Efecto del tratamiento de la morfología oclusal con materiales para restauraciones preventivas / Effect of treating occlusal morphology with materials for preventive restorations

Introducción: las fosas y fisuras son áreas formadas por delgadas irregularidades de la capa del esmalte de la superficie oclusal. La compleja morfología en dientes posteriores es un determinante biológico asociado al desarrollo de caries. Objetivo: evaluar el efecto de diversas formas de tratar la morfología oclusal en la adaptación y penetración de materiales utilizados en restauraciones preventivas. Material y métodos: diseño experimental e in vitro. Sesenta terceros molares fueron distribuidos aleatoriamente en dos grupos: surco sin ameloplastia y con ameloplastia; además, contaban con acondicionamiento del esmalte que se subdividió en tres subgrupos: 1) sellador de fosas y fisuras, 2) adhesivo/sellador de fosas y fisuras y 3) adhesivo/ resina Flow. Resultados: los subgrupos adhesivo/sellador y adhesivo/ Flow alcanzaron mayores valores de adaptación íntima a las paredes del surco. Las diferencias fueron significativas entre los materiales (p = 0.0009). Las mayores zonas de desadaptación resultaron para el sellador sin y con ameloplastia. La penetración de los materiales fue mayor en los surcos con ameloplastia. En los surcos tratados con ameloplastia, el adhesivo/Flow reveló el mayor porcentaje de penetración y la mejor adaptación a las paredes del surco. Conclusiones: la penetración del material está positivamente correlacionada con la profundidad del surco. El sellador con y sin ameloplastia mostró pobre adaptación a las paredes del surco (AU)

Introduction: pits and fissures are areas formed by fine irregularities in the enamel layer of the occlusal surface. The complex morphology in posterior teeth are biological determinants associated with the development of caries. Objective: to evaluate the effect of various ways of treating occlusal morphology on the adaptation and penetration of materials used in preventive restorations. Material and methods: experimental design, in vitro. Sixty third molars were randomly distributed into two groups: groove without ameloplasty and with ameloplasty, with enamel conditioning with three subgroups: 1) pit and fissure sealer, 2) adhesive/pit and fissure sealer, 3) adhesive/resin flow. Results: the adhesive/sealant and adhesive/flow subgroups reached higher values of intimate adaptation to the furrow walls. The differences were significant between the materials (p = 0.0009). The largest areas of maladjustment were found for the sealant without and with ameloplasty. The penetration of the materials was greater in the grooves with ameloplasty. In the grooves treated with ameloplasty, the adhesive/flow revealed the highest percentage of penetration and the best adaptation to the walls of the groove. Conclusions: the penetration of the material is positively correlated with the depth of the furrow. The sealant with and without ameloplasty showed poor adaptation to the sulcus walls (AU)

Tratamiento integral de una adolescente con dentinogénesis imperfecta tipo I / Comprehensive treatment of an adolescent with type I dentinogenesis imperfecta

La dentinogénesis imperfecta (DI) es un desorden hereditario de carácter autosómico dominante, que se origina durante la etapa de histodiferenciación en el desarrollo dental y altera la formación de la denti-na. Se considera una displasia dentinaria que puede afectar ambas denticiones con una incidencia de 1 en 6000 a 8000 nacimientos. El tratamiento del pa-ciente con DI es complejo y multidisciplinario, supone un desafío para el odontólogo, ya que por lo general están involucradas todas las piezas dentarias y afec-ta no solo la salud buco dental sino el aspecto emo-cional y psicológico de los pacientes. Objetivo: des-cribir el tratamiento integral y rehabilitador realiza-do en una paciente adolescente con diagnóstico de DI tipo I. Relato del caso: Paciente de sexo femenino de 14 años, que concurrió en demanda de atención a la Cátedra de Odontología Integral Niños de la FOU-BA derivada del Hospital "Prof. Dr. Juan P. Garrahan" con diagnóstico de osteogénesis imperfecta tipo III (OI). Nunca recibió atención odontológica y el motivo de consulta fue la apariencia estética de sus piezas dentarias. Se realizó el examen clínico y radiográfico arrojando el diagnóstico de DI tipo I asociada a OI. Conclusión: El tratamiento rehabilitador de la DI tipo I en los pacientes en crecimiento y desarrollo debe estar dirigido a intervenir de manera integral y tem-prana para resolver la apariencia estética y funcio-nal, evitar las repercusiones sociales y emocionales y acompañar a los pacientes y sus familias (AU)

Dentinogenesis imperfecta (DI) is an autosomal dominant inherited disorder that originates during the histodifferentiation stage of tooth development and alters dentin formation. It is considered a den-tin dysplasia that can affect both dentitions with an incidence of 1 in 6000 to 8000 births. The treatment of patients with DI is complex and multidisciplinary, it is a challenge for the dentist, since in general all the teeth are involved and it affects not only oral health but also the emotional and psychological aspect of the patients. Objective: To describe the comprehen-sive and rehabilitative treatment carried out in an adolescent patient with a diagnosis of DI type I. Case report: A 14-year-old female patient, who required dental attention at the Department of Pediatric Den-tistry of FOUBA and was referred from the Hospital "Prof. Dr. Juan P. Garrahan" with a diagnosis of os-teogenesis imperfecta type III (OI). The patient never received dental care and the reason for consultation was esthetic appearance of her teeth. A clinical and radiographic examination was performed, resulting in a diagnosis of DI type I associated with OI. Conclu-sion: Rehabilitative treatment of DI in growing and developing patients will be aimed at early and com-prehensive intervention to resolve esthetic and func-tional appearance, avoid social and emotional reper-cussions and accompany patients and their families (AU)

Grado de microfiltración en ionómero de vidrio y resina compuesta nanoparticulada en lesiones cervicales no cariosas / Degree of microleakage in glass ionomer and nanoparticulate composite resin in non-carious cervical lesions

Introducción: El grado de microfiltración en el ionómero de vidrio y la resina compuesta nanoparticulada en lesiones cervicales no cariosas es de gran importancia para elegir el material restaurador más adecuado para cada caso clínico. Objetivo: Describir el grado de microfiltración en ionómero de vidrio y resina compuesta nanoparticulada en lesiones cervicales no cariosas. Métodos: Se realizó una revisión bibliográfica, correspondiente al nivel exploratorio, en busca de responder cinco preguntas científicas sobre el tema. Se identificaron 62 artículos de las bases de datos de Google Académico o Scopus entre 2015 y 2022. Resultados: Los estudios consultados sugieren que la resina compuesta nanoparticulada es una opción de restauración efectiva y estética en odontología, especialmente en casos de cavidades de alta carga mecánica y estética dental. Los estudios de casos que se revisan demuestran que el grado de microfiltración en las lesiones cervicales no cariosas puede ser significativamente mayor en las restauraciones con ionómero de vidrio en comparación con las resinas compuestas nanoparticuladas. Conclusiones: Se concluye que el elemento fundamental en el tratamiento es realizar un correcto diagnóstico, determinando las necesidades para mejorar la salud dental y realizar una correcta planificación, por lo que es necesario conocer los diferentes tipos de tratamientos con la finalidad de seleccionar el más adecuado, que cumpla con las características biológicas, mecánicas y estéticas, ya que uno de los objetivos fundamentales de cualquier tratamiento es devolver la función y la estética de modo satisfactorio y con la mayor durabilidad posible.

Introduction: The degree of microleakage in glass ionomer and nanoparticulated composite resin in non-carious cervical lesions is of great importance for choosing the most suitable restorative material for each clinical case. Objective: To describe the degree of microleakage in glass ionomer and nanoparticulated composite resin in non-carious cervical lesions. Methods: A literature review, corresponding to the exploratory level, was carried out to answer five scientific questions on the subject. Sixty-two articles were identified from Academic Google or Scopus databases between 2015 and 2022. Results: The studies consulted suggest that nanoparticulated composite resin is an effective and esthetic restorative option in dentistry, especially in cases of cavities with high mechanical load and dental esthetics. The case studies reviewed demonstrate that the degree of microleakage in non-carious cervical lesions can be significantly higher in glass ionomer restorations compared to nanoparticulated composite resins. Conclusions: It is concluded that the fundamental element in treatment is to carry out a correct diagnosis, determining the needs to improve dental health and to carry out correct planning, so it is necessary to know the different types of treatments with the aim of selecting the most suitable one, which complies with the biological, mechanical and esthetic characteristics, since one of the fundamental objectives of any treatment is to restore function and esthetics in a satisfactory way and with the greatest possible durability.

Materiales bioactivos para restauraciones directas en dientes posteriores / Bioactive materials for direct restorations in posterior teeth

Se trata de paciente femenino de 22 años de edad, en quien se realizó una restauración en un molar siguiendo la filosofía de mínima intervención desde el diagnóstico hasta la obturación con un material bioactivo. Los objetivos del tratamiento fueron devolver la funcionalidad y estética de dicho molar, pero sobre todo brindar una protección a largo plazo mediante la liberación y recarga de iones de calcio, fosfato y flúor proporcionado por el material bioactivo (AU)

t is about a female patient of twenty-two years, in which a restoration was made in a molar following the philosophy of minimal intervention from diagnosis to filling with a bioactive material. The objectives of the treatment were to restore the functionality and aesthetics, but mainly to provide long-term protection through the release and recharge of calcium, phosphate and fluoride ions provided by the bioactive material used (AU)

Propiedades flexurales y estabilidad de color de materiales restauradores estéticos indirectos / Flexural properties and color stability of indirect esthetic restorative materials

Introducción: Las diferencias en las propiedades mecánicas de los materiales cerámicos y a base de resina plantean la interrogante sobre cuál puede tener un mejor desempeño a largo plazo. Objetivos: Evaluar la resistencia flexural y estabilidad de color de diferentes materiales restauradores estéticos indirectos. Métodos: Los materiales seleccionados fueron Filtek™ Z250 XT (3M ESPE), Ceramage (SHOFU Dental), VITA VM® LC y VITA ENAMIC® (VITA Zahnfabrik), IPS e.max® (Ivoclar-Vivadent) y Zolid FX (Amann Girrbach AG). El ensayo de resistencia flexural (n = 10) fue realizado en una máquina universal de ensayos mecánicos. Las lecturas de color (n = 5) se midieron en un espectrofotómetro VITA Easyshade V®. Resultados: Los materiales totalmente cerámicos mostraron un mejor desempeño mecánico (p < 0,001). Los resultados de estabilidad de color muestran que Ceramage, IPS e.max® y Zolid FX, mostraron una diferencia estadísticamente significativa (p ≤ 0,002) con Filtek Z250 XT, VITA VM® LC y VITA ENAMIC®. Conclusiones: Los materiales totalmente cerámicos presentaron una mayor resistencia flexural y estabilidad de color que los materiales de base polimérica. A pesar de ello, los materiales estéticos indirectos con polímeros en su composición, como Ceramage, se presentan como una alternativa válida, ya que además de tener propiedades mecánicas adecuadas, poseen una estabilidad de color semejante a los materiales cerámicos(AU)

Introduction: Differences in the mechanical properties of ceramic and resin-based materials pose the question of which of the two will perform better in the long run. Objectives: Evaluate the flexural resistance and color stability of different indirect esthetic restorative materials. Methods: The materials selected were Filtek™ Z250 XT (3M ESPE), Ceramage (SHOFU Dental), VITA VM® LC and VITA ENAMIC® (VITA Zahnfabrik), IPS e.max® (Ivoclar-Vivadent) and Zolid FX (Amann Girrbach AG). The flexural resistance assay (n = 10) was conducted in a universal mechanical testing machine. Color readings (n = 5) were taken with a VITA Easyshade V® spectrophotometer. Results: All-ceramic materials had better mechanical performance (p < 0.001). Color stability results show that Ceramage, IPS e.max® and Zolid FX displayed a statistically significant difference (p ≤ 0.002) with respect to Filtek Z250 XT, VITA VM® LC and VITA ENAMIC®. Conclusions: All-ceramic materials exhibited greater flexural resistance and color stability than polymer-based materials. However, indirect esthetic materials with polymers in their composition, such as Ceramage, are presented as a valid alternative, due to their appropriate mechanical properties and their color stability, which is similar to that of ceramic materials(AU)

Can bulk-fill resin restorations be an alternative to resin-modified glass ionomer cement restorations in primary molars of toddlers? a randomized clinical trial protocol / ¿Pueden las restauraciones de resina bulk-fill ser una alternativa a las restauraciones de cemento de ionómero de vidrio modificado con resina en los molares primarios en niños preescolares? un protocolo de ensayo clínico aleatorizado

Background: The aim of this study was to elaborate a randomized clinical trial protocol to evaluate the effectiveness of class I restorations in resin-modified glass ionomer cement (RMGIC) and bulk-fill resin in primary molars with untreated early childhood caries in toddlers. Material and Methods: A total of 59 toddlers up to 36 months old with at least two primary molar teeth with untreated dental caries of single surface on different sides of the mouth will be selected at the Pediatric Dentistry Clinics of the Faculty of Dentistry at Federal University of Minas Gerais (UFMG), Brazil. Teeth with untreated dental caries in the left and right sides of each patient's mouth will be randomly distributed into 2 groups: Group 1 (Control): encapsulated RMGIC restoration with Riva light cure (SDI, Florida, USA) and Group 2 (Test): Filtek bulk-fill composite resin restoration (3M/ESPE, St. Paul, USA) with universal single bond adhesive system (3M/ESPE, St. Paul, USA). A single trained dentist will perform all restorative procedures. The restorations will be evaluated after 1, 6, 12, 18 and 24 months by two trained and calibrated examiners. Cost-efficacy analysis will be carried out. Kaplan-Meier survival analysis, Log-rank test, Cox regression, Poisson regression analysis, Mann-Whitney test or Kruskal-Wallis will be performed to analyze data. Conclusion: The protocol will make it possible to determine the most efficacy material for the restoration of cavities in cavities in primary molars of toddlers.

Antecedentes: El objetivo de este estudio fue elaborar un protocolo de ensayo clínico aleatorizado para evaluar la efectividad de las restauraciones de clase I en cemento de ionómero de vidrio modificado con resina (RMGIC) y resina bulk-fill en molares primarios con caries de la primera infancia no tratadas en niños preescolares. Material y Métodos: Un total de 59 niños de hasta 36 meses de edad con al menos dos molares temporales con caries no tratada de superficie única en diferentes lados de la boca serán seleccionados en las Clínicas de Odontología Pediátrica de la Facultad de Odontología de la Universidad Federal de Minas Gerais (UFMG), Brasil. Los dientes con caries no tratada en los lados izquierdo y derecho de la boca de cada paciente se distribuirán aleatoriamente en 2 grupos: Grupo 1 (Control): restauración RMGIC encapsulada con fotopolimerización Riva (SDI, Florida, EE. UU.) Y Grupo 2 (Prueba): Restauración de resina compuesta bulk-fill Filtek (3M / ESPE, St. Paul, EE. UU.) con sistema adhesivo de unión simple universal (3M / ESPE, St. Paul, EE. UU.). Un solo dentista capacitado realizará todos los procedimientos de restauración. Las restauraciones serán evaluadas después de 1, 6, 12, 18 y 24 meses por dos examinadores capacitados y calibrados. Se llevará a cabo un análisis de coste-eficacia. Se realizarán análisis de supervivencia de Kaplan-Meier, prueba de rango logarítmico, regresión de Cox, análisis de regresión de Poisson, prueba de Mann-Whitney o Kruskal-Wallis para analizar los datos. Conclusión: El protocolo permitirá determinar el material más eficaz para la restauración de caries en molares temporales de niños preescolares.

Remoção seletiva de tecido cariado e proteção pulpar indireta: relato de casos clínicos / Selective caries removal and indirect pulp capping: clinical cases report

Objetivo: este artigo se propõe a discutir o tratamento de lesões profundas de cárie em molares permanentes, através da técnica de remoção seletiva de tecido cariado e restauração de resina composta, em dois casos clínicos, utilizando apenas sistema adesivo (caso 1) ou proteção pulpar indireta com cimento de hidróxido de cálcio (caso 2). Relato de casos: os indivíduos foram diagnosticados com dentes apresentando lesões profundas de cárie, isto é, com mais de 50% em profundidade da dentina, confirmada pelo exame radiográfico interproximal. O conjunto de resultados de testes de sensibilidade pulpar positivo ao frio e teste de percussão horizontal e vertical negativos, juntamente com a ausência de dor espontânea e normalidade do periápice (radiografia periapical), completaram os requisitos exigidos para execução da técnica de remoção seletiva de dentina cariada amolecida. Os dentes receberam restaurações adesivas na mesma sessão, sobre a dentina cariada amolecida da parede pulpar que havia recebido forramento de cimento de hidróxido de cálcio ou não, dependentes de uma randomização. Ambos os casos apresentados mostraram sucesso clínico em acompanhamento de 18 meses, tanto na manutenção da vitalidade pulpar quanto na sobrevivência da restauração. Considerações finais: com base nos casos apresentados, sabendo das limitações deste modelo de estudo, e em concordância com a literatura, a remoção seletiva de tecido cariado pode ser executada com sucesso no tratamento de lesões profundas de cárie, respeitando-se todos os passos da técnica, e parece não haver necessidade de uso de proteção pulpar indireta.(AU)

Objective: this article aims to discuss the treatment of deep caries lesions in permanent molars through the selective caries tissue removal technique and composite resin restoration of two clinical cases, using only an adhesive system (case 1) or an indirect pulp protection of calcium hydroxide cement (case 2). Cases report: the participants were diagnosed with deep caries lesions, that is, more than 50% in depth of the dentin involved, which was confirmed by the interproximal radiography. In both cases, it was obtained positive response to cold test, negative response to horizontal and vertical percussion tests, absence of spontaneous pain and no periapical lesion (periapical radiography), which completed the requirements for performing the selective caries removal of soft dentin. These teeth received adhesive restorations in the same session, under the softened carious dentin of the pulp wall that had received calcium hydroxide cement or not, depending on randomization. Both cases had clinical success in the 18-month follow- -up, showing pulp vitality and restoration survival. Final considerations: based on the clinical cases reported, considering de limitations of this study model, and in agreement with the literature, the selective removal of carious tissue can be successfully performed in the treatment of deep carious lesions, respecting all the steps of the technique and indirect pulp protection seems to be unnecessary.(AU)

Alternativas de tratamiento para pacientes jóvenes con pérdida de estructura dentaria. Parte 1: caso clínico / Treatment alternatives for young patients with loss of dental structure. Part 1: a clinical Case

El objetivo de este artículo es presentar una alternativa de tratamiento rehabilitador para pacientes jóvenes con gran pérdida de estructura dental vinculada a lesiones de origen no bacteriano. Se presenta el caso clínico de un paciente de 36 años de edad, con reflujo gastroesofágico crónico bajo tratamiento médico, que concurrió a la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), en busca de un cambio estético en su sonrisa y relatando sensibilidad al calor, al frío y dolor al masticar. No manifestó sintomatología dolorosa a nivel muscular ni articular. En función de sus posibilidades económicas y de la etiología erosiva de las lesiones existentes en sus piezas dentarias, se llevó a cabo una rehabilitación oral adhesiva con resinas compuestas utilizando la sistematización de atención que sugiere la Cátedra. Las resinas compuestas actuales, en combinación con las técnicas y procedimientos desarrollados en este artículo han demostrado un adecuado comportamiento al ser utilizadas como restauraciones definitivas en pacientes que necesitan rehabilitación oral total debido a la gran pérdida de estructura dental por erosión ácida (AU)

Restableciendo la oclusión funcional con restauraciones parciales de cerámica adhesiva tipo Onlay. Reporte de caso clínico / Functional Rehabilitation with an Onlay Ceramic Adhesive Restoration: Case Report

Resumen: El objetivo de este artículo es analizar las indicaciones para la selección adecuada de restauraciones parciales de cerámica adhesiva tipo Onlay, proporcionando el protocolo clínico paso a paso para su correcta aplicación. Principios biomecánicos basados en consideraciones morfológicas y términos geométricos, deberán estar presentes para la cuidadosa preparación de cavidades tipo Onlay. Se discuten conceptos sobre las preparaciones cavitarias bajo condiciones esenciales en la preservación de tejido dental sano, sin compromiso de cúspides de soporte o vertientes que comprometan el resultado final de la restauración en condiciones funcionales y estéticas debidamente planificadas. La sugerencia del autor es respetar y seguir de forma puntual cada uno de los pasos aplicados en el protocolo clínico restaurador, para mejorar el resultado final de las restauraciones en los casos clínicos personalizados.

Abstract: The objective of this article was to analyze the indications for the proper selection of Onlay adhesive ceramic restorations, providing a step-by-step clinical protocol. Biomechanical principles based on morphological considerations and geometric terms must be present for the careful preparation of Onlay-type cavities. Concepts about cavitary preparations are discussed under essential conditions in the preservation of healthy dental tissue, without compromising the functional and aesthetic results over time. The author's suggestion is to respect and follow in a timely manner each of the steps applied in this restorative clinical protocol, to improve the final outcome of the restoration.

A Fiberglass and Resin Post Technique Combined with Fragment Collage of an Upper Central Incisor: Multidisciplinary Treatment / Unión de fragmento de un incisivo central superior con una técnica combinada: Tratamiento multidisciplinario

ABSTRACT: The clinical treatment of anterior tooth fractures requires specialized knowledge, technical skill, and a degree of artistic sense to ensure successful treatment. Herein, we describe the reattachment of an original tooth fragment with endodontic involvement via the utilization of a micro-hybrid composite resin and an aesthetic fiberglass post.

RESUMEN El tratamiento clínico de las fracturas coronarias en dientes anteriores superiores requiere de conocimientos especializados, habilidades técnicas y un grado de sentido artístico para garantizar un exitoso tratamiento. En este reporte de caso, se describe la unión de un fragmento de un incisivo superior, que requirió previamente un tratamiento endodóntico, mediante la utilización de una resina compuesta micro- híbrida y un poste de fibra de vidrio.

Tratamiento Rehabilitador Estético-Oclusal con Resinas Compuestas en una Paciente con Mordida Profunda y Desgaste Severo / Aesthetic-Occlusal Rehabilitation Treatment with Composite Resins in a Patient with Deep Bite and Dental Wear

RESUMEN: La rehabilitación oral tradicional del paciente con mordida profunda y braquifacial puede ser muy compleja e invasiva, sin embargo, podría involucrar muchas especialidades para su resolución ideal. Un análisis integral estético-oclusal es necesario antes de empezar el tratamiento para hacer propuestas con el menor costo biológico, de tiempo y económico. La odontología adhesiva permite una propuesta aditiva y no invasiva como un tratamiento de mediano plazo o transitorio. Este artículo presenta un caso de una paciente de 46años de edad con mordida profunda anterior y desgaste dental severo en las caras palatinas de los dientes antero-superiores, sin disfunción temporomandibular, ni compromisos sistémicos. Se destaca la rehabilitación estética- oclusal con el mínimo compromiso biológico (ultra-conservadora), mediante restauraciones adhesivas semi-indirectas de resina compuesta con acompañamiento de 12meses. Esta propuesta rehabilitadora con resinas compuestas representa una alternativa de tratamiento para el manejo del paciente con mordida profunda anterior. El control a un año de tratamiento demostró que se siguió una secuencia y resolución que aseguró los principios de la rehabilitación oral, al mismo tiempo, se procedió de la manera menos invasiva posible.

ABSTRACT: The traditional oral rehabilitation of the patient with deep bite and brachifacial can be very complex and invasive, however, a number of treatments could be considered to improve rehabilitation. A comprehensive aesthetic-occlusal analysis is necessary prior to starting treatment in order to consider the best procedure, time involved, and economic cost. Adhesive dentistry allows an additive and non-invasive proposal as a medium-term or transitory treatment. A case of a 46-year-old patient is presented, with anterior deep bite and severe dental wear on palatal surfaces of the antero-superior teeth, without temporomandibular dysfunction, or systemic compromises. The objective was to emphasize the aesthetic and occlusal rehabilitation with the least biological commitment (ultraconservative), through semi-indirect adhesive restorations of composite resin with 12 months follow-up. This restorative proposal with composite resins represents an alternative treatment for patient management with anterior deep bite. Control at one year of treatment showed that a sequence and resolution was followed, that ensured adequate oral rehabilitation in the least invasive manner possible.

Direct resin composite restoration of endodontically-treated permanent molars in adolescents: bite force and patient-specific finite element analysis

Abstract Objective To evaluate the influence of three levels of dental structure loss on stress distribution and bite load in root canal-treated young molar teeth that were filled with bulk-fill resin composite, using finite element analysis (FEA) to predict clinical failure. Methodology Three first mandibular molars with extensive caries lesions were selected in teenager patients. The habitual occlusion bite force was measured using gnathodynamometer before and after endodontic/restoration procedures. The recorded bite forces were used as input for patient-specific FEA models, generated from cone-beam computed tomographic (CT) scans of the teeth before and after treatment. Loads were simulated using the contact loading of the antagonist molars selected based on the CT scans and clinical evaluation. Pre and post treatment bite forces (N) in the 3 patients were 30.1/136.6, 34.3/133.4, and 47.9/124.1. Results Bite force increased 260% (from 36.7±11.6 to 131.9±17.8 N) after endodontic and direct restoration. Before endodontic intervention, the stress concentration was located in coronal tooth structure; after rehabilitation, the stresses were located in root dentin, regardless of the level of tooth structure loss. The bite force used on molar teeth after pulp removal during endodontic treatment resulted in high stress concentrations in weakened tooth areas and at the furcation. Conclusion Extensive caries negatively affected the bite force. After pulp removal and endodontic treatment, stress and strain concentrations were higher in the weakened dental structure. Root canal treatment associated with direct resin composite restorative procedure could restore the stress-strain conditions in permanent young molar teeth.

Choosing the Criteria for Clinical Evaluation of Composite Restorations: An Analysis of Impact on Reliabilty and Treatment Decision

Abstract Objective: To assess the reproducibility of two clinical criteria for the evaluation of restorations in primary teeth and the impact on treatment decision. Material and Methods: A cross-sectional study was performed selecting 71 resin-based composite restorations placed in primary molars of children who had sought dental treatment at a dental school. Two trained examiners evaluated independently the restorations using modified FDI and USPHS criteria. All restorations were assessed separately with each system in random order to avoid memory bias. Kappa statistics were used to determine inter-examiner reliability considering each parameter of both criteria and score final about treatment decision. McNemar test was used to compare the treatment decision with two criteria. The significance level was set at 5%. Results: Kappa values ranged from 0.28 to 0.93 with USPHS and 0.28 to 0.88 with FDI, considering each parameter separately. Inter-examiner agreement for treatment decision was excellent for both criteria (Kappa: 0.85-0.90). For clinical decision-making, no difference between criteria was found, irrespective of examiner. Conclusion: Low inter-examiner agreement for evaluation of each parameter of USPHS and FDI criteria does not reflect on reproducibility for treatment decision. Both criteria may be suitable for evaluation of composite restorations in primary teeth.

Fechamento de diastema com resina composta: relato de caso / Closure of diastema with composite resin: case report

Este trabalho tem o objetivo relatar um caso clínico de fechamento de diastema inter incisivos pela técnica de restauração direta em com resina composta. Paciente, sexo feminino, compareceu a Clínica Integrada de Adultos queixando-se da estética do seu sorriso devido à coloração amarelada e um espaço presente entre os dentes incisivos superiores. No exame clínico notou-se a presença de diastema mesial entre os dentes 11 e 21. Foi feito um plano de tratamento, no qual foi sugerido a paciente o fechamento do diastema por meio de restaurações diretas com resina composta. Após a aprovação da paciente, foi selecionada a cor dos dentes com o auxílio da Escala Vita e proposto a realização de um clareamento antes do tratamento restaurador. Realizado o clareamento e após ter aguardado 21 dias para estabilização da cor, deu início a etapa restauradora, a qual consistiu no ataque ácido seguido pela aplicação do sistema adesivo. A resina composta foi sendo colocada em incrementos de 1mm com o auxílio de fita de poliéster a fim de restabelecer a parede palatina e o contato interproximal. Posteriormente, a resina foi sendo colocada até a face vestibular respeitando a anatomia dentária. Uma semana após a restauração, foi realizado acabamento e polimento com pontas diamantadas tronco-cônicas de granulação fina, discos de lixa, disco de feltro e pasta diamantada. O resultado satisfatório após o fechamento do diastema pela técnica direta em resina composta demonstrou-se uma opção de tratamento viável, uma vez que restabeleceu a função e a estética do sorriso da paciente.

This paper aims to report a clinical case of closure of inter-incisive diastema by the technique of direct restoration with composite resin. A female patient attended the Integrated Adult Clinic complaining about the aesthetics of her smile due to the yellow color and a space between the upper incisor teeth. In the clinical examination, the presence of mesial diastema between teeth 11 and 21 was noted. A treatment plan was made, in which the patient was suggested to close the diastema by means of direct restorations with composite resin. After the patient's approval, the color of the teeth was selected with the aid of the Vita Scale and it was proposed to perform a whitening procedure before the restorative treatment. After bleaching and after waiting 21 days for color stabilization, the restorative stage began, which consisted of the acid attack followed by the application of the adhesive system. The composite resin was placed in 1mm increments with the aid of polyester tape in order to reestablish the palatal wall and interproximal contact. Subsequently, the resin was placed up to the buccal surface, respecting the dental anatomy. One week after the restoration, finishing and polishing was carried out with fine-grained cone-shaped diamond tips, sanding discs, felt disc and diamond paste. The satisfactory result after the closure of the diastema by the direct technique in composite resin proved to be a viable treatment option, since it restored the function and aesthetics of the patient's smile.

Rehabilitación estética mínimamente invasiva en diente anterior afectado por hipoplasia de esmalte: Reporte de caso clínico / Minimally Invasive Restoration in Anterior Teeth Affected by Enamel Hypoplasia: Clinical Case Report

RESUMEN La preservación de tejido dental sano contribuye a la práctica de una Odontología conservadora, permitiendo la aplicación de los principios biológicos y mecánicos de una forma más predecible. Las preparaciones cavitarias mínimamente invasivas son el complemento de la correcta selección de materiales adhesivos y de resina compuesta. La correcta aplicación de un protocolo adhesivo nos proporcionará resultados estéticos imperceptibles y un longevo desempeño clínico.

ABSTRACT The preservation of healthy dental structures contributes to the practice of a conservative dentistry. This concept involves the implementation of biological and mechanical principles in a more predictable manner. Minimally invasive cavity preparations are the complement to the selection of adhesive and composite resin materials. The correct application of an adhesive protocol will provide imperceptible aesthetic restorations and adequate clinical performance.

Comparación in vitro de la resistencia adhesiva de los sistemas adhesivos grabado y enjuague y autograbado / In vitro Comparison of the adhesive strength of the etch and rinse adhesive systems and self etching

Resumen El propósito del estudio fue comparar in vitro la resistencia adhesiva de los sistemas Etch and rinse (grabado y enjuague), 4ta y 5ta generación; y los sistemas Self Etch (autograbado), 6ta y 7ma generación. Se realizó un estudio descriptivo, comparativo. Se utilizaron 20 terceros molares extraídos por motivos ortodóncico y profilácticos. Los cuales fueron cortados por la mitad y se obtuvo 40 muestras, en forma aleatoria los dientes fueron divididos en cuatro grupos, 10 con 4ta generación, 10 con 5ta, 10 con 6ta y 10 con 7ma. Se realizó una prueba de tracción vertical medida en kilogramos fuerza, para luego ser transformados a megapascales (Mpa). Las resinas de 4ta generación obtuvieron una resistencia adhesiva de 29,9 Mpa, las de 5ta una resistencia de 16,9 Mpa, la de 6ta una resistencia de 27,5 Mpa y las de 7ma generación una resistencia de 11,0 Mpa. Los resultados se sometieron a pruebas de normalidad mediante la prueba de Shapiro Wilk, y que fueron analizados mediante el ANOVA de un factor, y se encontró diferencias estadísticamente significativas entre los cuatro grupos de estudio con un valor p de 0,001. Se concluye que el sistema adhesivo de 4ta generación clasificado como Etch and Rinse presentó mejor resistencia adhesiva, seguido del adhesivo de 6ta generación clasificado como Self Etch.

Abstract The purpose of the study was to compare in vitro the adhesive strength of the Etch and Rinse systems of the 4th and 5th generation; and Self Etch systems of the 6th and 7th generation. A descriptive, comparative study was carried out. Twenty third molars were used for this study, (these molars were extracted for orthodontic and prophylactic purposes). Each teeth were cut into two pieces obtaining 40 pieces in total, then they were chosen randomly of which 10 pieces were cut with the 4th generation adhesive strength, 10 with the 5th generation, 10with the 6th generation and 10th with the 7th generation of the adhesive. A vertical traction test was performed, measured in kilograms force, and then transformed into megapascals (Mpa). The 4th generation resins obtained an adhesive resistance of 29.9 Mpa, the 5th generation resins obtained a resistance of 16.9 Mpa, the 6th generation obtained a resistance of 27.5 Mpa and the 7th generation obtained a resistance of 11.0 Mpa. The results were subjected to normality tests using the Shapiro Wilk test. These results were analyzed using the oneway ANOVA, finding statistically significant differences between the four study groups with a p-value of 0.001. As a conclusion; the 4th generation adhesive system classified as Etch and Rinse showed better adhesive strength, followed by the 6th generation adhesive system classified as Self Etch .

Reabilitação neuroclusal em paciente odontopediátrico com mordida cruzada posterior unilateral: relato de caso clínico / Neuro-occlusal rehabilitation in pediatric dental patient with unilateral posterior crossbite: clinical case report

Objetivo: relatar a sequência clínica de tratamento para descruzar uma mordida cruzada posterior unilateral na dentição decídua por meio da reabilitação neuroclusal. Relato de caso: o caso clínico foi realizado em um paciente do sexo masculino, com 5 anos de idade, diagnosticado com mordida cruzada posterior unilateral funcional do lado direito. Após a verificação de interferências dentais nos caninos e molares em oclusão cêntrica, realizaram-se os ajustes oclusais. Seguiu-se então o protocolo para confecção de pistas diretas de Planas, utilizando resina composta em planos inclinados na metade vestibular da face oclusal dos dentes 84 e 85 e na face vestibular dos dentes 53, 54 e 55. Logo após a confecção das pistas, observou-se a correção da mordida cruzada e a estabilidade na mudança postural da mandíbula. Considerações finais: a reabilitação neuroclusal por meio de pistas diretas de Planas apresenta grande eficácia na correção da mordida cruzada posterior, proporcionando estabilidade mandibular e estímulo para o crescimento e desenvolvimento crânio-maxilo-facial. (AU)

Objective: To report the clinical treatment sequence to uncross a unilateral posterior crossbite in deciduous dentition using neuro-occlusal rehabilitation. Case report: The clinical case was performed in a 5-year-old male patient diagnosed with a functional unilateral posterior crossbite on the right side. After verifying dental interferences with canines and molars in centric occlusion, the occlusal adjustments were performed. The protocol for producing Planas direct tracks was followed using composite resin in inclined planes in the buccal half of the occlusal surface of teeth 84 and 85 and in the buccal surface of teeth 53, 54, and 55. After the preparation of tracks, the crossbite correction and the stability in postural mandibular change were observed. Final considerations: Neuro-occlusal rehabilitation using Planas direct tracks is highly effective in correcting posterior crossbite, providing mandibular stability and stimulus for the growth and development of the maxillofacial skull. (AU)

Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL - a randomized controlled clinical trial

Abstract Objective The aim of this randomized, controlled, prospective clinical trial was to evaluate the performances of two different universal adhesives and one etch-rinse adhesive for restoration of non-carious cervical lesions (NCCLs). Material and Methods Twenty patients with at least seven NCCLs were enrolled. Lesions were divided into seven groups according to adhesive systems and application modes: GSE: GLUMA Universal-self-etch, GSL: GLUMA Universal-selective etching, GER: GLUMA Universal-etch-and-rinse, ASE: All-Bond Universal-self-etch, ASL: All-Bond Universal-selective etching, AER: All-Bond Universal-etch-and-rinse, SBE (Control): Single Bond2-etch-and-rinse. A total of 155 NCCLs were restored with a nano hybrid composite (Tetric N-Ceram). Restorations were scored with regard to retention, marginal discoloration, marginal adaptation, recurrent caries and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after one week, 6, 12 and 24 months. Statistical evaluations were performed using Chi-square tests (p=0.05). Results The recall rate was 81.9% after the 24-month follow-up. The cumulative retention rates for self-etch groups (GSE: 72.2%, ASE:75%) were significantly lower than other experimental groups (GSL: 93.7%, GER: 100%, ASL: 94.1%, AER: 100%, SBE: 100%) at the 24-month follow-up (p<0.05). Regarding marginal adaptation and marginal discoloration, GSE and ASE groups demonstrated more bravo scores after 6 and 12-month observations but differences were not significant (p>0.05). Only one restoration from ASL group demonstrated post-operative sensitivity at 6 and 12-month observations. No secondary caries was observed on the restorations at any recall. At the end of 24-month observations, no significant differences were detected among groups regarding any of the criteria assessed, except retention. Conclusion GLUMA Universal and All-Bond Universal showed better results in etch-and-rinse and selective etching mode compared to the self-etch mode regarding retention. Etch-and-rinse and selective etching application modes of the current universal adhesives tended to provide better clinical outcomes considering the criteria evaluated at the end of 24-month evaluation.