Anterior esthetic restoration using DSD (digital smile design) for a patient with congenital missing tooth of maxillary central incisor

The prosthodontic treatments in maxillary anterior teeth focus on achieving esthetic appearances. It is possible to improve the esthetic appearance by adjusting the shape, arrangement, and color of the maxillary anterior teeth. For anterior teeth restoration, it is necessary to evaluate the relationship of teeth, lip and gingival architecture with the facial profile of patient. Also, clinician needs to fully understand what the patient wants to. DSD (digital smile design) concept can be applied as a tool to improve communication with the clinician, technician and patient. In addition, DSD can help to meet the needs of the patient. In this case, it was impossible to achieve symmetry due to congenital missing of maxillary central incisor. The definitive treatment goal was to get the harmony of maxillary anterior teeth, lip and the patient's face. This case report describes that the patient and clinician got the satisfying esthetic outcome by using DSD.

Evaluación del tratamiento endodóntico y su relación con el tipo y la calidad de la restauración definitiva / Evaluation of edodontic treatment and its relationship with the type and quality of the definitive restoration

Introducción El éxito endodóntico está determinado por la calidad de los tratamientos de canales radiculares y restaurador, en conjunto con la ausencia de signos y síntomas. Objetivo Determinar el porcentaje de éxito de tratamientos de conductos y su relación con el tipo y la calidad de la restauración coronaria. Material y métodos Se realizó un estudio clínico retrospectivo en donde se evaluaron 227 dientes sometidos a tratamiento de canales radiculares con 4 años de evolución, por un dentista contralor, que realizó el examen clínico y radiográfico de estos dientes, evaluando los signos y síntomas que presentaron y el tipo y la calidad del tratamiento restaurador. Los datos se analizaron mediante el programa estadístico STATA 13. Resultados En los tratamientos evaluados existe un porcentaje de éxito del 93,8% y un 6,2% de fracaso, además de una asociación significativa en cuanto a que los dientes con una restauración coronaria adecuada, directa o indirecta, están relacionados con tratamientos considerados como exitosos, mediante test de Fisher (valor p < 0,01) con un nivel de confianza del 95%. Conclusiones Los resultados obtenidos en este estudio muestran un alto porcentaje de éxito de los dientes tratados endodónticamente (93,8%) y que existe una asociación estadísticamente significativa entre la calidad de la obturación y la sintomatología (p < 0,01) con un nivel de confianza del 95%.

Introduction Success in endodontic treatment is determined by the quality of the root canal treatment and definitive coronal restoration, with the absence of signs and symptoms. Objective The aim of this study was to determine the success rate of root canal treatment and its relationship with the type and quality of the coronary restoration. Material and methods A retrospective clinical study was conducted on 227 endodontically treated teeth over a period of 4 years. The analysis was performed by a comptroller dentist, who carried out the clinical and radiographical examination, evaluating signs and symptoms and the type and quality of the coronary restoration. The data analysis was performed using the STATA 13 statistics program. Results The results obtained show that there is a success rate of 93.8% and a 6.2% failure rate of the teeth evaluated. There was also significant evidence as regards teeth with proper restorations, whether direct or indirect, and root canal treatments considered as successful, according to Fisher's Test (P<.01), with a confidence level of 95%. Conclusions It can be concluded with the results obtained, that there is a high success rate (93.8%), and that there is a statistically significant association between the quality of the restoration and the presence of symptoms.

Influência de diferentes procedimentos restauradores na resistência á fratura de dentes com cavidade classe IV submetidos ao clareamento dental interno / Influence of different restorative procedures on fracture of teeth with class IV cavities submitted to internal dental bleaching

Este estudo teve o objetivo de investigar a influência de diferentes procedimentos restauradores diretos com resina composta e pinos de fibra de vidro, na resistência à fratura de dentes com cavidades Classe IV, tratados endodonticamente e submetidos ao clareamento interno. Quarenta (n=40) incisivos laterais superiores humanos hígidos foram utilizados. Todos os dentes, com exceção do Grupo controle, foram submetidos ao tratamento endodôntico e então divididos em 5 Grupos (n=8): GI: Dentes hígidos; GII: Dentes tratados endodonticamente + resina composta (RC); GIII: Dentes tratados endodonticamente + clareamento com peróxido de hidrogênio (PH) a 35% + RC; GIV: Dentes tratados endodonticamente + Clareamento com PH a 35% + pino de fibra de vidro (Everstick/StichTeck) + RC; GV: Dentes tratados endodonticamente + Clareamento PH a 35% + RC e pino de fibra de vidro (Fibrekor Post; Jeneric Pentron Inc., Wallingford, CT, USA);. Os dentes tratados endodônticamente receberam cortes na coroa simulando uma classe IV e posteriormente restaurações de resina composta. O sistema LED-LASER Whitening Lase Light Plus (DMC Equipamentos Ltda, São Carlos, SP, Brasil) foi utilizado para ativação do agente clareador. Após o processo de clareamento, a restauração provisória e o tampão cervical dos dentes submetidos ao clareamento foram removidos para que cada Grupo fosse submetido ao procedimento restaurador. Após a confecção das restaurações as mesmas foram submetidas ao teste de resistência a fratura, em máquina de ensaios (EMIC). A Análise de Variância apontou efeito significativo de Grupos sobre a resistência (p=0,041). O teste de Tukey foi aplicado nas comparações múltiplas das médias de resistência, identificando somente a média de GIII (dentes tratados endodonticamente + clareamento com PH a 35% + RC) significativamente menor do que a GI ( dentes Hígidos) (p=0,026). Concluiu-se que os dentes com cavidade classe IV, tratados endodonticamentes, submetidos ao clareamento dental interno com PH a 35% com aceleração de luz e restaurados apenas com RC, apresentam resistência a fratura comprometida quando comparado aos dentes hígidos. Quando os dentes tratados endodonticamente forem submetidos ao claremaento interno, o uso de pinos é recomendado, quando o clareamento interno não for realizado, a restauração direta pode ser realizada apenas com RC

This study aimed to investigate the influence of restorative procedures on fracture resistance of teeth with Class IV cavities endodontically treated and submitted to internal bleaching with light source acceleration using LED-LASER system. Forty (n = 40) lateral incisors and healthy humans were used. All teeth, except for the control Group, were submitted to endodontic treatment and then divided into 5 Groups (n = 8): GI: healthy teeth, GII: endodontically treated teeth + composite, GIII: Teeth whitening endodontically treated with PH 35% + composite, GIV: Teeth whitening endodontically treated with PH 35% glass fiber post (Everstick / StichTeck) + composite, GV: Teeth whitening endodontically treated PH 35% + composite fiber and glass post (Fibrekor Post; Jeneric Pentron Inc., Wallingford, CT, USA). The crow of endodontically treated tooth was cut simulating a Class IV. The system LED LASER-Light Plus Whitening Lase (DMC Equipment Ltda, São Carlos, SP, Brazil) was used to activate the bleaching agent. After the whitening process, the buffer cervical and the temporary restoration of teeth submitted to bleaching have been removed so that each Group was subjected to the restorative procedure. After restorations the specimens were subjected to the same fracture toughness test, in a testing machine (EMIC). Analysis of Variance (ANOVA) showed significant effect on the resistance Group (p = 0.041). The Tukey test was applied in multiple comparisons for resistance means values, identifying only the mean of GIII (endodontically treated teeth bleaching with PH 35% + composite) significantly lower than GI (healthy teeth) (p = .026). It was concluded that teeth endodonticamentes treated with cavity class IV, subjected to internal dental bleaching with PH 35% and only restored with RC, have lower fracture toughness when compared to healthy teeth. When endodontically teeth were submitted to internal bleaching use of pins is recommended. And when internal bleaching is not carried out, the direct restoration can be done only with RC