Funcionalização de matriz colágena estável em volume utilizando Fibrina Rica em Plaquetas injetável (i-PRF) para o tratamento de Recessão Gengival unitária / Volume-stable collagen matrix (VCMX) biofunctionalized wit injectable platelet-rich fibrin (i-PRF) for the treatment of single gingival recession: randomized clinical trial

Substitutos de enxerto de tecido conjuntivo têm sido amplamente utilizados para superar as limitações dos enxertos autógenos no tratamento de defeitos dos tecidos moles periodontais e peri-implantares. No entanto, o desempenho clínico desses biomateriais ainda é inferior. A biofuncionalização de matrizes colágenas usando fibrina rica em plaquetas injetável (i-PRF) foi proposta como uma estratégia para aprimorar a bioatividade e, portanto, a eficácia clínica desses substitutos mucosos. Desta forma, o objetivo deste estudo foi avaliar a eficácia do uso da matriz colágena estável em volume (FG) biofuncionalizada com i-PRF no tratamento de recessões gengivais unitárias (RGs) do ponto de vista clínico, estético e de parâmetros centrados no paciente. Para tal, foram selecionados 66 pacientes portadores de RGs unitárias RT1, os quais foram alocados aleatoriamente em um dos seguintes grupos: grupo CAF (n=22), retalho posicionado coronariamente (CAF); grupo CAF+FG (n=22), CAF associado à FG; e grupo CAF+FG+i-PRF (n=22), CAF associado à FG biofuncionalizada com i-PRF. Após 6 meses, os três grupos apresentaram taxas de recobrimento radicular significativas [CAF: 69,1% (2,02 ± 1,06 mm); CAF+FG: 67,44% (1,7 ± 0,81 mm) e CAF+FG+i-PRF: 64,92% (1,64 ± 0,80 mm), sem diferença entre os grupos (p=0,33). Os grupos que receberam os biomateriais forneceram um maior ganho em espessura de tecido queratinizado (ETQ) (CAF: 0,12 ± 0,2 mm; CAF+FG: 0,43 ± 0,24 mm; CAF+FG+i-PRF: 0,48 ± 0,25 mm; p=0,000). Não foram observadas diferenças significativas em termos de altura de tecido queratinizado em nenhum dos grupos e tempos avaliados (p>0,05). Todos os grupos apresentaram redução significativa da hipersensibilidade dentinária e melhorias nas condições estéticas (p>0,05). Também não foram observadas diferenças em termos de dor e morbidade pósoperatórias (p>0,05). Dentro das limitações do presente estudo, conclui-se que as três abordagens forneceram resultados semelhantes e satisfatórios após 6 meses de acompanhamento. A adição da FG, biofuncionalizada ou não com i-PRF, proporcionou benefícios adicionais em termos de ganho de ETQ. (AU)

Soft tissue graft substitutes have been widely used to overcome the limitations of autogenous grafts in the treatment of periodontal and peri-implant soft tissue defects. However, the clinical performance of these biomaterials is still inferior. The biofunctionalization of collagen matrices using injectable platelet-rich fibrin (i-PRF) has been proposed as a strategy to enhance the bioactivity and, therefore, the clinical efficacy of these biomaterials. Thus, the aim of this study was to evaluate the effectiveness of using biofunctionalized volume-stable collagen matrix (VCMX) with i-PRF in the treatment of single gingival recessions (GRs) from clinical, esthetic, and patient-centered parameters. For this purpose, 66 patients with single RT GRs were selected and randomly allocated to one of the following groups: CAF group (n=22), coronally advanced flap (CAF); CAF+VCMX group (n=22), CAF combined with VCMX; and CAF+ VCMX +iPRF group (n=22), CAF combined with biofunctionalized VCMX with i-PRF. After 6 months, all three groups exhibited significant root coverage rates [CAF: 69.1% (2.02 ± 1.06 mm); CAF+FG: 67.44% (1.7 ± 0.81 mm); and CAF+FG+iPRF: 64.92% (1.64 ± 0.80 mm), with no difference between the groups (p=0.33). The groups that received the biomaterials showed a greater gain in keratinized tissue thickness (KTT) (CAF: 0.12 ± 0.2 mm; CAF+FG: 0.43 ± 0.24 mm; CAF+FG+i-PRF: 0.48 ± 0.25 mm; p=0.000). No significant differences were observed in terms of keratinized tissue height in any of the groups and assessed time points (p>0.05). All groups showed a significant reduction in dentin hypersensitivity and improvements in esthetic conditions (p>0.05). No differences were also observed in terms of post-operative pain and morbidity (p>0.05). Within the limitations of this study, it is concluded that all three approaches provided similar and satisfactory results after 6 months of follow-up. The addition of VCMX, whether biofunctionalized or not with i-PRF, provided additional benefits in terms of keratinized tissue thickness gain. (AU)

Rethinking the decision-making process to treat gingival recession associated with non-carious cervical lesions

Abstract The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented.

Six month follow-up of two bulk-fill composites in non-carious cervical lesions: double blind randomized clinical trial / Evaluación clínica a 6 meses de restauraciones cervicales en lesiones no cariosas con resinas compuestas bulk-fill: estudio aleatorio doble ciego

Objective: To assess the six-month clinical outcome of restorations of non-carious cervical lesions (NCCL) with two composite resins: Bulk-Fill and nanohybrid resin. Materials and methods: Fifty-one patients, with three NCCLs each, were randomly allocated into three restoration groups: Tetric-N-Ceram Bulk-Fill (TB); Filtek Bulk-Fill (FB); y Filtek Z350XT (Z350). Adhesive techniques and restorative procedures were performed according to the manufacturers' instructions for the different materials. A 4mm increment was applied in TB and FB, and increments of ≤2mm depth were applied in Z350. Restorations were assessed by two calibrated examiners at baseline and at six months according to the FDI World Dental Federation guidelines (1: excellent, 2: acceptable, 3: sufficient, 4: unsatisfactory, 5: unacceptable) in Marginal Staining (MS), Fracture-Retention (FR), Marginal Adaptation (MA), Postoperative Sensitivity (S) and Caries (C). Wilcoxon test was used for the comparison between baseline and 6 months, and Kruskal-Wallis for the comparison of the three groups at six months (95% significance). Results: Forty-six patients with a total of 138 restorations attended a check-up at six months and were evaluated with excellent clinical outcome. In MS, 91.2% for Z350 and 97.8% for FB and TB; in FR, 97.8% for Z350 and 100% for FB and TB; in MA, 95.6% for Z350, 97.8% for FB and 100% for TN; in S, 95.6% for all three groups; and 100% for C. No statistically significant differences were found between the three groups nor in the comparison between the baseline and 6 months (p>0.05) Conclusion: No significant differences are observed between the three groups of resins in the parameters of MS, MA, S, FR and C regarding clinical outcome at six months.

Objetivo: Evaluar el comportamiento clínico a 6 meses en restauraciones de lesiones cervicales no cariosas (LCNC) con dos resinas compuestas Bulk-Fill y una resina nanohíbrida. Materiales y métodos: En 51 pacientes se restauraron 3 LCNC distribuidas aleatoriamente en 3 grupos, TB: Tetric-N-Ceram Bulk-Fill, FB: Filtek Bulk-Fill y Z350: Filtek Z350XT. Las técnicas adhesivas y procedimientos restauradores fueron realizados según las instrucciones de los fabricantes para los diferentes materiales. En TB y FB se aplicó un incremento de 4mm y en Z350 se aplicó incrementos ≤2mm de profundidad. Dos operadores calibrados evaluaron las restauraciones al baseline y 6 meses mediante los criterios clínicos FDI (1: excelente, 2: aceptable, 3: suficiente, 4: insatisfactorio, 5: inaceptable) en Tinción Marginal (TM), Fractura-Retención (FR), Adaptación Marginal (AM), Sensibilidad Postoperatoria (S) y Caries (C). Se utilizó Wilcoxon para la comparación entre baseline ­ 6 meses y Kruskal-Wallis para la comparación de los 3 grupos a 6 meses (significancia de 95%). Resultados: A los 6 meses asistieron 46 pacientes con un total de 138 restauraciones siendo evaluados con comportamiento clínico excelente; en TM 91,2% para Z350 y 97,8% para FB y TB; en FR, Z350 presentó 97,8% y en FB y TB el 100%; en AM, 95,6% para Z350, 97,8% para FB y 100% para TN; en S presentó 95,6% para los tres grupos; en C se presentó el 100%. No hubo diferencias estadísticamente significativas entre los 3 grupos y en la comparación de baseline - 6 meses (p>0.05). Conclusión: No existen diferencias significativas en el comportamiento clínico a 6 meses entre los 3 grupos de resinas en los parámetros TM, AM, S, FR Y C.

Three-dimensional finite element analysis of severe wedge-shaped defective premolar restored with fiber post and composite resin / 中国组织工程研究

BACKGROUND:Someone regards that treatments such as root canal therapy and post-core restoration can increase the fracture probability of teeth. Can fiber reinforced composite post enhance the fracture resistance of the severe wedge-shaped defected premolar? Three-dimensional finite element can simplify complex dental systems into a model analyzed by computer, and conduct biomechanical research through the model analysis. OBJECTIVE:To analyze the stress distribution of sever wedge-shaped defected first premolar which restored by fiber reinforced composite post and composite resin. METHODS:We established the three-dimensional finite element models of severe wedge-shaped defected maxil ary first premolar before and after restoration with fiber reinforced composite post and composite resin. The maximum bite force was designed to 267 N that was applied at 45° angle. Then, we analyzed the distribution of maximum principal stress in finite element models. RESULTS AND CONCLUSION:The maximum principal stress was concentrated in the tip of defected region. After restoration, the distribution of maximum principal stress was similar to that of the normal premolar, and the tensile stress was distributed uniformly in the upper-central part of buccal root. It may be beneficial for improving fracture resistance ability of severe wedge-shaped-defect premolar by restoration with fiber reinforced composite post and composite resin.

Relação entre lesões cervicais não cariosas e hábitos / Relationship between non-carious cervical lesions and habits

Introdução: O desenvolvimento de lesões cervicais não cariosas (LCNC) em idosos é decorrente da maior permanência dos dentes no arco dentário e do contato com fatores etiológicos. Objetivos: Avaliar a prevalência de lesões cervicais não cariosas em idosos, correlacionada com hábitos de higiene, dieta ácida e hábitos para-funcionais. Métodos: Estudo observacional transversal em 100 indivíduos idosos, sendo 53% do gênero feminino e 47% do masculino, com média de idade de 71 ± 8 anos e variação de 60 a 93 anos. A distribuição do estado civil evidenciou 26% de solteiros, 39% de casados, 4% de separados e 31% de viúvos, enquanto a distribuição étnica correspondeu a 73% de leucodermas, 11% de melanodermas, 14% de feodermas e 2% de xantodermas, no período de novembro de 2007 a janeiro de 2008, na Clínica de Especilização em Odontogeriatria da Associação Paulista de Cirurgiões Dentistas (Regional São Bernardo do Campo). Foi aplicado exame do estado mental, questionário e exame clínico. Resultados: a) não foram observadas associação entre a quantidade de fatores intrínsecos e a presença de erosão e nem correlação entre a quantidade de fatores extrínsecos e o número de dentes ou porcentagem de dentes comprometidos pela erosão; b) não foram observadas correlações entre a presença de hábitos para-funcionais e o número de dentes com abfração ou porcentagem de dentes comprometidos pela abfração; c) não foram observadas correlações significativas entre o número de dentes ou porcentagem de dentes comprometidos pela abrasão e nenhum dos hábitos de higiene. Conclusão: Os indivíduos pesquisados mostraram 77% com pelo menos uma lesão cervical não cariosa, mas sem qualquer correlação com os fatores etiológicos de cada lesão específica; 12% da amostra apresentaram erosão dentária, mas sem correlação com a dieta ácida; 42% da amostra apresentaram abfração dentária, mas sem correlação com hábitos parafuncionais; e 63% da amostra apresentaram abrasão dentária, mas sem correlações...

Introduction: The development of non-carious cervical lesions (LCNC) in teeth of elderly people is due to the largest stay in dental arch in contact with etiologic factors. Objectives: To evaluate the prevalence of non-carious cervical lesions in elderly patients, correlating them with hygiene habits, acid diet and parafunctional habits. Methods: A cross-sectional observational study was carried out on 100 elderly patients, of which 53% were female and 47% male; the mean age was 71 ± 8 years (ranging from 60 to 93). The sample showed significant differences in the sample distribution in terms of marital status (26% single, 39% married, 4% divorced, 31% widowed) and race (73% Caucasian, 11% black, 14% mixed black-white, and 2% Asian), from November 2007 to January 2008, in Gerodontics Course at the Paulista Association of Dental Surgeons (in São Bernardo do Campo city). Participants were put through a mental test, as well as a questionnaire and a clinical examination. Results: a) No association was found between the quantity of intrinsic factors and the presence of erosion, and neither was there a correlation between the quantity of extrinsic factors and the number of teeth or the percentage of teeth involved by erosion; b) no correlation between the presence of parafunctional habits and the number or percentage of teeth with abfraction lesions was observed; c) there was no significant correlation between the number of teeth or the percentage of teeth involved by abrasion and any of the hygiene habits. Conclusion: 77% of the participants had at least 1 non-carious cervical lesion, but without any correlation with etiologic factors for each lesion in particular; 12% had tooth erosion, but without any correlation with an acid diet; 42% had tooth abfraction, but without any correlation with parafunctional habits; and 63% had tooth abrasion, but without a significant correlation with hygiene habits.

Abfraction lesions reviewed: current concepts / Uma revisão sobre lesões de abfração: conceitos atuais

Non-carious cervical lesions are characterized by structural loss near the cementoenamel junction, without the presence of caries. A number of theories have arisen to explain the etiology of such lesions, although the real causes remain obscure, as is reflected by the contradictory terminology used in the literature. In addition to describing acidic and abrasive processes documented as etiological factors, attention is given to the role of mechanical stress from occlusal load, which is the most accepted theory for the development of abfraction lesions. Considering that tensile stress leads to the failure of restorations in the cervical region and that this is a fruitful area for future research, the present study has highlighted diagnosis, prognosis and the criteria for treatment.

As lesões cervicais não cariosas são caracterizadas pela perda de estrutura próxima à junção cemento-esmalte sem a presença de cárie. Algumas teorias têm surgido para tentar explicar a etiologia dessas lesões, embora as causas verdadeiras permaneçam obscura devido à terminologia contraditória na literatura. Apesar dos processos abrasivos e erosivos serem apontados como fatores etiológicos, atenção é dada ao papel da força biomecânica das cargas oclusais que é a teoria mais aceita para o desenvolvimento das lesões de abfração. Ao considerar que falhas de restauração podem ocorrer por tensões de tração e que constituem área promissora para pesquisas futuras, o presente trabalho demonstra os conceitos atuais sobre diagnóstico, prognóstico e critérios para o tratamento.

Lesões não cariosas no idoso / Non-carious lesions in elderly

Introdução: O desenvolvimento de lesões cervicais não cariosas (LCNC) em idosos é decorrente da maior permanência dos dentes no arco dentário e do contato com fatores etiológicos. Objetivos: Avaliar a prevalência de lesões cervicais não cariosas em idosos, correlacionada com hábitos de higiene, dieta ácida e hábitos para-funcionais. Métodos: Estudo observacional transversal em 100 indivíduos idosos, 53% do gênero feminino e 47% do masculino, com média de idade de 71 ± 8 anos e variação de 60 a 93 anos. A distribuição do estado civil evidenciou 26% de solteiros, 39% de casados, 4% de separados e 31% de viúvos, enquanto a distribuição étnica correspondeu a 73% de leucodermas, 11% de melanodermas, 14% de feodermas e 2% de xantodermas, no período de novembro de 2007 a janeiro de 2008, na Clínica de Especialização em Odontogeriatria da Associação Paulista de Cirurgiões Dentistas (Regional São Bernardo do Campo). Foi aplicado mini-exame do estado mental, questionário e exame clínico. Resultados: Não foram observadas associação entre a quantidade de fatores intrínsecos e a presença de erosão nem correlação entre a quantidade de fatores extrínsecos e o número de dentes ou porcentagem de dentes comprometidos pela erosão. Não foi observada correlação entre a presença de hábitos para-funcionais e o número de dentes com abfração ou porcentagem de dentes comprometidos pela abfração. Não foi observada correlação significativa entre o número de dentes ou porcentagem de dentes comprometidos pela abrasão e nenhum dos hábitos de higiene. Conclusão: Os indivíduos pesquisados mostraram 77% com, pelo menos, uma lesão cervical não cariosa, mas sem qualquer correlação com os fatores etiológicos de cada lesão específica; 12% da amostra apresentaram erosão dentária, mas sem correlação com a dieta ácida; 42% da amostra apresentaram abfração dentária, mas sem correlação com hábitos para-funcionais; e 63% da amostra apresentaram abrasão dentária, mas sem correlação significativa com...

Introduction: The development of non-carious cervical lesions (LCNC) in teeth of elderly people it is due to the largest stay in dental arch, in contact with etiologic factors. Objectives: To evaluate the prevalence of non-carious cervical lesions in elderly patients, correlating with hygiene habits, an acid diet and parafunctional habits. Casuistic and Methods: A cross-sectional observational study was carried out on 100 elderly patients, of which 53% were female and 47% male; the mean age was 71 ± 8 years (the ages ranged from 60 to 93 years old). The sample showed significant differences in the sample distribution in terms of marital status (26% single, 39% married, 4% divorced, 31% widowed) and race (73% Caucasian, 11% black, 14% mixed black-white, and 2% Asian), from November 2007 to January 2008, during the major specialization course in Gerodontics at the Paulista Association of Dental Surgeons (in the city of São Bernardo do Campo). Participants were put through a mini mental test, as well as a questionnaire and a clinical examination. Results: No association was found between the quantity of intrinsic factors and the presence of erosion, and neither was there a correlation between the quantity of extrinsic factors and the number of teeth or the percentage of teeth involved by erosion; no correlation between the presence of parafunctional habits and the number or percentage of teeth with abfraction lesions was observed; there was no significant correlation between the number of teeth or the percentage of teeth involved by abrasion and any of the hygiene habits. Conclusion: The researched patients showed: 77% of the participants had at least 1 non-carious cervical lesion, but without any correlation with etiologic factors for each lesion in particular; 12% had tooth erosion, but without any correlation with an acid diet; 42% had tooth abfraction, but without any correlation with parafunctional habits; 63% had tooth abrasion, but without a significant...