El material restaurador ideal en la era de la odontología de invasión mínima. Rescatando al oro directo / The ideal restorative material at the minimal invasive dentistry era. Rescuing direct gold

Los logros de los avances obtenidos en el manejo actual de la caries han dado la oportunidad a los odontólogos de detectar lesiones de caries en sus estadios incipientes. A pesar de la existencia de una gran variedad de materiales restauradores directos disponibles en el mercado actual y que pueden utilizarse para restaurar lesiones pequeñas de caries, el material que tiene más posibilidades de éxito para este tipo de lesiones es sin duda alguna el oro cohesivo, también conocido como oro directo (AU)

The goals obtained with the current management of dental caries has given the dentists the opportunity to detect incipient caries lesions in early stages. Although, the current existence of a great variety of direct restorative materials available in the market to restore small caries lesions, the material that may show better success for these type of lesions, is without any doubt: the gold foil or direct gold (AU)

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

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

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

Anatomical post: a simple and safe alternative

Objective: To describe a clinical case that called for an anatomical post to be made to support and retain an indirect restoration in the anterior tooth. Case report: A 72-year-old female patient came to the office complaining that the crown of tooth 22 had come loose. A clinical and radiographic examination of element 22 was performed, and showed a very broad root canal, total displacement of the cast metal crown-core set, and satisfactory endodontic treatment. The restorative planning for this patient included the making of an anatomical post from Exacto # 2 fiberglass post (Angelus, Brazil), and refilling it with Bulk One composite resin (3M, USA), using self-adhesive resin cement U200 (3M, USA). The reconstruction of the coronary portion of the post was also performed with the same composite resin (Bulk One 3M, USA). The preparation for full crown and temporary restoration was performed in the same session, using self-curing acrylic resin. The all-ceramic crown was molded and cemented in subsequent sessions. Conclusion: The use of anatomical posts with composite resin represents a technically viable alternative for rehabilitating endodontically treated teeth with wide root canals, in cases where conventional prefabricated fiber posts cannot be adapted easily. The advantages that stand out are that these posts can be applied easily, at low cost, and in a single session.

Objetivo: Descrever um caso clínico de confecção do pino anatômico para suporte e retenção de restauração indireta em dente anterior. Relato do Caso: Paciente feminina, 72 anos, compareceu ao consultório queixando-se que a coroa do dente 22 havia "soltado". Realizou-se exame clínico e radiográfico do elemento 22, que apresentou conduto radicular bastante amplo, deslocamento total do conjunto núcleo/coroa e tratamento endodôntico satisfatório. O planejamento restaurador para essa paciente incluiu a confecção de pino anatômico, com pino de fibra de vidro Exato #2(Angelus, Brasil) reembasado com resina composta Bulk One (3M, EUA), utilizando o cimento resinoso autoadesivo U200 (3M, EUA). Foi realizada a reconstrução da porção coronária do pino também com resina composta do tipo Bulk. Realizou-se, na mesma sessão de atendimento, o preparo para coroa total e restauração provisória utilizando dente de estoque e resinaacrílica autopolimerizável. Em sessões seguintes foi realizada a moldagem e cimentação da coroa total em cerâmica pura. Conclusão: A utilização de pinos anatômicos com resina composta representa uma alternativa tecnicamente viável, de fácil aplicabilidade, com baixo custo e em única sessão, para reabilitação de dentes tratados endodonticamente com conduto radicular onde os pinos em fibra pré-fabricados convencionais não apresentam boa adaptação.

Superficial effects of different finishing and polishing systems on the surface roughness and color change of resin-based CAD/CAM Blocks / Efectos superficiales de diferentes sistemas de acabado y pulido en la rugosidad superficial y el cambio de color de los bloques de Resina CAD/CAM

ABSTRACT: CAD/CAM blocks are widely used in dental restorations around the world. This study aimed to investigate the effects of different polishing and finishing systems on surface roughness and color change of resin-based CAD/CAM blocks. In this study, material samples of 2×7×12mm were prepared. In three different experimental groups, surface polishing was carried out with one-step, two-step and multi-step polishing systems. The samples in one subgroup of each experimental group were polished with the diamond paste. Once the initial roughness and color values of the samples were measured using a profilometer and a spectrophotometer, the samples were immersed in coffee. Surface roughness and color change (ΔE00) results were statistically analyzed using two-way variance analysis (ANOVA). Finishing and polishing systems created significantly different levels of surface roughness on the hybrid ceramic block (Vita Enamic) but not on the composites block (Brilliant Crios, Grandio Blocs). While the two-step and multi-step finishing and polishing systems produced the lowest color change on hybrid ceramic blocks, one-step and two-step systems achieved this on composite blocks (p<0.05). In all test groups, the supplementary polishing performed after regular polishing procedures helped us reduce the surface roughness and color change on CAD/CAM blocks. The findings obtained in this study suggest that one and two-step polishing systems are more suitable for resin-based composite CAD/CAM blocks; for hybrid ceramic CAD/CAM blocks, on the other hand, two and multi-step finishing and polishing systems seem to be more efficient concerning lower surface roughness and resistance to color changes.

RESUMEN: Los bloques CAD/CAM son ampliamente utilizados en las restauraciones dentales, alrededor del mundo. El objetivo de este estudio es investigar los efectos de diferentes sistemas de pulido y acabado sobre la rugosidad de la superficie y el cambio de color de los bloques CAD/CAM de resina. En este estudio se prepararon muestras de material de 2×7×12mm. El pulido de la superficie se llevó a cabo en tres grupos experimentales con sistemas de pulido de un paso, de dos pasos y de varios pasos. Las muestras de un subgrupo de cada grupo experimental se pulieron con la pasta de diamante. Una vez medidos los valores iniciales de rugosidad y color de las muestras mediante un perfilómetro y un espectrofotómetro, las muestras se sumergieron en café. Los resultados de la rugosidad superficial y el cambio de color (ΔE00) se analizaron estadísticamente mediante un análisis de varianza de dos vías (ANOVA). Los sistemas de acabado y pulido crearon niveles de rugosidad superficial significativamente diferentes en el bloque cerámica híbrida (Vita Enamic) pero no en el bloque de composites (Brilliant Crios, Grandio Blocs). Mientras que los sistemas de acabado y pulido de dos y varios pasos produjeron el menor cambio de color en los bloques de cerámica híbrida, los sistemas de un paso y dos pasos lo consiguieron en los bloques de composite (p<0,05). En todos los grupos de prueba, el pulido suplementario realizado después de los procedimientos de pulido regulares nos ayudó a reducir la rugosidad de la superficie y el cambio de color en los bloques CAD/CAM. Los hallazgos obtenidos en este estudio sugieren que los sistemas de pulido de uno y dos pasos son más adecuados para los bloques CAD/CAM de resina; en cambio, para los bloques CAD/CAM de cerámica híbrida, los sistemas de acabado y pulido de dos y varios pasos parecen ser más eficientes en lo que respecta a la menor rugosidad de la superficie y la resistencia a los cambios de color.

Accuracy of cone-beam CT in detecting vertical root fractures in teeth with post-endodontic restorations: an in vitro study

The aim of this study was to evaluate the accuracy of cone-beam CT (CBCT) for the detection of artificially created vertical root fractures (VRF) in extracted teeth restored with metallic (MP) and fiberglass (FGP) posts. After root canal obturation, 60 extracted human premolars were scanned by using the highest-resolution settings of a CBCT unit. Theprepared roots were randomly divided into three groups: group C (control group): non-restored and non-endodontically treated teeth (n = 20); group MP (n = 20); group FGP (n = 20). In all groups, 10 teeth were artificially fractured. Two external and independent observers blindly recorded the presence or absence of VRF. Sensitivity, specificity, accuracy, intra-and interobserver agreement were calculated. Kappa value for inter-and intraobserver agreement was 0.82 and 0.84 respectively, demonstrating goodagreement. The highest values for sensitivity (0.80 -0.90), specificity (1.00) and accuracy (0.90 -0.95) were found in the control group. The teeth with FGP restoration presented the lowest sensitivity (0.30 -0.50) and accuracy (0.60 -0.65) values. Both examiners had a good performance in the diagnosis of fractures in teeth with MP, with accuracy ranging between 0.85 -0.90. The presence of MP did not influence accuracy; however, the presence of FGP reduced the diagnostic capacity of CBCT.

Filtración marginal y contracción en la polimerización en nuevas resinas Bulk Fill: una revisión de la literatura / Marginal leakage and polymerization shrinkage in new Bulk Fill resins: a review of the literature

A pesar de los avances e innovaciones de los materiales dentales, la microfiltración marginal y la contracción durante la polimerización continúan siendo una de las causas principales del fracaso de los tratamientos en odontología restauradora. Un sellado marginal correcto será posible cuando las fuerzas de adhesión superen las fuerzas generadas por la contracción de polimerización y las fuerzas generadas por los cambios dimensionales térmicos posteriores a la polimerización, por lo que investigaciones previas demostraron que estas limitaciones pueden ser superadas con el uso de resinas Bulk Fill como material de relleno de cavidades extensas y profundas de dientes posteriores. Estas resinas. de relleno masivo, están recibiendo atención, principalmente porque se pueden colocar, a diferencia de las resinas convencionales, en incrementos de 4 mm sin afectar la contracción de la polimerización, la adaptación de la cavidad o el grado de conversión. El objetivo de la presente revisión bibliográfica es describir la contracción de polimerización y la consecuente filtración marginal que sufren las resinas compuestas para el sector posterior Bulk Fill con base de datos de la literatura (AU)

Despite advances and innovations in dental materials, marginal microfiltration and shrinkage during polymerization continue to be one of the main causes of treatment failure in Restorative Dentistry. A correct marginal seal will be possible when the adhesion forces exceed the forces generated by polymerization contraction and the forces generated by post-polymerization thermal dimensional changes, for which previous research has shown that these limitations can be overcome with the use of Bulk Fill resins as filling material for large and deep posterior tooth cavities, these massive filling resins are receiving attention mainly because they can be placed, unlike conventional resins, in 4 mm increments without affecting polymerization shrinkage. , cavity adaptation or degree of conversion. The objective of the present bibliographic review is to describe the polymerization contraction and consequent marginal filtration suffered by Composite Resins for the Bulk Fill posterior sector with a literature database (AU)

Light curing in dentistry and clinical implications: a literature review

Abstract Contemporary dentistry literally cannot be performed without use of resin-based restorative materials. With the success of bonding resin materials to tooth structures, an even wider scope of clinical applications has arisen for these lines of products. Understanding of the basic events occurring in any dental polymerization mechanism, regardless of the mode of activating the process, will allow clinicians to both better appreciate the tremendous improvements that have been made over the years, and will also provide valuable information on differences among strategies manufacturers use to optimize product performance, as well as factors under the control of the clinician, whereby they can influence the long-term outcome of their restorative procedures.

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.

Clinical outcome of root caries restorations using ART and rotary techniques in institutionalized elders

Abstract The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART), in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9%) using the conventional technique (p < 0.03). However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.

Acción de los agentes blanqueadores sobre materiales de restauración / Action of bleaching agents on restorative materials

El propósito del trabajo será analizar comparativamente los diversos efectos que producen sobre las restauraciones dentales agentes blanqueadores.El objetivo será valorar los cambios que experimentan en la superficie los materiales de restauración, sometidos a la acción de un agente blanqueador. La metodología utilizada será visualización microscópica electrónica de barrido ambiental. Los resultados obtenidos tendrán transferencia relevante a Insti-tuciones formadoras de recursos humanos en Salud Bucal, al campo profesional odontológico y a empresas o fabricantes para el mejoramiento de su producto...

Solubility of nanofilled versus conventional composites

Solubility of resin-based composite materials is of great importance in restorative dentistry, since inorganic ions present as fillers within composites can leach into the surrounding environment resulting in breakdown of the restoration. The aim of this study was to evaluate and compare solubility values of three different nanofilled light-activated composites with other four conventional composite dental materials. Seven commercial light-activated composite materials: Tetric Evo Ceram, Premise, Herculite, Z100, Z250, P60, Supreme XT. Ten disc specimens were prepared for each composite material using a stainless steel mold with 15 mm in inner diameter and 1 mm in thickness. The curing of each composite specimen was divided into five segments and each segment was photo-cures for 40 seconds. Water solubility of different materials was calculated by means of weighting the samples before and after water immersion [15 days] and desiccation. Data were analyzed by one-way ANOVA at 5% level of significance. Tetric Evo Ceram composite showed the lowest solubility values, while Premise composite dis-played the highest values. Solubility values of the tested composites did not show significant differences among them [P>0.05]. All the composites being tested in this study exhibited solubility values within the acceptable limits and composite composition is insignificantly influences its water solubility values

Do Clinical Experience Time and Postgraduate Training Influence the Choice of Materials for Posterior Restorations? Results of a Survey with Brazilian General Dentists

The aims of this study were to evaluate the materials available for posterior restorations and to assess whether clinical experience time and post-graduate training influence dentists' choices. A cross-sectional study was conducted using a questionnaire with closed questions applied to dentists (n=276) of a mid-sized city of the southern Brazil. Information was collected regarding sociodemographic variables, level of specialization, time since graduation and working place. In addition, options regarding posterior restorations including the first choice of material, type of composite resin (if used) and use of rubber dam were also collected data. Data were submitted to descriptive analysis and the associations were evaluated using chi-square and Fisher's exact tests (α=0.05). The response rate was 68% (187). Direct composite resin was broadly indicated (73.2%) as the first-choice for posterior restorations. Most professionals used microhybrid composite (74.5%) and 42.6% of the participants used rubber dam for placement of posterior composite restorations. Dentists with more time of clinical practice used less composite (p=0.014). Specialists used more frequently rubber dam to restore posterior teeth than did non-specialists (p=0.006). The results of this survey revealed that direct composite was the first choice of dentists for posterior restorations; microhybrid was the preferred type of composite and the use of rubber dam for composite resin placement in posterior teeth was not frequent; time since graduation and level of specialization affected dentists' choices.

O objetivo deste estudo foi avaliar as possíveis opções restauradoras para dentes posteriores. Além disso, foi avaliada a possível relação entre tempo de formação e grau de formação profissional com suas escolhas. Este estudo transversal foi realizado a partir de questionários respondidos por cirurgiões-dentistas da cidade de Pelotas/RS. Foram avaliadas variáveis sociodemográficas, nível de especialização e ano de graduação. Além disso, foram obtidas informações sobre a primeira opção restauradora para dentes posteriores, tipo de resina composta e uso de isolamento absoluto. Dados foram submetidos à análise descritiva, e as associações foram testadas por meio do teste de Chi-quadrado ou do teste exato de Fisher, quando apropriado. A taxa de resposta foi de 68%. Os cirurgiões-dentistas, em sua maioria, escolheram o uso de resina composta como a primeira opção restauradora para dentes posteriores. Em relação ao tipo de resina usada, a maioria dos profissionais escolheu a resina microhíbrida; e apenas 42.6% utilizou isolamento absoluto para a realização da restauração posterior. Cirurgiões-dentistas com mais tempo de graduação utilizaram menos resina composta para dentes posteriores (p=0.014). Cirurgiões-dentistas que frequentaram cursos de pós-graduação usaram mais isolamento absoluto (p=0.006). Restauração direta de resina composta foi a primeira opção de tratamento restaurador para dentes posteriores; resina composta microhíbrida foi o tipo de resina preferido pelos cirurgiões-dentistas e o uso de isolamento absoluto para realização de restaurações posteriores não foi frequente. Tempo desde a graduação e grau de especialização influenciaram a escolha dos cirurgiões-dentistas.

Anterior composite restorations in clinical practice: findings from a survey with general dental practitioners

Objectives: The aim of this study was to assess technical preferences of general dental practitioners when restoring anterior composite restorations. How the level of clinical experience or post-graduate training infuenced their options was also tested. Material and Methods: A cross-sectional study was performed using a questionnaire with general dental practitioners (GDPs) (n=276) in Southern Brazil. Information regarding post graduation training (specialization, master's or PhD degree) and linical experience (years since completing graduation) were gathered. The options regarding anterior composite restorations (type of composite, adhesive system, light curing unit, polishing procedures and rubber dam use) were collected. Data were submitted to descriptive analysis and associations were tested. Results: Response rate was 68% (187). GDPs selected microhybrid composite (52%) and 2-step total etch adhesive system (77%). LED was the preferred method of activation for 72.8%. Immediate polishing was preferred by 75%, using a combination of techniques. Most of the respondents (74.3%) did not use rubber dam. More experienced clinicians used more halogen lights (p<0.022), performed more light monitoring (p<0.001) and were resistant to use rubber dam (p<0.012). Dentists with post-graduation training used 3-etch-and-rinse system more frequently (p<0.04), usually monitored light intensity (p<0.014) and placed rubber dam more frequently (p<0.044). Conclusions: Hybrid composite, simplifed adhesives, LED units and immediate polishing were preferred by Southern Brazilian dentists for anterior composite restorations. Few dentists used rubber dam to perform composite restorations in anterior teeth. Clinical experience and post-graduation training infuenced the dentists' choices. .

Porcelanas dentales, 2da parte: clasificación según el método de elaboración de la restauración / Dental porcelains, 2nd part: classification according to the elaboration method of the restoration

Las restauraciones elaboradas con porcelana ocupan un lugar central en la odontología restauradora y rehabilitadora estética. Las propiedades físicas y estéticas, indicaciones clínicas y técnica de trabajo de las porcelanas dentales están íntimamente relacionadas con su composición y estructura. Su comprensión se convierte en decisiva para el exitoso trabajo del clínico.

Materiales dentales: la segunda década del siglo XXI / Dental materials: the second decade of the 21st century

El objetivo de este artículo es enumerar y hacer un breve análisis de los principales aspectos del desarrollo en el área de los materiales de uso odontológico en los que se centra la investigación científica en laactual década. Se presenta información y algunas referencias bibliográficas sobre los avances producidosrecientemente en los conocimientos sobre los materiales metálicos, poliméricos y cerámicos querepercuten en las alternativas clínicas disponibles. Se recalca la necesidad de valorar críticamente los resultados de la investigación para poder definir suaplicabilidad en la toma de decisiones en la atención de la salud bucal.

Remoción quimico-mecánica de lesión de caries en diente permanente con Papacárie Duo(TM): reporte de un caso / Chemomechanical removal of carious lesion in a permanent tooth with Papacárie Duo(TM): report of a case

Este trabajo tiene como objetivo presentar el protocolo clínico de Papacárie Duo(TM), desde el diagnóstico de la lesión de caries hasta el procedimiento restaurador. Una paciente femenina de 12 años de edad se presentó a la consulta odontopediátrica por dolor al frío y durante la ingesta de alimentos dulces. El examen clínico y radiográfico reveló caries en la pieza 46, clasificada como score 6, según el sistema ICDAS (cavidad extensa con exposición de la dentina). La conducta clínica consistió en la eliminación del tejido infectado por medio de la remoción quimico-mecánica de la caries utilizando el gel a base de papaína y restauración con ionómero vítreo. Se concluye, a partir de este protocolo, que la eliminación quimico-mecánica de la lesión de caries es un método de fácil aplicación basdado en la odontología mínimamente invasiva.

Porcelanas dentales / Dental porcelains

Las restauraciones elaboradas con porcelana ocupan un lugar central en la odontología restauradora y rehabilitadora estética. Las propiedades físicas y estéticas, las indicaciones clínicas y la técnica de trabajo de las porcelanas dentales están íntimamente relacionads con su composición y estructura. Su comprensión se convierte en decisiva para el exitoso trabajo del clínico.

Criterios para la selección de postes de base orgánica reforzados con fibras (PBORF) / Criteria for the selection of fiber-reinforced posts (PBORF)

Los postes de base orgánica reforzados con fibras son protagonistas en la rehabilitación posendodóntica contemporánea. Sin embargo, en la actualidad, coexisten en el mercado postes que ofrecen características físicas y ópticas muy diferentes y que pueden generar distintos pronósticos en la rehabilitación. Este artículo presenta los criterios más importantes para seleccionar PBORF que ofrezcan adecuados rendimientos físicos, estéticos y que impliquen una técnica clínica con mayor seguridad para el proceso de rehabilitación.

Restoration of posterior teeth using occlusal matrix technique.

This article describes a technique for duplicating occlusal surface anatomy using the Biteperf device. Duplication requires an intact occlusal enamel surface and is only indicated when caries lesions are hidden. The occlusal matrix technique allows for preservation of all anatomic details. When the last layer of composite has been placed, the occlusal matrix is forced into the uncured composite to replicate the original occlusal surface, instead of performing manual curing and shaping as in the standard approach. It is technically possible to achieve this effect with any material that is able to copy anatomic details. The main benefits of the occlusal matrix technique, more precisely the Biteperf, are the technical ease of use due to its simplicity and its high accuracy in reconstructing occlusal morphology.

Tratamiento de la caries dentinaria en odontopediatría: remoción parcial de la dentina cariada / The management of dentinal caries lesions in pediatric dentistry: incomplete caries removal

Los avances en el campo de la cariología incorporan permanentemente criterios que modifican sustancialmente el tratamiento de esta enfermedad.Por su impacto en su terapéutica, es objetivo de este trabajo la revisión de las técnicas de remoción parcial de la dentina cariada en dientes primarios y permanentes, tomando en especial consideración los fundamentos biológicos que las sustentan.