and G8: no treatment. When used, the laser was irradiated without water cooling, scanning mode during 10 seconds. The surface roughness data were subjected to ANOVA. For wear profile, we used Kruskal-Wallis test and Dunn post-hoc, all with α= 0.05. RESULTS: The results showed no statistically significant difference when comparing the groups as regards to the surface roughness (P> 0.05). Regarding the percentage of lost volume, the G5 and G6 groups presented the best results (G5 = 7.8% and G6 = 8.5%), with the lowest loss of dentin volume compared to other groups (P< 0.05). The G8 group (no treatment) had the highest lost volume (G8 = 39.1% followed by the G7 group (fluoride varnish), which had 25.9%. CLINICAL SIGNIFICANCE: The use of Er,Cr:YSGG laser and fluoride varnish can be an effective method to increase the acid resistance of dentin after erosive challenges, and limit problems related to hypersensitivity.

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BACKGROUND/AIM: Maxillary canines have a high incidence of impaction which may be associated with unexpected damage during maxillofacial trauma. The aim of this study was to evaluate how an impacted canine could influence the stress distribution in the dentoalveolar complex during a simulated impact before and after surgical removal plus the protective effect offered by a mouthguard. MATERIALS AND METHODS: Cross-sectional finite element models of the central incisor and support structures of a patient with an impacted canine in a transverse position were made using ImageJ and Marc/Mentat software. The following impact conditions were simulated: (a) incisor with impacted canine; (b) incisor with surgical socket after impacted canine extraction; and (c) incisor after bone healing. The impacts were also simulated with a 3 mm custom-fitted ethylene vinyl acetate mouthguard. A non-linear dynamic impact finite element analysis was performed in which a rigid object hit the model at 1 m/s. Maximum and minimum principal stresses as well as von Mises stresses were analyzed. RESULTS: Higher values of compressive and tensile stresses occurred on the cortical bone in the models after impacted canine extraction. The highest stress concentrations in the enamel and dentin structures were observed after bone healing. The mouthguard reduced the stress in the alveolar bone and dental structures. CONCLUSIONS: Use of mouthguards during impact reduced the compressive and tensile stresses in the alveolar bone, mainly in the fragile regions of the impacted canine or surgical socket.

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STATEMENT OF PROBLEM: Posterior composite restorations may be negatively affected by acidic and colored drinks. Little information is available about the effect of acidic drinks on bulk-fill composite resins. PURPOSE: The purpose of this in vitro study was to investigate the effect of acidic drinks on the different properties of conventional and bulk-fill composite resins. MATERIAL AND METHODS: A conventional composite resin and 2 representative bulk-fill composite resins were used to prepare disk-shaped specimens. The degree of conversion (DC) was monitored by spectroscopy (n=5). The specimens were divided into 5 groups: control, artificial saliva, acai juice, red wine, and Coca-Cola and were maintained for 30 days of challenge (3 periods of 15 min/d). Surface topography parameters were measured by interferometry (n=5). Elastic modulus (E) and Vickers hardness (VH) were determined by microhardness dynamic indentation (n=5). Diametral tensile strength (DTS) was determined at 0.5 mm/min (n=5). Shade matching was evaluated by using the Vitapan Classic Shade Guide. The DC, Sa, Ssk, Sku, Sdq, and DTS were statistically analyzed using 2-way ANOVA, followed by the Tukey HSD tests. E and VH were statistically analyzed by 3-way ANOVA, followed by Tukey HSD tests (α=.05). Shade matching was analyzed with the Kruskal-Wallis test. RESULTS: DC values were similar for the immediate evaluation and after 24 hours, regardless of the composite resin (P<.05). All surface topography parameters increased significantly after the acidic drinks and were greatest for Coca-Cola. The E, VH, and DTS decreased significantly for all composite resins tested (P<.05). Acai juice and red wine produced more surface staining than Coca-Cola. CONCLUSIONS: Acidic drinks negatively influenced the physical and mechanical properties of conventional and bulk-fill composite resins.

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BACKGROUND/AIMS: Dental trauma is the cause of several consequences to the injured tooth. However, the stresses and strains at adjacent teeth non-directly impacted as a possible cause of sequelae are still unknown. The aim of this study was to evaluate the stress distribution in incisors adjacent to an upper central incisor when it suffers a frontal impact in order to identify a potential explanation for sequelae in non-traumatized teeth. MATERIALS AND METHODS: A three-dimensional (3D) finite element model of the maxillary central incisors, lateral incisors and canines was created from a cone-beam scan of a patient with normal occlusion. Non-linear dynamic impact analysis was performed, simulating the right central incisor being impacted by a steel ball with a velocity of 10 m/s. A functional chewing load (100 N) on the palatal surface of the central incisor was simulated for comparison. Displacements, strains and modified von Mises stresses were calculated for the adjacent teeth. RESULTS: During impact on the central incisor, the adjacent teeth showed root displacement. Considerable stress concentrations were observed on the palatal surfaces, proximal and labial surfaces of teeth adjacent to the traumatized incisor. Stresses in the adjacent teeth were higher than stresses calculated during functional biting. Compressive stresses were concentrated at the proximal areas of the adjacent incisors. High levels of deformation were found in the root dentin of adjacent teeth during the traumatic event. CONCLUSIONS: A frontal impact on an anterior tooth generated stresses at the roots of adjacent teeth. These stresses may play a role in clinically observed sequelae of teeth adjacent to traumatized teeth.

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BACKGROUND/AIM: Dental trauma is a common emergency in children with primary teeth. The aim of this study was to determine stress propagation to the permanent tooth germ and surrounding bone and soft tissues during dental trauma to primary central incisors with three levels of physiological root resorption. MATERIAL AND METHODS: Stresses were determined using finite element analysis (FEA). Cross-sectional models were created using cone-beam computed tomography images of 3.5, 5, and 6 years olds, representing three different physiological root resorption stages of a maxillary primary central incisor. The models included periodontal ligament, bone, and soft tissues. An impact with an asphalt block moving at 1 m/s,was simulated for two impact two directions, frontal on the labial tooth surface, and on the incisal edge. Stresses and strains were recorded during impact. RESULTS: The impact caused stress concentrations in the surrounding bone and soft tissues and permanent tooth germ, regardless of the direction of impact and the primary tooth resorption stage. Impact stresses in dental follicles and surrounding bone increased in models with more physiological root resorption of the primary tooth. Incisal impact generated higher stress concentrations in surrounding bone and soft tissues and permanent tooth germ regardless of physiological root resorption stage. The primary incisor with no physiological root resorption showed high stress concentrations at its root apex. CONCLUSION: During impact to a primary incisor, stresses most significant for potential damage to the formation of permanent enamel and dentin were at the dental follicle and surrounding bone tissue with the three levels of physiological root resorption.

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This study investigated the use of scientific evidence and the practice of evidence-based dentistry (EBD) among dentists working in Brazil. An online questionnaire was emailed to dentists registered with Brazilian state dental councils. The questionnaire assessed the demographic, educational, and work characteristics of the sample, along with habits in reading scientific articles and other updating resources. Data were analyzed descriptively and by using Bonferroni, Kruskal-Wallis, ANOVA, and T-test statistical methods (α = 0.05). A total of 795 responses were received between June, 2015 and January, 2016. The response rate was not calculated because it was not possible to determine precisely how many dentists received these e-mails. Over 77% of the responding dentists completed postgraduate training. They referred mainly to books, scientific or clinical journals, conferences, and short-term courses for updating their knowledge. Dentists who reported having a habit of reading scientific journals (60.9%) showed a preference for reading case reports, clinical research articles, and literature reviews. Most dentists (77.5%) reported changing their clinical behaviors or procedures based on information gleaned from journal articles. The types of articles that led them to change their clinical practices were primarily clinical research articles and case reports. Working in the public sector was also associated with a lower prevalence of a habit of reading scientific journals and practicing EBD (i.e., self-reported practice). The results suggest that dentists are interested in reading journal articles, especially those addressing clinical outcomes, and that there is room for improving the practice of EBD, particularly in the public sector.

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BACKGROUND/AIM: Lectin (ScLL) has been recently evaluated in the oral cavity due to its anti-inflammatory activities. ScLL could be a promising agent for blocking osteoclast activity and preventing root resorption. The aim of this study was to evaluate the effect of ScLL on the viability of the RAW 264.7 macrophage lineage, osteoclast-like maturation and the release of TNF-α and nitric oxide (NO). MATERIALS AND METHODS: The viability of RAW 264.7 cells was determined by MTT and Alamar Blue assays after ScLL treatment for 24 hours. ScLL effects on RANKL-induced osteoclast-like maturation were assessed by tartrate-resistant acid phosphatase (TRAP) staining and F-actin ring formation. The supernatant was collected to detect the release of TNF-α using ELISA and NO using a nitrite assay. RESULTS: ScLL suppressed osteoclast-like maturation by decreasing TRAP activity as well as F-actin ring formation. ScLL at 10 µg/mL showed the highest values of NO release compared with all other groups (P < .05). Lower levels of TNF-α were found for the negative control. CONCLUSIONS: ScLL at 5 µg/mL suppressed osteoclast-like maturation in vitro and had no cytotoxic effect on RAW cell cultures.

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BACKGROUND/AIM: Custom-fitted mouthguards are devices used to prevent dental injuries. The aim of this study was to verify the influence of the antagonist contact on the stresses and strains of the anterior teeth, shock absorption and displacement of EVA custom-fitted mouthguards during a horizontal impact. MATERIALS AND METHODS: Finite element models of human maxillary central incisors with and without a mouthguard for different occlusion conditions (with and without antagonist contact) were created based on tomography. A nonlinear dynamic impact analysis using the single-step Houbolt method was performed in which a rigid object hit the model at 1 m s-1 . Strain and stress were evaluated by means of Von Mises and Critical modified Von Mises criterion and shock absorption during impact were calculated as well as the mouthguard displacement. RESULTS: The model without mouthguard and without antagonist contact showed the highest stress and strain values at the enamel and dentin in the tooth crown on impact compared to the model without mouthguard and with antagonist contact. Mouthguard presence reduced the stress and strain values regardless of the occlusion condition. The mouthguard displacement decreased with the mandibular antagonist contact. CONCLUSIONS: Mouthguards are efficient at decreasing the stress and strain values on the tooth in front of an impact reaching more than 90% of shock absorption. A mouthguard with balanced occlusion and maximum number of contacts with mandibular anterior teeth should be considered because it reduces mouthguard displacement.

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O objetivo deste trabalho é apresentar um caso clínico, demonstrando a associação entre diferentes tipos de restaurações e sistemas cerâmicos, na reabilitação do sorriso de uma paciente do gênero feminino com queixas em relação à cor e ao posicionamento dos elementos anteriores superiores. Ao exame clínico constatou-se exposição do metal da coroa metalocerâmica no elemento 21 e escurecimento, mau posicionamento dos elementos 13, 12, 22 e 23, além de diferença de cor entre os dentes. Foi proposto como plano de tratamento a substituição das coroas metalocerâmicas por novas coroas nos elementos 11 e 21, e a confecção de facetas indiretas em cerâmica reforçada por dissilicato de lítio (IPS e-max Press, Ivoclar Vivadent) nos dentes 13, 12, 22 e 23. A associação entre coroas metalocerâmicas e facetas convencionais, mostrou-se uma forma de tratamento efetiva na reabilitação do sorriso, garantindo ao final do tratamento correta seleção de cor, boa adaptação marginal das restaurações, alinhamento adequado e também, bons resultados estéticos e boa função mastigatória, contribuindo para a satisfação da paciente.

The aim of this study is to present a clinical case demonstrating the association between different types of restorations and ceramic systems in the smile rehabilitation of a female patient with complaints about the color and and placement of the maxillary anterior elements. On clinical examination it was found metal exposure of the metal-ceramic crown on element 21, darkening and poor positioning of elements 13,12, 22 and 23, as well as, color difference between the teeth. Was proposed as treatment plan the replacement of metal-ceramic crowns by new crowns in the elements 11 e 21, and the making of indirect veneers in ceramic reinforced by lithium dissilicate (IPS e-max Press, Ivoclar Vivadent) on teeth 13, 12, 22 and 23. The association between metal-ceramic crowns and conventional veneers, proved to be a form of effective treatment in the smile rehabilitation, ensuring in the end of the treatment correct color selection, good marginal adaptation of restorations, proper alignment and also good esthetic results and good chewing function , contributing to patient satisfaction.

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A perda óssea, em resposta à doença periodontal, compromete a estabilidade dentária, e gera desconforto ao paciente. A contenção interdentária pode ser uma opção de tratamento definitivo, destinado principalmente à população carente. Além de possuir baixo custo, é um procedimento conservador e estético que proporciona melhor distribuição de tensão ao tecido de suporte. A paciente O. P. C., 49 anos, gênero feminino, compareceu ao Hospital Odontológico da Universidade Federal de Uberlândia, apresentando sinais clínicos de periodontite, tal como mobilidade dos incisivos centrais e laterais inferiores, inflamação e sangramento a sondagem. O reestabelecimento da saúde periodontal foi obtido através da adequação do meio bucal e o protocolo para estabilização dentária e da perda óssea foi determinado. Optou-se pela técnica de contenção intracoronária com associação de fibras de reforço impregnadas por sistema adesivo e resina composta, do dente 13 ao 23. Nessa mesma sessão, também foi proposto à reconstrução estética e fechamento de diastema empregando resina composta nos dentes anteriores inferiores. Após 13 anos de acompanhamento clínico e radiográfico verificou-se paralização e estabilização da perda óssea, reestruturação da crista óssea e redução da mobilidade dentária. Sendo assim, este relato de caso de contenção interdentária com fibra de vidro e resina composta é mais uma informação segura de que este protocolo pode ser indicado em casos de perda óssea, desde que este seja seguido rotineiramente o protocolo de boa higiene bucal e acompanhamento periódico pelo cirurgião-dentista.

Bone loss in response to periodontal disease compromises the dental stability, and causes discomfort to the patient. After basic periodontal therapy, dental splinting might be a definitive option of treatment, mainly intended for the lower class population. Besides of the low cost, it is a conservative and aesthetic procedure that also improves the stress distribution in the support tissues. The patient O. P. C., 49 years, female gender, attended the Dental Hospital of the Universidade Federal de Uberlândia, presenting clinical signs of periodontitis, such as mobility in the lower incisors, inflammation and bleeding on probing. After reestablishment of periodontal health through the adequacy of the oral cavity, the protocol to stabilize the teeth and bone loss was established. We selected the splinting technique using glass fiber-reinforced associated with composite resin extending from canine to canine. In the same session, it was proposed the esthetic reconstruction and closing diastema with composite resin in the mandibular anterior teeth. After 13-years of clinical and radiographic follow-up, it was verified the stagnation and stabilization of bone loss, restructuring of the bone crest, and reduction of mobility of teeth. Thus, this case report of interdental splint with fiberglass and composite resin is more one safety information that this protocol can be indicated in cases of bone loss, since it is routinely followed by a protocol of good oral hygiene and regular monitoring by the dentist

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Purpose: This study evaluated the influence of cobalt-60 gamma irradiation on mechanical properties of restorative materials. Material and Methods: Two glass ionomer cement (Ketac Molar and RelyX Luting), a composite resin (Filtek Z350) and two feldspathic ceramics (VITA VMK-95 and StarLight) were evaluated. The samples were made in accordance with the ISO normative for the four-point bending test (n = 20), diametral tensile (n = 20) and microhardness tests; Knoop hardness (KHN) for glass ionomer and composite, and Vickers hardness (VHN) for ceramics (n = 10). The samples were divided into two groups: irradiated (Ir), subjectedto cobalt-60 gamma irradiation in a similar protocol used for patients with head and neck tumor; and control group (C), samples not subjected to the irradiation protocol. Results: Data were analyzed using one-way ANOVA, for diametral tensile and four-point bending test, and two-way ANOVA followed by the Tukey?s HSD test (?=.05), for Knoop and Vickers microhardness. Gamma irradiation significantly reduced the diametral tensile strength only for Ketac Molar (P<.001). Composite resin presented flexural strength values significantly decreased when submitted to the radiotherapy (P<.003). For all materials tested, the microhardness was not influenced by the region (top and bottom). Irradiation increased the KHN values for Ketac Molar (P<.000) and decreased for the RelyX Luting 2 (P<.002). The VHN was not influenced by the irradiation. Conclusions: Gamma irradiation therapy influenced the mechanical properties of the glass ionomers and the composite resin, although not alters any ceramic properties.

Objetivo: Este estudo avaliou a influência da radiação do cobalto 60 nas propriedades mecânicas de materiais restauradores. Materiais e Métodos: Dois ionômeros de vidro (Ketac Molar e RelyX Luting), uma resina composta (Filtek Z350) e duas cerâmicas feldspáticas (VITA VMK-95 e StarLight) foram avaliadas. As amostras foram confeccionadas de acordo com as normas da ISO para os testes de flexão de quatro pontos (n=20), tração diametral (n=20) e teste de microdureza; Knoop (KHN) para o ionômero de vidro e resina composta e Vickers (VHN) para a cerâmica (n=10). As amostras foram divididas em dois grupos: irradiado (Ir), submetidas à radiação gama do cobalto com um protocolo similar ao usado para o tratamento de câncer de cabeça e pescoço; e um grupo controle (C) que não recebeu radiação. Resultados: Os dados foram analisados utilizando One Way ANOVA para tração diametral e flexão de quatro pontos ukey (?=,05), para microdureza Knoop e Vickers. A resina composta apresentou e Two Way ANOVA seguido do teste de T uma diminuição nos seus valores de resistência flexural (p<0,003). Para todos os materiais testados, a microdureza não apresentou diferença estatística quanto à região (topo ou base). A irradiação aumentou os valores de microdureza do Ketac Molar (p<0,000) e diminuiu para o RelyX Luting2 (p<0,002). A VHN não foi influenciada pela irradiação. Conclusão:Irradiação gama influenciou as propriedades mecânicas dos ionômeros de vidro e resina composta, no entanto não alterou as propriedades das cerâmicas avaliadas.

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Dental structure deterioration, like enamel erosion, is caused through dissolution by endogenous or exogenous acid substances in the oral cavities. The demineralization caused exclusively by endogenous acid as the chronic regurgitations and gastric dysfunctions that cause erosive tooth lesions are known as perimolysis. This clinical case report describes the oral rehabilitation of a patient with perymolisis using direct composite resin restorations. This patient had erosive lesions on lingual, incisor, and occlusal surfaces of almost all teeth, a situation which, among other disturbances, caused alteration in vertical dimension of occlusion, muscular pain, and esthetic damage. Multifactorial aspects were applied to diagnosis, planning, and functional and esthetic rehabilitation of anteriorand posterior teeth.

A deterioração estrutural dental, como a erosão do esmalte, é causadapor dissoluções de substâncias ácidas endógenas ou exógenas nas cavidades orais. A desmineralização causada exclusivamente por ácido endógeno como as regurgitações crônicas e disfunções gástricas que causam lesões dentárias erosivas são conhecidos como perimólise. Este relato de caso clínico descreve a reabilitação oral de um paciente com perimólise usando restaurações de resina composta direta. Este paciente apresentava lesões erosivas na língua, incisivos e superfícies oclusais de quase todos os dentes, uma situação que, entre outros distúrbios, causa alteração na dimensão vertical de oclusão, dor muscular e dano estético. Aspectos multifatoriais foram aplicados ao diagnóstico, planejamento e reabilitação funcional e estética dos dentes anteriores e posteriores.

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The aim of this article is to describe a step-by-step protocol for emergency care of a young patient with multidisciplinary direct restorative approach for recovering crown-root fractures. Fractures of maxillary incisors are a frequent consequence of trauma in children and teenagers. Glass fiber post associated with composite resin restoration represents a conservative approach for this rehabilitation. This paper presents a case of a 14-year-old male patient with a crown-root fracture in a left maxillary lateral incisor. The patient was submitted to a periodontal surgery for coronal lengthening. After that, the post luting and restoration technique was performed. Finally, a mouthguard was made for preventing new trauma. The multidisciplinary treatment described for crown-root fracture rehabilitation is simple, providing esthetics and function with a conservative approach in younger patients.

O objetivo deste artigo é descrever passo a passo, um protocolo para tratamento de emergência de pacientes jovens, com abordagem multidisciplinar e restauração direta em resina composta para a reabilitação de fraturas corono-radiculares. Fraturas de incisivos superiores são uma consequência frequente de traumas em crianças e adolescentes. Pinos de fibra de vidro associados às restaurações em resina composta representam abordagem conservadora para este tipo de situação. Este artigo apresenta caso clinico de um paciente do sexo masculino de 14 anos de idade, com fratura corono- radicular em incisivo lateral superior esquerdo. Inicialmente,o paciente foi submetido à cirurgia periodontal para aumento de coroa clínica. Depois, foi realizada cimentação do pino de fibra de vidro, seguido de restauração direta em resina composta. Por fim, um protetor bucal foi confeccionado para prevenir novo trauma. O tratamento multidisciplinar descrito para reabilitação de fraturas corono-radiculares é simples, proporcionando estética e função com uma abordagem conservadora em pacientes jovens.

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O objetivo deste trabalho é relatar um caso clínico, demostrando protocolo conservador para reabilitação estética com facetas indiretas de cerâmica associadas ao clareamento dental. Paciente do gênero masculino insatisfeito em relação à estética do seu sorriso apresentou ao exame clínico restaurações em resina composta nos dentes anteriores com pigmentação e fraturas marginais. Foi realizada remoção das restaurações para avaliação dos diastemas. Inicialmente, foi realizado clareamento externo em consultório com peróxido de hidrogênio a 38%. Após uma semana, foram feitos preparos minimamente invasivos na superfície vestibular e moldagem. Os laminados foram confeccionados com cerâmica feldspática e cimentados adesivamente ao substrato dentário. Feita a cimentação, foi feito ajuste oclusal mantendo os contatos oclusais fisiológicos. A associação entre o clareamento dentário e laminados cerâmicos, com preparos conservadores, mostrou-se eficaz para a reabilitação estética e funcional do sorriso contribuindo para a satisfação do paciente.

The aim of this study is to describe a clinical case, showing conservative approach for aesthetic rehabilitation with ceramic veneers associated with tooth bleaching. A male patient presented dissatisfaction with smile was submitted to clinical examination and showing composite resin restorations on anterior teeth with marginal fractures and pigmentation. Restoration removal was performed for diastemata evaluation. Initially, was performed in-office tooth bleaching with hydrogen peroxide 38%. After one week, preparations were made with minimally removal of tooth structure at buccal surface and the impression was made. The veneers were fabricated with feldspathic ceramic and cemented adhesively to the tooth substrate. Once the luting procedure was performed, occlusal adjustment was made keeping the physiological occlusal contacts. The association between tooth bleaching and ceramic veneers with conservative approach was effective for the esthetic and functional rehabilitation of the smile contributing to patient satisfaction.

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Objetivo: Avaliar a perda estrutural e alteração morfológica da superfície de diferentes instrumentos de corte após preparo cavitário e diferentes métodos de esterilização. Material e Método: Cavidades padronizadas na superfície vestibular de incisivos bovinos foram realizadas na região do limite cemento-esmalte usando cinco diferentes tipos de instrumentos de corte (n= 4): Ca- broca cilíndrica Carbide #56 (KG Sorensen), Kg- ponta diamantada cilíndrica #1093 (KG Sorensen), Mi- ponta diamantada cilíndrica #1093 (Microdont), Fa- ponta diamantada cilíndrica #1093 (Fava) e Cv- ponta diamantada cilíndrica artificial #8,2137 (CVDentUS). Cada ponta foi submetida a um ciclo que envolveu a realização de microscopia eletrônica de varredura (MEV) inicial, preparo cavitário (PC), limpeza com ultrassom (US), três métodos de esterilização: glutaraldeído a 2% (Gl), estufa - calor seco (DH) ou autoclave - calor úmido (WH), e MEV final. Resultados: Foram encontradas diferenças significativas para a interação entre os fatores. Conclusão: O método de esterilização modifica estruturalmente os instrumentos de corte de modo diferente entre os tipos de instrumentos testados. O glutaraldeído foi o método que apresentou pior resultado para as brocas carbides. As pontas diamantadas apresentaram grande variabilidade de resultados para a interação dos fatores desgaste de instrumentos de corte e processos de esterilização.

Objective: evaluate the loss of mass and the morphologic surface alteration of different cutting instruments after cavity preparation from dental structure and different methods of sterilization. Material and Method: standardized cavities in the buccal surface of bovine incisors had been carried through in the region of the limit enamel-cementum using five different types of cut instruments (n=4): Ca- cylinder carbide bur #56 (KG Sorensen), Kg- cylindrical diamond bur #1093 (KG Sorensen), Mi- cylindrical diamond bur #1093 (Microdont), Fa- cylindrical diamond bur #1093 (Fava) and Cv- cylindrical artificial diamond bur #8.2137 (CVDentUS). Each tip was submittes to a cycle that involved: Initial Scanning Electron Microscopy (SEM), cavity preparation (PC), clean-up ultrasonic (US), three methods of sterilization: glutaraldehyde 2% (Gl), dry heat (DH) or wet heat (WH) and final SEM. Results: significant difference for the interaction between factors was found. Conclusion: the sterilization method modifies structurally the cut instruments in different way among types of the instruments tested. Glutaraldehyde proved to be the worst method for sterilizing carbide bur. The diamond instruments showed great variability of results for the interaction of wear of cutting instruments and sterilization processes.

RESUMO

Grande variedade de tratamento é indicada para dentes traumatizados, com fratura de esmalte e dentina, durante a infância e adolescência, dependente da quantidade de remanescente dentário. Dentre as possibilidades de tratamento para recuperação estética, funcional e biomecânica, materiais odontológicos que mimetizam propriedades das estruturas dentárias são almejados. Pinos de fibra de vidro tem sido cada vez mais utilizados pela capacidade de distribuir as tensões de forma favorável, minimizando o risco de fraturas em dentes com mínimo remanescente coronário, podendo ser associados à restaurações diretas e indiretas. O objetivo do presente relato de caso clínico é apresentar alternativa de tratamento com maior preservação de remanescente assegurando retenção do material restaurador, selamento do canal radicular e adequada longevidade de tratamento para dentes com fratura coronária com envolvimento de esmalte e dentina, em paciente hebiátrico.

Wide range of treatment is indicated for traumatized teeth with enamel and dentin fracture during childhood and adolescence, dependent on the amount of remaining. Among the treatment options for recovery aesthetic and functional biomechanics, dental materials that mimic properties of dental structures are desired. Glass fiber posts have been increasingly used for its ability to distribute stresses favorably, minimizing the risk of fractures in teeth with minimal remaining coronal, and may be associated with direct and indirect restorations. The purpose of this case report is to present an alternative treatment with greater preservation of remnant ensuring retention of the restorative material, sealing the root canal and adequate treatment for longevity of teeth with coronal fracture involving enamel and dentin of a hebiatric patient.

RESUMO

This study evaluated the effect of adhesive application only to enamel on the marginal microleakage of composite resin restorations performed with different adhesive systems. Standardized cylinder-shaped cavities were prepared on the buccal surface of eighty bovine incisors. Two etch-and-rinse (Adper Scotchbond Multi-purpose [3M ESPE, St. Paul, MN USA] and Adper Single Bond 2 [3M ESPE]) and two self-etching (Clearfil SE Bond [Kuraray, Osaka, Japan] and Adper Prompt [3M ESPE]) adhesive systems were evaluated. The adhesives were applied only to enamel or to both dentin and enamel. After adhesive light-activation, the cavities were restored with composite resin. The samples were coated with two layers of nail polish, except an area of 1-mm wide around of the restoration, and immersed in a methylene blue solution. Afterwards, the specimens were ground in order to obtain powder which was immersed in absolute alcohol. The solutions were centrifuged and the supernatant was analyzed using an absorbance spectrophotometer. Linear regression was used to estimate the dye concentration. Data were analyzed using ANOVA and Tukey's tests (alpha = 0.05). The etch-and-rinse adhesives showed lower microleakage means compared to those of the self-etching adhesives. Adper Prompt presented higher microleakage means. There was no difference between the modes of application of the adhesive on the cavity for all adhesive systems, except for Clearfil SE Bond. This showed lower microleakage when applied to the whole cavity. Bonding to dentin may not reduce microleakage of composite restorations.

Assuntos

RESUMO

A colagem de fragmento dentário é alternativa estética e conservadora para dentes traumatizados. O objetivo deste trabalho foi realizar revisão sistemática da literatura científica de pesquisas clínicas que abordaram a colagem de fragmento dentário, compreendendo o período de 1955 até Março de 2012, associando-a a caso clínico para ilustrar técnica que parece ser adequada. Para a busca bibliográfica utilizou-se o site Pubmed/Medline com os seguintes descritores: "tooth fragment reattachment" e "dental bonding fragments". Foram obtidos 147 resumos, os quais foram lidos por dois revisores individualmente. Obtiveram-se 41 pesquisas laboratoriais, 6 pesquisas clínicas, 5 revisões de literatura e 94 casos clínicos. Porém, apenas 5 artigos foram considerados nesta revisão, de acordo com os critérios de inclusão e exclusão estabelecidos. Consideraram-se os seguintes aspectos: meio de armazenagem do fragmento, técnica de preparo do remanescente e do fragmento, materiais para a colagem e sucesso clínico. Adicionalmente, apresenta-se relato de caso clínico, de paciente de 8 anos de idade, envolvendo a colagem de fragmento após fratura coronária dos dentes 11 e 21 com acompanhamento clínico de 12 meses. Após avaliação sistemática da literatura, percebe-se que são poucos artigos que descrevem criteriosamente a técnica, abordando os critérios de interesse estabelecidos. A colagem de fragmento dentário demonstrou altas taxas de sucesso, principalmente nos primeiros 24 meses das avaliações clínicas. E parece ser eficaz quanto à manutenção da função mastigatória, à saúde periodontal e à satisfação do paciente. Além de conservadora, é fácil, rápida, de excelente resultado estético e funcional, resgatando ainda o equilíbrio emocional do paciente.

The tooth fragment reattachment is conservative and aesthetic alternative traumatized teeth. The aim of this study was realize systematic review of literature seeking clinical researches approaching of tooth fragment reattachment between the period of 1955 until 2012 march and associate it with a an clinical case, that illustrates a proper technique. For bibliographic search was used the PubMed / Medline website using the following keywords: "tooth fragment reattachment" and "dental bonding fragments." One hundread and forty seven abstracts were obtained, which were read by two reviewers, individually. Forty-one laboratorial researches, six clinical trials, five literature reviews and night-four clinical cases were obtained. However, only five were considered in this review, in accordance to the established inclusion and exclusion criteria. The following aspects were considered: medium storage of the fragment, preparation technique of dental remaining and fragment, bonding materials and clinical success. In addition, it was presented a case report of an 8 year old patient, involving the bonding of fragment after coronary fracture of teeth 11 and 21 with clinical follow up of 12 months. After systematic evaluation of the literature, it were found few articles with a careful description of the technique addressing the established interest criteria. The collage of fragments showed high success rates, especially in the first 24 months of clinical evaluations, and seems to be effective in maintenance of chewing, periodontal health and patient satisfaction. Besides being conservative, it's easy, fast, excellent both in cosmetic and functional outcome, and can also rescue the patient's emotional balance.