Evidence-practice gap in treatment decisions about defective composite and amalgam restorations among Brazilian dentists

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). This study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap

Reparar ou substituir? quando e como intervir em restaurações defeituosas / Repair or replace? when and how to intervene in defective restorations

A alta prevalência de cárie ao redor do mundo faz com que os tratamentos restauradores figurem entre os procedimentos mais executados pelos cirurgiõesdentistas. Também é bastante comum os profissionais relatarem novas lesões de cárie ao redor das restaurações ou até mesmo fraturas parciais ou totais das mesmas, fatores que podem ser considerados como "falhas" do procedimento restaurador. Diante dessas situações, a maioria dos profissionais entende que é necessário realizar a substituição completa da restauração. No entanto, existem outras técnicas mais conservadoras e que podem ser tão efetivas quanto a substituição/troca, como por exemplo a realização de reparo das restaurações apresentando defeitos. O objetivo deste artigo é apresentar de forma clara e objetiva aos clínicos que se deparam diariamente com este cenário, qual seria o melhor momento para intervir, e quais as alternativas de tratamento, baseadas na melhor evidência científica disponível, a se realizar frente às falhas dos procedimentos restauradores, sempre alinhadas com a filosofia de Mínima Intervenção.

The high prevalence of caries worldwide makes restorative treatments some of the most commonly performed dental treatments. It is pretty common to find new caries lesions around the restorations or even partial or total fractures, factors that can be considered a "failure" for the restorative procedure. In these situations, most professionals understand that it is necessary to replace the restoration, but other more conservative techniques are as effective as a replacement, such as repairing the restorations. This article aims to present a clear and evidence-based when is the best time to intervene and what is the best treatment to be carried out in case of failure of the restorative procedures, in line with Minimal Intervention principles.

Sellado de lesiones de caries: reporte de caso / Selamento de lesões de cárie: relato de caso / Sealing of caries lesions: case report

El objetivo de este estudio fue informar un caso clínico de sellado de lesiones activas de caries, puntuación 5 del Sistema Internacional de Detección y Evaluación de Caries - ICDAS, en los primeros molares permanentes de un chico de 9 años. En el examen clínico, se identificaron lesiones activas, código 5 y 3 en los dientes 16 y 26, respectivamente. Sin embargo, en el examen radiográfico se observó que la lesión del diente 26 también se encontraba en la mitad externa de la dentina. Por lo tanto, ambas lesiones fueron consideradas como código 5. Así, para el sellado de las lesiones, se realizó un tratamiento de intervención mínima, usando sellante resinoso con capa intermedia de adhesivo. Después de 6 meses de acompañamiento, se observó la pérdida de la integridad del sellado del diente 16 realizándose la reparación del mismo; después de un año ambas lesiones estaban inactivas. Por lo tanto, el sellado de las lesiones de caries parece ser adecuado para las lesiones del esmalte que alcanzan la mitad exterior de la dentina

O objetivo deste estudo foi relatar um caso clínico de selamento de lesões de cárie ativas, escore 5 do International Caries Detection and Assessment System- ICDAS, em primeiros molares permanentes de um menino de 9 anos. Ao exame clínico, foram identificadas lesões ativas, escore 5 e 3 nos elementos 16 e 26, respectivamente. Entretanto, no exame radiográfico observou-se que a lesão do dente 26 também estava em metade externa de dentina. Dessa forma, ambas as lesões eram escore 5. O tratamento de mínima intervenção com o selamento das lesões de cárie foi realizado, usando selante resinoso com camada intermediária de adesivo. Em 6 meses de acompanhamento, observou-se perda de integridade do selante no dente 16, sendo realizado o reparo; após um ano, as lesões estavam paralisadas. Portanto, o selamento de lesão de cárie parece ser adequado para lesões em esmalte atingindo metade externa de dentina

The aim of this study was to report a clinical case of sealing active caries lesions, score 5 of the International Caries Detection and Assessment System- ICDAS, in the first permanent molars of a 9-year-old boy. On clinical examination, active lesions were identified, score 5 and 3 in molars 16 and 26, respectively. However, radiographic examination determined that the lesion of tooth 26 was also in the external half of dentin. Thus, both lesions were score 5. The minimal intervention treatment with the sealing of the carious lesions was performed, using resinous sealant with an intermediate layer of adhesive. In 6 months of follow-up, loss of integrity of the sealant was observed on tooth 16, and the repair was carried out; after one year, the lesions were paralyzed. Therefore, the sealing of caries lesions seems to be suitable for enamel lesions reaching the external half of dentin

Effect of Light Sources on Bond Strength of Different Composite Resins Repaired with Bulk-Fill Composite / Efecto del tipo de fuente luz en la resistencia adhesiva de distintas resinas compuestas reparados con una resina bulk-fill

Abstract: The aim of this study was to evaluate and compare the effects of different light sources on shear bond strength when bulk-fill composite was used for the repair of different composite resins. A total of 126 samples made from six resin composites with different properties were aged (thermal-cycling with 5000 cycle), exposed to the same surface treatments and adhesive procedure. Then, they were repaired with a bulk-fill composite. At the polymerization step, each group was divided into three subgroups (n=7) and light cured with a QTH light source for 40s and two different LED light sources for 20s. Subsequently, the specimens were aged in distilled water at 37 ºC for 4 weeks and then subjected to shear bond strength test. Then, the specimens were examined under a stereomicroscope to identify modes of failure and visualized by Scanning Electron Microscope. Data obtained from the study were analyzed using ANOVA and Tukey HSD Test (α=0.05). In all groups, the light curing units had an impact on shear bond strength (p<0.05). Among the study groups, the greatest bond strength values were observed in the specimens repaired using the LED and the specimens repaired with the QTH light curing unit had the lowest bond strength values. It was concluded that the content of composite resins and light curing units may influence bond strength of different composites repaired with the bulk-fill composite.

Resumen: El objetivo de este estudio fue evaluar y comparar los efectos de diferentes fuentes de luz sobre la resistencia de la unión al cizallamiento cuando se utiliza una resina bulk-fill para la reparación de diferentes resinas compuestas. Se envejecieron un total de 126 muestras fabricadas con seis compuestos de resina con diferentes propiedades (ciclo térmico con 5000 ciclos), expuestas a los mismos tratamientos de superficie y procedimiento adhesivo. Luego, fueron reparadas con una resina bulk- fill. En el paso de polimerización, cada grupo fue dividido en tres subgrupos (n=7) y fotopolimerizado con una fuente de luz QTH por 40s y dos fuentes de luz LED por 20s. Posteriormente, los especímenes se envejecieron en agua destilada a 37 ºC durante 4 semanas y luego se sometieron a una prueba de resistencia adhesiva de cizalla. Luego, los especímenes fueron examinados bajo un estereomicroscopio para identificar los modos de falla y visualizados por el Microscopio Electrónico de Barrido. Los datos obtenidos del estudio fueron analizados usando el ANOVA y la prueba Tukey HSD (α=0.05). En todos los grupos, las unidades de fotopolimerización tuvieron un impacto en la fuerza de adhesión al cizallamiento (p<0,05). Entre los grupos de estudio, los mayores valores de fuerza de adhesión se observaron en los especímenes reparados utilizando el LED y los especímenes reparados con la unidad de fotopolimerización QTH tuvieron los valores de fuerza de adhesión más bajos. Se llegó a la conclusión de que el contenido de las resinas compuestas y las unidades de fotopolimerización pueden influir en la fuerza de adhesión de los diferentes compuestos reparados con resinas bulk-fill.

Machinability of Zirconia Toughened Mica Glass Ceramics for Dental Restorations / Usinabilidade de cerâmica de vidro de mica temperada com zircônia para restaurações dentárias

Objective: For a dental material to be machinable for CAD/CAM technology, it must offer convenient machining, under a given set of cutting conditions. Quantitative evaluation of machinability has been assessed in literature through various parameters such as tool wear, penetration rates, surface roughness, cutting force and power. A machinable ceramic will typically demonstrate a higher tool penetration rate with signs of reduced diamond tool wear and edge chipping. The purpose of this in vitro study was to evaluate the feasibility of machining an experimental ceramic, 20 wt.% zirconia reinforced mica glass ceramics (G20Z) for indirect dental restorations and compare the tool penetration rates of G20Z to commercially available dental ceramics, Presintered Zirconia (PSZ) and IPS emax CAD. Material and Methods: Precursors of base glass (SiO2 -Al2O3 -K2O -MgO-B2O3 -F) were melted at 15000C for 2 h in a platinum crucible and quenched in deionised water. The glass frit was ball milled with 20 wt. % YSZ (G20Z) and subject to two stage heat treatment in a muffle furnace. Specimens of G20Z (12 X 2 mm) were evaluated for their feasibility of machining under varying spindle speed, depth of cut, and feed rates. Influence of depth of cut, spindle speed and feed rate (vc=8000-16000 rpm, d=0.4-0.8 mm, f=0.1- 0.3 mm/tooth) on cutting forces, material response, surface roughness and tool wear were investigated. Tool penetration rates, tool wear and margin chipping were also evaluated and compared with Pre-sintered Zirconia (PSZ) and e.max CAD in a custom dental milling surveyor at 30,000 rpm with a load of 0.98 N under water lubrication for 6 min. Tool penetration rates were calculated as the ratio of length of cut and milling time with a measuring microscope and scanning electron microscope was used for tool wear and edge chipping. ANOVA and Tukey Kramer tests were used for statistically comparing the means of each group. Results: Spindle speed and feed rate play a significant role in influencing surface roughness, thrust force, cutting forces and tool wear. Penetration rates of G20Z (0.32 ±0.12 mm/min) was significantly greater than PSZ (0.26 ±0.06 mm/min) and IPS e.max CAD (0.21 ±0.05 mm/min). SEM observations reveal tool abrasion and edge chipping regardless of the ceramic type. Conclusion: High spindle speeds delivers low cutting forces with an average surface roughness of 1.61 µm, with abrasive wear of the tool insert and brittle fracture of zirconia mica glass ceramic composites. G20Z with its machinable nature demonstrates greater tool penetration rates than PSZ and IPS e.max CAD. Tool wear and edge chipping is seen in all the investigated ceramics. (AU)

Objetivo: Para que um material odontológico seja usinável para a tecnologia CAD / CAM, ele deve oferecer uma usinagem conveniente, sob um determinado conjunto de condições de corte. A avaliação quantitativa da usinabilidade tem sido avaliada na literatura por meio de vários parâmetros, como desgaste da ferramenta, taxas de penetração, rugosidade da superfície, força de corte e potência. Uma cerâmica usinável normalmente demonstrará uma maior taxa de penetração da ferramenta com sinais de desgaste reduzido da ferramenta de diamante e lascamento da borda. O objetivo deste estudo in vitro foi avaliar a viabilidade da usinagem de uma cerâmica experimental, 20% em peso de cerâmica de vidro de mica reforçada com zircônia (G20Z) para restaurações dentárias indiretas e comparar as taxas de penetração da ferramenta de G20Z com as cerâmicas dentais comercialmente disponíveis, Zircônia Presinterizada (PSZ) e IPS emax CAD. Material e Métodos: Precursores de vidro base (SiO2-Al2O3-K2O -MgO-B2O3 -F) foram fundidos a 15000C por 2 h em um cadinho de platina e temperados em água deionizada. A frita de vidro foi moída com 20% em peso de YSZ (G20Z) e submetida a tratamento térmico em duas fases em mufla. Amostras de G20Z (12 x 2 mm) foram avaliadas quanto à sua viabilidade de usinagem sob variação de velocidade do fuso, profundidade de corte e taxas de avanço. A influência da profundidade de corte, velocidade do fuso e taxa de avanço (vc = 8000-16000 rpm, d = 0,4-0,8 mm, f = 0,1- 0,3 mm / dente) nas forças de corte, resposta do material, rugosidade da superfície e desgaste da ferramenta foram investigadas. As taxas de penetração da ferramenta, o desgaste da ferramenta e o lascamento da margem também foram avaliados e comparados com Zircônia pré-sinterizada (PSZ) e e.max CAD em um topógrafo de fresamento dentário personalizado a 30.000 rpm com uma carga de 0,98 N de lubrificação subaquática por 6 min. As taxas de penetração da ferramenta foram calculadas como a razão entre o comprimento de corte e o tempo de fresamento com um microscópio de medição e um microscópio eletrônico de varredura foi usado para o desgaste da ferramenta e lascamento da borda. Os testes ANOVA e Tukey Kramer foram usados para comparar estatisticamente as médias de cada grupo. Resultados: a velocidade do fuso e a taxa de avanço desempenham um papel significativo em influenciar a rugosidade da superfície, força de impulso, forças de corte e desgaste da ferramenta. As taxas de penetração de G20Z (0,32 ± 0,12 mm / min) foram significativamente maiores do que PSZ (0,26 ± 0,06 mm / min) e IPS e.max CAD (0,21 ± 0,05 mm / min). As observações do SEM revelam a abrasão da ferramenta e o lascamento da borda, independentemente do tipo de cerâmica. Conclusão: As altas velocidades do fuso proporcionam baixas forças de corte com uma rugosidade superficial média de 1,61 µm, com desgaste abrasivo do inserto da ferramenta e fratura frágil de compósitos de cerâmica de vidro de zircônia. G20Z com sua natureza usinável demonstra maiores taxas de penetração da ferramenta do que PSZ e IPS e.max CAD. O desgaste da ferramenta e o lascamento da borda são vistos em todas as cerâmicas investigadas. (AU)

Reparación comparada con reemplazo de restauraciones directas posteriores defectuosas en pacientes con dentición permanente / Repair versus complete replacement for defective direct restorations in permanent teeth

RESUMEN: Introducción: Las restauraciones directas posteriores defectuosas han sido tratadas tradicionalmente a través del reemplazo de la restauración. Sin embargo, por las posibles complicaciones de este procedimiento, la reparación de las restauraciones ha sido ampliamente utilizado en la práctica clínica, pero su uso sigue siendo controvertido. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos una revisión sistemática que incluyó nueve estudios primarios, todos correspondientes a ensayos aleatorizados. Como conclusión podemos señalar que la reparación comparado con el reemplazo de restauraciones directas posteriores defectuosas podría aumentar el riesgo de necesidad de reintervención, podría resultar en poca o nula diferencia en el riesgo de sensibilidad postoperatoria y podría aumentar el riesgo de caries secundaria, pero la certeza de la evidencia es baja.

ABSTRACT: Introduction: Traditionally, restoration replacement has been widely used for the treatment of defective restorations in permanent teeth. Due to complications related to total replacement, restoration repair has been incorporated into dental practice. However, the use of repair over replacement for defective restorations is still controversial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified one systematic review including nine studies overall, of which all were randomized trials. We conclude that repair versus complete replacement may improve the risk of reintervention, may make little or no difference to risk of postoperative sensibility and may improve the risk of secondary caries, but the certainty of the evidence has been assessed as low.

Como reparar uma restauração oclusal de resina composta em dentes decíduos? Relato de caso / How to repair an occlusal composite resin restoration on primary teeth? Case report

Frente à necessidade de reintervenção em restaurações insatisfatórias, os clínicos podem, em geral, optar pela substituição ou reparo. Este artigo relata um caso clínico de reparo de uma restauração de resina composta com falha em dente decíduo. Após profilaxia e isolamento relativo, a porção da resina composta a ser reparada foi asperizada com uma ponta diamantada em alta rotação com o intuito de melhorar a união mecânica entre a resina envelhecida e a nova (reparo). Foi realizado o condicionamento com gel de ácido fosfórico a 34% por 15 segundos, seguido de lavagem e secagem. Uma camada do sistema adesivo Single Bond Universal (3M ESPE) foi aplicada ativamente durante 20 segundos, seguido de jato de ar comprimido por 5 segundos e fotoativação por 10 segundos. Por fim, a resina composta fluida (Filtek Z350 XT Flow; 3M ESPE) foi inserida e fotoativada por 20 segundos. A realização de um adequado protocolo clínico envolvendo tratamentos físicos e químicos de superfície é fundamental para a efetividade da intervenção e a manutenção do dente decíduo clinicamente funcional até a esfoliação fisiológica.

Facing need for reintervention in unsatisfactory resto-rations, clinicians may generally choose for replacement or repair. This paper reports a clinical case of repair of a composite resin restoration with failure in primary tooth. After prophylaxis and relative isolation, the portion of the composite resin to be repaired was roughed with a high-speed diamond bur to improve the mechanical bond between the aged and new resin (repair). Conditioning with 34% phosphoric acid gel was performed for 15 seconds, followed by washing and drying. One layer of the adhesive system Single Bond Universal (3M ESPE) was actively applied for 20 seconds and light- cured for 10 seconds. Finally, the flowable composite resin (Filtek Z350 XT Flow; 3M ESPE) was inserted and light-cured for 20 seconds. An adequate clinical protocol involving physical and chemical surface treatments is essential for the effectiveness of the intervention and the main-tenance of the primary tooth clinically functional until physiological exfoliation.

Comportamento biomecânico das diferentes conexões entre restaurações monolíticas de zircônia e bases de titânio em próteses implanto-suportadas / Torque maintenance capacity, vertical misfit, load to failure and stress concentration in zirconia restorations cemented or notched to titanium bases

Este estudo avaliou a eficiência da pré-carga antes e após fadiga, desajuste vertical, carga para fratura e a concentração de tensões em restaurações de zircônia cimentadas ou acopladas a uma base de titânio (TB). Para isto, quarenta implantes foram incluídos em cilindros de polióxido de metileno (POM-DelrinDupont) e separados em dois grupos: restauração de zircônia cimentada em um TB ou acoplada em um TB experimental. Os corpos de prova tiveram o torque e o desajuste vertical avaliados antes e após a fadiga cíclica (200 N / 2 Hz / 2 x 106 ciclos / 37 °C). A carga até a fratura foi calculada em uma máquina universal de ensaios (1 mm / min, 1000 kgf) e as falhas foram avaliadas por estereomicroscopia e microscopia eletrônica de varredura. Modelos tridimensionais foram criados baseados na geometria dos espécimes laboratoriais e a concentração de tensão calculada pelo método dos elementos finitos. Os dados dos testes in vitro foram submetidos à análise de variância dois fatores e teste de Tukey (α = 0,5). As restaurações cimentadas apresentaram menor perda de torque (19,79 N.cm), menor desajuste vertical (3,77 µm), menor concentração de tensão na restauração (88,2 MPa) e maior carga de fratura (451,3 N) do que as restaurações acopladas (15,95 N.cm, 10,51 µm, 99,8 MPa e 390,8 N, respectivamente). Conclusão: A presença de uma camada de cimento entre a restauração e a base de titânio reduziu a suscetibilidade ao afrouxamento do parafuso do pilar, melhorou a resistência à carga compressiva e reduziu a concentração de tensão na restauração(AU)

The goal of this study was to evaluate the torque and vertical misfit before and after fatigue, the load to failure and the stress concentration of zirconia restorations cemented or notched to a titanium base (TB). Forty implants were included in Acetal Polyoxymethylene (POM-Delrin-Dupont) cylinders and divided in two groups: zirconia restoration cemented on a TB and zirconia restoration notched on an experimental TB. The specimens had their torque loosening and vertical misfit evaluated before and after cyclic fatigue (200 N / 2 Hz/ 2 x 106 cycles /37 °C). Load to failure was calculated in an universal testing machine (1 mm/min, 1000 kgf) and failures were evaluated by optical microscopy and scanning electron microscopy. Three-dimensional models were created based in the in vitro geometries and the stress concentration calculated using the finite element method. Data from the in vitro tests were submitted to two-way analysis of variance and Tukey test (α = 0.5). The cemented restorations presented less torque loosening (19.79 N.cm), lower vertical misfit (3.77 µm), lower stress concentration in the restoration (88.2 MPa) and higher fracture load (451.3 N) than notched restorations (15.95 N.cm, 10.51 µm, 99.8 MPa and 390.8 N, respectively). Conclusion: The presence of a cement layer between restoration and titanium base reduced the susceptibility to abutment screw loosening, improved the resistance to compressive load and reduced the stress concentration in the restoration(AU)

Effect of surface treatments and universal adhesive application on the microshear bond strength of CAD/CAM materials

PURPOSE: The aim of this study was to evaluate the microshear bond strength (µSBS) of four computer-aided design/computer-aided manufacturing (CAD/CAM) blocks repaired with composite resin using three different surface treatment protocols.MATERIALS AND METHODS: Four different CAD/CAM blocks were used in this study: (1) flexible hybrid ceramic (FHC), (2) resin nanoceramic (RNC), (c) polymer infiltrated ceramic network (PICN) and (4) feldspar ceramic (FC). All groups were further divided into four subgroups according to surface treatment: control, hydrofluoric acid etching (HF), air-borne particle abrasion with aluminum oxide (AlO), and tribochemical silica coating (TSC). After surface treatments, silane was applied to half of the specimens. Then, a silane-containing universal adhesive was applied, and specimens were repaired with a composite, Next, μSBS test was performed. Additional specimens were examined with a contact profilometer and scanning electron microscopy. The data were analyzed with ANOVA and Tukey tests.RESULTS: The findings revealed that silane application yielded higher µSBS values (P<.05). All surface treatments were showed a significant increase in µSBS values compared to the control (P<.05). For FHC and RNC, the most influential treatments were AlO and TSC (P<.05).CONCLUSION: Surface treatment is mandatory when the silane is not preferred, but the best bond strength values were obtained with the combination of surface treatment and silane application. HF provides improved bond strength when the ceramic content of material increases, whereas AlO and TSC gives improved bond strength when the composite content of material increases.

Reparación de defecto localizado en restauración de amalgama como tratamiento de mínima intervención en cariología / Repair of a localized defect in a restoration with amalgam filling as minimal intervention treatment in cariology

Introducción: La reparación de restauraciones ha sido estudiada desde muy recientemente, pero a pesar de haber demostrado efectividad y mejoras en la terapéutica de la caries dental, aún tiene seguidores y detractores, lo que justifica la necesidad de estudios que sigan avalando tales prácticas. Objetivo: Describir, a través de la presentación de un caso, la reparación de un defecto localizado en una restauración de amalgama como tratamiento de mínima intervención en cariología. Presentación del caso: Paciente femenina de 16 años con antecedentes de salud acude a consulta refiriendo una pequeña fractura de restauración en diente 4.6 desde hace varias semanas. La regularización del defecto en la restauración, la mínima preparación cavitaria, la eliminación del fragmento de la base intermedia, la protección del complejo dentino-pulpar y el llenado de la cavidad resultante, fueron los primeros pasos de una técnica que se cumplimentó luego del pulido final de la interface tejido dentario-restauración y se evolucionó cinco años después. Se evidenció el estado y presencia de la reparación de la restauración realizada, sin fracturas añadidas, microfiltraciones, sintomatologías, desplazamientos ni pérdidas de la continuidad. Conclusiones: La reparación del defecto localizado de amalgama se realizó con el fin de preservar los tejidos dentarios no afectados como lo dicta la mínima intervención en cariología. Cinco años más tarde, la evolución evidencia una práctica que se tradujo en resultados satisfactorios e incremento de la calidad de vida de la paciente(AU)

Introduction: Restoration repair has been studied recently; but, even when it has demonstrated effectiveness and improvements in the therapy of dental caries, it still has followers and detractors that justify the need for studies that continue supporting such practices. Objective: To describe, through a case presentation, the repair of a defect located in a restoration with amalgam filling as minimal intervention treatment in cariology. Case presentation: Sixteen-year-old female patient with health history that went to the clinic reporting a small fracture of a restoration performed in tooth 4.6 several weeks ago. The regularization of the defect in the restoration, minimum cavity preparation, elimination of the fragment of the intermediate base, protection of the dentin-pulp complex, and filling of the resulting cavity were the first steps of a technique that was completed after the final polishing of the dental tissue/restoration interface that was evolved five years later. The status and presence of the restoration repair performed without added fractures, microfiltration, symptomatology, displacement or loss of continuity was evidenced. Conclusions: The repair of the localized defect in a restoration with amalgam filling was performed with the aim of preserving the unaffected dental tissues as dictated by minimal intervention in cariology. Five years later, the patient´s evolution shows a practice that resulted in satisfactory results and an increase in the patient's quality of life(AU)

Carilla dentales con técnica de resina inyectada. Reporte de caso / Dental veneers with injectable composite resin technique. Case Report

La técnica de resina inyectada es un trata-miento estético con el que es posible prede-cir el resultado final y trasladar del encerado diagnóstico la forma anatómica deseada a una restauración sobre la superficie dental, prediciendo el aspecto estético para esco-ger el color y la textura del material restaura-dor; estableciendo parámetros oclusales como modificar la posición y alineación de dientes, contorno fisiológico, perfil labial, posición del borde incisal y orientación gingi-val. Además, esta técnica puede realizarse con o sin preparación de la superficie, ase-gura una adaptación uniforme del material de restauración y aumenta el potencial para diseñar preparaciones más conservadoras, pues conservar tejido dental y predecir el resultado final son objetivos de esta técnica. El presente reporte de caso es sobre la rehabilitación estética y funcional con cari-llas dentales de resina inyectada en pacien-te femenina de 19 años que se presentó a la clínica dental de la Subdirección de Desa-rrollo Estudiantil, Cultural, Arte y Deporte (SUDECAD), de la Universidad Nacional Autonóma de Honduras en el Valle de Sula (UNAH-VS), con 4 dientes afectados que presentaban dolor, grietas a nivel del esmal-te, pigmentaciones oscuras, restos de restauraciones previas con pobre anatomía y mal adaptadas; como resultado, una sonri-sa poco favorecedora. En este caso se presenta una opción de tratamiento funcio-nal y estético con el que se le dió solución rápida y predecible. Tratamiento que forma parte de la continua búsqueda para brindar una sonrisa estética y saludable que todo profesional de la Odontología debe ofrecer...(AU)

Influence of different universal adhesives on the repair performance of hybrid CAD-CAM materials

OBJECTIVES: The aim of this study was to investigate the microshear bond strength (μSBS) of different universal adhesive systems applied to hybrid computer-aided design/computer-aided manufacturing (CAD-CAM) restorative materials repaired with a composite resin. MATERIALS AND METHODS: Four types of CAD-CAM hybrid block materials—Lava Ultimate (LA), Vita Enamic (VE), CeraSmart (CS), and Shofu Block HC (SH)—were used in this study, in combination with the following four adhesive protocols: 1) control: porcelain primer + total etch adhesive (CO), 2) Single Bond Universal (SB), 3) All Bond Universal (AB), and 4) Clearfil Universal Bond (CU). The μSBS of the composite resin (Clearfil Majesty Esthetic) was measured and the data were analyzed using two-way analysis of variance and the Tukey test, with the level of significance set at p < 0.05. RESULTS: The CAD-CAM block type and block-adhesive combination had significant effects on the bond strength values (p < 0.05). Significant differences were found between the following pairs of groups: VE/CO and VE/AB, CS/CO and CS/AB, VE/CU and CS/CU, and VE/AB and CS/AB (p < 0.05). CONCLUSIONS: The μSBS values were affected by hybrid block type. All tested universal adhesive treatments can be used as an alternative to the control treatment for repair, except the AB system on VE blocks (the VE/AB group). The μSBS values showed variation across different adhesive treatments on different hybrid CAD-CAM block types.

Minimally invasive aesthetic rehabilitation in composite resin: report of two clinical cases / Reabilitação estética minimamente invasiva em resina composta: relato de dois casos clínicos

Patient demand looking for the perfect smile has been steadily growing in the last few years. Thus, these two case reports discuss some ultra-conservatives approach to achieve good esthetic results. In the first case the clinical protocol of a restorative approach is described, the cosmetic remodeling of the teeth and in the second case, the replacement of extensive unsatisfactory composite restorations. The treatment planning was based on diagnostic waxing and the making of mock-up in both cases. Teeth bleaching were also performed before restoration. To conclude, these conservative relative therapies with composite resin restorations provide an ultra-minimally invasive protocol with excellent esthetic appearances and fuction, especially for young people. (AU)

A demanda do paciente que procura o sorriso perfeito tem crescido constantemente nos últimos anos. Assim, esses dois relatos de casos clínicos discutem uma abordagem ultraconservadora para alcançar bons resultados estéticos. No primeiro caso é descrito o protocolo clínico de uma abordagem restauradora, a remodelação cosmética dos dentes e, no segundo caso, a substituição de restaurações compostas extensas insatisfatórias. O planejamento do tratamento baseouse em enceramento diagnóstico e a confecção de mock-up. O clareamento dos dentes foi realizado antes da restauração. Para concluir, essas terapias relativas conservadoras com restaurações de resina composta fornecem um protocolo ultra minimamenteinvasivo com excelentes aparências estéticas. (AU)

Colagem de fragmentos: uma alternativa de reparo para fraturas dentárias - revisão de literatura / Dental bonding fragments: a repair alternative for tooth fractures ­ Literature review

Introdução: fraturas coronárias de dentes anteriores são frequentemente observadas, tanto em crianças, quanto em adolescentes, devido à posição desses elementos na cavidade oral serem bastante vulneráveis. Em virtude disso, a colagem de fragmentos surge como uma alternativa viável de reparo dos elementos dentários, uma vez em que eles sofreram algum tipo de trauma. Objetivo: o objetivo desse estudo é evidenciar, por meio de uma revisão bibliográfica, fundamentos, vantagens, desvantagens e aplicações dessa técnica operatória. Materiais e Métodos: foi realizado levantamento na literatura científica, utilizando artigos de revisão encontrados nas bases de dados PubMED/Medline, Lilacs e Scielo. Foram selecionados artigos de acordo com os critérios de inclusão: disponibilidade do texto integral do estudo e clareza no detalhamento metodológico utilizado. Os descritores utilizados foram "fragmento dentário" ("tooth fragment") e "refixamento" ("reattachment"). Resultados: a colagem de fragmento pode ser aplicada em dentes vitais e não vitais, a depender do tamanho da fratura, das condições periodontais, da largura biológica da invasão, dentre outros fatores. É um procedimento mais simples e apresenta uma maior durabilidade do que as restaurações com resina composta. Em contrapartida, caso o fragmento não esteja bem hidratado, podem ocorrer mudanças de cor, além de existir a possibilidade de deslocamento do fragmento. Conclusão: em virtude dos avanços e melhorias dessa técnica, a colagem de fragmento dentário constitui uma excelente opção clínica para o reestabelecimento funcional e estético da estrutura dentária comprometida.

Introduction: coronary fractures of anterior teeth are frequently observed in both children and adolescents because the position of these elements in the oral cavity is quite vulnerable. Because of that, the collage of fragments appears as a viable alternative of repair of the dental elements once they have suffered some type of trauma. Objective:this study aims to present, through a bibliographic review, the fundamentals, advantages, disadvantages and applications of this surgical technique. Materials and Methods: we conducted a survey in the scientific literature, using review articles found in PubMED / Medline, Lilacs and Scielo databases. Articles were selected according to the inclusion criteria: availability of the full text of the study and clarity in the methodological detail used. The descriptors used were "tooth fragment" and "reattachment". Results: fragment collage can be applied to vital and non-vital teeth, depending on the size of the fracture, periodontal conditions, the biological width of the invasion, among other factors. It is a simpler procedure and has a higher durability than composite resin restorations. On the other hand, if the fragment is not well hydrated, color changes may occur, in addition to the possibility of fragment displacement. Conclusion: due to the advances and improvements of this technique, dental bonding fragments is an excellent clinical option for the functional and esthetic reestablishment of the compromised dental structure.

Skin color affect the replacement of amalgam for composite in posterior restorations: a birth-cohort study

Abstract The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.

Color evaluation of a resin cement light polymerized by different light sources and submitted to potentially staining beverages / Avaliação da cor de um cimento resinoso fotopolimerizado por diferentes fontes de luz e submetidos a bebidas potencialmente corantes

Introduction: The color stability of resin cements, whether dual-pre-cured or photopolymerizable, as well as the color of the dental substrate, are fundamental for the aesthetic success of ceramic restorations, since the ceramic presents a high level of translucency due to its small thickness. Objective: The aim of this in vitro study was to evaluate the color of a resin cement light polymerized by different light sources and immersed in potentially staining beverages. Material and method: Were made 42 specimens of resin cement Variolink-Esthetic (2×6mm) (n=7), being half polymerized with LED light (F1) and half with Halogen light (F2). The specimens were stored in artificial saliva at 37 °C±1 °C. After 24 hours, they were polished with abrasive discs, and divided for the purpose of being submitted to the different solutions for 2 minutes per day, for 28 days, as follows: S1 - Coca-Cola; S2 - Red Wine; and S3 - Distilled Water (Control). Five color readouts were taken: T0 - initial; T1 - 7 days; T2 - 14 days; T3 - 21 days; and T4 - 28 days; with a spectrophotometer (Model SP62S). The color change data (ΔE*) were submitted to statistical analysis, ANOVA and Tukey (p≤0.05). Result: Analyzing the factor solution, S2 (5.89 (±0.02)), produced a higher ΔE* value than S1 (3.79 (±0.02)) and (S1), a higher value than S3 (1.41 (±0.02)). Analyzing the factor light source, F2 (4.05 (±0.12)), produced a higher ΔE* value than F1 (3.33 (±0.12)). When analyzing the factor time, ΔE* values were found to increase gradually over the course of time: T1(2.36 (±0.08)); T2(3.27 (±0.08)); T3(4.06 (±0.08)); and T4(5.09 (±0.08)). Conclusion: It was concluded that red wine produced a greater color change; Halogen light promoted highest degree of pigmentation; and the longer the time of immersion, the greater the color change of the material.

Introdução: A estabilidade de cor dos cimentos resinosos, sejam eles de presa dual ou fotopolimerizáveis, assim como a cor do substrato dental, são fundamentais para o sucesso estético das restaurações cerâmicas uma vez que a cerâmica apresenta alto nível de translucidez devido a sua pequena espessura. Objetivo: O objetivo deste estudo in vitro foi avaliar a cor de um cimento resinoso fotopolimerizado por diferentes fontes de luz e imersos em bebidas potencialmente corantes. Material e método: Foram confeccionados 42 espécimes do cimento resinoso Variolink-Esthetic (2×6mm) (n=7), sendo metade fotopolimerizado com luz LED (F1) e metade com luz Halógena (F2). Os espécimes foram mantidos em saliva artificial à 37 °C±1 °C. Após 24 horas, foram polidos com discos abrasivos e subdivididos para serem imersos 2 minutos por dia, durante 28 dias, nas diferentes soluções: S1 - Coca-Cola; S2 - Vinho Tinto; e S3 - Água destilada (controle). Foram realizadas 5 leituras de cor: T0 - inicial; T1 - 7 dias; T2 - 14 dias; T3 - 21 dias; e T4 - 28 dias; com auxílio de um espectrofotômetro (modelo SP62S). Os dados de alteração de cor (ΔE*) foram submetidos a análise estatística, ANOVA e Tukey (p≤0,05). Resultado: Analisando o fator solução, S2 (5,89 (±0,02)), proporcionou maior ΔE* que S1 (3,79 (±0,02)) e este (S1), maior que S3 (1,41 (±0,02)). Analisando o fator fonte de luz, F2 (4,05 (±0,12)), proporcionou maior ΔE* que F1 (3,33 (±0,12)). E analisando o fator tempo, obteve-se que ΔE* foi gradativamente aumentando no decorrer do tempo: T1(2,36 (±0,08)); T2(3,27 (±0,08)); T3(4,06 (±0,08)); e T4(5,09 (±0,08)). Conclusão: Conclui-se que o vinho tinto promoveu maior alteração de cor; a luz Halógena promoveu maior pigmentação e; quanto maior o tempo de imersão, maior alteração de cor do material.

Retrospective study of dental treatment under general anesthesia of 62 disabled children and adolescents / 北京大学学报(医学版)

OBJECTIVE@#To retrospectively figure out the oral health status, treatment and follow-ups after dental treatment under general anesthesia (DGA) of disabled children or adolescents.@*METHODS@#Clinical data of disabled children or adolescents and normal children as control received DGA in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology from August 2008 to September 2015 were recorded, including: gender, birth date, treatment date, disability type, oral health status before treatment, treatment content and follow-ups (in 1 year). Differences among ages and disabilities were analyzed statistically.@*RESULTS@#Sixty-two disabled patients and fifty-seven controls were recruited, mean aged (9.38±5.22) years and (3.00±1.41) years. Most patients had 10 to 15 problem teeth with which the mean number of the disabled children and adolescents was (11.79±4.98) while that of the normal controls was (12.40±4.11). Caries, pulpitis, periapical periodontitis, dental trauma and developmental tooth anomalies of the disabled patients accounted for 67.56%, 13.54%, 15.15%, 1.07%, and 2.68%, respectively and the DMFT/dmft index was 11.55±5.56 while in the control group those were at 65.35%,19.09%,14.14%,0,1.41% and 12.23±4.42. The DMFT/dmft index of the disabled patients in the group 6-12 years (8.35±4.69) was significantly less than that of the other three groups (P<0.01) while no differences were found in disabilities (P=0.239). Resin restoration, pit and fissure sealant, preventive resin restoration, pulpotomy, pulpectomy/RCT, extraction and crown of the disabled patients were performed as 52.71%, 7.24%, 8.56%, 0.72%, 17.13%, 10.01% and 3.62% respectively whereas those made up as 56.31%, 1.27%, 0.13%, 2.29%, 19.87%, 7.90% and 12.23% in the control group. Thirty-five (56.45%) disabled patients and forty-three (75.44%) controls recalled. Problem teeth within one year after operation in diabled patients and controls were both nearly twice as much as the number within half a year. Restoration loss/fractured mainly occurred in anterior primary teeth while secondary/ recurrent caries and pulpitis/perapical periodontitis mostly occurred in primary molars.@*CONCLUSION@#Oral health status in our disabled children and adolescents is poor. Though dental treatment under GA is an effective way to improve the oral health of disabled children and adolescents, periodic follow-ups and family oral health care are equal important for oral health maintenance.

One-year aging effects on microtensile bond strengths of composite and repairs with different surface treatments

Abstract The present study aimed to evaluate effects of different surface treatments and aging of composite cylinders on bond strength of composite resin repair. Thirty-two composite cylinders were produced and divided into four groups according to type of surface treatment and storage time of composite cylinder and repair. Cylinder surface of control group (Gcontrol) received no treatment before composite repair. Other groups were sandblasted with aluminum oxide (GAl2O3), followed by silane (GAl2O3sil) or adhesive (GAl2O3ad). Composite cylinders were stored in artificial saliva for either 24 hours or 1 year. Repairs were performed and stored in artificial saliva for 24 hours or 1 year and repair strength was evaluated using microtensile bond strength test. Data were submitted to Student’s t test, two-way ANOVA, and post hoc test for storage time and treatment (α = 0.05). Gcontrol group showed lower values of aging of composite cylinder and storage time of repair (24 hours or 1 year for both) compared with other groups (p < 0.05). GAl2O3ad and GAl2O3sil groups did not exhibit decreased microtensile bond strength with aged repairs (1 year; p > 0.05). Polymer degradation was significant for composite cylinders during the first year of storage in Gcontrol, GAl2O3, and GAl2O3ad groups (p < 0.05). In GAl2O3sil group, storage time of composite cylinders was not significant (p > 0.05). Aging of composite resin influenced bond strength of restoration repair for up to 1 year. Sandblasting with Al2O3, followed by application of silane layer, produced high bond strength after composite or repair aging.

Efeito de diferentes sistemas de obturação na resistência à fratura de raízes tratadas endodonticamente / The Influence of different obturation systems on the fracture resistance of endodontically treated roots

Objective: This study aimed to compare the fracture resistance of endodontically treated roots filled by different obturation systems. Material and methods: Ninety-six maxillary central incisors were used and decoronated, retaining 12 mm of the roots. On the basis of obturation systems, the roots were randomly divided into 4 groups (n=24): Group1 (COGR): control group (unprepared, unfilled), Group 2 (AVGR): ActiV GP points/ActiV GP sealer, Group 3 (GPGR): Gutta percha points / AH plus sealer, and Group4 (GAGR): Gutta percha points/ActiV GP sealer. The last three groups were obturated with the single cone technique. The roots were then stored in 100% relative humidity at 37 °C for 2 weeks. A vertical compressive force was exerted in a universal testing machine until fracture occurred. Data were statistically analyzed using one-way ANOVA. Results: Mean (SD) failure loads for groups ranged from 920.51 ± 210.37 to 1113.44 ± 489.42 N. The fracture resistance between the different study groups indicated no statistical difference (p>0.05). Conclusions: ActiV GP system did not exert a significant effect on the fracture resistance of endodontically treated teeth.(AU)

Objective: Comparar a resistência à fratura de raízes tratadas endodonticamente obturadas através de diferentes sistemas. Materiais e Métodos: Noventa e seis incisivos centrais superiores foram utilizados, tiveram as coroas removidas, restando 12 mm de raíz. De acordo com o sistema de obturação, as raízes foram divididas em 4 grupos (n=24): Grupo1 (COGR): grupo controle (sem preparo, sem preenchimento), Grupo2 (AVGR): cones ActiV GP / cimento ActiV GP, Grupo3 (GPGR): cones de guta percha / cimento AH plus, e Grupo4 (GAGR): cones de guta percha / cimento ActiV GP. Os últimos três grupos foram obturados através da técnica de cone único. As raízes foram armazenadas em 100% de umidade relativa a 37 °C durante 2 semanas. Uma força compressiva vertical foi aplicada através de uma máquina de ensaio universal até ocorrer fratura. Os dados foram analisados estatisticamente através de ANOVA ­ 1 fator. Resultados: A carga média (SD) obtida no momento da falha variou entre 920.51 ± 210.37 até 1113.44 ± 489.42 N. A resistência à fratura entre os diferentes grupos estudados não indicaram diferença estatística. Conclusão: O sistema ActiV GP não exerceu um efeito significante na resistência à fratura em dentes tratados endodonticamente.(AU)

Restauración de molares endodonciados, con resina híbrida sobre muñón de amalgama: a propósito de un caso / Restoration of endodontic molars with hybrid resin over amalgam stump: about a case

Introducción: En la actualidad la restauración funcional y estética de dientes endodonciados con gran pérdida de tejido dentario, es efectuada a través del método indirecto; sin embargo, la construcción de muñones de amalgama como elemento de sustitución de metal es una opción terapéutica viable. Objetivo: Mostrar la viabilidad de la restauración estética y funcional de molares endodonciados y con gran pérdida de tejido dentario, por vía directa mediante resina híbrida sobre muñón de amalgama. Presentación del caso: Tratamiento impuesto a un paciente de 35 años con antecedentes de traumatismo dentario condicionantes de fracturas complicadas de corona en 36 y 37, tratados con endodoncias radicales de 2 años de evolución. Acudió a la consulta presentando pérdidas de más de dos tercios del tejido coronal en ambos casos. Luego de comprobar que ambos molares cumplían con los requerimientos, se realizó la preparación de las cavidades, seguida de la confección de muñones de amalgama, sobre los cuales pasadas las 48 horas, se realizó la restauración definitiva con resina híbrida nano composite. Conclusiones: El tratamiento cosmético con nano composite sobre muñón de amalgama, resulta una alternativa terapéutica viable en la restauración estética y funcional por vía directa, aun en molares con gran pérdida de tejido dentario y tratamiento pulporadicular radica(AU)

Introduction: Nowadays functional and aesthetic restoration of endodontic teeth with a great loss of dental tissue, is performed by means of an indirect method, however the construction of amalgams stumps as an element for the metal substitution is a viable therapeutic option. Objective: To show the viability of endodontic molars aesthetic and functional restoration with a great loss of dental tissue, through direct method with resin on amalgam stump. Case Presentation: Treatment applied to a 35-year-old patient with antecedents of traumatism conditioning complicated fractures of crown in 36 and 37, treated with radical endodontic therapy 2 years ago. Arrived to the consulting room presenting losses of more than two thirds of the coronal tissues in both cases. After verifying that both molars met the requirements, the cavities were prepared, followed by the conformation of amalgams stumps over which after 48h, was applied a nano hybrid resin for the definitive restoration. Conclusions: The cosmetic treatment with Nano composite resin over the amalgam stump is an alternative and viable therapy for the functional and aesthetic restoration by means of a direct procedure, even in molars with great loss of dental tissue and subjected to radical endodontic therapy(AU)