Restablecimiento de guía anterior con restauraciones adhesivas / Reestablishing of anterior guidance with adhesive restorations

La estética ha llegado a formar una parte muy importante en la odontología actual. Sin embargo, no debemos sobreponer las necesidades estéticas sobre las necesidades funcionales. La pérdida de estructura dental asociada a bruxismo puede ser considerada patológica cuando compromete la guía anterior, la cual es la influencia en los movimientos mandibulares que proveen las superficies contactantes de los dientes maxilares anteriores con los mandibulares anteriores y evita contactos excéntricos dañinos en los dientes posteriores. El objetivo de este reporte de caso es presentar una alternativa conservadora para restablecer tanto la estética como la funcionalidad de una paciente de 34 años de edad que acudió a la Clínica de Prostodoncia de la Universidad Autónoma de Guadalajara en busca de rehabilitación estética de dientes anteriores. Una vez realizada su evaluación inicial se llegó al diagnóstico de pérdida de guía anterior por desgaste patológico asociado a bruxismo. El tratamiento incluyó tratamientos de conductos, remoción de caries y restauraciones mal ajustadas, coronas y carillas para restablecer la guía anterior. Se cumplieron con las expectativas estéticas que tenía la paciente al igual que con las necesidades funcionales que fueron objetivo desde el inicio, logrando un restablecimiento de la guía anterior de manera conservadora (AU)

Esthetics has become a very important part of dentistry today. However, we should not superimpose esthetic needs over functional needs. The loss of tooth structure associated with bruxism can be considered pathologic when it compromises the anterior guidance, which is the influence on mandibular movements that provides the contacting surfaces of the maxillary anterior teeth with the mandibular anterior teeth and avoids damaging eccentric contacts in the posterior teeth. The aim of this case report is to present a conservative way to restore both esthetics and function in a 34-year-old patient who came to the Prosthodontics Clinic of the Universidad Autónoma de Guadalajara in search of an esthetic appearance of her anterior teeth. After her initial evaluation, a diagnosis of anterior guide loss due to pathological wear associated with bruxism was made. Treatment included root canal treatment, removal of caries, and ill-fitting restorations, crowns, and veneers to reestablish the anterior guidance. The aesthetic expectations of the patient have met as well as the functional needs that were aimed from the beginning, achieving a conservative reestablishment of the anterior guidance system (AU)

Bond strength comparison among 10-MDP-containing and non-10-MDP-Containing adhesives in different degrees of dental fluorosis / Comparación de fuerza de unión entre adhesivos que contienen y no contienen 10-MDP en diferentes grados de fluorosis dental

Dental fluorosis can cause changes in the enamel surface, conditioning its functionality and esthetics. The application of dental adhesives is a treatment option; however, their use on fluorotic teeth can result in limitations. The aim of this study was to compare the shear bond strength of two different adhesives, one with 10-MDP and one without 10-MDP, in different degrees of dental fluorosis.This is an in vitro study on dental enamel samples, a total of 180 samples with the inclusion criteria were treated, randomly divided into two groups of 90, according to the type of dental adhesive, where each group was again divided into three groups of 30 samples, representing different degrees of dental fluorosis according to the Thylstrup-Fejerskov index (Group I: TF1 and TF2; Group II: TF3; Group III: TF4). Normality tests, two-factor ANOVA, and post-hoc tests were used to determine differences between the groups, with a significance level of 95%. As results, a statistically significant difference was shown between the use of dental adhesive with 10-MDP and the three groups of dental fluorosis (p=0.011), in addition, a Tukey post-hoc test on the groups treated with 10-MDP adhesive revealed a statistically significant difference between group I versus group II, and group I versus group III, (p=<0.05). It is concluded that the use of adhesive systems with 10-MDP presents a better shear bond strength on enamel with dental fluorosis grades I and II in the Thylstrup-Fejerskov index.

La fluorosis dental puede ocasionar cambios en la superficie del esmalte, condicionando su funcionalidad y estética, la aplicación de adhesivos dentales es una opción de tratamiento, sin embargo, su uso en dientes fluoroticos puede resultar en limitaciones. El objetivo de este estudio consistió en comparar la fuerza de adhesión a la cizalladura de dos diferentes adhesivos, uno con 10-MDP y otro sin 10-MDP, en diferentes grados de fluorosis dental. Se trata de un estudio in vitro en muestras de esmalte dental, un total de 180 muestras con los criterios de inclusión fueron tratadas, aleatoriamente divididas en dos grupos de 90, de acuerdo al tipo de adhesivo dental, donde cada grupo fue dividido nuevamente en tres grupos de 30 muestras, representando diferentes grados de fluorosis dental según el índice de Thylstrup- Fejerskov (Grupo I: TF1 y TF2; Grupo II: TF3; Grupo III: TF4). Para determinar diferencias entre los grupos se utilizaron pruebas de normalidad, ANOVA de dos factores, y pruebas post-hoc, con un nivel de significancia de 95%. Como resultados, se mostró una diferencia estadísticamente significativa entre el uso de adhesivo dental con 10- MDP y los tres grupos de fluorosis dental (p=0.011), además, una prueba post hoc de Tukey sobre los grupos tratados con adhesivo 10-MDP revelaron una diferencia estadísticamente significativa entre el grupo I frente al grupo II, y el grupo I frente al grupo III, (p=<0.05) Se concluye que el uso de sistemas adhesivos con 10-MDP presentan una mejor resistencia de adhesión al cizallamiento en esmalte con grados de fluorosis dental I y II en el índice de Thylstrup-Fejerskov

Adhesión a dentina part II: estrategias para optimizar la adhesión a dentina y protocolos adhesivos / Dentin bonding part II: strategies to optimize dentin bonding and adhesive protocols

La adhesión a dentina con sistemas adhesivos polimé-ricos representa un desafío que surge de la necesi-dad de vincular un sustrato dentario heterogéneo y variable con materiales que presentan todavía cier-tos aspectos a atender para poder conseguir el máxi-mo desempeño. El propósito del presente artículo es evaluar algunas de las estrategias propuestas para mejorar la adhesión a dentina, y sugerir un protocolo de trabajo con los diferentes tipos de sistemas adhesivos (AU)

Dentin bonding with polymeric adhesive systems represents a challenge that arises from the need to link a heterogeneous and variable dental substrate with materials that still have certain aspects to be addressed in order to achieve maximum performance. The aim of this article is to evaluate some of the proposed strategies to improve dentin bonding and to suggest a protocol for each different type of bonding systems (AU)

Avaliação clínica de restaurações Classe V em cavidades tratadas com o laser de Er: YAG associado ao uso de sistemas adesivos autocondicionantes / Clinical evaluation of Class V restorations in cavities treated with Er: YAG laser associated with the use of self-etching adhesive systems

O objetivo deste estudo clínico, controlado, randomizado, cego e prospectivo foi de avaliar a efetividade clínica de restaurações em lesões não cariosas (cavidades Classe V) realizadas em superfícies dentais pré-tratadas ou não com laser de Er:YAG e utilizando dois sistemas adesivos autocondicionantes. Este estudo foi realizado com um total de 91 lesões e divididas em 4 grupos (n = 23) :G1(FL): Sem pré-tratamento e utilizando o adesiso FL-Bond II/Shofu; G2 (CF): sem pré-tratamento e utilizando o adesivo Clearfil SE Bond 2/Kuraray Noritake; G3 (Laser + FL): pré-tratamento associado ao uso do FL-Bond II/Shofu e G4 (Laser + CF): pré-tratamento associado ao uso do Clearfil SE Bond 2/Kuraray Noritake Os dentes avaliados foram os pré-molares de ambas as arcadas. A avaliação foi feita imediatamente após o tratamento e ao longo do tempo, em 3, 6 e 12 meses após a finalização da restauração. Para a avaliação da sensibilidade foi considerado a EVA (Escala Visual Analógica) e para a qualidade da restauração o método do USPHS modificado, considerando a avaliação de perda de retenção, integridade marginal, pigmentação marginal, presença de lesão de cárie em margem de restauração, vitalidade pulpar e sensibilidade pós-operatória. Os dados foram registrados em tabelas de frequência, e os escores transformados em postos para a aplicação do teste ANOVA. A significância estatística foi considerada para valores de p<0,05. Para os resultados da avaliação de sensibilidade houve uma diferença estatística significante da sensibilidade ao longo do tempo (p<0,001), sendo que essa diferença se deu a partir da avaliação T1 (48 horas) em todos os grupos. Em relação aos critérios avaliados no USPHS, foram encontrados variações estatísticas em alguns tópicos: Pigmentação marginal - G1 (FL) (p=0,041) e G2 ( Laser + FL) (p=0,009) e Integridade marginal G1(FL)( p=0,036). Os demais grupos e critérios não apresentaram variações estatísticas significantes.Pré-tratamentos com laser Er:YAG podem ser uma alternativa viável em restaurações adesivas do tipo classe V; no entanto, nenhum efeito sinérgico de ambos os tratamentos combinados foi observado.

The objective of this clinical, controlled, randomized, blinded and prospective study was to evaluate the clinical effectiveness of restorations in non-carious lesions (Class V cavities) performed on dental surfaces pre-treated or not with Er:YAG laser and using two adhesive systems self-conditioning. This study was carried out with a total of 91 lesions and divided into 4 groups (n = 23) :G1(FL): No pre-treatment and using the FL-Bond II/Shofu adhesive; G2 (CF): without pre-treatment and using Clearfil SE Bond 2/Kuraray Noritake adhesive; G3 (Laser + FL): pre-treatment associated with the use of FL-Bond II/Shofu and G4 (Laser + CF): pre-treatment associated with the use of Clearfil SE Bond 2/Kuraray Noritake The teeth evaluated were the premolars of both arcades. Assessment was performed immediately after treatment and over time, at 3, 6, and 12 months after completion of the restoration. The VAS (Visual Analogue Scale) was used for the sensitivity assessment and the modified USPHS method for the quality of the restoration, considering the assessment of loss of retention, marginal integrity, marginal pigmentation, presence of caries in the restoration margin. , pulp vitality and postoperative sensitivity. Data were recorded in frequency tables, and the scores were transformed into ranks for the application of the ANOVA test. Statistical significance was considered for values of p<0.05. For the results of the sensitivity evaluation, there was a statistically significant difference in sensitivity over time (p<0.001), and this difference occurred from the T1 evaluation (48 hours) in all groups. Regarding the criteria evaluated at the USPHS, statistical variations were found in some topics: Marginal pigmentation - G1 (FL) (p=0.041) and G2 (Laser + FL) (p=0.009) and Marginal integrity - G1(FL)( p =0.036). The other groups and criteria did not present significant statistical variations. Pretreatments with Er:YAG laser can be a viable alternative in class V adhesive restorations; however, no synergistic effect of both treatments combined was observed.

Effect of Sodium Ascorbate or Alpha-Tocopherol on the Resin-Dentin Interface and Bond Strength after Endodontic Treatment and Bleaching / Efecto del Ascorbato de Sodio o Alfa-Tocoferol sobre la Interfaz Resina-Dentina y la Fuerza de Unión Después del Tratamiento de Endodoncia y Blanqueamiento

The objective of this in vitro study was to assess the effects of two antioxidants (sodium ascorbate [SA] and alpha-tocopherol [AT]) on the adhesive interface and dentin bond strength immediately after bleaching with 38 % hydrogen peroxide (38HP) in endodontically-treated teeth. Two stages of experimentation were carried out. Bovine incisors were allocated into four groups (n = 10/group for each experiment): NB, non-bleached restored crowns; 38HP, bleached and immediately restored crowns; 38HP-SA, bleached crowns and SA use; and 38HP-AT, bleached crowns and AT use. Hybrid layer length in dentin (μm) and bond strength (MPa) were assessed with confocal microscopy laser and micro-shear bond strength (μSBS) test, respectively. Failure mode was determined by stereomicroscope. Data analysis was performed with analysis of variance (ANOVA) and Kruskal-Wallis, Dunn, Tukey, and Fisher-exact tests (a = 0.05). Higher values of hybrid layer length were observed similarly in the NB and 38HP-SA groups. The highest μSBS mean values were observed in the NB group (18 .51 ? 1.33), whereas the SBS values for 38HP-AT (1.68 ? 0.32) were similar to the 38HP group (1.61 ? 0.51) (p > 0.05) and significantly lower than the 38HP-SA group (5.78 ? 0.71). Adhesive failures were predominant in the 38HP and 38HP-AT groups. Cohesive and mixed failures were mostly observed in the NB and 38HP-SA groups, respectively. In conclusion, AT has no immediate effect on the hybrid layer formation and μSBS of dentin. Although SA promotes an increase in hybrid layer formation, it was not reflected in the μSBS values.

El objetivo de este estudio in vitro fue evaluar los efectos de dos antioxidantes (ascorbato de sodio [AS] y alfa-tocoferol [AT]) sobre la interfaz adhesiva y la fuerza de unión de la dentina inmediatamente después del blanqueamiento con peróxido de hidrógeno al 38 % (38HP) en endodoncia. -Dientes tratados. Se llevaron a cabo dos etapas de experimentación. Los incisivos bovinos se dividieron en cuatro grupos (n = 10 / grupo para cada experimento): NB, coronas restauradas no blanqueadas; 38HP, coronas blanqueadas y restauradas inmediatamente; 38HP- AS, coronas blanqueadas y uso SA; y 38HP-AT, coronas blanqueadas y uso de AT. La longitud de la capa híbrida en dentina (μm) y la fuerza de unión (MPa) se evaluaron con láser de microscopía confocal y la prueba de fuerza de unión por micro-cizallamiento (μSBS), respectivamente. El modo de falla se determinó mediante estereomicroscopio. El análisis de los datos se realizó con análisis de varianza (ANOVA) y pruebas de Kruskal-Wallis, Dunn, Tukey y Fisher (α = 0,05). De manera similar, se observaron valores más altos de longitud de capa híbrida en los grupos NB y 38HP-AS. Los valores medios más altos de μSBS se observaron en el grupo NB (18,51 ? 1,33), mientras que los valores de SBS para 38HP-AT (1,68 ? 0,32) fueron similares a los del grupo 38HP (1,61 ? 0,51) (p> 0,05) y significativamente más bajos que el grupo 38HP-AS (5,78 ? 0,71). Las fallas adhesivas fueron predominantes en los grupos de 38HP y 38HP-AT. Las fallas cohesivas y mixtas se observaron principalmente en los grupos NB y 38HP-AS, respectivamente. En conclusión, la AT no tiene un efecto inmediato sobre la formación de la capa híbrida y el μSBS de dentina. Aunque AS promueve un aumento en la formación de capas híbridas, no se refleja en los valores de μSBS.

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

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

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

Comparison of the clinical effect of the adhesive strategies of universal adhesives in the treatment of non-carious cervical lesions: systematic review and meta-analysis

Objective: to compare, through a systematic review and a meta-analysis, the clinical effect of the adhesive strategies of universal adhesives (UA) in the treatment of non-carious cervical lesions (NCCLs). material and method: a search of the literature was carried out up to january 2018, in the biomedical databases: Pubmed, Embase, Scielo, Science Direct, SIGLE, LILACS, BBO, Google Scholar and the Central Register of Cochrane Clinical Trials. the selection criteria of the studies were as: randomized clinical trials, with a maximum age of 5 years and which report the clinical effects (marginal adaptation, discoloration or marginal staining, presence of secondary caries, postoperative sensitivity, retention and fractures) of the UA in the treatment of NCCLs. the risk of study bias was analyzed through the Cochrane Handbook of systematic reviews of interventions. results: the search strategy resulted in eight articles that reported no difference in marginal adaptation, discoloration or marginal staining, presence of secondary caries and postoperative sensitivity among the adhesive strategies of the UA; however they reported a difference between the retention and the presence of fractures, with the conventional adhesive strategy resulting in a better clinical effect. conclusion: the reviewed literature suggests that the conventional adhesive strategy of UAs results in greater retention and absence of fractures in the treatment of NCCLs.

A randomized clinical trial on the sealing of occlusal carious lesions: 3-4-year results

Abstract This randomized clinical trial aimed to assess the efficacy of sealing occlusal carious lesions in permanent teeth. The sample consisted of 54 occlusal carious lesions in permanent molars and premolars of 49 patients aged 8–43 years (median: 19 years). The inclusion criteria comprised the presence of a cavity with no access allowing biofilm control. The maximum depth of the lesion was the middle third of the dentin thickness, as assessed by bitewing radiography. The teeth were randomly assigned to sealant treatment (n = 28) or restorative treatment (n = 26). Clinical and radiographic examinations were performed after 1 year and after 3–4 years. The outcomes depended on the clinical performance of the sealant/restoration and the control of caries progression observed radiographically. Survival analysis was performed to assess success rates. Over the 3-4 years of monitoring, 2 sealants were totally lost, 1 needed repair, and 1 showed caries progression, totaling 4 failures in the sealant group. In the restoration group, 1 failure was observed (in need of repair). The success rates were 76% and 94% in the sealant and the restoration groups, respectively (p > 0.05). The sealing of occlusal carious lesions in permanent teeth succeeded in controlling caries over a 3–4-year period. However, sealed carious lesions require patient compliance in attending regular follow-ups to control the occurrence of clinical failures of the sealants.

Influência da contaminação cavitária na adaptação marginal das restaurações de resina composta / Influence of cavity contamination on marginal adaptation of composite resin restorations

Objetivo: avaliar a influencia da contaminação cavitária na adaptação marginal das restauraçõesde resina composta e a associação da lisozima ao sistema adesivo. Materiais e Métodos:Foram selecionados 40 terceiros molares permanentes e confeccionados preparos cavitários classeV com pontas diamantadas cilíndricas 1090 (4 mm de largura, 6 mm de comprimento e 1,5 mmde profundidade). Todos os dentes foram esterilizados e divididos aleatoriamente em 4 grupos(n=10): G1: sistema adesivo (SA) e restauração com resina composta (RC); G2: cavidadescontaminadas com 10 μl de Streptococcus mutans (0,5 de Mc Farland), SA e RC; G3:sistema adesivo associado com lisozima (ADL) e RC e G4: cavidades contaminadas com 10 μlde Streptococcus Mutans (0,5 de Mc Farland), ADL e RC. A lisozima foi adicionada ao SA com ummicrobrush embebido no SA e na lisozima em pó. Os dentes foram impermeabilizados e imersosem azul de metileno por 4 horas a 37ºC. Os dentes foram seccionados e fotografados. Resultados:A avaliação da microinfiltração foi feita por dois avaliadores utilizando o Programa Tpsdig. Paraavaliar a calibração entre os examinadores, foi utilizado o teste de Correlação de Pearson. As médiasdas porcentagens de fendas e bolhas foram submetidas ao teste de Kruskal Wallis com 5% designificância. Conclusão: a contaminação cavitária com Streptococcus mutans acarretou na formaçãode fendas entre a resina composta e as margens cavitárias. A lisozima associada ao sistemaadesivo não influenciou na formação de fendas e bolhas nas restaurações de resina composta.

Objective: evaluate the influence of cavity contamination on marginal adaptation of compositerestorations and the association of lysozyme to the adhesive system. Materials and Methods:Were selected 40 permanent third molars and made cavity preparations class V with cylindricaldiamond burs 1090 (4 mm wide, 6 mm long and 2 mm deep). All teeth were sterilized and randomlydivided into 4 groups (n = 10): G1: adhesive system (SA) and restoration with compositeresin (CR); G2: cavity contaminated with 10 μl of Streptococcus mutans (0.5 McFarland), SA andRC; G3: adhesive system associated with lysozyme (ADL) and RC and G4: cavity contaminated with10 μl of Streptococcus mutans (0.5 Mc Farland), ADL and RC. Lysozyme was added to the SA witha microbrush embedded in the SA and powdered lysozyme. The teeth were sealed and immersedin a methylene blue for 4 hours at 37 ° C. The teeth were sectioned and photographed. Results:The evaluation of microleakage was made by two reviewers using the Tpsdig Program. To assessthe calibration of examiners, we used the Pearson correlation test. The mean percentages of cracksand bubbles were submitted to Kruskal Wallis test at 5% significance level. Conclusion: the cavityStreptococcus mutans contamination resulted in the formation of cracks between the compositeresin and the cavity margins. Lysozyme associated with the adhesive system did not influence theformation of cracks and bubbles in the composite restorations.

Scanning electron microscopy analysis of microstructure of the adhesive interface between resin and dentin treated with papain gel.

Aim: The aim of this in vitro study was to observe and compare the microstructure of the adhesive interface between resin and dentin treated with Papacarie® using scanning electron microscopy (SEM). Materials and Methods: Totally, 10 human dentin slabs were randomly distributed into two groups. The control group (n = 5) was subjected to etching with 37% phosphoric acid for 20 s and washed for 30 s, dried with absorbent paper, and the bonding agent was applied along with low viscosity resin. In turn, the experimental group (n = 5) was subjected to the same procedure, but Papacarie® (Fórmula and Ação, São Paulo, Brazil) was added for 30 s prior to etching. Adper™ Single Bond 2 (3M ESPE, São Paulo, Brazil) adhesive was applied to both groups following manufacturer instructions. The specimens were prepared for observation under SEM with ×1.000, ×2.000, ×2.200 and ×5.000 magnification. The micrographs were evaluated with respect to the formation of the hybrid layer, thickness, shape and length of the tags and microtags. Results: In the experimental group there was the formation of more fine hybrid layer and tags with average of similar length to the control group; microtags in less number and without formation of lateral branches. The resin tags presented conical, smooth and uniform characteristics. Conclusions: When Papacarie® was used prior to the application of a bonding agent it could interfere with the formation of the hybrid layer without changing the length of the tag. Moreover, the morphology in the experimental group was found to be more uniform and regular.