RESUMO
RESUMEN La restauración de grandes preparaciones cavitarias clases II MOD es un escenario clínico de alta complejidad. Elegir correctamente una resina compuesta y planificar la secuencia de estratificación permitirá mejorar la adaptación de las masas de resina y controlar el estrés de contracción de polimerización. En el siguiente reporte de caso clínico, se expone el protocolo paso a paso para el uso combinado de una resina compuesta para estratificación de esmalte de alto índice de refracción para la restauración de los rebordes marginales perdidos y la superficie oclusal, junto a una resina compuesta bulk-fill de baja viscosidad para la reconstrucción dentinaria en un diente posterior con gran destrucción coronaria.
ABSTRACT The restoration of large class II MOD cavity preparations is a highly complex clinical scenario. Selecting correctly a composite resin and planning the stratification sequence will improve the adaptation of the composite resin masses and will control the polymerization shrinkage stress. In the following clinical case report, the step- by-step protocol of the combined use of an high-refractive-index enamel-like composite resin is shown for the restoration of lost marginal ridges and the occlusal surface, together with a low viscosity Bulk-Fill composite resin for dentine reconstruction in a highly damaged posterior tooth.
RESUMO
Abstract This study evaluated the effect of the use of glass ionomer cement (GIC) and flowable bulk-fill resin composite (BFRC) for filling pulp chambers and the type of high-speed handpiece light used on dentin removal during access preparation for endodontic retreatment in molar teeth. Twenty maxillary molars were treated endodontically. BFRC (Opus Bulk Fill Flow APS, FGM) was used to fill the pulp chamber and replace coronal dentin (n = 10). In the remaining teeth, the pulp chamber was filled with GIC (Maxion R, FGM). Conventional resin composite (Opallis, FGM) was used to restore the enamel layer in all teeth. The samples in each group were divided into two subgroups, and the root canals were reaccessed using a handpiece with white or ultraviolet light. The teeth were scanned using micro-CT before and after root canal reaccess. The dentin volume removed was calculated and analyzed using 2-way analysis of variance and Tukey's test (α = 0.05). The crown and pulp chamber locations with dentin removal are described using frequency distribution. During the access, fewer pulp chamber walls were affected and a lower volume of dentin was removed from the pulpal floor in the group restored with GIC than in the group restored with BFRC. No effect was observed on the coronal dentin walls with respect to the filling protocols and type of light used. For dentin removal from the pulp chamber, handpieces with white light performed better than those with ultraviolet light, irrespective of the filling protocol used. The use of GIC to fill the pulp chamber and use of white handpiece light reduced dentin removal from the pulpal floor and resulted in fewer affected dentin walls.
Resumo Este estudo avaliou os efeitos do cimento de ionômero de vidro (GIC) e da resina composta fluida bulk fill (BFRC) usados como preenchimento da câmara pulpar; e o tipo de iluminação das turbinas de alta rotação na remoção dentinária após cavidades de acesso para retratamento endodôntico em dentes molares. Vinte molares superiores foram tratados endodonticamente. Dez dentes foram restaurados usando BFRC (Opus Bulk Fill Flow APS, FGM) para preencher a câmara pulpar e dentina coronária; e resina composta convencional (Opallis, FGM) para restaurar a camada de esmalte. Os outros dentes foram restaurados usando GIC (Maxion R, FGM) para preencher a câmara pulpar e resina composta (Opallis, FGM). As amostras foram divididas em dois grupos e os canais radiculares foram novamente acessados com turbina de alta-rotação com iluminação branca ou ultravioleta. Os dentes foram escaneados usando micro-CT antes e após o novo acesso ao canal radicular. O volume de dentina removida foi calculado e os dados foram analisados por ANOVA bidirecional e teste de Tukey (α=0,05). As regiões na coroa e na câmara pulpar que apresentaram dentina removida no acesso dos canais foram descritas por meio de distribuição por frequência. A reabertura do canal radicular com GIC resultou em menos paredes afetadas da câmara pulpar e menor volume de dentina removida no assoalho. Nenhum efeito foi observado nas paredes de dentina coronária considerando aos protocolos de preenchimento. A turbina de alta rotação com iluminação branca reduziu a remoção de dentina da câmara pulpar, independentemente do protocolo de restauração utilizado. O uso de turbina de alta rotação com iluminação branca e GIC para preencher a câmara pulpar reduziram a remoção de dentina do assoalho e afetaram menos paredes dentinárias.
RESUMO
Abstract: The aim of this study was to evaluate and compare the effects of different light sources on shear bond strength when bulk-fill composite was used for the repair of different composite resins. A total of 126 samples made from six resin composites with different properties were aged (thermal-cycling with 5000 cycle), exposed to the same surface treatments and adhesive procedure. Then, they were repaired with a bulk-fill composite. At the polymerization step, each group was divided into three subgroups (n=7) and light cured with a QTH light source for 40s and two different LED light sources for 20s. Subsequently, the specimens were aged in distilled water at 37 ºC for 4 weeks and then subjected to shear bond strength test. Then, the specimens were examined under a stereomicroscope to identify modes of failure and visualized by Scanning Electron Microscope. Data obtained from the study were analyzed using ANOVA and Tukey HSD Test (α=0.05). In all groups, the light curing units had an impact on shear bond strength (p<0.05). Among the study groups, the greatest bond strength values were observed in the specimens repaired using the LED and the specimens repaired with the QTH light curing unit had the lowest bond strength values. It was concluded that the content of composite resins and light curing units may influence bond strength of different composites repaired with the bulk-fill composite.
Resumen: El objetivo de este estudio fue evaluar y comparar los efectos de diferentes fuentes de luz sobre la resistencia de la unión al cizallamiento cuando se utiliza una resina bulk-fill para la reparación de diferentes resinas compuestas. Se envejecieron un total de 126 muestras fabricadas con seis compuestos de resina con diferentes propiedades (ciclo térmico con 5000 ciclos), expuestas a los mismos tratamientos de superficie y procedimiento adhesivo. Luego, fueron reparadas con una resina bulk- fill. En el paso de polimerización, cada grupo fue dividido en tres subgrupos (n=7) y fotopolimerizado con una fuente de luz QTH por 40s y dos fuentes de luz LED por 20s. Posteriormente, los especímenes se envejecieron en agua destilada a 37 ºC durante 4 semanas y luego se sometieron a una prueba de resistencia adhesiva de cizalla. Luego, los especímenes fueron examinados bajo un estereomicroscopio para identificar los modos de falla y visualizados por el Microscopio Electrónico de Barrido. Los datos obtenidos del estudio fueron analizados usando el ANOVA y la prueba Tukey HSD (α=0.05). En todos los grupos, las unidades de fotopolimerización tuvieron un impacto en la fuerza de adhesión al cizallamiento (p<0,05). Entre los grupos de estudio, los mayores valores de fuerza de adhesión se observaron en los especímenes reparados utilizando el LED y los especímenes reparados con la unidad de fotopolimerización QTH tuvieron los valores de fuerza de adhesión más bajos. Se llegó a la conclusión de que el contenido de las resinas compuestas y las unidades de fotopolimerización pueden influir en la fuerza de adhesión de los diferentes compuestos reparados con resinas bulk-fill.
Assuntos
Cura Luminosa de Adesivos Dentários/métodos , Reparação de Restauração DentáriaRESUMO
Bulk-fill resin composites represent an excellent alternative to the conventional incremental layering technique for the reduction of polymerization stress on the adhesive interface. Marginal seal can be further improved by the incorporation of bioactive fillers, such as those encountered in Giomers. However, the high translucency required for the adequate polymerization of bulk-fill materials can seriously jeopardize the final aesthetic outcome of the restorations, especially in the presence of inhomogeneous or stained dentin substrates. The aim of this case report was to present the combined use of two bulk-fill Giomer materials (Beautifil Bulk Flowable and Beautifil II LS, Shofu) for the restoration of three posterior maxillary teeth displaying a black stained dentin substrate due to amalgam corrosion products. This technique allowed completion of the restorations with a satisfactory aesthetic and biomimetic outcome. The adequate preservation of the anatomy and function of the three restorations after 24-months follow-up, provides evidence of the enhanced marginal sealing capacity of these bioactive materials and the success of bulk-fill techniques over time.
Las resinas compuestas de tipo bulk-fill representan una excelente alternativa a la técnica incremental para la reducción de la tensión de polimerización sobre la interfaz adhesiva. La incorporación de rellenos bioactivos, como los que se encuentran en los materiales con tecnología giomer, refuerzan aún más el sellado marginal de estas restauraciones. Sin embargo, la alta translucidez, necesaria para la adecuada polimerización de los materiales tipo bulk-fill, puede comprometer seriamente el resultado estético final de las restauraciones, especialmente en presencia de sustratos dentarios no homogéneos u oscurecidos. El objetivo de este reporte de caso fue presentar el uso combinado de dos materiales giomer tipo bulk-fill (Beautifil Bulk Flowable y Beautifil II LS, Shofu) para la restauración de tres dientes maxilares posteriores con un sustrato dentinario ennegrecido debido a productos de corrosión de amalgama. Esta técnica permitió completar las restauraciones con un resultado estético y biomimético satisfactorio. La adecuada conservación de la anatomía y la función de las tres restauraciones tras un período de 24 meses, aporta evidencia sobre la adecuada capacidad de sellado marginal de estos materiales bioactivos y el éxito de las técnicas de restauración tipo bulk-fill en el tiempo.
Assuntos
Humanos , Feminino , Adulto , Descoloração de Dente , Resinas Compostas , Selantes de Fossas e Fissuras , Amálgama Dentário , Estética DentáriaRESUMO
OBJECTIVES: This study evaluated the effects of the resin thickness on the microhardness and optical properties of bulk-fill resin composites. METHODS: Four bulk-fill (Venus Bulk Fill, Heraeus Kulzer; SDR, Dentsply Caulk; Tetric N-Ceram Bulk Fill, Ivoclar vivadent; SonicFill, Kerr) and two regular resin composites (Charisma flow, Heraeus Kulzer; Tetric N-Ceram, Ivoclar vivadent) were used. Sixty acrylic cylindrical molds were prepared for each thickness (2, 3 and 4 mm). The molds were divided into six groups for resin composites. The microhardness was measured on the top and bottom surfaces, and the colors were measured using Commission Internationale d'Eclairage (CIE) L*a*b* system. Color differences according to the thickness and translucency parameters and the correlations between the microhardness and translucency parameter were analyzed. The microhardness and color differences were analyzed by ANOVA and Scheffe's post hoc test, and a student t-test, respectively. The level of significance was set to alpha = 0.05. RESULTS: The microhardness decreased with increasing resin thickness. The bulk-fill resin composites showed a bottom/top hardness ratio of almost 80% or more in 4 mm thick specimens. The highest translucency parameter was observed in Venus Bulk Fill. All resin composites used in this study except for Venus Bulk Fill showed linear correlations between the microhardness and translucency parameter according to the thickness. CONCLUSIONS: Within the limitations of this study, the bulk-fill resin composites used in this study can be placed and cured properly in the 4 mm bulk.
Assuntos
Humanos , Fungos , Dureza , VênusRESUMO
OBJECTIVES: This study evaluated the effects of the resin thickness on the microhardness and optical properties of bulk-fill resin composites. METHODS: Four bulk-fill (Venus Bulk Fill, Heraeus Kulzer; SDR, Dentsply Caulk; Tetric N-Ceram Bulk Fill, Ivoclar vivadent; SonicFill, Kerr) and two regular resin composites (Charisma flow, Heraeus Kulzer; Tetric N-Ceram, Ivoclar vivadent) were used. Sixty acrylic cylindrical molds were prepared for each thickness (2, 3 and 4 mm). The molds were divided into six groups for resin composites. The microhardness was measured on the top and bottom surfaces, and the colors were measured using Commission Internationale d'Eclairage (CIE) L*a*b* system. Color differences according to the thickness and translucency parameters and the correlations between the microhardness and translucency parameter were analyzed. The microhardness and color differences were analyzed by ANOVA and Scheffe's post hoc test, and a student t-test, respectively. The level of significance was set to alpha = 0.05. RESULTS: The microhardness decreased with increasing resin thickness. The bulk-fill resin composites showed a bottom/top hardness ratio of almost 80% or more in 4 mm thick specimens. The highest translucency parameter was observed in Venus Bulk Fill. All resin composites used in this study except for Venus Bulk Fill showed linear correlations between the microhardness and translucency parameter according to the thickness. CONCLUSIONS: Within the limitations of this study, the bulk-fill resin composites used in this study can be placed and cured properly in the 4 mm bulk.