Enfoque de Tratamiento de una Adolescente con Amelogénesis Imperfecta / Treatment Approach for an Adolescent with Amelogenesis Imperfecta

La amelogénesis imperfecta (AI) es un grupo de tras-tornos hereditarios, clínica y etiológicamente hete-rogéneos, derivados de mutaciones genéticas, que se caracterizan por anomalías cualitativas y cuanti-tativas del desarrollo del esmalte, pudiendo afectar la dentición primaria y/o permanente. El tratamiento del paciente con AI es complejo y multidiscliplinario; supone un desafío para el odontólogo, ya que por lo general están involucradas todas las piezas dentarias y afecta no solo la salud buco dental sino el aspecto emocional y psicológico de los pacientes. Con el obje-tivo de describir el tratamiento integral y rehabilita-dor realizado en una paciente con diagnóstico de AI tipo III, se reporta el caso de un adolescente de sexo femenino de 13 años, que concurrió en demanda de atención a la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), cuyo motivo de consulta fue la apariencia estética y la hipersensibilidad de sus pie-zas dentarias. Durante el examen clínico intraoral, se observó que todas las piezas dentarias presentaban un esmalte rugoso, blando, con irregularidades y una coloración amarronada, compatible con diagnóstico de Amelogénesis Imperfecta tipo III hipomineralizada. Conclusión: El tratamiento rehabilitador de la AI en los pacientes en crecimiento y desarrollo estará diri-gido a intervenir de manera integral y temprana para resolver la apariencia estética y funcional, evitar las repercusiones sociales y emocionales, y acompañar a los pacientes y sus familias (AU)

Amelogenesis imperfecta (AI) is a group of clinically and etiologically heterogeneous hereditary disorders, derived from genetic mutations, characterized by qualitative and quantitative anomalies of enamel development, which can affect primary and/or permanent dentition. The treatment of patients with AI 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 comprehensive and rehabilitative treatment carried out in an adolescent patient with a diagnosis of type III AI. Case report: The case of a 13-year-old female patient, who required dental attention at the Department of Dentistry for Children of the School of Dentistry of the University of Buenos Aires, whose reason for consultation was esthetic appearance and hypersensitivity of her teeth. In the intraoral clinical examination, it was observed that all the teeth had rough, soft enamel, with irregularities and a brownish color, compatible with the diagnosis of type III hypomineralized Amelogenesis Imperfecta. Conclusion: Rehabilitative treatment of AI in growing and developing patients will be aimed at early and comprehensive intervention to resolve esthetic and functional appearance, avoid social and emotional repercussions and accompany patients and their families (AU)

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)

The use of a liner under different bulk-fill resin composites: 3D GAP formation analysis by x-ray microcomputed tomography

Abstract Gap formation of composite resin restorations is a serious shortcoming in clinical practice. Polymerization shrinkage stress exceeds the tooth-restoration bond strength, and it causes bacterial infiltration within gaps between cavity walls and the restorative material. Thus, an intermediate liner application with a low elastic modulus has been advised to minimize polymerization shrinkage as well as gap formation. Objective: The purpose of this in vitro study was to assess gap formation volume in premolars restored with different bulk-fill composites, with and without a resin-modified glass-ionomer cement (RMGIC) liner, using x-ray micro-computed tomography (micro-CT). Methodology: Sixty extracted human maxillary premolars were divided into six groups according to bucco-palatal dimensions (n=10). Standardized Class II mesio-occluso-distal cavities were prepared. G-Premio Bond (GC Corp., Japan) was applied in the selective-etch mode. Teeth were restored with high-viscosity (Filtek Bulk Fill, 3M ESPE, USA)-FB, sonic-activated (SonicFill 2, Kerr, USA)-SF and low viscosity (Estelite Bulk Fill Flow, Tokuyama, Japan)-EB bulk-fill composites, with and without a liner (Ionoseal, Voco GmbH, Germany)-L. The specimens were subjected to 10,000 thermocycles (5-55°C) and 50,000 simulated chewing cycles (100 N). Gap formation based on the volume of black spaces at the tooth-restoration interface was quantified in mm3 using micro-computed tomography (SkyScan, Belgium), and analyses were performed. Data were analyzed using repeated-measures ANOVA and the Bonferroni correction test (p < 0.05). Results: The gap volume of all tested bulk-fill composites demonstrated that Group SF (1.581±0.773) had significantly higher values than Group EB (0.717±0.679). Regarding the use of a liner, a significant reduction in gap formation volume was observed only in Group SFL (0.927±0.630) compared with Group SF (1.581±0.773). Conclusion: It can be concluded that different types of bulk-fill composite resins affected gap formation volume. Low-viscosity bulk-fill composites exhibited better adaptation to cavity walls and less gap formation than did sonic-activated bulk-fill composites. The use of an RMGIC liner produced a significant reduction in gap formation volume for sonic-activated bulk-fill composites.

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

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

Effect of dentin preparation mode on the bond strength between human dentin and different resin cements

Abstract The aim was to evaluate the influence of different dentin preparation mode in the smear layer characteristics (SL), hybrid layer (HL), and microtensile bond strength (µTBS) to dentin with two resin cements. The occlusal dentin of 120 third molars was exposed. The teeth were divided into 4 groups (n=30) according to the dentin preparation mode: 1- fine grain diamond bur; 2- coarse grain diamond bur; 3- multi laminate carbide steel bur; and, 4- ultrasonic CV Dentus diamond bur. Each treated dentin group was divided into 2 sub-groups (n=15) according to the resin cement: (1) RelyX U200 and (2) RelyX ARC. Resin composite blocks were cemented on dentin. After storage at 37o C for 24 h, beams with a cross section area of 1.0 mm2 were obtained, and tested in a universal testing machine at a crosshead speed of 0.5 mm/min. Two additional teeth for each sub-group were prepared to analyze the SL and HL on a scanning electron microscopy. According to Kruskal-Wallis test and Dunn tests, there was no significant difference in µTBS among the rotary instruments within each resin cement group. RelyX ARC obtained higher µTBS values compared to RelyX U200 (p<0.05). RelyX ARC formed evident HL, which was not observed for RelyX U200. The dentin mode preparation did not influence the µTBS of the resin cements. The SL was different for all instruments. The cementing agent is more determinant in the hybrid layer formation and bond strength to dentin than the instruments applied on dentin.

Resumo O objetivo deste estudo foi avaliar a influência de diferentes modos de preparação da dentina nas características da smear layer (SL), da camada híbrida (CH) e na resistência de união à microtração (RUµT) à dentina com dois cimentos resinosos. A dentina oclusal de 120 terceiros molares humanos foi exposta. Os dentes foram divididos em 4 grupos (n=30) de acordo com o modo de preparação da dentina: 1 - ponta diamantada de granulação fina; 2 - ponta diamantada de granulação grossa; 3 - ponta de carboneto de aço multilaminada; 4 - ponta diamantada ultrassônica. Cada grupo foi subdividido em dois subgrupos (n=15) de acordo com o cimento resinoso: (1) RelyX U200 e (2) RelyX ARC. Blocos de resina composta foram cimentados na dentina. Após armazenamento a 37 °C por 24 h, as amostras foram cortadas para obter palitos com área de 1,0 mm2, os quais foram testados em máquina de ensaio universal com velocidade de 0,5 mm/min. Dois dentes adicionais por subgrupo foram preparados para analisar as características da SL e da CH em microscópio eletrônico de varredura. De acordo com o teste de Kruskal-Wallis e o teste de Dunn, não houve diferença significativa na RUµT entre os instrumentos rotatórios para cada cimento resinoso. RelyX ARC obteve maiores valores de RUµT em comparação ao RelyX U200 (p<0,05). RelyX ARC formou uma CH evidente, o que não foi observado para o RelyX U200. O modo de preparação da dentina não influenciou na RUµT dos cimentos resinosos. A SL foi diferente para todos os instrumentos. O agente de cimentação foi mais determinante na formação da camada híbrida e na resistência de união do que os instrumentos utilizados para preparar a dentina.

Efficacy of removal of cariogenic bacteria and carious dentin by ablation using different modes of Er: YAG lasers

The primary objective of this in vitro study was to evaluate the efficiency of removal of cariogenic bacteria and carious dentin by ablation using two lasers: fluorescence-feedback controlled (FFC) Er:YAG laser and different pulses of Er:YAG laser based on variable square pulse technology (VSPt). The secondary objective was to measure the temperature during laser ablation of carious tissue. Seventy-two extracted human molars were used in this study. Sixty teeth with carious dentin were randomly divided into four experimental groups according to the treatment for caries removal: group 1: 400 µs (FFC group); group 2: super short pulse (SSP group, 50 µs pulse); group 3: medium short pulse (MSP group, 100 µs pulse); group 4: short pulse (SP group, 300 µs pulse) and one positive control group with no treatment. Twelve teeth without carious lesion were used as a negative control group. After caries removal, swabs were taken with cotton pellets and real-time PCR analysis was performed. During caries ablation, a thermal infrared camera was used to measure the temperature changes. In all experimental groups, specimens were free of bacterial contamination after the treatment. In the SSP, MSP and SP groups, temperatures measured during caries ablation were significantly higher compared to temperatures in the FFC group (P<0.001). In this in vitro study, laser treatment for removal of carious dentin and cariogenic bacteria was an efficient treatment modality without causing excessive temperatures that might adversely affect pulp vitality.

Effect of cavity preparation design and ceramic type on the stress distribution, strain and fracture resistance of CAD/CAM onlays in molars

Abstract Objective This study aimed to evaluate the effect of the cavity preparation and ceramic type on the stress distribution, tooth strain, fracture resistance and fracture mode of human molar teeth restored with onlays. Material and Methods Forty-eight molars were divided into four groups (n=12) with assorted combinations of two study factors: BL- conventional onlay preparation with boxes made from leucite ceramic (IPS-Empress CAD, Ivoclar Vivadent); NBL- conservative onlay preparation without boxes made from leucite ceramic; BD- conventional onlay preparation with boxes made from lithium disilicate glass ceramic (IPS e.max CAD, Ivoclar Vivadent); NBL- conservative onlay preparation with boxes made from lithium disilicate glass ceramic cuspal deformation (µS) was measured at 100 N and at maximum fracture load using strain gauge. Fracture resistance (N) was measured using a compression test, and the fracture mode was recorded. Finite element analysis was used to evaluate the stress distribution by modified von Mises stress criteria. The tooth strain and fracture resistance data were analyzed using the Tukey test and two-way ANOVA, and the fracture mode was analyzed by the chi-square test (α=0.05). Results The leucite ceramic resulted in higher tooth deformation at 100 N and lower tooth deformation at the maximum fracture load than the lithium disilicate ceramic (P<0.001). The lithium disilicate ceramic exhibited higher fracture resistance than the leucite ceramic (P<0.001). The conservative onlay resulted in higher fracture strength for lithium disilicate ceramic. Finite element analysis results showed the conventional cavity preparation resulted in higher stress concentration in the ceramic restoration and remaining tooth than the conservative onlay preparation. The conservative onlays exhibited increased fracture resistance, reduced stress concentration and more favorable fracture modes. Conclusion Molars restored with lithium disilicate CAD-CAM ceramic onlays exhibited higher fracture resistance than molars restored with leucite CAD-CAM ceramic onlays.

Comparative study between laser and conventional techniques for class V cavity preparation in gamma-irradiated teeth (in vitro study)

Abstract Objective: The purpose of this study was to compare laser with conventional techniques in class V cavity preparation in gamma-irradiated teeth. Methods: Forty extracted human teeth with no carious lesions were used for this study and were divided into two main groups: Group I (n = 20) was not subjected to gamma radiation (control) and Group II (n=20) was subjected to gamma radiation of 60 Gray. Standard class V preparation was performed in buccal and lingual sides of each tooth in both groups. Buccal surfaces were prepared by the Er,Cr:YSGG laser (Waterlase iPlus) 2780 nm, using the gold handpiece with MZ10 Tip in non-contact and the "H" mode, following parameters of cavity preparation - power 6 W, frequency 50 Hz, 90% water and 70% air, then shifting to surface treatment laser parameters - power 4.5 W, frequency 50 Hz, 80% water and 50% air. Lingual surfaces were prepared by the conventional high-speed turbine using round diamond bur. Teeth were then sectioned mesio-distally, resulting in 80 specimens: 40 of which were buccal laser-treated (20 control and 20 gamma-irradiated specimens) and 40 were lingual conventional high-speed bur specimens (20 control and 20 gamma-irradiated specimens). Results: Microleakage analysis revealed higher scores in both gamma groups compared with control groups. Chi-square test revealed no significant difference between both control groups and gamma groups (p=1, 0.819, respectively). A significant difference was revealed between all 4 groups (p=0.00018). Conclusion: Both laser and conventional high-speed turbine bur show good bond strength in control (non-gamma) group, while microleakage is evident in gamma group, indicating that gamma radiation had a dramatic negative effect on the bond strength in both laser and bur-treated teeth.

Resistencia a la fractura in vitro de incrustaciones cerámicas usando dos materiales como bases cavitarias / in vitro fractures strength of ceramic inlays, using two types of cavity bases

Las bases cavitarias son usadas en odontología restauradora,varios materiales se recomiendan como base cavitaria en incrustaciones cerámicas. Objetivo: Comparar la resistencia a la fractura in vitro de una cerámica (disilicato de litio) como material restaurativo usando diferentes bases cavitarias en inlays en premolares. Material y métodos: Se elaboraron cavidades estandarizadas para inlays cerámicas MOD en 30 premolares. Se asignaron aleatoriamente tres grupos (n = 10): grupo 1: sin base cavitaria; grupo 2: base ionómero de vidrio reforzado con resina (VitrebondTM, 3M); grupo 3: base resina compuesta (FiltekTM Z350 XT, 3M). Las incrustaciones fueron fabricadas con disilicato de litio (IPS e.max®, Ivoclar) cementadas con (RelyXTM, 3M) y almacenadas en agua bidestilada (37 oC por 24 horas). Semidió la resistencia a la fractura en una máquina universal de pruebas mecánicas (MTS® Alliance RT/30) a una velocidad de 0.5 mm/minuto,fracturadas las muestras se registró bajo microscopia estereoscópica elmodo de fallo. Los datos se analizaron usando ANOVA de una vía y comparaciones post hoc con la prueba Scheffé. (Programa IBM SPSS STATISTICS 21.0). Resultados: El grupo control (sin base) obtuvo la media más alta (105.16 Kgf ± 11.41) siendo estadísticamente significativa con relación al grupo 2 (77.04 ± 19.69). El grupo 3 obtuvo una media (94.81 ± 10.65) siendo estadísticamente diferente del grupo 2 (p = .001). El modo de fallo más común fue el patrón IV (60 por ciento). Conclusiones: La resistencia a la fractura de inlays cerámicas de disilicato de litio es mayor en cavidades sin base cavitaria...

Influence of crosshead speed on failure load and failure mode of restored maxillary premolars

We analyzed the effect of the crosshead speed of an applied load on failure load and failure mode of restored human premolars. Fifty intact, noncarious human premolars were selected. Class II mesio-occlusodistal preparations were made with a water-cooled high-speed preparation machine, and the teeth were restored with composite resin. The specimens were divided into five groups (n = 10 each) and tested individually in a mechanical testing machine, in which a 6.0-mm-diameter steel cylinder was mounted to vary the crosshead speed: v0.5: 0.5 mm/min; v1: 1.0 mm/min; v2.5: 2.5 mm/min; v5: 5.0 mm/min; and v10: 10.0 mm/min. The cylinder contacted the facial and lingual ridges beyond the margins of the restorations. Peak load to fracture was measured for each specimen (N). The means were calculated and analyzed with one-way analysis of variance followed by Tukey's test (a = 0.05). The mean load at failure values were (N) as follows: v0.5, 769.4 ± 174.8; v1, 645.2 ± 115.7; v5, 614.3 ± 126.0; v2.5, 609.2 ± 208.1; and v10, 432.5 ± 136.9. The fracture modes were recorded on the basis of the degree of the tooth structural and restorative damage: (I) fracture of the restoration involving a small portion of the tooth; (II) fractures involving the coronal portion of the tooth with cohesive failure of the composite resin; (III) oblique tooth and restoration fracture with periodontal involvement; and (IV) vertical root and coronal fracture. Varying crosshead speeds of 0.5–5.0 mm/min did not influence the failure load of restored maxillary premolars; however, increasing the crosshead speed to 10 mm/min decreased the failure load values and the degree of tooth structural damage.

Effect of new innovative restorative carbomised glass cement on intrapulpal temperature rise: an ex-vivo study

Abstract This study aimed to evaluate the temperature changes that occurred in the pulp chamber when using GCP Glass Carbomer Fill (GCP) and two different resin-modified glass-ionomer (RGI) restorative materials at different dentin thicknesses. A standardized Class I occlusal cavity with 1 mm or 2 mm dentin thickness was prepared in the extracted human molar teeth. RGI and GCP fills were placed in the cavities and cured with two different light-curing units. This study included a total of 120 samples, with 20 samples in each group. The pulp microcirculation method was used for measuring the intrapulpal temperature changes. Statistical analysis was performed using the two-way ANOVA and Tukey HSD multiple comparison tests. Statistically significant differences were observed between 1 mm and 2 mm dentin thicknesses (p < 0.001). The GCP groups (both 1 mm and 2 mm dentin thicknesses) exhibited higher temperatures than the other groups (p < 0.001), and Fuji II LC and Photac Fil Quick Aplicap showed similar values (p > 0.05). The highest temperature changes were observed with 1 mm dentin thickness. While RGI materials in both dentin thicknesses did not cause temperature changes that were harmful to the pulp, GCP CarboLED LCU caused the highest intrapulpal temperature rise, and these values were borderline harmful to the dental pulp.

Tratamiento expectante en molar permanente joven: reporte de caso / Stepwise excavation in young permanent molar: case report

La caries dental es la causa principal por la que se realizan tratamientos de conducto, sin embargo existen procedimientos de protección pulpar para el manejo de lesiones cariosas profundas, que ayudan en la recuperación del tejido pulpar. Uno de los procedimientos es el tratamiento expectante, éste va a ser efectivo en preservar la pulpa que podría ser expuesta durante la remoción de caries profunda donde no hay signos clínicos que indiquen pulpitis irreversible. El tratamiento expectante, al ser en dos etapas tiene como objetivo detener el avance de la lesión cariosa, minimizar la dentina cariada retenida y permitirle a la pulpa recuperarse generando dentina reparativa para evitar cualquier exposición pulpar en una segunda sesión. Se describe el manejo de lesiones cariosas profundas en molar permanente joven mediante el tratamiento expectante a través de un reporte de caso. Paciente femenino de 15 años presenta dolor provocado a los cambios térmicos en el segundo molar inferior izquierdo. Las radiografías revelaron lesión cariosa profunda, clasificación R4 de Pitts, ausencia de radiolucidez apical y espacio del ligamento periodontal normal. A la prueba objetiva de diagnóstico con frío, se observó respuesta positiva, diagnosticándose Pulpitis Reversible. Basado en estos hallazgos se decide mantener la vitalidad pulpar y realizar el tratamiento expectante. El tratamiento expectante constó de dos fases, en la primera se retiró el tejido cariado de paredes y piso, dejándose dentina afectada y se colocó hidróxido de calcio seguido de una restauración temporal. En la segunda fase, 6 meses después, tras confirmar el mantenimiento de la vitalidad pulpar y formación de puente dentinario, se reabrió la cavidad y se colocó la restauración definitiva con resina compuesta. Se realizaron dos controles posteriores, el primero 12 meses después de iniciado el tratamiento y el segundo 60 meses después...

Dental caries is one of the main reasons to perform root canal treatments; however there are procedures to protect the pulp in case of deep caries lesions. During caries removal pulp tissue could be exposed, so stepwise excavation is one procedure which will be effective in pulp preservation. Stepwise excavation consists of two stages, its purpose is stop caries progression, change cariogenic environment and allow the pulp recover generating reparative dentine to avoid pulp exposure in a second visit. Below we describe the management of deep carious lesions in a young permanent molar treated with stepwise excavation. A 15-year-old female patient with cause pain due to thermal changes in second inferior left molar, X-Rays revealed deep caries lesion, R4 Pitts ́s classification, no signs of apical radiolucency or widening of the periodontal ligament space. Presents positive response to sensibility test with cold so Reversible Pulpitis is diagnosed, because of these findings it was decided to keep pulp vitality and perform stepwise excavation. This procedure consists in two phases: the first one is taking out the caries lesion from walls and floor, leaving affected dentin and placed calcium hidroxyde paste over, followed by a temporal restoration with glass ionomer. The second phase is six months later, once pulp vitality is confirmed and dentinal bridge is formed, so the cavity is reopened and definitive restoration is placed with composite resin.Two subsequent check-ups were carried out, the first one 12 months after stepwise excavation had been performed and the second control was 60 months later, clinical and radiographic controls were performed in both controls and no pathology was found considering the treatment as effective.

Efecto antimicrobiano de una solución de superoxidación con pH neutro para desinfección de cavidades clase I / Effectiveness of a neutral pH super-oxidized solution for antimicrobial disinfection of class I cavities

Objetivo: determinar la disminución de la carga bacteriana en dentina de cavidades clase I posterior a la aplicación de clorhexidina 2 por ciento en comparación con la aplicación de solución de superoxidación con pH neutro. Material y métodos: Se realizó un estudio transversal clínico, a 30 pacientes en el Área de Clínicas de la Facultad de Estomatología en la Universidad Autónoma de San Luis Potosí, de los cuales se obtuvieron 60 muestras en cavidades clase I en primeros y segundos molares inferiores permanentes, previas al tratamiento y 60 posteriores que se dividieron en tres grupos, grupo control (n = 20), grupo A correspondiente a clorhexidina al 2 por ciento (n = 20) y grupo B correspondiente a solución de superoxidación con pH neutro (n = 20), posteriormente las muestras fueron llevadas al laboratorio donde se realizó una dilución seriada, para posteriormente sembrar las muestras en placas de agar soya tripticaseina y hacer el conteo de UFC después de haber sido incubadas 24 horas. Resultados: Se realizó una comparación de todos los grupos en cuanto a la disminución de carga bacteriana pretratamiento y postratamiento. Se observó diferencia es tadística significativa en el grupo tratado con clorhexidina al 2 por ciento (p < 0.01) mientras que en los grupos tratados con agua destilada y solución de superoxidación con pH neutro no fueron significativas, ambas con una (p > 0.05) entre las muestras pretratamiento y postratamiento. Conclusiones: Se logró obtener muestras en primeros y segundos molares inferiores en las que se cuantificaron microorganismos previos y posteriores al tratamiento mediante la cuantificación de UFC. Se encontraron diferencias significativas entre grupos, por lo que podemos decir de acuerdo con nuestros resultados que la clorhexidina al 2 por ciento tiene mayor efecto antimicrobiano en la desinfección de cavidades clase I que la solución de superoxidación con pH neutro.

background: Dental caries is a disease characterized by demineralization of the hard tissues of the tooth. If left untreated, it leads to cavitation, discomfort, pain, and the eventual loss of the tooth. A range of antiseptics have been used to eliminate microorganisms from cavities, one of the most common being chlorhexidine, due to the advantages it offers. Nowadays there are products available that offer not only the same microbicidal capacity, but also a greater half-life and superior tissue compatibility. One new option for cavity disinfection is pH neutral super-oxidation solution. Objective: To determine the decrease in bacterial load in the dentin of class I cavities following the application of 2% chlorhexidine compared to a neutral pH over-super-oxidized solution. Material and methods:A clinical cross-sectional study was conducted involving a total of 30 patients at the Faculty of Stomatology Clinics of the Autonomous University of San Luis Potosí, from whom 60 samples were obtained from class I cavities in first and second permanent lower molars prior to treatment and 60 following...

Comparación del sellado marginal y la adaptación interna en restauraciones directas con resina colocadas con técnica ultrasónica y convencional usando cuatro sistemas adhesivos diferentes en dientes extraídos / A comparison of marginal sealing and internal adaptation in the placement of direct resin restorations on extracted teeth, using an ultrasonic and a conventional technique with four different adhesive systems

Objetivo: comparar el sellado marginal y la adaptación interna que se obtiene en obturaciones directas mediante técnica convencional con resina de nanorrelleno y técnica de colocación ultrasónica con resinas de baja contracción de polimerización, usando cuatro tipos de adhesivos en preparaciones clase V de dientes extraídos. Material y métodos: Se llevó a cabo un estudio experimental, comparativo y analítico en 32 dientes extraídos a los cuales se les realizó preparaciones clase V de 2 mm oclusogingival, 2 mm mesiodistal y 2 mm de profundidad. Se dividieron en dos grupos; en uno de ellos se obturó empleando técnica convencional y resina de nanorrelleno y en el otro se aplicó una técnica ultrasónica, usando resina de baja contracción. A su vez, cada grupo se subdividió en cuatro, usando diferentes adhesivos (OptiBond all in one Kerr TM , OptiBond Solo Plus Kerr TM , OptiBond FL Kerr TM y OptiBond XTR Kerr TM). Los dientes fueron cortados y analizados al microscopio de barrido (FEI Quanta 200 Scanning Electron Microscope). La información se analizó en el programa SPSS 17.0. Para comparar los grupos de estudio se empleó la prueba U de Mann-Whitney. Resultados: Se encontraron diferencias estadísticamente significativas en el sellado marginal y en la adaptación interna, siendo mejor la técnica de ultrasonido con resina de baja contracción de polimerización (p < 0.05). Con respecto al tipo de adhesivo utilizado, se encontraron diferencias significativas con OptiBond FL TM, el cual tuvo mejor interrelación (p < 0.05)

Objective: To compare the marginal sealing and internal adaptation obtained in direct restorations when using a conventional technique involving nano-filled resin vs. ultrasonic placement using low-polymerization shrinkage resins, and four different types of adhesives in class V preparations on extracted teeth. Material and methods:An experimental, comparative, analytical study was conducted on 32 extracted teeth with class V preparation (2 mmocclusogingival, 2 mm mesiodistal, and 2 mm depth). These were divided into 2 groups: one in which the teeth were restored using a conventional technique with nano-filled resin, and the other, in which an ultrasonic technique using a low-shrinkage resin was employed. In turn, each group was subdivided into 4 groups, in which different KerrTM adhesives were used (OptiBond All-In One, OptiBond Solo Plus, OptiBond FL, and...

Comparación de dos clasificaciones de preparaciones cavitarias y lesiones cariosas: Mount y Hume, y Black / Comparison of two classifications of cavity preparations and carious lesions: Mount & Hume, and Black

Introducción: en la práctica clínica de la estomatología es común encontrar profesionales que no conocen ni saben aplicar la clasificación de preparaciones cavitarias de Mount y Hume. En la literatura en idioma español es escasa la información acerca del tema, a pesar de que las entidades rectoras del gremio internacional la consideran vigente. Objetivo: comparar la clasificación de las preparaciones cavitarias dentales según Mount y Hume, modificada por Lasfargues y otros, con la de Black. Métodos: se realizó un estudio de revisión bibliográfica sobre la clasificación de las preparaciones cavitarias según Mount y Hume, en la que se incluyeron artículos publicados desde 2006 hasta 2014. Se revisaron revistas de impacto en Internet que tratan el tema (en: Google académico, Scopus, Scielo, Hinari, y Medline). Los términos utilizados fueron: new cavity classification, cavity design, preservation and restoration of tooth structure, enamel remineralization, Mount Hume Lasfargues Classification. Los 163 artículos obtenidos fueron tamizados; pero el estudio se ciñó solo a 52 artículos que trataban estas temáticas de manera más integral. Análisis e integración de la información: se consideró a la clasificación de Black como insuficiente en cuanto a las nuevas tecnologías y conceptos actuales orientadas al logro de terapias mínimamente invasivas. Mount y Hume demuestran con su clasificación las limitaciones de las preparaciones de Black. Consideraciones finales: la clasificación de Black presentó limitaciones en relación con la de Mount y Hume, y Lasfargues. Ambas clasificaciones deben coexistir, y es factible aplicarlas en la estomatología conservadora actual(AU)

Introduction: in dental practice it is common to find professionals who do not know or are unable to apply Mount & Hume's cavity preparation classification. Information about the subject is scarce in the literature published in Spanish, despite the fact that leading dental institutions worldwide consider it to have current validity. Objective: compare Mount & Hume's classification of dental cavity preparations as modified by Lasfargues and colleagues, with Black's. Methods: a bibliographic review was conducted of papers about Mount & Hume's classification of cavity preparations published from 2006 to 2014. The review included high impact online journals from the databases Google Scholar, Scopus, Scielo, Hinari and Medline. The search terms used were new cavity classification, cavity design, preservation and restoration of tooth structure, enamel remineralization, Mount Hume Lasfargues Classification. The 163 papers obtained were scanned, but the study was restricted to the 52 which dealt with the topic in a more comprehensive manner. Data analysis and integration: black's classification was considered to be insufficient in the light of the new technologies and current concepts about minimally invasive therapies. Mount & Hume's classification shows the limitations of Black's preparations. Final considerations: black's classification had limitations with relation to Mount & Hume's and Lasfargues'. Both classifications should coexist and it is feasible to apply them in current conservative dental practice(AU)

Effect of resin-modified glass-ionomer cement lining and composite layering technique on the adhesive interface of lateral wall

Interface integrity can be maintained by setting the composite in a layering technique and using liners. Objective The aim of this in vitro study was to verify the effect of resin-modified glass-ionomer cement (RMGIC) lining and composite layering technique on the bond strength of the dentin/resin adhesive interface of lateral walls of occlusal restorations. Material and Methods Occlusal cavities were prepared in 52 extracted sound human molars, randomly assigned into 4 groups: Group 2H (control) – no lining + two horizontal layers; Group 4O: no lining + four oblique layers; Group V-2H: RMGIC lining (Vitrebond) + two horizontal layers; and Group V-4O: RMGIC lining (Vitrebond) + four oblique layers. Resin composite (Filtek Z250, 3M ESPE) was placed after application of an adhesive system (Adper™ Single Bond 2, 3M ESPE) dyed with a fluorescent reagent (Rhodamine B) to allow confocal microscopy analysis. The teeth were stored in deionized water at 37oC for 24 hours before being sectioned into 0.8 mm slices. One slice of each tooth was randomly selected for Confocal Laser Scanning Microscopy (CLSM) analysis. The other slices were sectioned into 0.8 mm x 0.8 mm sticks to microtensile bond strength test (MPa). Data were analyzed by two-way ANOVA and Fisher's test. Results There was no statistical difference on bond strength among groups (p>0.05). CLSM analysis showed no significant statistical difference regarding the presence of gap at the interface dentin/resin among groups. Conclusions RMGIC lining and composite layering techniques showed no effect on the microtensile bond strength and gap formation at the adhesive interface of lateral walls of high C-factor occlusal restorations. .

Papacarie: A Chemomechanical Caries Removal Agent.

Chemomechanical caries removal (CMCR) is a noninvasive technique eliminating infected dentine via a chemical agent. Th e objective of CMCR is to eliminate the outer layer or infected dentin, leaving the aff ected layer or partly demineralized dentin, which can be remineralized and repaired. As this process based on minimally invasive dentistry, it not only removes infected tissues, also preserves healthy dental structure, avoiding pulp irritation and patient discomfort. Th is is a method of caries removal based on dissolution. Instead of drilling, this method uses a chemical agent assisted by an a traumatic mechanical force to remove soft carious structure. Th e chemomechanical method for caries removal is most outstanding among other alternative methods. Th is paper reviews one of the chemomechanical removal agent, Papacarie.

Chemomechanical versus drilling methods for caries removal: an in vitro study

The purpose of this study was to compare the performance of chemomechanical caries removal (CMCR) with that of conventional drilling for efficacy of caries removal, time spent, morphological changes and microhardness of surface dentin, and microleakage of subsequent restorations. Forty-six carious deciduous molars were randomly divided into two groups: one each for caries removal by (1) CMCR and by (2) drilling. The completeness of caries removal was evaluated by visual and tactile criteria and a caries detector device. Twenty teeth in each group were restored with glass ionomer (GI) and subjected to thermocycling before undergoing microleakage and microhardness tests. In each group, three restored teeth were used for polarized light microscopic analysis, and three unrestored teeth for scanning electron microscopy (SEM). There was no significant difference in the completeness of caries removal between groups. However, time spent for caries removal by CMCR was significantly longer than that required for drilling. Restorations in the CMCR group had significantly more microleakage than those in the drilling group. Dentin hardness of the cavity floor after CMCR was also significantly lower. Microscopic analyses showed roughened and irregular dentin surfaces in the CMCR group, unlike the smooth surfaces observed in the drilling group. In conclusion, CMCR was as efficacious as drilling in term of completeness of caries removal, but required longer excavation times and resulted in lower microhardness of residual dentin as well as more microleakage after restorations with GI. Further laboratory and clinical evaluations on the efficiency and performance of CMCR for the durability of subsequent restorations are required.