Influence of repositioning guides' color and usage on precision in tooth color measurement with a clinical spectrophotometer

Abstract Repositioning guides are commonly employed in clinical studies to ensure consistent tooth color measurements. Yet, their influence on measured color remains uncertain. Objective This study evaluated the impact of repositioning guides' color and usage on tooth color measurement using a clinical spectrophotometer. Methodology In total, 18 volunteers participated in this study, in which the color of their upper left central incisor and upper left canine was measured with or without repositioning guides (control). The guides were made from pink, blue, or translucent silicone, as well as an acetate-based bleaching tray. Tooth color was measured in triplicates using a clinical spectrophotometer based on the CIELAB system. The standard deviations of these readings were used to estimate reproducibility, and color differences (ΔE00) between the measurements with guides and the control were calculated. Results Repositioning guides had a minimal effect on L* values and no effect on b* values. The use of pink silicone increased a* values, whereas blue or translucent silicone reduced them. Irrespective of the evaluated tooth, the lowest ΔE00 values were observed for the translucent silicone and bleaching tray. The usage of guides only affected data variability for the L* color coordinate. Conclusion Using repositioning guides can significantly impact the precision of tooth color measurement with a clinical spectrophotometer.

Effects of whitening dentifrices on the enamel color, surface roughness, and morphology

The aim of this study was to evaluate the whitening and abrasion effects of dentifrices containing different whitening agents on artificially stained and unstained enamel. 160 human dental enamel discs were distributed into four groups according to the type of dentifrices applied on them (n=40): Group I, non-whitening dentifrice (control group); Group II, dentifrice containing charcoal; Group III, dentifrice containing blue covarine; Group IV, dentifrice containing hydrogen peroxide. Half of the specimens in each group were immersed in coffee solution. Color measurements were evaluated from stained and unstained specimens before and after brushing by a spectrophotometer. The surface roughness of each unstained specimen was analyzed using a profilometer after the brushing and bleaching. The surface of one randomly selected specimen from each group was observed using a scanning electron microscope (SEM). Statistical analysis of the color change was performed using the Kruskal-Wallis test. The one-way ANOVA was used to evaluate surface roughness. Group III provided significantly higher recovery on ΔE00 values than other groups on the unstained enamel (p<0.05). Group IV showed significantly the highest ΔE00 values on stained enamel (p<0.05) and also Group IV showed the highest surface roughness values (p<0.05), SEM revealed a more irregular surface in groups III and IV. It can be stated that dentifrice containing blue covarine is both an effective and a safe way to provide whiter teeth with routine home tooth brushing.

El objetivo de este estudio fue evaluar los efectos de blanqueamiento y abrasión de los dentífricos que contienen diferentes agentes blanqueadores en el esmalte teñido y no teñido artificialmente. Se distribuyeron 160 discos de esmalte dental humano en cuatro grupos según el tipo de dentífrico aplicado sobre ellos (n=40): Grupo I, dentífrico no blanqueador (grupo control); Grupo II, dentífrico que contiene carbón vegetal; Grupo III, dentífrico que contiene azul; Grupo IV, dentífrico que contiene peróxido de hidrógeno. La mitad de los especímenes de cada grupo se sumergieron en una solución de café. Las mediciones de color se evaluaron a partir de especímenes teñidos y no teñidos antes y después del cepillado con un espectrofotómetro. La rugosidad de la superficie de cada muestra sin teñir se analizó utilizando un perfilómetro después del cepillado y del clareamiento. La superficie de un espécimen seleccionado al azar de cada grupo se observó utilizando un microscopio electrónico de barrido (MEB). El análisis estadístico del cambio de color se realizó utilizando la prueba de Kruskal-Wallis. Se utilizó el ANOVA para evaluar la rugosidad de la superficie. El grupo III proporcionó una recuperación significativamente mayor en los valores de ΔE00 que otros grupos en el esmalte no teñido (p<0,05). El Grupo IV mostró significativamente los valores más altos de ΔE00 en el esmalte teñido (p<0.05) y también el Grupo IV mostró los valores más altos de rugosidad superficial (p<0.05), el análisis en MEB reveló una superficie más irregular en los grupos III y IV. Se puede afirmar que el dentífrico que contiene azul es una forma efectiva y segura de proporcionar dientes más claros con el cepillado de rutina en el hogar.

Faceta Direta de Resina Composta utilizando Pigmentos Opacificadores para Reabilitação Estética Anterior de Dente Escurecido: Relato de Caso / Direct Composite Resin Veneer using Opacifying Pigments for Anterior Aesthetic Rehabilitation of Discolored Teeth: Case Report

O tratamento estético de dentes com alteração de cor é um grande desafio na Odontologia Restauradora. Nesse sentido, a utilização de técnicas de estratificação com resina composta associada ao uso de pigmentos opacificadores permite que seja possível restaurar por meio de uma técnica direta, que resulta em um menor desgaste da estrutura dental durante o preparo. Dessa forma, o presente trabalho apresenta um caso clínico de faceta direta de resina composta utilizando associação de três pigmentos opacificadores. Paciente do sexo masculino, 54 anos, procurou atendimento apresentando alteração de cor severa do dente 21, relato de trauma dental, tratamento endodôntico e contraindicação de novo protocolo de clareamento interno, sendo sugerido, como plano de tratamento, a restauração direta com resina composta. Para a confecção da faceta direta de resina, foi utilizada uma mistura de três opacificadores na consistência fluida. Para verificar o valor da camada aplicada da mistura, foram feitas fotografias em preto e branco. A estratificação prosseguiu com camadas de resina translúcida para a base palatina, resina opaca de dentina e resina acromática translúcida para o esmalte. Como resultado, constatou-se a função e eficácia do uso da associação de pigmentos opacificadores na resolução do caso, em seguida, foi realizada uma reavaliação após 30 dias e 7 meses do procedimento restaurador, quando verificou-se a estabilidade de cor da restauração. Concluiu-se, portanto, que a utilização da técnica de estratificação de resinas compostas associada a utilização de pigmentos opacificadores traz resultados estéticos satisfatórios e favoráveis por meio de uma técnica direta, realizada em sessão clínica única e com alta previsibilidade.

The esthetic treatment of teeth with discoloration is a major challenge in restorative dentistry. In this sense, the use of composite resin veneering techniques associated with the use of opacifying stains allows restorations to be made using a direct technique, which results in less wear to the tooth structure during preparation. Thus, the present study presents a clinical case of a direct composite resin veneer using an association of three opacifying pigments. A 54-year-old male patient presented with severe color change on the central upper left incisor, a report of dental trauma, endodontic treatment, and contraindication for a new internal bleaching protocol. In order to make the direct resin veneer, a mixture of three opacifiers in a fluid consistency was used. To check the value of the applied layer of the mixture, black and white photographs were taken. Layering proceeded with translucent resin layers for the palatal base, opaque dentin resin and translucent achromatic resin for the enamel. As a result, the function and efficacy of the use of the association of opacifying pigments was verified in the resolution of the case. A reevaluation was performed 30 days and 7 months after the restorative procedure, when the color stability of the restoration was verified. This case allows to conclude that using composite resin layering technique associated with the use of opacifying pigments brings satisfactory and favorable aesthetic results through a direct technique, performed in a single clinical session and with high predictability.

Dental and composite resin discoloration induced by different hydraulic calcium silicate-based cements: two-year in vitro assessment

Abstract Few long-term studies assess the discoloration induced by hydraulic calcium silicate-based cement on dental structures. In addition, as far as we know, no long-term study has assessed the discoloration induced by these cement on composite resin. Objective This in vitro study aimed to assess, during a period of two years, the discoloration potential of different hydraulic calcium silicate-based cements (hCSCs) on the enamel/dentin structure and composite resin restoration. Methodology A total of 40 enamel/dentin discs were obtained from bovine incisors, and 40 composite resin discs (10 mm in diameter × 2 mm thick) were fabricated. A 0.8 mm-deep cavity was made in the center of each disc and filled with the following hCSCs (n=10): Original MTA (Angelus); MTA Repair HP (Angelus); NeoMTA Plus (Avalon); and Biodentine (Septodont). An initial color measurement was performed (T0 - baseline). After 7, 15, 30, 45, 90, 300 days, and two years, new color measurements were performed to determine the color (ΔE00), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and whiteness index (WID). Results For enamel/dentin, the ΔE00 was significant among groups and periods (p<0.05). NeoMTA Plus had the greatest ΔE00. The NeoMTA Plus group had the greatest ΔE00 after two years for composite resin. Significant reduction in lightness was observed for all groups after two years (p<0.05). The most significant WID values were observed after 30 days for Biodentine (enamel/dentin) and MTA Repair HP groups (composite resin) (p<0.05). Conclusions The hCSCs changed the colorimetric behavior of both substrates, leading to greater darkening over time. The Bi2O3 in the Original MTA seems relevant in the short periods of color change assessment.

Tooth discoloration induced by endodontic sealers and cervical limit: 1-year in vitro evaluation

Abstract This laboratory study aimed to evaluate the influence of endodontic sealer and cervical limit of root filling on the discoloration of root canal treated teeth. Bovine incisors were randomly distributed into six experimental groups and control (n=21/group), according to the endodontic sealer used [AH Plus (AP); MTA Fillapex (MF) and Sealer Plus BC (SPB)] and the cervical limit of root filling [dental cervix (DC) or 2 mm in apical direction (2mm-AD)]. Tooth discoloration (ΔE) was evaluated by a digital spectrophotometer using the CIED2000 method. Color assessments were performed immediately before (baseline), 1 week, 1, 3, 6 months, and 1 year after obturation. Data were analyzed by ANOVA and Tukey's post-hoc tests (α=5%). Teeth filled with the three sealers showed perceptible tooth discoloration (ΔE≥2.7) in 1 week, maintaining similar values over time. There was a significant difference between MF and SPB sealers in the 2mm-AD groups. In addition, 2mm-AD groups promoted significantly lower discoloration than DC groups for AH (3 months) and SPB (1 and 3 months) sealer,s. Teeth filled with AP, MF, and SPB sealers displayed discoloration from 1 week to one year, with differences between MF and SPB sealers. A cervical limit of filling material at 2 mm from the dental cervix seems more advisable, promoting lower crown discoloration.

Resumo O presente estudo laboratorial teve como objetivo avaliar a influência do cimento endodôntico e do limite cervical da obturação radicular na alteração de cor de dentes tratados endodonticamente. Incisivos bovinos foram distribuídos aleatoriamente em seis grupos experimentais e um controle (n=21/grupo), de acordo com o cimento endodôntico utilizado [AH Plus (AP); MTA Fillapex (MF) e Sealer Plus BC (SPB)] e o limite cervical da obturação [Colo dentário (CD) ou 2mm na direção apical (2mm-DA)]. A alteração de cor (ΔE) foi avaliada por um espectofotômetro digital usando o método CIED2000. As avaliações de cor foram realizadas imediatamente antes (baseline), 1 semana, 1, 3, 6 meses e 1 ano após a obturação. Os dados foram analisados pelos testes ANOVA e post-hoc de Tuckey (α=5%). Dentes obturados com os três cimentos apresentaram alteração de cor perceptível (ΔE≥2.7) em 1 semana, mantendo valores semelhantes ao longo do tempo. Houve uma diferença significativa entre os cimentos MF e SPB nos grupos 2mm-DA. Além disso, os grupos 2mm-DA promoveram uma alteração de cor significativamente menor do que o grupos CD para os cimentos AH (3 meses) e SPB (1 e 3 meses). Os dentes obturados com os cimentos AH, MF e SPB apresentaram alteração de cor entre 1 semana a um ano, com diferenças entre os cimentos MF e SPB. O limite cervical do material obturador a 2mm do colo dentário parece mais aconselhável, promovendo menor alteração de cor da coroa dentária.

Spectrophotometric analysis of internal bleaching of traumatized teeth with coronal discoloration following regenerative endodontic procedures

Aim: The objective of this study was to describe a case series concerning internal bleaching of anterior traumatized teeth that underwent regenerative endodontic procedures (REP). Methods: Seven non-vital maxillary anterior teeth discolored after regenerative endodontic procedures were included and divided into two groups according to the medication protocol used in the REP: (1) Triple antibiotic paste (TAP) group (n=4); (2) Calcium hydroxide and 2% chlorhexidine gel (HC+CHX) (n=3). The bleaching technique used was walking bleach, where sodium perborate associated with distilled water was used. Bleaching agent was replaced weekly until the darkened tooth was slightly lighter than the adjacent tooth. The color was recorded with the aid of a digital spectrophotometer in two moments (T1: prior the first session of bleaching, T2: fourteen days after the last session of bleaching). The change in color after the procedure (ΔE) was calculated and reported in a descriptive analysis. Results: The ΔE for all teeth showed color differences exceeding the perceptibility threshold (ΔE > 3.7). Both groups showed similar ΔE (TAP: 18.3 ± 11.5; HC+CHX: 14 ± 11.2) at the end of the treatment. The average number of sessions needed to achieve satisfactory results was 1.7 ± 0.6 for HC+CHX group and 2.3 ± 0.5 for TAP group. Conclusion: Internal bleaching with sodium perborate associated with distilled water is effective in treating discolored teeth after regenerative endodontic procedures

A Dieta Branca é Necessária Durante e Após o Clareamento Dental? Uma Revisão de Literatura / Is The White Diet Necessary During and After Tooth Whitening? A Review of the Literature

A valorização da estética tornou-se usual durante o tratamento odontológico, sendo o clareamento dental um dos procedimentos mais procurados para o tratamento de alterações na cor e diversos autores consideram que a dieta branca é importante para que o seu resultado estético não seja comprometido. Porém, outros autores afirmam que a ingestão de alimentos e de bebidas com corantes não interfere imediatamente e posteriormente no resultado do tratamento clareador. Este artigo verifica, por meio de revisão de literatura, se a dieta branca é realmente necessária durante ou após o clareamento dental. Foi realizado um levantamento bibliográfico nas bases LILACS e PUBMED, sendo encontrados 16 artigos que se enquadravam nos critérios de inclusão. Estudos in vitro, in situ e in vivo expostos nesse trabalho, relatam que não há interferência dos pigmentos durante o clareamento no resultado do procedimento. Há consenso também de que após o tratamento clareador, o vinho tinto interfere na manutenção da cor. Portanto, indicar a dieta branca ainda é uma recomendação que parcialmente não é baseada em evidências científicas, devido à falta de congruência nos resultados das pesquisas.

The appreciation of aesthetics has become usual during dental treatment, with tooth whitening being one of the most sought procedures for the treatment of color changes and several authors consider that the white diet is important so that its aesthetic result is not compromised. However, other authors state that the ingestion of food and drinks with dyes does not interfere immediately and later in the result of the bleaching treatment. This article verifies, through literature review, if the white diet is really necessary during or after tooth whitening. A bibliographic search was performed in LILACS and PUBMED, and 16 articles were found that met the inclusion criteria. In vitro, in situ and in vivo studies exposed in this work report that there is no interference of pigments during bleaching on the result of the procedure. There is also a consensus that after the bleaching treatment, red wine interferes with color maintenance. Therefore, indicating the white diet is still a recommendation that is partially not based on scientific evidence, due to the lack of congruence in research results.

Decoloración coronaria inducida por la utilización de Biodentine y MTA blanco en procedimientos de regeneración pulpar: estudio ex vivo / Coronal discoloration induced by the use of Biodentine and white MTA in pulp regeneration procedures: an ex-vivo study

Se comparó el grado de decoloración de la corona clínica en piezas dentarias anteriores humanas ex-traídas, sometidas a procedimientos de regeneración endodóntica, utilizando MTA blanco o sustituto bioac-tivo de la dentina (Biodentine) como barrera cervical, en presencia de coágulo sanguíneo como andamio. En total se prepararon 24 piezas dentarias anterio-res superiores humanas que fueron divididas en dos grupos control (GC) y dos grupos experimentales (GE). Cada uno incluía 6 piezas dentarias. En los GE se colo-có sangre humana fresca en el interior del conducto, y se confeccionó una barrera de Biodentine (GE3) o MTA (GE4). En los GC se colocó una torunda de algo-dón estéril saturada con solución fisiológica estéril, y se confeccionó una barrera de Biodentine (GC1) o MTA (GC2). El color se evaluó de acuerdo con el espa-cio de color CIE L* a* b* utilizando imágenes fotográfi-cas digitales estandarizadas en dos puntos de tiempo: día 0 (T0) y día 35 (T35). La descripción de los datos in-cluyó mediana (Md), primer cuartil (Q1), tercer cuartil (Q3), media y desviación estándar (DE). Se emplea-ron las pruebas de los rangos con signo de Wilcoxon (RSW) y ANOVA de una vía; p < 0,05 fue considerado significativo. Cuando se comparó ∆E se observaron diferencias significativas entre GC1 y el resto de los materiales (p < 0,05). ∆E fue menor en GC1 (media ± DE; 2,1 ± 1,6) que en los grupos restantes que no pre-sentaron diferencias significativas entre sí. En base a estos resultados, la estabilización del coágulo san-guíneo, como así la limpieza de la cavidad previa a la colocación del Biodentine y el uso de barreras cervi-cales, es imprescindible para evitar la coloración de la corona clínica (AU)

Discoloration remains an unfavorable complication of otherwise successful regenerative endodontic procedure of immature teeth with necrotic pulp. Objective: Compare the degree of discoloration of extracted human teeth after regenerative endodontic procedures, using MTA or Biodentine as a cervical barrier with a blood clot as a scaffold. In total 24 human upper anterior teeth were prepared and divided into two control groups (CG) and two experimental groups (EG). In the EG, fresh human blood was placed inside the root and a Biodentine (GE3) or MTA (GE4) barrier was made in. A sterile cotton swab saturated with sterile physiological solution was placed in the GCs and a Biodentine (GC1) or MTA (GC2) barrier was made in. The color was evaluated according to the CIE L* a* b* color space using standardized digital photographic images at two time points: day 0 (T0) and day 35 (T35). The description of the data included median (Md), first quartile (Q1), third quartile (Q3), means, and standard deviation (SD). Wilcoxon signed rank tests (RSW) and one-way ANOVA were used. p < 0.05 was considered significant. When ∆E was compared, significant differences were observed between GC1 and the rest of the materials (p < 0.05). ∆E was lower in CG1 (mean ± SD; 2.1 ± 1.6) than in the remaining groups, which did not present significant differences between them. There was no significant difference between tooth discolorations with materials in the presence of blood. However, in the absence of blood, Biodentine exhibited less tooth discoloration than MTA (AU)

Management of Tooth Discoloration after Orthognathic Surgery Complications: Report of Two Cases

ABSTRACT: Orthognathic surgery is performed for the correction of craniofacial discrepancies. However, complications, such as tooth discoloration are possible. This case report presents two patients who underwent bilateral sagittal split ramus osteotomy associated with segmental Le Fort I osteotomy and genioplasty. During surgeries, the apical region of anterior teeth was accidentally injured in both cases. After three-week surgery follow-up, the injured teeth showed a change in color to dark pink. In both teeth, the root canal treatment was performed followed by the non vital tooth bleaching. Three sessions were necessary to achieve a significant color change of the teeth. The two-year follow-up showed that both teeth preserved an acceptable color. It was concluded that tooth discoloration after orthognathic surgery is a possible complication, which could be overcome following a conservative approach. Additionally, patients should be informed preoperatively.

RESUMEN: La cirugía ortognática es comúnmente realizada para corregir las discrepancias cráneo-faciales. Sin embargo, se pueden producir complicaciones tales como la pigmentación dentaria. Este reporte de casos presenta a dos pacientes que fueron sometidos osteotomía sagital bilateral de la rama mandibular asociada a osteotomía segmentaria Le Fort I y genioplastía. Durante la fase quirúrgica, la región apical de dientes anteriores fueron accidentalmente dañados en ambos casos. Después de tres semanas de seguimiento de la cirugía, los dientes afectados mostraron un cambio de color a rosado oscuro. Se realizó el tratamiento de conductos seguido de aclaramiento interno en ambas piezas dentarias. Fueron necesarias tres sesiones para lograr un cambio de color significativo. El seguimiento de dos años mostró que ambos dientess conservaron un color aceptable. En conclusión, la pigmentación dentaria después de la cirugía ortognática es una posible complicación, sin embargo, puede ser tratada por medio de un enfoque conservador. Además, los pacientes deben ser informados antes de la cirugía.

Spectrophotometric evaluation of coronal discoloration induced by bioceramic root canal filling materials / Evaluación espectrofotométrica de la decoloración coronal inducida por materiales biocerámicos de obturación del conducto radicular

The aim of this study is to evaluate the crown discoloration induced by bioceramic root canal filling materials (OrthoMTA and iRoot SP) compared to AH Plus. Material and Methods: Sixty intact mandibular single rooted premolars were sectioned 2 mm below the cemento-enamel junction, prepared, and randomly assigned into four groups according to the root filling materials: OrthoMTA, iRoot SP, AH Plus and unfilled. Results: Before placement of the materials in the pulp chamber and the coronal third of the root, the spectral reflectance lines of the crowns were recorded by a digital spectrophotometer at baseline, and after filling at 1 week and 1, 3 and 6 months and ∆Ε values were calculated. All materials used induced clinically perceptible crown discoloration (∆Ε>3.7) and no significant difference was detected between these materials (p>0.05). Regardless of the material, discoloration progressed significantly within the three months (p<0.05) however, at 6 months, the discoloration reduced for AH Plus and no further increase for bioceramic materials was detected. Conclusion: Bioceramic root filling materials tested induced clinically perceptible crown discoloration and their application in the esthetic zone should be performed with caution.

Objetivo: El objetivo de este estudio es evaluar la decoloración de la corona inducida por materiales biocerámicos de obturación del conducto radicular (OrthoMTA e iRoot SP) en comparación con AH Plus. Material y Métodos: Se seccionaron sesenta premolares mandibulares de raíz única intactos, 2 mm por debajo de la unión cemento-esmalte, se prepararon y se asignaron al azar en cuatro grupos de acuerdo con los materiales de obturación radicular: OrthoMTA, iRoot SP, AH Plus y sin relleno. Resultados:Antes de la colocación de los materiales en la cámara pulpar y el tercio coronal de la raíz, las líneas de reflectancia espectral de las coronas se registraron con un espectrofotómetro digital al inicio del estudio, y a la semana 1, así como a 1, 3 y 6 meses, y los valores ?? fueron calculados. Todos los materiales utilizados indujeron una decoloración de la corona clínicamente perceptible (??> 3,7) y no se detectaron diferencias significativas entre estos materiales (p> 0,05). Independientemente del material, la decoloración progresó significativamente dentro de los tres meses (p<0.05); sin embargo, a los 6 meses, la decoloración se redujo para AH Plus y no se detectó ningún aumento adicional para los materiales biocerámicos. Conclusiones: Los materiales biocerámicos de obturación radicular probados indujeron una decoloración de la corona clínicamente perceptible y su aplicación en la zona estética debe realizarse con precaución.

Different approaches for aesthetic rehabilitation of discolored nonvital anterior teeth / Diferentes abordagens para reabilitação estética de dentes anteriores escurecidos não-vitais

ABSTRACT An ideal aesthetic standard consists of facial and smile harmony. Discolored teeth generally cause an imbalance in facial aesthetics, leading to low self-esteem and disturbance in social relationships. Causes of teeth discoloration are classified as intrinsic or extrinsic. Bleaching is considered a safe and effective treatment for discolored nonvital teeth and can be associated with restorative treatment to properly correct the dental color and maximize the aesthetic results. This paper aims to present two case reports of single discolored nonvital anterior teeth and the protocol used to reestablish the dental harmony of these patients by bleaching and direct composite resin restoration. To exert minimally invasive dentistry is very important to preserve tooth structure and reduce the risk of fracture. Internal bleaching, although may not be sufficient to reestablish the aesthetic in some cases, it is important to minimize dental preparation to perform an indirect or direct restoration. Dentists must take into account the patients expectations, dominate the restorative technique and know the dental materials to properly be able to restore function and aesthetics and consequently improve life quality and social relationships.

RESUMO Um padrão estético ideal consiste na harmonia facial e do sorriso. Dentes descoloridos geralmente causam um desequilíbrio na estética facial, levando a baixa auto-estima e interferência nas relações sociais. As causas da descoloração dos dentes são classificadas como intrínsecas ou extrínsecas. O clareamento é considerado um tratamento seguro e eficaz para os dentes não vitais escurecidos e pode ser associado ao tratamento restaurador para corrigir adequadamente a cor dental e maximizar os resultados estéticos. O objetivo deste trabalho é apresentar dois relatos de casos de dentes anteriores não vitais escurecidos e o protocolo utilizado para restabelecer a harmonia dentária desses pacientes por meio de clareamento e restauração direta em resina composta. Para exercer uma Odontologia minimamente invasiva é muito importante preservar a estrutura dentária e reduzir o risco de fratura. O clareamento interno, embora possa não ser suficiente para restabelecer a estética em alguns casos, é importante para minimizar o preparo dental para realizar uma restauração indireta ou direta. Os dentistas devem levar em consideração as expectativas dos pacientes, dominar a técnica restauradora e conhecer os materiais dentários para poder restaurar adequadamente a função e a estética e, consequentemente, melhorar a qualidade de vida e as relações sociais.

Research on the color stability of Biodentine and MTA within the blood environment / 口腔疾病防治

Objective@#To compare the color stability of Biodentine and mineral trioxide aggregate (MTA) within the blood environment in vitro and to further investigate the underlying reasons for such color instability. @*Methods @#We first generated Biodentine and MTA discs with a diameter of 5 mm and a height of 3 mm. 24 discs of each material were randomly divided into two groups: the deionized water group and the defibrinated sheep blood group. Discs of each group were immersed for 1 day or 7 days before assessments. First, all discs were photographed to directly compare the discoloration of Biodentine and MTA. The color degree of the two materials was tested by a spectrophotometer. Then, the high-resolution morphological characteristics were observed by scanning electron microscopy. Finally, the chemical contents of each element in the material were measured by energy-dispersive spectroscopy.@*Results @#Compared to immediately after stripping, a change in the brightness of discs after immersion in defibrinated sheep blood for 1 day was observed only in MTA. On the 7th day after being immersed in blood, the colors of both the Biodentine and MTA discs darkened and turned deep red, but the darkness of the MTA discs increased significantly. The color change of MTA immersed in blood was measured on a spectrophotometer with a greater 7-day ∆E (21.257 ± 0.955) than the Biodentine 7-day ∆E (5.833 ± 0.501) (t=24.781, P < 0.001). MTA exhibits more discoloration as the immersion time goes on. A significant difference was noted between the 1-day ∆E(6.233 ± 0.888) and the 7-day ∆E(t=19.956, P < 0.001) of MTA immersed in blood. However, there was no statistically significant difference between the 1-day ∆E (6.790 ± 0.831) and the 7-day ∆E(t=1.707, P=0.163) of Biodentine immersed in blood. It was observed by scanning electron microscopy that after 7 days of immersion in the defibrinated sheep ablood, the surface porosity of MTA was larger than that of Biodentine, and the crystal edge of MTA became rounded and blunt. The analysis by energy-dispersive X-ray spectroscopy showed that the oxygen content decreased and the bismuth content increased in MTA after immersion in defibrinated sheep blood for 7 days. Zirconium was not detected in Biodentine due to its low radiodensity, but the contents of other elements were stable in Biodentine after immersion in defibrinated sheep blood for 7 days. @* Conclusion@#The color stability of Biodentine within the blood environment is better than that of MTA in vitro, which is mainly related to the low surface porosity and stable composition of the anti-radiation agent of Biodentine.

Descoloração da coroa após obturação endodôntica com diferentes cimentos: estudo clínico / Crown discoloration after endodontic obturation with different cements: a clinical study

Objetivo: O objetivo do presente estudo foi avaliar clinicamente a descoloração da coroa dentária após obturação do canal radicular com diferentes cimentos endodônticos. Métodos: Trinta e dois dentes foram tratados endodonticamente e obturados com AH Plus (AHP), Endofill (END), MTA Fillapex (MTA) ou Sealer 26 (SEA), divididos em oito pacientes por grupo. O registro das cores foi realizado com um espectrofotômetro antes da intervenção (T0 ), aos 30 (T1 ) e aos 90 dias após a intervenção (T2 ). As avaliações foram feitas no centro da coroa dentária e a variação de cor (ΔE) foi calculada por meio da Commission International de l'Eclai- rage (CIE) L*a*b. Um operador, especialista em Endodontia, realizou os procedimentos clínicos. Os dados foram submetidos a medidas repetidas ANOVA e teste de Tukey (Δ=5%). Resultados: Não houve diferença estatisticamente significativa na variação de cores entre os cimentos (AHP ΔE=4,11; END ΔE = 6,34; SEA ΔE = 8,77 e MTA ΔE = 12,15), p>0,05. Porém, houve diferença entre os períodos analisados (T1ΔE= 5,65; T2 ΔE = 10,02). Conclusões: Dentro das limitações deste estudo, todos os cimentos endodônticos causaram alterações cromáticas clinicamente perceptíveis na coroa dentária. No entanto, o AH Plus promoveu menos alterações cromáticas na coroa dentária (AU).

Introduction: The aim of this study was to evaluate the crown discoloration after root canal filling with different endodontic cements clinically. Methods: Thirty-two teeth were endodontically treated and filled with AH Plus (AHP), Endofill (END), MTA Fillapex (MTA), or Sealer 26 (SEA), divided into eight patients per group. Color recording was performed with a spectrophotometer before the intervention (T0 ) and at 30 (T1 ) and 90 days post-intervention (T2 ). The evaluations were done in the center of the dental crown and color variation (ΔE) was calculated by means of the Commission International de IEclairage (CIE) L*a*b. The data were subjected to repeated measures ANOVA and Tukeys test (alpha=5%). Results: There was no statistically significant difference in color variation between the cements (AHP ΔE=4.11; END ΔE=6.34; SEA ΔE=8.77, and MTA ΔE=12.15), p>0.05. However, there was a difference between the periods tested (T1 ΔE=5.65; T2 ΔE=10.02). Conclusions: All tested endodontic cements altered the color of dental crowns (AU).

Solving color irregularities with a bioactive bulk-fill restorative system: case report and 24-months follow up / Resolución de irregularidades de color con un sistema restaurador bulk-fill bioactivo: reporte de caso y seguimiento de 24 meses

Bulk-fill resin composites represent an excellent alternative to the conventional incremental layering technique for the reduction of polymerization stress on the adhesive interface. Marginal seal can be further improved by the incorporation of bioactive fillers, such as those encountered in Giomers. However, the high translucency required for the adequate polymerization of bulk-fill materials can seriously jeopardize the final aesthetic outcome of the restorations, especially in the presence of inhomogeneous or stained dentin substrates. The aim of this case report was to present the combined use of two bulk-fill Giomer materials (Beautifil Bulk Flowable and Beautifil II LS, Shofu) for the restoration of three posterior maxillary teeth displaying a black stained dentin substrate due to amalgam corrosion products. This technique allowed completion of the restorations with a satisfactory aesthetic and biomimetic outcome. The adequate preservation of the anatomy and function of the three restorations after 24-months follow-up, provides evidence of the enhanced marginal sealing capacity of these bioactive materials and the success of bulk-fill techniques over time.

Las resinas compuestas de tipo bulk-fill representan una excelente alternativa a la técnica incremental para la reducción de la tensión de polimerización sobre la interfaz adhesiva. La incorporación de rellenos bioactivos, como los que se encuentran en los materiales con tecnología giomer, refuerzan aún más el sellado marginal de estas restauraciones. Sin embargo, la alta translucidez, necesaria para la adecuada polimerización de los materiales tipo bulk-fill, puede comprometer seriamente el resultado estético final de las restauraciones, especialmente en presencia de sustratos dentarios no homogéneos u oscurecidos. El objetivo de este reporte de caso fue presentar el uso combinado de dos materiales giomer tipo bulk-fill (Beautifil Bulk Flowable y Beautifil II LS, Shofu) para la restauración de tres dientes maxilares posteriores con un sustrato dentinario ennegrecido debido a productos de corrosión de amalgama. Esta técnica permitió completar las restauraciones con un resultado estético y biomimético satisfactorio. La adecuada conservación de la anatomía y la función de las tres restauraciones tras un período de 24 meses, aporta evidencia sobre la adecuada capacidad de sellado marginal de estos materiales bioactivos y el éxito de las técnicas de restauración tipo bulk-fill en el tiempo.

Clinical performance of whitening on devitalized teeth: a retrospective observational study / Desempenho clínico do clareamento em dentes desvitalizados: estudo observacional retrospectivo

Objective: This retrospective observational study evaluated the clinical performance of intracoronal whitening and correlated the main factors that interfere with its stability and patient satisfaction. Material and Methods: The paper was designed following the STROBE statement. Patients from the Institute of Science and Technology - ICT/UNESP database who underwent nonvital tooth whitening from August 2010 to July 2015 were selected. Data collection was performed by researching the institution records, patients interview, clinical and radiographic examination. Data were analyzed using MannWhitney test and Spearman's correlation (p < 0.05). Results: The initial search on 1275 records resulted in 43 patients, of whom 18 were selected according to eligibility criteria. There was positive correlation only between the degree of patient's satisfaction and the perception of color difference after whitening treatment (p < 0.05). Color relapse was observed in all conditions, independently of the period of followup (p > 0.05). There was no case of external cervical root resorption. Conclusion: Color changes after whitening influenced patient's satisfaction. There was no correlation among the color relapse and height of gutta-percha, return interval or cause of darkening (AU)

Objetivo: Este estudo observacional retrospectivo avaliou o desempenho clínico do clareamento interno e correlacionou os principais fatores que interferem em sua estabilidade e satisfação do paciente. Material e Métodos: O artigo foi elaborado seguindo o STROBE. Pacientes do banco de dados do Instituto de Ciência e Tecnologia ­ ICT/UNESP que foram submetidos ao clareamento dental em dentes desvitalizados entre agosto de 2010 e julho de 2015 foram selecionados. A coleta de dados foi realizada por meio de pesquisa em prontuários da instituição, entrevista com os pacientes, exames clínico e radiográfico. Os dados foram analisados usando o teste de Mann-Whitney e correlação de Spearman (p < 0,05). Resultados: A pesquisa inicial em 1275 registros resultou em 43 pacientes, dos quais 18 foram selecionados de acordo com os critérios de elegibilidade. Houve correlação positiva apenas entre o grau de satisfação do paciente e a percepção da diferença de cor após o tratamento clareador (p < 0,05). A recidiva da cor foi observada em todas as condições, independentemente do tempo de acompanhamento (p > 0,05). Não houve nenhum caso de reabsorção cervical externa. Conclusão: As mudanças de cor após o clareamento influenciaram a satisfação do paciente. Não houve correlação entre a recidiva da cor e a altura do guta-percha, o intervalo de retorno ou a causa do escurecimento. (AU)

Dental discoloration caused by Grey-MTAFlow cement: analysis of its physicochemical, biological and antimicrobial properties

Abstract Tricalcium silicate-based cement are materials used in reparative and regenerative procedures in endodontics. A recently proposed formulation aimed to enhance handling during clinical use with a versatile material applicable by syringe. Although, the use of bismuth oxide as radiopacifier and grey raw powder are drawbacks considering aesthetics. Objectives Evaluate physicochemical, biological, and antimicrobial properties of Grey-MTAFlow (Ultradent) and assess whether the addition of zinc oxide (ZnO) prevents dentinal discoloration caused by bismuth oxide. Methodology Grey-MTAFlow was manipulated in 'thin' consistency for all tests. Luminosity, color change, ion migration to dentine, radiopacity, setting time, ISO 6876:2012 linear flow, volumetric lateral flow and central filling of simulated grooves scanned using micro-computed tomography (μCT), pH, calcium release, volumetric change using μCT, chemical characterisation, cytotoxicity, and antimicrobial activity were assessed. Addition of 5% ZnO to Grey-MTAFlow and a bismuth-containing experimental composition were comparatively tested. Statistical analyses used Shapiro-Wilk, T-test, ANOVA, and Kolmogorov-Smirnov (p<0.05). Results The addition of ZnO to Grey-MTAFlow prevented dentine darkening after 90 days due to bismuth migration reduction, although no statistical difference was found (p=0.863). ZnO addition significantly enhanced Grey-MTAFlow radiopacity without differences in initial setting time. Grey-MTAFlow presented an ISO linear flow of 10.9 mm and a balanced volumetric lateral flow with central filling in μCT evaluation. All compositions presented an alkaline pH after immersion. Grey-MTAFlow had a significantly higher calcium ion release after 28 days in comparison to 24 hours (p=0.011) and volumetric expansion of 0.4±1.8% after immersion. ZnO addition altered the hydrated cement matrix once calcium hydroxide (portlandite) could not be detected in characterisation. Neither of the materials produced inhibition halos nor reduced bacterial turbidity, but all presented cytocompatibility above 100%. Conclusion Grey-MTAFlow expanded after immersion and exhibited higher luminosity values after the evaluation period when ZnO was added, but chemical modifications after this addition occurred.

Is there an association between crown discoloration and pulp necrosis in traumatized permanent teeth? A meta-analysis

Abstract The present study aimed to identify the scientific evidence regarding the association between crown discoloration and pulp necrosis in traumatized permanent teeth. A systematic literature search was conducted in the PubMed/Medline, Lilacs/BBO, Scopus, Web of Science, Cochrane Library databases, and grey literature. Quality assessment and bias control were carried out according to the Fowkes and Fulton guidelines. Meta-analysis was performed, and the odds ratio was calculated with a 95% confidence interval. The quality assessment of the evidence was determined for the meta-analysis outcomes using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From 2,702 studies identified, five articles met the inclusion criteria. One among these showed no methodological soundness and was excluded from the meta-analysis, and the remaining four studies were included in the meta-analysis. The total number of traumatized permanent teeth evaluated in the meta-analysis was 367. The results showed a positive association between crown discoloration and pulp necrosis in permanent teeth. Teeth with crown discoloration showed 23 times more chance to present pulp necrosis than teeth without crown discoloration (OR 23.82 [1.25, 452.87]; p = 0.03), with a very low certainty of evidence. There is a significant association between crown discoloration and pulp necrosis of traumatized permanent teeth. Due to the very low strength of evidence according to GRADE, this result should be viewed with caution.

Tooth color alteration after debonding in orthodontic patients with adhesive removal using composite bur or tungsten carbide bur: a single center, randomized controlled clinical trial / Alteração da cor do dente após descolagem de braquetes em pacientes ortodônticos pela remoção de adesivo usando broca de compósito ou broca carbide de tungstênio: ensaio clínico unicêntrico randomizado e controlado

Objective: The objective of this study was to determine whether recently developed fiber reinforced composite burs provided better results by comparing tooth discoloration after debonding of orthodontic brackets. Material and Methods: A split-mouth, randomized controlled trial was carried out in one orthodontic office; including 23 patients with intact, vital and caries-free four upper incisors aged 12 to 30 years who completed their fixed orthodontic treatment. For each patient, upper central and lateral incisors on each side of the mouth were randomly selected to remove the adhesive with either a tungsten carbide bur (TC) (n = 46) or a fiber-reinforced composite bur (FC) (n=46). Color evaluation of each tooth was conducted at two time points: immediately after finishing and polishing procedure and two months afterwards. The primary outcome would be the amount of color change in each group during the post treatment phase. The participants, the person assessing the color change and the statistician were blinded to TC group assignment. Color changes in each group were analyzed with the Paired T-test. The color change corresponding to the resin removal method was also statistically analyzed with the Independent T-test at α=0.05 as the level of significance. Results: 86 teeth, 43 in each group, were analyzed. The ΔE value was 3.713±1.161, for teeth finished TC and 2.114±0.514 for teeth finished with FC (p<0.01). Conclusion: Adhesive removal with FC bur results in a more color-resistant tooth surface in comparison with tungsten carbide bur. (AU)

Objetivo: O objetivo deste estudo foi determinar se as brocas de material compósito reforçadas com fibras, recentemente desenvolvidas, proporcionam melhores resultados, pela comparação da descoloração dentária após a remoção de braquetes ortodônticos. Material e Métodos: Um ensaio clínico controlado randomizado com boca dividida foi realizado em um consultório ortodôntico, incluindo 23 pacientes, com idade entre 12 e 30 anos, com incisivos superiores intactos, vitais e livres de cárie, que completaram o tratamento ortodôntico com aparelho fixo. Para cada paciente, incisivos centrais e laterais superiores de cada lado da boca foram selecionados aleatoriamente para remover o adesivo ortodôntico com uma broca carbide de tungstênio (TC) (n = 46) ou uma broca de compósito reforçada com fibra (FC) (n = 46). A avaliação da cor de cada dente foi realizada em dois momentos: imediatamente após o acabamento e polimento e dois meses após. O resultado primário foi a quantidade de mudança de cor em cada grupo durante a fase pós-tratamento. Os participantes, a pessoa que avaliou a mudança de cor e o estatístico não tinham conhecimento da atribuição ao grupo TC. As mudanças de cor em cada grupo foram analisadas com o teste-t pareado. A mudança de cor correspondente ao método de remoção da resina também foi analisada estatisticamente com o teste-t independente considerando um nível de significância α = 0,05. Resultados: foram analisados 86 dentes, 43 em cada grupo. O valor de ΔE foi 3,713 ± 1,161, para dentes finalizados com broca TC e 2,114 ± 0,514 para dentes finalizados com broca FC (p <0,01). Conclusão: A remoção do adesivo com broca FC resulta em uma superfície de dente mais resistente à cor em comparação com a broca carbide de tungstênio (AU)

Smile makeover by veneers ­ case report / Sonrisa mejorada por carillas dentales - reporte de un caso

Ceramic veneers have evolved in the last few years as an aesthetic restoration in the field of aesthetic dentistry. It is a conservative option as compared to full coverage crowns for improving the patients smile. Ceramic veneers are widely used for smile designing in patients with fluorosis, midline diastema, hypoplastic teeth, and peg shape laterals. Clinical relevance: This article highlights the smile designing of a young patient with fluorosis using ceramic veneers, which not only improves the smile of the patient but has positive psychological benefits.

Las carillas de cerámica han evolucionado en los últimos años como una restauración estética en el campo de la odontología estética. Es una opción conservadora para mejorar la sonrisa de los pacientes en comparación con las coronas de cobertura total. Las carillas de cerámica se usan ampliamente para el diseño de sonrisas en pacientes con f luorosis, diastema de la línea media, dientes hipoplásicos, o laterales en forma de clavija. Relevancia clínica: este artículo destaca el diseño de la sonrisa en un paciente joven con f luorosis utilizando carillas de cerámica, que no solo mejora la sonrisa del paciente sino que entrega beneficios psicológicos.

Effectiveness of over-the-counter tooth-whitening strips and toothbrushing for stain removal / Eficácia da utilização de tiras de clareamento dental e da escovação na remoção de manchas dentais

Objective: The present study compared the effectiveness of over-the-counter tooth-whitening strips and too-thbrushing for stain removal. Materials and method: Forty bovine teeth were subjected to initial color re-adings and divided into two groups: 20 teeth were stained with grape juice for seven days and 20 did not receive any treatment (control). Each group was subdivided into two groups (n=10) according to treatment: whitening strips twice/day (30 minutes/7 days) and mechanical brushing with toothpaste (one year). After the treatments, final color readings were taken and color stability (ΔEab), coordinates (ΔL, Δa, Δb), and whitening index (WID) were calculated and analyzed statistically (two-way ANOVA, Bonferroni α=0.05). Results: Statis-tical differences were found for ΔEab and all coordinates between the Control and Stained groups, with major changes in the Stained groups for both treatments. In the Control group, whitening strips produced greater changes in Δb (p <0.05), indicating decrease of yellowness. For the Stained group, whitening strips produced greater changes in Δa (p <0.05), indicating redness reduction. Conclusion: Both treatments were effective for removing stains, and whitening strips were more efficient and effective for changing the color of teeth without previous staining. (AU)

Objetivo: o presente estudo comparou a eficácia das tiras de clareamento dentário e da escovação na remoção de manchas. Materiais e método: quarenta dentes bovinos foram submetidos à lei-tura inicial de cor e divididos em dois grupos: 20 manchados com suco de uva por 7 dias e 20 não receberam tratamento (controle). Cada grupo foi subdividido em 2 grupos (n=10) de acordo com o tratamento: tiras de clareamento 2 vezes/dia (30 minutos/7 dias) e escovação mecânica com cre-me dental (1 ano). Após os tratamentos, leituras finais de cor foram realizadas. Então, a estabili-dade de cor (ΔEab), as coordenadas (ΔL, Δa, Δb) e o índice de clareamento (WID) foram calculados e analisados estatisticamente (two-way ANOVA, Bonferroni α=0,05). Resultados: diferenças es-tatísticas foram encontradas em ΔEab e todas as coordenadas entre os grupos controle e mancha-dos, com maior alteração no grupo manchado, independente do tratamento. No grupo controle, o clareamento produziu maior alteração em Δb (p <0,05), indicando redução do croma amarelo. Nos dentes manchados, ocorreu maior alteração em Δa nos dentes clareados (p <0,05), indicando diminuição do croma vermelho. Conclusão: am-bos os tratamentos foram eficazes na remoção de manchas e o clareamento dentário mostrou-se um método mais eficiente e efetivo para alteração de cor de dentes que não haviam sido submetidos à pigmentação prévia. (AU)