Assessment of a conservative approach for restoration of extensively destroyed posterior teeth

Abstract Extensive restorations in posterior teeth always bring doubts to the clinicians regarding the best protocol, mainly when structures of reinforcement were lost. Objective This study aimed to evaluate the effect of beveling on the fracture resistance and pattern of class II (MOD) restored teeth. Methodology Ninety human premolars were randomly assigned into 9 groups: CTR (control/sound); NC (cavity preparation, non-restored); RU (restored, unbeveled); RTB (restored, entire angle beveling); RPB (restored, partial/occlusal beveling); EC (endodontic access/EA, non-restored); EU (EA, unbeveled); ETB (EA, entire angle beveling); EPB (EA, partial/occlusal beveling). Teeth were restored with Esthet X resin composite and stored in distilled water for 24 h before the inclusion in PVC cylinders. The axial loading tests were performed with 500 kgF at 0.5 mm/min crosshead speed until fracture of the specimens. Fracture resistance and pattern were accessed and data were analyzed using one-way ANOVA and Tukey's HSD test (α=0.05). Results Mean (±SD) failure loads ranged from 136.56 (11.62) to 174.04 (43.5) kgF in the groups tested without endodontic access. For endodontically accessed teeth, fracture resistance ranged from 95.54 (13.05) to 126.51 (19.88) kgF. Beveling of the cavosurface angle promoted the highest fracture resistance values (p<0.05) and prevented catastrophic fractures. Conclusions Cavosurface angle beveling is capable of improving fracture resistance and pattern for both endodonticaly accessed and non-accessed teeth.

Recuperando o guia incisal de um paciente com bruxismo: Relato de caso / Recovering the incisal guidance of a patient with bruxism: Case report

O objetivo do presente relato de caso clínico foi descrever a reabilitação estética e funcional dos incisivos anteriores superiores de um paciente com bruxismo. Paciente do gênero masculino, 23 anos de idade, bruxoma, procurou tratamento para os dentes anteriores superiores devido aos diastemas dentários e também por causa dos comprimentos reduzidos dos incisivos centrais superiores. Para isso, foi realizada a gengivoplastia e osteotomia na região dos incisivos centrais superiores com o objetivo de melhorar as posições dos contornos gengivais e aumentar o comprimento desses dentes. Após 90 dias, o clareamento dentário foi realizado. Depois de 1 mês as facetas de resina composta foram confeccionadas nos incisivos centrais superiores. Durante o tratamento as necessidades e perspectivas do paciente foram levadas em consideração para alcançar o sucesso clínico. Após a conclusão dos procedimentos, o resultado final foi satisfatório. Portanto, um plano de tratamento integrado se mostrou de extrema valia, principalmente quando o paciente é devidamente esclarecido das opções disponíveis de tratamento e colabora com o mesmo.

The objective of the present case report was to describe the aesthetic and functional rehabilitation of the upper anterior incisors of a patient with bruxism. A 23-year-old male patient, with bruxism, sought treatment for his upper anterior teeth due to diastemas and reduced lengths of the upper central incisors. The gingivoplasty and osteotomy were performed in the region of the upper central incisors to improve the positions of the gingival contours and increase the length of these teeth. After 90 days, teeth whitening was performed. After 1 month the composite resin veneers were made in the upper central incisors. During treatment, the needs and perspectives of the patient were considered to achieve clinical success. The treatments were finalized, and the final result was satisfactory. Therefore, an integrated treatment plan proved to be extremely important, especially when the patient is adequately informed of the available treatment options and collaborates with the treatment.

Abordagem multidisciplinar na restauração de um dente posterior extensamente destruído - relato de caso / Extensive posterior tooth restoration with a multidisciplinary approach - case report

Entre os tipos mais frequentes de restaurações dentárias, destacam-se as restaurações dos tipos compostas e/ou complexas em dentes posteriores, sendo comum a perda de uma ou mais cúspides, necessitando de uma abordagem multidisciplinar. No contexto atual da Odontologia minimamente invasiva, as resinas compostas têm destaque importante, pois possibilitam a substituição de restaurações insatisfatórias sem sacrificar excessivamente as estruturas dentárias sadias. Esta característica importante permite a realização de restaurações extensas em dentes desvitalizados. Este relato de caso clínico objetiva descrever uma técnica restauradora de um dente posterior envolvendo uma abordagem multidisciplinar (periodontia, endodontia e dentística restauradora), apresentando e discutindo a sequência dos procedimentos adotados. Neste caso clínico foi realizada uma cirurgia periodontal com intuito de possibilitar a posterior restauração direta em resina composta, associada a um retentor intrarradicular reforçado com fibra de vidro. Dessa forma, com a evolução das técnicas e materiais disponíveis para os clínicos gerais e especialistas, esta abordagem possibilita a devolução da estética e da função em um pequeno número de sessões clínicas, com custo reduzido quando comparado aos tratamentos restauradores indiretos.

Complex or composite posterior teeth restorations are among the most common types, and the loss of one or more cuspids is very frequent and often requires a multidisciplinary approach. Within the context of minimally invasive Dentistry, composite resins are widely used since they allow the replacement of unsatisfactory restorations, avoiding excessive wear of the healthy tooth structure. This enables extensive restorations in devitalized teeth. This report aims to describe a restoration technique applied on a posterior tooth through multidisciplinary approach (periodontics, endodontics and restorative dentistry), presenting and discussing the adopted procedures. In this clinical case, a periodontal surgery was performed in order to allow the subsequent direct composite resin restoration associated with an intra-radicular fiber post. Thus, with the evolution of techniques and materials available to the general practitioner and specialists, direct restorations allow aesthetical and functional restoration with a small number of clinical sessions with a lower cost when compared to indirect restorations.

Use of restorative materials for direct and indirect restorations in posterior teeth by Brazilian dentists

Introduction: Often, dentists perform procedures aiming at more esthetical than long-term clinical performance of restorations. Objective: To evaluate the prevalence of use of different direct and indirect restorative materials in posterior teeth. Material and methods: In 2004, a questionnaire was applied to 486 dentists living at five geographical regions of Brazil. The dentists answered a questionnaire containing four questions, in which they reported the most widely used restorative material for direct (amalgam, composite resin, and glass ionomer) and indirect restorations (gold, silver, and copper/aluminum alloys, indirect resin composites, and ceramics) and specified the reason for using the material type selected. Results: In 2004, amalgam was the direct restorative material most used by dentists at almost all regions, except from South region, where resin composite was the most used. Esthetics was the main reason stated for the use of resin composites. As for indirect restorations, metallic restorations were the most used in Northeast (77.8%). No differences were found regarding the material type use between metallic and aesthetic materials at North, Southeast and Center-West regions. At South region, esthetic restorations were the most used. Conclusion: Despite the limitations of this present study, direct and indirect metallic restorations were the most common materials in 2004.

O que o cirurgião-dentista que pratica a Odontologia deve saber a respeito do amálgama dentário / What the dentist should know about dental amalgam

Muitas organizações não governamentais, cientistas, docentes, dentistas, médicos, ativistas e advogados tem trabalhado incansavelmente para legislar sobre o fim do amálgama como material restaurador odontológico, cujos artigos e opiniões contribuem para incentivar a “terceira guerra” contra o amálgama. O UNEP concluiu as discussões sobre um acordo internacional, a Convenção de Minamata sobre o Mercúrio, que tem como objetivo reduzir os impactos ambientais significativos para a saúde devido … poluição atmosférica por mercúrio e inclui disposições que tratam de diversos produtos que contêm esse elemento químico. Alguns desses produtos deverão ser banidos a partir de 2020. As restaurações de am álgama não foram atingidas pela proibição, no entanto, o tratado sugere algumas disposições relativas … diminuição gradual de uso desse material, sem exigir medidas proibitivas ou prazo de banimento. Segundo o recente relatório do UNEP de 2013, as maiores fontes antropogônicas (atividades humanas) de contaminação ambiental pelo mercúrio estão associadas … mineração artesanal de ouro, … queima de carvão, produção de cimentos, metais ferrosos e não ferrosos. A quantidade de vapor liberado das restaurações de amálgama pela cremação para a atmosfera por ano em escala mundial não chega a atingir 1% do total emitido pelos demais setores de poluição. Com relação a possíveis vapores provocados por resíduos de amálgama, não existe nenhum dado registrado até 2013 pelo UNEP. Nos sistemas aquáticos pode-se encontrar a forma mais tóxica de mercúrio, o metilmercúrio ou orgânico, que pode se acumular nos peixes e mamíferos marinhos consumidos pelos seres humanos; além disso, neste ambiente o mercúrio inorgânico, não tóxico, e o elementar, menos tóxico, podem ser transformados no metilmercúrio. A maior parte da exposição humana aos riscos … saúde devido ao mercúrio ocorre a partir do consumo de alimentos como peixes marinhos e/ou de água doce.

Many non-governmental organizations, scientists, professors, physicians, dentists, lawyers and activists have been working tirelessly to legislate on the end of amalgam as a dental restorative material, their articles and opinions contribute to encourage the “third war” against amalgam. The UNEP concluded discussions on an international agreement, the Minamata Convention on Mercury, which aims to reduce the health impacts due to environmental impacts due to air pollution by mercury, and includes provisions dealing with various products containing this chemical element. Some of these products may be banned by 2020. Amalgam fillings were not affected by the ban, however, the treaty suggests some provision for gradual reduction of use of this material, but without requiring prohibitive measures or a term of banishment. According to the recent report of UNEP (2013), the largest anthropogenic sources (human activity) of environmental mercury contamination are associated with gold mining, burning of coal and cement, ferrous and nonferrous metals production. The amount of vapor released annually to atmosphere from cremation of amalgam does not reach 1% of the total issued by other sectors of pollution. Regarding possible vapor caused by amalgam residues, there is no data recorded until 2013 by UNEP. In aquatic ecosystems the most toxic form of mercury, methylmercury or organic mercury, can be found, it can accumulate in fish and marine mammals that are consumed by humans, also in this environment the inorganic mercury (non-toxic) and the elemental mercury (less toxic) can be converted into methylmercury.

Endocrown para o tratamento de dentes despolpados / Endocrown: an alternative treatment for pulpless teeth

Um dos problemas odontológicos mais vivenciados pelos cirurgiões dentistas refere-se ao tratamento restaurador de dentes despolpados. Nessas situações, a retenção para o material restaurador é normalmente crítica. Quando a região da câmara coronária apresenta condições adequadas para os princípios de retenção podem-se empregar as coroas tipo Endocrown. No entanto, atualmente, este tipo de tratamento se torna não apenas um problema funcional, mas também estético. Dessa forma, o objetivo deste trabalho é apresentar uma sequência operatória para restaurar um dente posterior despolpado utilizando uma coroa Endocrown para restabelecer a função e a estética

One of the most common problems faced by the dentists is the restorative treatment of pulpless teeth. In these situations the retention for the restorative material is usually critic. When the pulp chamber presents appropriate conditions for the retention the Endocrown type crown can be used. However, nowadays, this type of treatment becomes not only a functional problem, but also an aesthetic one. In that way, the aim of this work was to present an operative sequence to restore a non vital tooth using Endocrown to reestablish aesthetics and function

Influence of different surface treatments on the shear bond strength of a methacrylate resin composite repaired with silorane-based resin

Introduction: When repairs are needed in restorations made with methacrylate-based resin composites, the clinician still has doubts whether it is possible to use a silorane-based material and which is the best procedure. Objective: To evaluate the shear bond strength between a methacrylate-based resin composite and a silorane-based material using different surface treatments. Material and methods: Eighty flat bases made with methacrylate resin composite (Filtek Z350 XT) were prepared (n = 8). The bases were stored into water at 37°C for one week. Ten groups were evaluated: G1 (control - no repair); G2 (surface grinding, washing, drying, adhesive and repair with Filtek Z350 XT); G3 (surface grinding, washing, drying, adhesive and repair with silorane - Filtek P90); G4 (surface grinding, washing, drying, adhesive, silane and repair with Filtek Z350 XT); G5 (surface grinding, washing, drying, application of silane, adhesive and repair with silorane - Filtek P90). All groups were kept at 37°C for 24 h in either water (G1 to G5) or ethanol (G6 to G10). The results were analyzed with one-way ANOVA and Tukey test (α = 0.05). Results: There were significant differences between groups (p < 0.001). Only repairs made with silane and Z350 XT (G4 = 46.2 ± 12.9; G9 = 48.1 ± 16.3) resulted in values similar to controls (G1 = 59.2 ± 15.8; G6 = 62.3 ± 15.9) (p = 0.33). The smallest value occured when the repair was performed with silane and silorane-based based and stored into ethanol (G10 = 29.9 ± 12.4). The storage media had little influence on the results. Conclusion: The silorane-based resin composite was not effective for repair of the methacrylate-based material.

Staining susceptibility of methacrylate and silorane-based materials: influence of resin type and storage time

Introduction: The color stability of composite resins is a fundamental factor in their clinical behavior. Objective: To evaluate the color stability of composite resins of different colors exposed to a cola-based soft drink after different storage periods. Additionally, three methacrylate-based materials and one silorane-based material were evaluated. Material and methods: Specimens of three methacrylate-based materials (Opallis EA3, DA3 and T-Neutral; Filtek Supreme XT A3E, A3D and CT; 4 Seasons A3 Enamel, A3 Dentin and High Value) and one silorane-based material (Filtek P90 A3) were prepared, light-cured for 40 s, and manually polished with Sof-Lex discs. Samples were stored for 1 h, 24 h or 7 days. The color was evaluated by CIE-Lab system before and after immersion for 10 min in a cola-based soft drink. Color variation (ΔE) was calculated from individual values of L*, a* and b*, being considered imperceptible when < 1, clinically acceptable when ≤ 3.3, and clinically inacceptable when higher than 3.3. Data were evaluated by two-way Anova and Dunnett's T3 tests (α = 0.05). Results: There were differences among the resins (p < 0.001), with an interaction effect being also observed (p < 0.001). Storage time was not significant (p = 0.246). P90 showed a ΔE smaller than one unit at all studied times. Supreme XT CT and 4 Seasons High Value showed higher ΔE, but not above the critical value of 3.3. The only material that showed ΔE higher than 3.3 was Opallis DA3 after 1 h of storage. Conclusion: The silorane-based composite resin showed smaller ΔE at the times studied.

Laminados cerâmicos na finalização dos tratamentos clínicos integrados / Laminate veneers and multidisciplinary management

de solucionar. Nestes casos, uma abordagem multidisciplinar éfundamental. Má posição dentária e margem gengival sem umcontorno adequado, normalmente, apresentam problema estético efuncional. Assim, um tratamento ortodôntico e periodontal paraadequação prévia é fundamental para o sucesso do tratamentoreabilitador. Além disso, cuidados e paciência durante todo otratamento são essenciais tanto por parte do profissional como porparte do paciente. Recentemente, os laminados cerâmicos têm sidoamplamente utilizados em dentes anteriores. Adicionalmente, essetratamento tem sido mais conservador quando comparado às coroastotais. Portanto, o presente trabalho demonstra por meio de um casoclínico, a associação da ortodontia, periodontia e dentística norestabelecimento do sorriso com laminados cerâmicos, de formaeficiente, conservadora e com resultados estéticos satisfatórios.

Some clinical cases are more complex. In these situations, amultidisciplinary approach is essential. Malposition dental and gingivalmargin without an adequate contour usually have functional andaesthetic problem. Thus, an integrated orthodontic-periodonticrestorativeapproach may enhance the aesthetic results whenprosthetic therapy itself is not feasible. Additionally, care and patiencethroughout treatment are essential for both the professional and thepatient's part. Recently, ceramic laminate veneers have been widelyused in anterior teeth. Additionally, this treatment has been moreconservative. Therefore, this article presents integrated orthodontics,periodontics and restorative smile solution.

Free-hand stratification with composite resins for the closure of anterior diastema

Introduction: Dental diastemas are common findings at dental clinics. This clinical situation produces discomfort in many patients and its solution is difficult to many professionals. Silicone guides, made from waxed casts, have been used to assist the stratification of resin composites in cases of dental diastemas. This technique, however, does not necessarily need to be used as protocol in all situations. Objective: To demonstrate the stratification technique without silicone guides. Case report: The present study reports a case of stratification technique for anterior diastemas closure without silicone guide. Conclusion: The closure of diastemas can be quickly and easily performed using composite resins without the need of previously manufacturing silicone guides.

56-month clinical performance of Class I and II resin composite restorations

OBJECTIVE: This study evaluated the 56-month clinical performance of Class I and II resin composite restorations. Filtek P60 was compared with Filtek Z250, which are both indicated for posterior restorations but differ in terms of handling characteristics. The null hypothesis tested was that there is no difference in the clinical performance of the two resin composites in posterior teeth. MATERIAL AND METHODS: Thirty-three patients were treated by the same operator, who prepared 48 Class I and 42 Class II cavities, which were restored with Single Bond/Filtek Z250 or Single Bond/Filtek P60 restorative systems. Restorations were evaluated by two independent examiners at baseline and after 56 months, using the modified USPHS criteria. Data were analyzed statistically using Chi-square and Fisher's Exact tests (a=0.05). RESULTS: After 56 months, 25 patients (31 Class I and 36 Class II) were analyzed. A 3% failure rate occurred due to secondary caries and excessive loss of anatomic form for P60. For both restorative systems, there were no significant differences in secondary caries and postoperative sensitivity. However, significant changes were observed with respect to anatomic form, marginal discoloration, and marginal adaptation. Significant decreases in surface texture were observed exclusively for the Z250 restorations. CONCLUSIONS: Both restorative systems can be used for posterior restorations and can be expected to perform well in the oral environment.

Fechamento de diastema anterior: associação de procedimentos ortodôntico e restaurador / Anterior closure diastema: association of orthodontic and restorative procedures

Muitas vezes, somente a mecânica ortodôntica não é suficiente para solucionar os casos de fechamento de diastemas. Da mesma forma, apenas uma abordagem restauradora pode resultar em dentes desproporcionais, com uma aparência desarmônica. Nesses casos, uma abordagem multidisciplinar é fundamental. Uma movimentação ortodôntica prévia é essencial para o sucesso do tratamento restaurador, assim como uma comunicação entre o ortodontista e o profissional que realizará as restaurações pode ser favorável no prognóstico. Portanto, esse trabalho ilustra por meio de um caso clínico, aspectos ortodônticos e restauradores que devem ser considerados na realização de fechamento de diastemas.

Several aspects beyond the restorative phase itself such as orthodontic movement and periodontal treatment must be considered in cases of closure of diastemas. In such cases, a multidisciplinary approach is essential. As patients during orthodontic treatment may show high risk of developing dental caries and periodontal disease, inflammation of the gingival tissue is a common finding. For this reason, a preliminary basic periodontal treatment is critical to the success of restorative procedure. In addition, postoperative care and instruction in phonetics, oral hygiene and periodic control must be considered by professionals and patients. Thus, this paper demonstrates through a case report, pre and postoperative issues that should be considered during the closure of diastemas using a layering technique with resin composites.

Procedimentos clínicos para restauração de dentes anteriores fraturados: colagem de fragmentos autógenos / Clinical procedures for the restoration of fractured anterior teeth: autogenous fragment reattachment

Fraturas em dentes anteriores superiores são comuns, especialmente nos incisivos centrais. Quando o fragmento dentário fraturado está presente ou não perdeu suas propriedades ópticas, pode e deve ser utilizada a técnica de colagem de fragmento. Atualmente, a técnica de colagem de fragmentos, além de ser uma forma conservadora para restabelecer a estética e função de dentes anteriores fraturados, permite a restauração da estrutura dentária com resultados ópticos excelentes e previsibilidade. Assim, o conhecimento da técnica de colagem de fragmento e dos materiais que podem ser empregados são fundamentais. Dessa forma, o objetivo do presente trabalho é apresentar, por meio de casos clínicos, a técnica de colagem de fragmento para restauração em dentes anteriores fraturados.

Fracture of anterior teeth is common especially on maxillary central incisors. When the fractured fragment is present or did not lose its optical properties, the reattachment should be indicated. Nowadays the technique for fragment reattachment besides being more conservative allows the restoration of the dental structure with excellent optical results and good long-term stability. Moreover the knowledge of fragment reattachment technique and dental materials employed plays an important role. Thus, it is the aim of the present work to demonstrate the technique for fragment reattachment in anterior fractured teeth.

Tratamentos restauradores indiretos e a importância dos aspectos periodontais / Indirect restorative treatments and the importance of periodontal aspects

Os tratamentos restauradores adesivos indiretos têm sido amplamente estudados e aperfeiçoados nos últimos anos. No entanto, a realização de qualquer procedimento terapêutico exige total respeito aos tecidos periodontais. São inúmeros os fatores que podem influenciar a longevidade de restaurações adesivas indiretas em dentes posteriores. Neste contexto, tem destaque a relação entre os materiais restauradores e os tecidos periodontais. Assim, a finalidade deste artigo, é demonstrar através de relato de caso clínico alguns dos aspectos a serem considerados para que uma boa inter-relação entre tratamentos restauradores e saúde periodontal seja obtida

The indirect adhesive restorative treatments have been widely studied and improved in recent years. The performance of any therapeutic procedure, however, requires full respect to periodontal tissues. There are numerous factors that can influence the longevity of indirect bonded restorations in posterior teeth. In this context, the relationship between restorative materials and periodontal tissues play an important role. Thus, the purpose of this paper is to demonstrate through a clinical report some of the aspects to be considered so a good relationship betweenrestorative treatments and periodontal health is achieved

Planejamento e considerações pré e pós-operatórias no fechamento de diastemas / Treatment planning and pre and postoperative considerations in the closure of diastema

Vários aspectos precisam ser considerados nos casos de fechamento de diastemas, além da fase restauradora, como a movimentação ortodôntica e o tratamento periodontal. Nesses casos, uma abordagem multidisciplinar é fundamental. Como pacientes em tratamento ortodôntico podem ser considerados de alto risco à cárie e à doença periodontal, é comum encontrar inflamação do tecido gengival. Assim, uma adequação prévia é fundamental para o sucesso do tratamento restaurador. Esse trabalho demonstra, por meio de um caso clínico, aspectos pré e pós-operatórios que devem ser considerados na realização de fechamento de diastema empregando a técnica de estratificação com resinas compostas.

Princípios e técnica de preparos dentários para restaurações de resina composta em dentes posteriores / Fundamental concepts and tooth preparation for direct posterior composites

O sistema restaurador adesivo de uso direto tem sido amplamente estudado e aperfeiçoado nos últimos anos. Isso possibilitou o aumento da faixa de utilização das resinas compostas em dentes posteriores, que até ADA1 (1998) eram restritas às restaurações profiláticas e preventivas em lesões incipientes. São inúmeros os fatores que podem influenciar na longevidade de restaurações adesivas diretas em dentes posteriores. O preparo do dente é fundamental para que este possa receber a restauração. Os princípios para preparos cavitários enunciados por Black4 (1908), sofreram algumas adaptações em seus conceitos e interpretações devido aos novos instrumentos, materiais e abordagens terapêuticas preventivas disponíveis atualmente.No entanto, todos os princípios ainda devem ser considerados durante o preparo dos dentes que receberão restaurações de resina composta aplicando os conceitos atuais. Conhecimento sobre aspectos de preservação de estrutura dentária, adequada forma de resistência e retenção, e técnicas de acabamento marginais são essenciais. Assim, o objetivo deste artigo é demonstrar alguns aspectos do preparo dos dentes posteriores para que possam favorecer a longevidade das restaurações de resina composta, pela aplicação dos conceitos modernos respeitando porém os princípios clássicos de preparos cavitários.

During the past few decades, direct dental materials have changed dentistry’s approach to diagnosis and management of dental caries. The potential uses of resin-based composites in restorative dentistry are expanding. Many factors contribute to the realization of clinical success with direct posterior composite restorations. Cavity preparation is essential for the clinical outcome. For many years the Black tooth preparations, with few modifications, formed the basis for most operative preparation procedures. Modifications of tooth preparation have resulted from improvements in restorative materials, instruments, and techniques, and the increased knowledge, however, Black’s principles of tooth preparation are still relevant. The restoration of posterior teeth with directly placed resin-bonded composite requires meticulous operative technique in order to ensure success. Conservation of tooth structure retention form, resistance form, and procedures for finishing the external walls of the tooth preparation all present a series of challenges that dentists and are essential. Thus, this article will address the principles, techniques, and other considerations during cavity preparation for achieving clinical success with direct posterior composite resin restorations.

Evaluación del desgaste por cepillado, in vitro, de una resina compuesta, fotopolimerizada por lámpara halógena: en dos tiempos diferentes / Wear evaluation of the in vitro toothbrushing of a composite resin cured by halogent light curing: in two different times

El objetivo de este trabajo fue evaluar el desgaste abrasivo por cepillado in vitro de la resina compuesta 4Seasons, de dos colores diferentes (A3 y C4) y polimerizadas por dos diferentes tiempos (20 e 40 s), utilizando cepillo dental y dentífrico; también se uso como material de referencia, el PMMA. Fueron confeccionados 10 especímenes, para cada uno de los 5 grupos (PMMA, A3 20s, A3 40s, C4 20s, C4 40s). Después de su confección, cada espécimen era almacenado en agua desmineralizada a 37 ± 2 ºC, por 24 horas, regularizados con lija; después del lavado en ultrasonido, volvían a ser almacenados en las mismas condiciones por 7 días. El cepillado fue realizado en una máquina para desgaste por cepillado, aplicándose una carga de 3N, con frecuencia de 4,5 ciclos/seg; el período de cepillado de un espécimen comprendía 150,000 ciclos. Fueron realizados 5 lotes de cepillado, de modo que un espécimen de cada material de cada grupo fuese sometido a cada una de las posiciones ocupadas por los 10 cepillos. La cantidad de masa pérdida fue calculada por pesaje (pre y post cepillado). Este trabajo también fue ilustrado con gráficos de rugosidad y MEB. La tasa media de desgaste fue de 2,8 mg para PMMA, de 5,5 mg para A3-20s, 4,7 mg para A3-40 s, 5,4 para C4-20s y 4,2 mg para C4-40s. ANOVA mostro que no hubo diferencia significante entre los grupos, para p=0,166. Concluyéndose que no existió diferencia de resistencia al desgaste abrasivo entre los grupos

To evaluate abrasive wear, by weight changes, of a resin composite to in vitro toothbrushing, of two different colors (A3 and C4), cured by two times (20 and 40 s). Resin composite 4Seasons was material studied and PMMA was used as reference material. Ten cylindric samples had been prepared for each one of the five evaluated groups (PMMA, A3 20s, A3 40s, C4 20s, C4 40s). After confection, samples were immersed in deionized water, at 37± ºC, for 24 h, and then regularized by abrasive gritting with sandpaper, after that, were cleaned in ultrasound bath, and restored to the same described conditions, for 7 days. The toothbrushing was then conducted in a proper machine that holds 10 specimens, with 3 N load of each toothbrush on the respective sample using dentifrice and water. 150.000 cycles were applied per group. Five lots of toothbrushing had been performed; in a way that one sample of each group had been submitted to the brushing action at one position in the machine. The amount of weight loss for each sample was calculated by means of weighting. Roughness and MEV were also evaluated. Data were analyzed with one-way ANOVA. The average rate of wear was of 2.8 mg for PMMA, 5.5 mg for A3-20s, 4.7 mg for A3-40 s, 5.4 for C4-20s, and 4,2 mg for C4-40s. One-way ANOVA showed no significant difference between groups (p=0.166). It was possible to conclude that difference of the resistance to the abrasive wear between the studied groups did not exist

Remodelación Cosmética de la Sonrisa / Cosmetic Contouring of Smile

La remodelación cosmética de los dientes naturales es una modalidad de tratamiento con beneficios estéticos que puede ser considerada económica y conservadora. No obstante, demanda del profesional no solo restaurar una sonrisa armoniosa, sino también, al mismo tiempo preocuparse con el aspecto funcional del tratamiento. Además, la remodelación cosmética pude ser relacionada a otros recursos operatorios como los restauradores adhesivos directos, proporcionando resultados aún más satisfactorios a los pacientes. De esta manera, este trabajo tiene por objetivo presentar un caso clínico, en el cual la remodelación cosmética asociada a diferentes recursos operatorios, puede ser empleada como una opción de tratamiento estético conservador.

Cosmetic contouring of natural teeth is a treatment with aesthetic benefits that can be considered economical as well as conservative. The dental professional has however not only to restore the smile harmony, but the functional aspects have to be considered at the same time in the treatment planning. Other treatments such as direct adhesive restorative treatments may additionally be used to provide better outcomes to the patients. The aim of the present work thus is to present a case of cosmetic contouring as a suitable aesthetic treatment option.

Tecnica caseira de clareação dentária em Odontologia Restauradora Cosmética / The use of home-bleaching technique in Cosmetic Restorative Dentistry

Historicamente, a clareação dentária tem sido uma alternativa conservadora de tratamento para dentes com manchamento intrínseco. Desde a descrição da técnica de clareação caseira por Haywood e Heymann, em 1989, diferentes métodos têm sido utilizados para se obter a clareação dentária. Em função dos bons resultados estéticos, tem sido amplamente utilizada pelos cirurgiões-dentistas. A clareação dentária possui a vantagem de permitir a associação com as demais técnicas restauradoras estéticas e/ou cosméticas. O tratamento clareador vem sendo utilizado como uma das técnicas cosméticas mais comumente requisitadas pelos pacientes. Dessa forma, o objetivo deste trabalho é apresentar e discutir a técnica de clareação caseira, com a apresentação de casos clínicos.