The Long?Forgotten Technique of Pin Retained Restoration ? A Case Report

To restore severely damaged teeth to the greatest state for health, function, and aesthetics continues to be a challenge for all practising dental surgeons. A pin retained restoration is an intricate restoration involving the insertion of one or more pins into the dentin to provide sufficient resistance and retention. These pins help in anchoring dental amalgam or composite to the tooth structure. This auxiliary retentive means help in the restoration of mutilated teeth in young individuals whose pulp chambers are relatively large and the dentinal tubules are comparatively immature. This case study sheds insights on the successful rehabilitation of a severely damaged premolar tooth with pins and composite resin restoration.

Alternativas clínicas para el uso de composites Bulk-Fill compactables y fluidos: Reporte de un caso paso a paso / Clinical Alternatives for the Use of Compactable and Flowable Bulk-Fill Composites: A Step-by-Step Case Report

Resumen: El uso de resinas compuestas Bulk-Fill para la restauración de dientes posteriores ha sido masificada en los últimos años en las diferentes disciplinas clínicas de la Odontología. Esto puede deberse principalmente a la simplicidad en la técnica de aplicación de este material ya que requiere de su inserción dentro de la preparación cavitaria en espesores de resina compuesta de hasta 4-5mm, lográndose una reducción considerable de tiempo de trabajo clínico. Ante la existencia de diferentes viscosidades de este tipo de resinas compuestas, ciertas dificultades han sido identificadas ante la selección de cada material Bulk-Fill en relación a las posibles combinaciones que se pueden realizar entre las diferentes marcas disponibles en el mercado, inclusive cuando se usan junto con resinas compuestas convencionales. El objetivo del siguiente reporte de caso, es mostrar dos posibilidades clínicas paso a paso utilizando inicialmente resinas Bulk-Fill compactable en un solo incremento para un segundo molar superior, y luego, a través de la combinación de resinas compuestas Bulk-Fill del tipo fluidas, junto a resinas compuestas Bulk-Fill compactables y resinas compuestas convencionales de estratificación para esmaltes de alto índice de refracción para un primer molar superior.

Abstract: The use of Bulk-Fill composite resins to perform posterior restorations has been massified in recent years in the different clinical disciplines of Dentistry. This may be due mainly to the simplicity in the application technique of this material as it requires its insertion into the cavity preparation in 4-5mm of composite resin thickness, achieving a considerable reduction of clinical working time. Given the existence of different viscosities of this type of composite resins, certain difficulties have been identified before the selection of each Bulk-Fill material related to the possible combinations that can be made between the different brands available in the market, even when they are used with conventional composite resins. The purpose of the following case report, is to present two step-by-step clinical possibilities using initially, compactable Bulk-Fill composite resin in a single increment for the restoration of a second upper molar, and later, through the combination of Bulk-Fill flowable composite resin together with compactable Bulk-Fill composite resin and a high- refractive-index enamel-like conventional composite resin, for a first upper molar.

Knowledge about composite restorations repair vs replacement- a survey among a subpopulation of saudi dental students / Conhecimento sobre reparo e substituição de restaurações de resina - uma pesquisa entre uma subpopulação de estudantes sauditas de odontologia

Objective: The purpose of this study was to evaluate the knowledge among dental students at King Khalid University, Jazan University, and Najran University in the kingdom of Saudi Arabia about when to repair or replace defective direct composite restoration. Materials and Methods: A questionnaire-based survey was formulated, pursuing the information about management (repair/replacement) of defective composite restorations and distributed among 200 dental students of three universities in the southern region of the kingdom of Saudi Arabia. The data were collected with the help of an online questionnaire. Data entry and the analysis were done using the statistical software package SPSS version 20.0. It was presented using descriptive statistics in the form of frequencies and percentages for qualitative variables, and range means and standard deviations for age, quantitative variable. Analytic statistics were done using Chi-Square tests (χ2) to test the significant difference between categorical variables. The level of significance, the p-value was 0.01(p<0.01). Results: The decision to choose between composite repair or replacement was influenced by whether this topic was taught to them at various undergraduate levels during Bachelor of Dental Surgery. The reason associated with the decision to repair defective composite restorations, 76% reported as cost-effective followed by Increased longevity (71%), the permanent filling (70%), patient's preference for repair (65%), and least time consuming (50%). 67% participants preferred significantly (p<0.001) repair due to secondary caries in the previously restored tooth with composite, followed by the small surface defect in a composite restoration (65%), risk of pulpal damage significantly (p<0.001) in a defective composite restoration (62.5%) and more invasive and destructive treatment option (35%). More than half of respondents 123 (61.5%) reported that they were not taught about composite repair during the Bachelor of Dental Surgery. Conclusion: It is suggested with the help of our study that didactic and clinical training components regarding composite repair should be seriously included in the teaching curriculum of dental institutions as it is in the best interest of the patient. Dental students should be provided with clinical training on this topic so that they can follow proper decision-making protocols available during repair or replacement of defective resin composite restorations. Other researches in the future can be carried out for refining the guidelines and techniques utilized for composite repair. (AU)

Objetivo: O objetivo deste estudo foi avaliar o conhecimento entre estudantes de odontologia da King Khalid University, Jazan University e Najran University, no reino da Arábia Saudita, sobre quando reparar ou substituir restaurações de resina composta direta defeituosas. Material e Métodos: Foi formulada uma pesquisa baseada em questionário, buscando informações sobre o manejo (reparo / substituição) de restaurações de resina composta e distribuída entre 200 estudantes de odontologia de três universidades da região sul do reino da Arábia Saudita. Os dados foram coletados com o auxílio de um questionário online. A entrada e análise dos dados foram feitas com o software estatístico SPSS versão 20.0. Foi apresentado por meio de estatística descritiva na forma de frequências e percentuais para as variáveis qualitativas, e amplitude de médias e desvios-padrão para a idade, variável quantitativa. A estatística analítica foi feita usando testes de qui-quadrado (χ2) para testar a diferença significativa entre as variáveis categóricas. Ao nível de significância, o valor de p foi de 0,01 (p <0,01). Resultados: A decisão de escolher entre o reparo ou substituição do compósito foi influenciada pelo fato de este tópico ter sido ensinado a eles em vários níveis de graduação durante o Bacharelado em Odontologia. O motivo associado à decisão de reparar restaurações de resina composta defeituosas, 76% relataram como custo-benefício seguido por maior longevidade (71%), restauração definitva (70%), preferência do paciente para reparo (65%) e menos demorado ( 50%). Sessenta e sete por cento dos participantes preferiram o reparo significativamente (p <0,001) devido a cárie secundária no dente previamente restaurado com resina composta, seguido pelo pequeno defeito de superfície em uma restauração composta (65%), risco de dano pulpar significativamente (p <0,001) em um restauração de resina composta com defeito (62,5%) e opção de tratamento mais invasiva e destrutiva (35%). Mais da metade dos entrevistados, 123 (61,5%) relataram que não foram ensinados sobre reparo de resina composta durante o Bacharelado em Odonotlogia. Conclusão: É sugerido com a ajuda de nosso estudo que os componentes do treinamento didático e clínico sobre reparo de resina composta devem ser seriamente incluídos no currículo de ensino de instituições odontológicas, pois é do interesse do paciente. Os estudantes de odontologia devem receber treinamento clínico sobre este tópico para que possam seguir os protocolos de tomada de decisão adequados disponíveis durante o reparo ou substituição de restaurações de resina composta com defeito. Outras pesquisas no futuro podem ser realizadas para refinar as diretrizes e técnicas utilizadas para reparo de resina (AU)

Conservative and esthetic closure of maxillary midline diastema without creating "black triangle" using direct resin composite

Anterior diastemas are common esthetic problems. One of the challenges in clinical esthetic dentistry is closing anterior diastemas without creating “black triangles” between the teeth. The success of a restorative treatment in anterior teeth depends on the esthetic integration between soft tissues and hard tissues. This report describes the successfully accomplished diastema closure case by producing the emergence profile with natural contours at the gingival-tooth interface and then generating of gingival recontouring process.

Direct Esthetic Rehabilitation of Teeth with Severe Fluorosis Using Uveneer Facial Template: A Case Report.

“Dental fluorosis,” a specific disturbance in tooth formation and an esthetic condition, is defined as a chronic, fluorideinduced condition, in which enamel development is disrupted and the enamel is hypomineralized. Fluorosis can be prevented by having an adequate knowledge of the fluoride sources, knowing how to manage this issue and therefore, avoid overexposure. Controlling the fluoride intake is the best preventive measure for dental fluorosis, however when this is already installed and causing esthetic problems to the patient, many treatment techniques are recommended. This article describes an esthetic rehabilitation of a case of severe fluorosis using a new system for placing direct composite veneer, the Uveneer System (Ultradent) which simulates predictable shape and symmetry of natural teeth. In cases of severe dental fluorosis, the tooth enamel usually becomes porous and tooth whitening methods are not recommended. Therefore, minimally invasive technique of direct composite veneering using facial templates is the treatment of choice as it is easy to use, enhance clinical productivity, saves time, requires minimal preparation and is cost effective.

A combined approach to non-carious cervical lesions associated with gingival recession

Non-carious cervical lesions (NCCLs) with gingival recession require specific consideration on both aspects of hard and soft tissue lesion. In the restorative aspect, careful finishing and polishing of the restorations prior to mucogingival surgery is the critical factor contributing to success. Regarding surgery, assessment of the configuration of the lesion and the choice of surgical technique are important factors. The precise diagnosis and the choice of the proper treatment procedure should be made on the basis of both restorative and surgical considerations to ensure the successful treatment of NCCLs.

Effective application duration of sodium ascorbate antioxidant in reducing microleakage of bonded composite restoration in intracoronally-bleached teeth

OBJECTIVES: The aim of this study was to determine an appropriate application duration of sodium ascorbate (SA) antioxidant gel in reducing microleakage of bonded composite restoration in intracoronally-bleached teeth. MATERIALS AND METHODS: Eighty endodontically-treated human incisors were randomly divided into eight groups: control, no bleaching; IB and DB, immediate and delayed bonding after bleaching, respectively; S10m, S60m, S24h, S3d and S7d, bleaching + SA gel for 10 min, 60 min, 24 hr, 3 day and 7 day, respectively. For bleaching, a mixture of 30% hydrogen peroxide and sodium perborate was applied for 7 day. All access cavities were restored using One-Step adhesive (Bisco Inc.) and then Aelite LS Packable composite (Bisco Inc.). The bonded specimens were subjected to 500 thermal cycles, immersed in 1% methylene blue for 8 hr, and longitudinally sectioned. Microleakage was assessed with a 0 - 4 scoring system and analyzed using nonparametric statistical methods (alpha = 0.05). RESULTS: Group IB showed a significantly higher microleakge than the control group (p = 0.006) and group DB a statistically similar score to the control group (p > 0.999). Although groups S10m, S60m, and S24h exhibited significantly higher scores than group DB (p 0.999). CONCLUSIONS: Application of SA gel for 3 day after nonvital bleaching was effective in reducing microleakage of composite restoration in intracoronally-bleached teeth.

Comprehensive Management of An Adult Patient With Dental Fluorosis.

Dental fluorosis is a condition of enamel hypo-mineralization due to the effects of excessive fluoride on ameloblasts during enamel formation. Bonding brackets to fluorosed teeth remains a notable clinical challenge because of frequent bracket failure at the compromised enamel interface. This case report presents comprehensive management of an adult patient with Angle’s class II div 1 malocclusion with crowding and severe dental fluorosis. Diagnosis: A diagnosis of severe dental flourosis was established based on Deans‘s index for fluorosis (score-3) with a skeletal Class I pattern and Angle’ s Class II Division I dental malocclusion with upper anterior crowding . Treatment plan: Orthodontic treatment with extraction of upper first premolars to correct the dental malocclusion followed by restorative procedure. Treatment results: Competent lips achieved after orthodontic treatment. A class-II molar relation was maintained .Excellent dental esthetics was seen after direct composite restoration.

Effect of film thickness of resin cement on bonding efficiency in indirect composite restoration / 대한치과보존학회지

The purpose of this study was to evaluate the effect of film thickness of various resin cements on bonding efficiency in indirect composite restoration by measurement of microtensile bond strength, polymerization shrinkage, flexural strength and modulus, fractographic FE-SEM analysis. Experimental groups were divided according to film thickness ( 0.05). 3. Panavia F showed significantly lower polymerization shrinkage than other resin cements (p < 0.05). 4. Composite-based resin cements showed significantly higher flexural strength and modulus than adhesive-based resin cements (p < 0.05). 5. FE-SEM examination showed uniform adhesive layer and well developed resin tags in composite-based resin cements but unclear adhesive layer and poorly developed resin tags in adhesive-based resin cements. In debonded surface examination, composite-based resin cements showed mixed failures but adhesive-based resin cements showed adhesive failures.

Influence of flowable materials on microleakage of nanofilled and hybrid Class II composite restorations with LED and QTH LCUs.

Background: Class II composite restorations are more frequently being placed with margins apical to the cementoenamel junction (CEJ) and margins within the dentin are prone to microleakage. Aims: This in vitro study was used to evaluate the influence of flowable composite and flowable compomer as gingival liner on microleakage in Class II composite restorations and compare a light-emitting diode (LED) unit with a quartz tungsten halogen (QTH) unit for light-activating composite resins. Materials and Methods: Mesioocclusal and distoocclusal Class II cavity preparations were made in 72 sound extracted premolars. The buccolingual width was 2.5 mm and the gingival margins of all the cavities were placed 1.0 mm apical to the CEJ. The boxes were prepared 1.5 mm deep axially, making 144 slot cavities. Teeth were randomly divided into the following two groups (n = 72): (I) Universal Filtek Supreme XT; Universal Filtek Supreme XT + Flwable Filtek XT and Universal Filtek Supreme XT + Dyract Flow and (II) Filtek Z250; Filtek Z250 + Flwable Filtek XT and Filtek Z250 + Dyract Flow. Flowable materials were injected into the gingival floor of the cavity to a thickness of 1.0 mm. Each increment was cured for 20 s. One-half of the subgroups in each group were cured with QTH and the other half with LED light curing units (LCUs). After 1 week of incubation at 37°C, the specimens were thermocycled (5-55°C, x1500), immersed in 0.5% basic fuchsine dye for 24 h and sectioned and microleakage was evaluated at the gingival margin by two examiners using a 0-3 score scale. The data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. Results: The groups utilizing flowable liners had significantly less microleakage (P < 0.05). No significant difference was identified between Universal Filtek Supreme XT and Filtek Z250 composites with and without flowable materials. There was no significant between utilizing flowable composite or flowable compomer and between each similar subgroup when polymerized with either the LED or the QTH LCUs. Conclusions: A layer of flowable materials at the gingival floor of Class II composite restorations may be recommended to improve the marginal seal of a restoration.

Effect of blood contamination and decontamination procedures on marginal adaptation and bond strength of composite restorations / Efeito da contaminação com sangue e de procedimentos de descontaminação na adaptação marginal e na resistência de união de restaurações de resina composta

Purpose: To evaluate the effect of blood contamination and different decontamination procedures on marginal adaptation and bond strength of a two-step total-etch adhesive system to dentin. Methods: A total of 135 bovine incisors had the labial surfaces ground to receive cylindrical cavities, and were randomly divided into a control and 8 experimental groups (n=15) according to contamination and decontamination procedures. Freshly collected human blood was applied onto the cavity either before or after light-curing of the adhesive. Four decontamination protocols were tested (drying with paper, water rinsing, phosphoric acid etching, and 10% NaOCl rinsing). The cavities were restored with Adper Single Bond and Filtek Z250 (3M ESPE). The specimens were subjected to thermal cycling before the dye staining test. The cavity floor was removed and the restorations were subjected to a push-out test. Data were analyzed by two-way ANOVA and Tukey's test (α=0.05). Results: Blood contamination after adhesive light-curing increased marginal gap and yielded lower push-out bond strength values (P<0.01). Conclusion: Water rinsing seems to be a reliable procedure for cavity decontamination. The decontamination procedures tested do not recover marginal sealing and bond strength when blood contamination occurs after light-curing of the adhesive.

Objetivo: Avaliar o efeito da contaminação com sangue e de procedimentos de descontaminação na adaptação marginal e resistência de união de um adesivo convencional de dois passos à dentina. Metodologia: Um total de 135 incisivos bovinos receberam cavidades cilíndricas na superfície vestibular, previamente desgastada. Os dentes foram divididos em grupo controle e 8 grupos experimentais (n=15), com base no momento da contaminação e nos procedimentos de descontaminação. Sangue recém-coletado foi aplicado nas cavidades, antes ou após a fotoativação do adesivo. Quatro procedimentos de descontaminação foram testados: secagem com papel, lavagem com água, condicionamento com ácido fosfórico e lavagem com hipoclorito de sódio a 10%. As cavidades foram restauradas com Adper Single Bond e Filtek Z250 (3M ESPE). Os espécimes foram submetidos à termociclagem antes da marcação com corante. O assoalho das cavidades foi removido e as restaurações foram submetidas ao teste de push-out. Os dados foram analisados por two-way ANOVA e teste de Tukey (α=0,05). Resultados: A contaminação após fotoativação do adesivo gerou fendas marginais maiores e resistência de união menor (P<0,001). Conclusão: A lavagem com água parece ser um método confiável de descontaminação. Os procedimentos testados não recuperam o selamento marginal e a resistência de união quando a contaminação ocorre após fotoativação do adesivo.

The effect of various bonding systems on the microtensile bond strength of immediate and delayed dentin sealing / 대한치과보존학회지

The purpose of this study was to compare the effect of various dentin bonding systems on microtensile bond strength of immediate dentin sealing (IDS) and delayed dentin sealing (DDS). Eighteen extracted permanent molars were used in this study. The teeth for DDS group were restored with a provisional restorations, and immersed in saline solution for 1 week, and divided into 3 subgroups according to various dentin bonding adhesives; SB subgroup (3 step total-etch adhesive), SE subgroup (2 step self-etch adhesive), XE subgroup (1 step self-etch adhesive). In IDS group, the teeth were divided into 3 subgroups, and applied with bonding adhesives as in DDS group. The teeth were restored with provisional restorations, and immersed in saline solution for 1 week. Indirect composite disc was cemented with resin cement, and all specimens were subjected to microtensile bond strength. The data were statistically analyzed with one-way ANOVA and Student t-test. The results were as follows: 1. The IDS group showed significantly higher microTBS than DDS group in 3 step total-etch and 2 step self-etch adhesive (p < 0.05). 2. In IDS and DDS group, 3 step total-etch adhesive showed the highest microTBS value, followed by 2 step self-etch, and 1 step self-etch adhesive. In IDS group, the microTBS value for 1 step self-etch adhesive was significantly different from those of the other subgroups (p < 0.05), and in DDS group, there were statistical differences in all subgroup (p < 0.05). 3. Failure modes of tested dentin bonding adhesives were mostly mixed failure and only 1 step self-etch adhesive showed adhesive failure.