Rehabilitating Form, Function and Natural Aesthetics with Onlay Ceramic IPS Empress Esthetic®: Evidence and Versatility / Rehabilitando forma, función y estética mediante el uso de un Onlay IPS Empress Esthetic®: Evidencia y Versatilidad

Abstract Clinical research and in vitro laboratory tests have enabled the development and improvement of dental ceramics. Comprehension of the physical and mechanical properties of this material is essential, in order to ensure a functional, aesthetic and long-lasting posterior ceramic restoration. The clinical protocol for onlay preparation involves important considerations in treatment planning, such as selection of the restorative material, biomechanical design, color selection, dental substrates conditioning and adhesive cementation. This article discusses a brief review on the topic and a case presentation in which a posterior tooth was rehabilitated with an IPS Empress Esthetic® ceramic onlay.

Resumen La investigación clínica y las pruebas de laboratorio in vitro han permitido el desarrollo de los materiales cerámicos en odontología. La comprensión de las propiedades físicas y mecánicas de este material es esencial para asegurar una restauración funcional, estética y duradera. El protocolo clínico para la preparación de un onlay implica consideraciones importantes en la planificación del tratamiento, tales como la selección del material restaurador, diseño biomecánico, selección de color, acondicionamiento de sustratos dentales y cementación adhesiva. Este artículo discute una breve revisión sobre el tema y una presentación de caso en la que un diente posterior fue rehabilitado con una restauración indirecta tipo Onlay.

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.

Evaluation of adaptation of ceramic inlays using optical coherence tomography and replica technique

Abstract Optical coherence tomography (OCT) has generally been used as a nondestructive technique to evaluate integrities of composite restorations. We investigated marginal and internal adaptations of ceramic inlay restorations with OCT and compared them to results with the silicone replica technique. Round-shaped class I cavities were prepared on 16 human maxillary first premolar teeth. Ceramic inlays were fabricated. Silicone replicas from inlays were obtained and sectioned to measure marginal and internal adaptations with a stereomicroscope (Leica Dfc 295, Bensheim, Germany). Inlays were cemented on respective teeth. Marginal and internal adaptations were then measured with the OCT system (Thorlabs, New Jersey, USA) in 200- μm intervals. Replica and OCT measurements were compared with independent samples t-tests. A paired t-test was used to evaluate the marginal and internal adaptations of each group (p < 0.05). Marginal and internal adaptations were 100.97 ± 31.36 and 113.94 ± 39.75 μm, respectively, using the replica technique and 28.97 ± 17.86 and 97.87 ± 21.83 μm, respectively, using OCT. The differences between the techniques were significant (p = 0.00 and p = 0.01, respectively). On evaluation within the groups, internal adaptation values were found to be significantly higher than the marginal adaptation values for the replica technique (p = 0.00) and OCT (p = 0.00). Therefore, the replica and OCT techniques showed different results, with higher values of marginal and internal adaptation found with the replica technique. Marginal and internal adaptation values of ceramic inlays, whether measured by replica or OCT techniques, were within clinically acceptable limits.

New fabrication method using additive manufacturing technologies for the pattern of pressed lithium disilicate onlay restorations / Novo método de fabricação, usando tecnologia aditiva, do padrão de restaurações do tipo onlay em dissilicato de lítio injetado

The digital workflow in dentistry allows for complete digital processing of the restoration starting with the digital impression using an intraoral scanner to until the fabrication of final reconstruction. Recent advances in 3D printing technologies opened new possibilities also for dental technicians through which wax-up and casting procedures in the laboratories could be eliminated. In this clinical report, a technique is described where the pattern was fabricated using additive manufacturing for pressed lithium disilicate onlay restorations. (AU)

O fluxo de trabalho digital em odontologia permite o processamento digital completo da restauração começando com a impressão digital usando um scanner intraoral até a fabricação da peça final. Os avanços recentes nas tecnologias de impressão 3D abriram novas possibilidades também para os técnicos em prótese dentária através dos quais os procedimentos de cera e fundição nos laboratórios poderiam ser eliminados. Neste relato de caso clínico, descreve-se uma técnica onde o padrão foi fabricado usando a fabricação de aditivos para restaurações do tipo onlay em dissilicato de lítio injetadas. (AU)

Comparison of the marginal adaptation of direct and indirect composite inlay restorations with optical coherence tomography

ABSTRACT Objective The purpose of the study was to use the photonic imaging modality of optical coherence tomography (OCT) to compare the marginal adaptation of composite inlays fabricated by direct and indirect techniques. Material and Methods Class II cavities were prepared on 34 extracted human molar teeth. The cavities were randomly divided into two groups according to the inlay fabrication technique. The first group was directly restored on cavities with a composite (Esthet X HD, Dentsply, Germany) after isolating. The second group was indirectly restored with the same composite material. Marginal adaptations were scanned before cementation with an invisible infrared light beam of OCT (Thorlabs), allowing measurement in 200 µm intervals. Restorations were cemented with a self-adhesive cement resin (SmartCem2, Dentsply), and then marginal adaptations were again measured with OCT. Mean values were statistically compared by using independent-samples t-test and paired samples t-test (p<0.05), before and after cementation. Results Direct inlays presented statistically smaller marginal discrepancy values than indirect inlays, before (p=0.00001442) and after (p=0.00001466) cementation. Marginal discrepancy values were increased for all restorations after cementation (p=0.00008839, p=0.000000952 for direct and indirect inlays, respectively). The mean marginal discrepancy value of the direct group increased from 56.88±20.04 µm to 91.88±31.7 µm, whereas the indirect group increased from 107.54±35.63 µm to 170.29±54.83 µm. Different techniques are available to detect marginal adaptation of restorations, but the OCT system can give quantitative information about resin cement thickness and its interaction between tooth and restoration in a nondestructive manner. Conclusions Direct inlays presented smaller marginal discrepancy than indirect inlays. The marginal discrepancy values were increased for all restorations that refer to cement thickness after cementation.

Long-term effects of vertical bone augmentation: a systematic review

ABSTRACT Extraction, periodontitis, or trauma can cause a reduction on the alveolar ridge. This could result in an insufficient alveolar bone width and height. Different techniques of vertical bone augmentation are described in literature. However, nowadays there is not enough evidence against lateral augmentation procedures to verify if these techniques are stable over a long period of time. Objective This review analyses the different techniques that are used to vertically augment the bone and evaluate if these techniques are stable over a long period of time. Material and Methods The MEDLINE-PubMed database was searched from its earliest records until December 22, 2014. The following search term was used: Alveolar Ridge augmentation [MESH]. Several journals were hand searched and some authors were contacted for additional information. The primary outcome measure that was analyzed was marginal bone level change around dental implants in the augmented sites, and the secondary outcomes were survival and success rates of dental implants placed in the augmented sites. Results The search yielded 203 abstracts. Ultimately, 90 articles were selected, describing 51 studies meeting the eligibility criteria. The marginal bone level change for the inlay technique and vertical guided bone regeneration are in agreement with the success criteria. Alveolar distraction showed more marginal bone level change after the first year of loading, and for the inlay technique very few studies were available. Conclusions Based on the available data in the current existing studies with a follow-up period of at least 4 to 5 years, one can summarize that there seems to be a trend that the onlay technique, alveolar distraction, and vertical guided bone regeneration are stable for at least 4 to 5 years.

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 2 / Diangosis and management of fractured teeth associated with parafunction: part 2

Objetivo: presentar la resolución clínica de una fractura dentaria incompleta mediante la realización de una restauración adherida de tipo onlay. Caso clínico: un paciente de 36 años de edad consultó por dolor al masticar enl a pieza 3.7, la cual presentaba una restauración plástica oclusal. Al removerla, se observó una fractura en dirección mesiodistal, sin movilidad de ambos cabos de fractura, por lo que se realizó una incrustación adherida de tipo onlay. Conclusión: el correcto diagnóstico de una fractura dentaria incompleta y la comprensión de su etiología son fundamentales para la elección de un tratamiento conservador y con un alto grado de predictibilidad, como lo son las restauraciones adheridas tipo onlay.

Uso de incrustaciones de resina compuesta tipo onlay en molares estructuralmente comprometidos / Use of onlay-type composite resin inlays in structurally involved molars

Las incrustaciones en resina compuesta son una alternativa de bajo costo ante los métodos de obturación directos, frente a las dificultades de la adaptación marginal y la ubicación de contactos proximales, porque permiten otorgar una mejor anatomía dental a la restauración y superar el fenómeno de contracción al polimerizar grandes capas de material por fuera de la cavidad dental. El objetivo del presente artículo fue exponer el uso de la resina compuesta bajo técnica indirecta como una alternativa de fácil manipulación y resultados clínicos considerables ante la afectación estructural de molares. Se presentaron dos casos clínicos de incrustaciones con resina compuesta de tipo inlay onlay en dos molares permanentes afectados estructuralmente, uno de ellos fue tratado endodónticamente. Para la obtención de un troquel de trabajo sobre el que se confecciona la incrustación bajo técnica incremental se obtienen modelos al impresionar con alginato la arcada de los dientes seleccionados, se realiza vaciado en silicona liviana del diente preparado y el resto en yeso piedra tipo III. El proceso de cementación en la cavidad bucal se lleva a cabo con cemento resinoso de doble curado. Las incrustaciones fueron sometidas a un control a los seis meses para evaluar los signos de filtración o desadaptación marginal mediante el secado con aire de la jeringa triple, explorador y radiografías periapicales, que mostraron ausencia de desadaptación o pigmentación marginal. Se concluyó que ante la afectación estructural de molares, las incrustaciones con resina compuesta bajo técnica indirecta fueron de fácil manipulación y se obtuvieron satisfactorios resultados clínicos(AU)

The composite resin inlays are a low cost alternative which seeks improvements to the direct filling methods meet the challenges of the marginal adaptation, location of proximal contacts, allows us to improve the restoration dental anatomy and overcome the phenomenon of contraction at large sections of material polymerized outside the dental cavity. The objective of this article was to show the use of the composite with indirect technique how an alternative to easy handle and significant clinical results with the structural involvement of molars. The article reports two cases of composite resin inlay onlay in two permanent molars structurally affected, one endodontically treated. The collection of models is performed by the arch alginate impression of the teeth selected, making silicone light casting the prepared tooth and the rest in type III dental stone to obtain a die of work on drawing up the inlay in incremental technique. The cementation process oral cavity is carried out with dual cure resin cement. To control at six months for signs of a leak or marginal jet we used air-dried syringe, explorer and periapical X-Ray. The clinical examination and radiographic analysis revealed a good performance of the restorations in the absence of mismatch or marginal pigmentation. In conclusions the use of the composite inlays in molars with structural involvement with indirect technique is an alternative to easy handle and significant clinical results(AU)

Effects of resin luting agents and 1 percent NaOCl on the marginal fit of indirect composite restorations in primary teeth

OBJECTIVE: The purpose of this study was to provide information regarding the marginal adaptation of composite resin onlays in primary teeth previously treated with 1 percent sodium hypochlorite (NaOCl) (pulp irrigant) using two different resin luting agents. MATERIAL AND METHODS: Forty extracted sound primary molars had their crowns prepared in a standardized machine and were randomly divided into 4 groups (n=10): G1 (1 percent NaOCl irrigation+EnForce); G2 (EnForce); G3 (1 percent NaOCl irrigation+Rely X); G4 (Rely X). The onlays were made with Z250 composite resin on plaster models. After luting, the tooth/restoration set was stored in 100 percent relative humidity at 37ºC for 24 h and finished with Soflex discs. Caries Detector solution was applied at the tooth/restoration interface for 5 s. The specimens were washed and four digital photos of each tooth were then taken. The extents of the gaps were measured with Image Tool 3.0 software. The percentage data were submitted to a Kruskal-Wallis test (α=0.05). The Relative Risk test analyzed the chance of a gap presence correlated to each group. RESULTS: There were no statistically significant differences (p>0.05) among the groups. The relative risk test revealed that some groups were more apt to have a presence of gaps than others. CONCLUSION: Neither the 1 percent NaOCl treatment nor the resin luting agents caused any alterations in the dental substrate that could have influenced the marginal adaptation of composite onlays in primary teeth.

Inlay/onlay: estética, produtividade e longevidade clínica / Inlay/onlay: esthetics, productivity and c1inicallongevity

Este artigo apresenta uma discussão sobre os aspectos que influenciam a decisão de indicar restaurações tipo inlay/onlay e sobre os fatores que devem ser considerados para a seleção do material restaurador a ser utilizado, resina composta ou porcelana.

This article presents a discussion on the aspects that may influence the indication decision for inlay/onlay restorations, and on the factors that should be considered when selecting the restorative material to be used, composite resin or porcelain.

Técnica de restauração semi-direta em dentes posteriores de tratamento / Semi-direct technique for the restoration of posterior teeth: a treatment alternative

As restaurações estéticas em dentes anteriores e posteriores são cada vez mais requisitadas pelos pacientes nos consultórios dentários, possibilitando tratamentos conservadores com mínima remoção de tecido dentário sadio. Nas situações em que grandes perdas de tecido são observadas, com caixas proximais amplas e perda de cúspides, a indicação convencional é a execução de restaurações adesivas indiretas. Esse tratamento envolve mais de uma sessão clínica e uma etapa laboratorial, sendo necessário o envio da moldagem do preparo e dos dentes antagonistas ao técnico em prótese dentária para que este confeccione a restauração. O presente caso clínico visa descrever a técnica semi-direta para restauração de dentes posteriores com resina composta como alternativa a técnicas convencionais de dentes posteriores.

Patients are increasingly demanding anterior and posterior aesthetic restorations in den tal offices, allowing conservative treatments with minimal removal of healthy tooth tissue. In situations where extensive tissue loss is observed, with large proximal boxes and loss of cusps, the conventional indication is the placement of indirect bonded restorations. This treatment involves more than one clinical session and a laboratory stage, requiring that an impression of the tooth preparation and of the antagonists be sent to the dental technician to construct the restoration. This clinical case report aims to describe the semi-direct technique for restoring posterior teeth with composite resin as an alternative to conventional techniques for posterior restorations.

Associação de técnicas no tratamento restaurador em dentes posteriores: onlay cerâmico X resina composta / Association of techniques in restorative treatment of posterior teeh: ceramic onlay x composite resin

O aumento da demanda por restaurações estéticas é uma realidade na clínica odontológica, sendo que essa tendência é observada não só no tratamento de dentes anteriores, mas também na região posterior. Alternativas restauradoras, como o uso de resinas compostas diretas, inlays, onlays e coroas em resina ou cerâmica, visam o equilíbrio funcional e estético dos dentes posteriores. Entretanto, a escolha da técnica empregada está principalmente associada à técnica empregada, está principalmente associada à condição do remanescente dentário. Assim, através do relato de um caso clínico, esse artigo busca conceituar importantes aspectos quanto ao uso de resinas compostas e restaurações indiretas do tipo onlay cerâmicos, enfatizando a importância na indicação desses dois tratamentos restauradores estéticos para dentes posteriores.

[Fatigue resistance and failure mode of endodontically restored premolars with indirect composite resin restoration-in vitro]

The present study aimed at determination of the fatigue resistance and failure mode of cusp-replacing onlays in endodontically treated premolars using indirect composite resin restorations. In this experimental study, 84 human premolars were randomly divided into 7 groups of 12. These groups were prepared as follows: Intact teeth used in group1 as control, the second group covers the endodontically treated teeth, restored with indirect onlays using Z-250 composite resin, the next two groups [i.e. 3, 4] were similar to the second group, but subjected to 1 and 2 million fatigue load cycles, respectively. Groups 5, 6, 7 were similar to groups 2, 3, 4, respectively, however, in these groups Tetric Ceram used as the restorative material. All specimens were loaded using a Universal Testing Machine until fracture occurred and the mode of failure observed with naked eye. Kruskal-Wallis and Chi-Square tests were used to analyze the data [alpha=.05]. All specimens withstood the masticating simulation. The mean fracture strength for groups 1 to 7 were: 1276.92, 1269.05, 1217.80, 1188.13, 1228.97, 1127.86, 1105.58, respectively. No statistically significant differences were found between the groups in fracture strength and failure mode. There was no statistically significant difference between two types of resin composite [P=0.203] and load cycles [P=0.298] after zero, 4 and 8 years aging. Within the limitation of this study, restored premolars with indirect composite onlays show fatigue resistance equal to natural tooth up to 8 years after restoration. Furthermore, no statistically significant differences were found between 4 and 8 years of load cycles. Tetric Ceram Z-250 restoration agent showed no effect on the tooth fracture resistance with the most observed fractures to be occur under CEJ with no capability to be restored

Effect of commercial dental investments at low temperature on the marginal adaptation of cast cp Ti inlays

Aim: The purpose of this study was to evaluate the adaptation of inlay restorations cast in commercially pure titanium (cp Ti) after inclusion of the wax patterns in either a phosphate-bonded investment (Rematitan Plus®) or a silicon oxide-based investment (Termocast®). Methods: The wax patterns were prepared over an inlay-type mold. After waxing, 5 measurements of the marginal adaptation were made on the mesial and distal faces. Five wax patterns were included in each type of investment under vacuum. The cast specimens were repositioned in the mold and other 5 measurements of the adaptation were made based on the same initial testing conditions. Data were analyzed statistically by two-way ANOVA and Duncan’s post-hoc (P<0.01) using the SPSS statistical software package version 12.0 (SPSS, Chicago, IL, USA). Results: The mean marginal discrepancies of the MOD inlays were higher in the Termocast® Group. Termocast® presented significantly greater marginal discrepancy than Rematitan Plus®. Due to the great permeability of the investment refractory material, internal porosity was extremely rare in Rematitan Plus® and more common in Termocast®. Conclusion: It may be concluded that Termocast® investment should not be indicated for cp Ti casting due to poor adaptation and porosity on the casting surface.

Clinical performance of indirect esthetic inlays and onlays for posterior teeth after 40 months

Aim: Searches for biocompatible restorative materials with better clinical properties, longevity and esthetics have resulted in the development of several ceramic types. The aim of this study was to evaluate the performance of Ceramco inlays and onlays over 40 months. Methods: Thirty ceramic indirect restorations were placed in 10 patients and all were adhesively cemented with a dual resin cement. The clinical performance was evaluated by a calibrated examiner who attributed scores adapted from the Cvar and Ryge criteria: color, marginal adaptation, abrasion, caries recurrence, fracture and postoperative pain. These assessments were performed after cementation of the restorations (T₀=baseline) and after 4 periods: T₁ (10 months), T₂ (20 months), T₃(30 months) and T₄ (40 months). Photographs were made in T₀ and T₄ to illustrate the general condition of each restoration. Data were analyzed statistically by Kruskal-Wallis H statistics (p=0.05) and results were presented using percentage values. Results: Clinical evaluation revealed no color alteration or abrasion (100%); a success rate of 96.7% for caries, fractures and postoperative pain; and 76.7% of failure for marginal adaptation. Conclusion: The ceramic restorations did not show alterations that could result in their replacement, although there was a moderate failure in the marginal adaptation.

Consistencia de cementos resinosos y asentamiento de restauraciones rígidas / Consistency of the resin cements and seating of rigid restorations

El objetivo de este trabajo fue evaluar la relación entre el asentamiento de restauraciones rígidas y la consistencia del medio cementante resinoso empleado. Los materiales seleccionados fueron RelyX ARC (R)(3M Espe) y Variolink II (Ivoclar-Vivadent). De este último se utilizó la pasta base, la mezcla de la pasta base con la catalizadora de baja viscosidad (VB BV) y la pasta base con la catalizadora de alta viscosidad (VB AV). Se evaluó la consistencia de los cementos a partir de un ensayo basado en el corrimiento de los materiales entre dos placas de vidrio y bajo una carga estandarizada. Para estudiar el asentamiento de las restauraciones se utilizó una mtriz circular de 2.5cm de diámetro y 4.8 cm de espesor con una perforación troncocónica central de ocho grados de divergencia. Sobre ella se construyeron incrustaciones de composite híbrido (Z250, EM ESPE), previa aplicación de dos capas de laca espaciadora (Pico Fit, Renfert). Se colocó el modelo sobre una superficie plana y se ubció en la cavidad la incrustación correspondiente para registrar la posición de su extremo mayor con un micrómetro digital (Digimatic, Mitutoyo Corp. (lectura A). Luego se pinceló la restauración 0,05 ml del cemento en estudio y se aplicó una carga central de 25 N e inmediatamente se fotopolimerizó durante 40 segundos sobre dos posiciones opuestas del extremo superior de la incrustación. Diez minutos después se registró la nueva posición de su extremo mayor (lectura B). Las diferencias entre Ay B fue considerada como la alteración producidapoir el asentamiento de la incrustación. El tamaño de la muestra dçfue de cuatro probetas para cada condición experimental. Puede concluirse que el asentamiento de las restauraciones rígidas es influenciado por la consistencia del cemento resinoso seleccionado.

Marginal integrity and microleakage of direct and indirect composite inlays: SEM and stereomicroscopic evaluation

O objetivo deste estudo foi avaliar a microinfiltração em restaurações diretas e indiretas em resina composta por meio de estereomicroscopia e microscopia eletrônica de varredura (MEV). Trinta incisivos bovinos foram lixados de forma a produzir uma plataforma incisal, simulando a face oclusal de um molar humano. Cada dente recebeu dois preparos proximais com 8º e término cervical em esmalte ou dentina. Uma cavidade foi restaurada pela técnica direta com Filtek Z250/Single Bond, e a outra pela técnica indireta com Solidex/RelyX ARC/Single Bond. As amostras foram armazenadas em água a 37°C por 24 horas e então imersas em solução de 50% de nitrato de prata por 6 horas em recipiente escuro. As amostras foram lavadas em água corrente, imersas em solução reveladora e expostas à luz fluorescente por 12 horas. Os dentes foram seccionados para avaliação da penetração do marcador em lupa estereoscópica e MEV. Não houve diferença entre as técnicas direta e indireta para o término em esmalte, porém, para o término em dentina, a técnica indireta resultou em menor infiltração. MEV mostrou infiltração similar à da lupa estereoscópica. A análise por meio de lupa estereoscópica e MEV melhora a avaliação da microinfiltração.

Type I tympanoplasty with tragal composite cartilage graft: inlay technique

Myringoplasty technique includes either an underlay or an only approaches using temporalis fascia or perichondrium as a graft material. Roland Eavy in 1998 descriped a transcanal cartilage butterfly inlay tympanoplasty technique in nine children under general anesthesia This technique was established to be successful to close ear drum perforations, easy and rapid with no external canal incisions. The aim of this study was to obtain our results with this technique. Tragal cartilage with double layer of perichondrium was used to close small to medium sized drum perforations in 30 adult patients with unilateral inactive chronic suppurative otitis media .The study was conducted in the period between February 2000 to October 2002.We evaluated the take rate and hearing improvement. The take rate was 100% at a follow up period of an average 18 months and all cartilage grafts were dry and intact at the last follow up period. All cases showed hearing improvement in. their audiometric results

Restaurações biológicas homólogas / Homologous biological restorations

Os autores apresentam, em um caso clínico, uma alternativa de tratamento para dentes posteriores com grande ou média destruição coronária, em que o material restaurador empregado foi uma coroa confeccionada a partir de um terceiro molar extraído do próprio paciente

Avaliaçäo clínica de inlays e onlays confeccionadas com dois tipos de cerâmica após 02 anos / Clinical evaluation of ceramic inlays and onlays made with two systems after 2 years

As restauraçöes em cerâmica pura têm sido uma opçäo restauradora largamente utilizada em dentes posteriores devido a sua excelente estética. Diversos tipos de sistemas cerâmicos estäo disponíveis no mercado para a fabricaçäo de restauraçöes parciais e coroas. Este trabalho teve o objetivo de avaliar o comportamento clínico de restauraçöes, do tipo inlay e onlay, confeccionadas com dois sistemas cerâmicos: cerâmica convencional (Duceram, Dentsply-Degussa) - D e cerâmica prensada (IPS Empress, Ivoclar-Vivadent)-IPS pelo período de 02 anos. Oitenta e seis restauraçöes, sendo 44 IPS e 42 D, foram cimentadas em 35 pacientes de ambos os sexos, com idade média de 35 anos. Vinte e sete pré-molares e cinquenta e nove molares receberam preparos cavitários classe II, num total de 33 onlays e 53 inlays. Todas as restauraçöes foram fixadas com cimento resinoso dual (Variolink II, Ivoclar-Vivadent) e sistema adesivo Syntac (Primer e Adhesive) e Heliobond (Ivoclar-Vivadent), sob isolamento absoluto. Os procedimentos operatórios foram realizados por apenas um operador. As avaliaçöes foram realizadas por dois examinadores independentes no baseline, após 01 e 02 anos mediante o critério USPHS modificado, quanto aos aspectos: sensibilidade pulpar, reincidência de cárie, fratura, reproduçäo de cor, descoloraçäo marginal, integridade marginal e textura superficial. Adicionalmente, radiografias e slides foram feitos. Após 02 anos, 100 por cento das restauraçöes foram reavaliadas e consideradas clinicamente excelentes ou aceitáveis. Dentre os itens analisados os seguintes apresentaram critério Bravo: descoloraçäo marginal - IPS (31,82 por cento); D (23,81 por cento); integridade marginal - IPS (18,18 por cento); D (11,9 por cento); reproduçäo de cor - IPS (4,55 por cento); D (9,52 por cento) e textura superficial - IPS (2,27 por cento); D (14,29 por cento). Nenhum escore "Charlie" ou "Delta foi atribuído às restauraçöes. Os resultados obtidos foram submetidos ao Teste Estatístico de Fisher e McNemar. Näo houve diferença estatisticamente significante entre as cerâmicas testadas após 02 anos. Dentre os aspectos avaliados, o item descoloraçäo marginal apresentou uma crescente porcentagem de escores "Bravo", para ambas as cerâmicas. Comparando-se esses dados com os obtidos no baseline verificou-se uma diferença estatisticamente significante (p > 0,05)...