Cara smile: Use of planning software to facilitate esthetic dental treatment in a case.

Treatment of the anterior teeth is challenging. Computer resources and software are available to facilitate a digital smile approach, thus allowing the dentist to plan and predict an esthetic result for a patient, particularly when an integrated multidisciplinary approach is necessary. Digital smile design has emerged as a tool in cosmetic dentistry that helps both professionals and the patient to visualize the result, in addition to facilitating a discussion between the two before establishing a final treatment decision. Here, we present a case involving a 27-year-old female who underwent multidisciplinary treatment initiated by digital planning using specific software, namely Cara Smile. The patient presented with complaints of maxillary tooth malalignment, staining, and fractures. To obtain the correct width-to-height ratio, a simulated gingival procedure was performed in the software. Gingivectomy was performed using digital simulation, and 90 days after surgery, cast and wax-up models maintaining the previously planned width-to-height ratio for the maxillary anterior teeth were made. Esthetic crowns and veneers were fabricated using the digital planning protocol. Therefore, Cara Smile is useful to facilitate the diagnosis through digital photos, improve communication between the various professionals involved in treatment, and guide the predictability of treatment and patient acceptance.

Physicomechanical properties of different nanohybrid composites after aging: color stability, flexural strength, and microhardness

Aim: To evaluate the physicomechanical properties of different hybrid composites (Charisma Diamond - CD, Aura - AU, NT Premium - NT, Opallis - OP, Filtek Z250 ­ Z250) after 6 months of aging in distilled water. Methods: Discs were fabricated and color measurements were performed after 24 hours and at 7, 30, and 180 days. Flexural strength was determined using the three-point bending test. For the microhardness test, the specimens were flattened to obtain polished and flat surfaces and indentations. The results for ∆E and microhardness were analyzed by two-way repeated-measures ANOVA and Tukey's HSD test. The flexural strength results were analyzed by two-way ANOVA and Tukey's test (α=0.05). Results: The ∆E values for composite resins varied in the following order: CD (3.54)a < Z250 (4.70)ab < AU (4.95)ab < OP (5.20)ab < NT (6.23)b. ∆E values were lower for 24 h (3.84)a < 7 days (4.43)ab < 30 days (4.93)b. The highest values were observed after 180 days (ΔE = 6.54)c. The flexural strength of composite resins varied in the following order: CD (89.17 MPa)a < Z250 (73.06 MPa)b < OP (60.30 MPa)c < NT (51.28 MPa)c < AU (23.77 MPa)d. Flexural strength values were significantly higher for 24 h (68.62 MPa)a < 180 days (51.40 MPa)b. The microhardness of composite resins varied in the following order: Z250 (112.05)a < CD (102.15)ab < OP (92.04)bc < NT (87.77)d < AU (87.68)d. Microhardness was significantly higher for 180 days (113.44)a < 24 h (78.21)b. Conclusion: The microhybrid (Z250) and one of the nanohybrid composites (CD) performed better. The color stability and flexural strength of all tested composites decreased with storage time

Premium protocol for planning a periodontal-restorative approach: Conservative, predictable, and reproducible.

Planning oral rehabilitation that involves an interdisciplinary approach is challenging, especially when it includes changes in the morphologic aspects of teeth and the architecture of gingival tissues. Patients commonly complain about the esthetics of maxillary anterior teeth, especially when diastemata are present. A guideline known as the golden proportion can be used to establish adequate width distribution of anterior teeth. Tooth proportion is also affected by incisogingival tooth length, hence gingival contouring should be evaluated as well. In these situations, the width-to-height ratio of 0.75:0.78 in the maxillary anterior teeth could be used to obtain wax-ups and a surgical guide, resulting in a more predictable esthetic outcome. Therefore, this clinical report describes a protocol for the planning of a periodontal-restorative approach with two wax-ups and a surgical guide using the golden proportion width-to-height ratio of 0.75:0.78 for the treatment of maxillary anterior teeth with diastemata using minimum thickness lithium disilicate veneers.

Effect of hydrogen peroxide application on color and surface roughness of two restorative materials

Aim: This study investigated the effect of an in-office bleaching technique on lightness, color and surface roughness of two commercially available materials: a resin-modified glass-ionomer cement and a nanohybrid resin composite. Methods: Twelve disk-shaped specimens were prepared with both materials. The samples were bleached with 35% hydrogen peroxide. Bleaching was tested initially onto a smooth surface and later onto a polished one of the same specimens. The effect of the treatments on lightness and color was verified with a spectrophotometer. Surface roughness was measured with a digital surface roughness tester. The data were statistically analyzed by repeated measures ANOVA and post hoc Tukey's test (alpha = 0.05). Results: Significant variation in lightness and color was observed on the resin-modified glass-ionomer cement after the first bleaching procedure. Roughness increased significantly only after polishing the resin-modified glass-ionomer cement surface. Composite color variation was evident in the last observation period, but roughness and lightness variation due to bleaching and polishing was not significant. Conclusion: The bleaching treatment caused significant color alterations on the materials tested. This study observed that the application of in-office bleaching onto the glass-ionomer cement promoted clinically observable color alteration, and polishing after bleaching is contraindicated for this material. (AU)

Influence of cervical preflaring on apical transportation in curved root canals instrumented by reciprocating file systems.

BACKGROUND: The aim of this study was to evaluate the influence of cervical preflaring on apical transportation in curved root canals prepared using the Reciproc and WaveOne reciprocating file systems. METHODS: Sixty curved canals were instrumented using Reciproc R25 and WaveOne Primary files, with and without preflaring (n = 15). A double-digital technique was used to digitally superimpose the file before instrumentation (#15 K-file) on the final apical reciprocating file (#25/08). The angle between the tip of the initial and final file was measured and recorded. Groups were compared using the Kruskal-Wallis test, and significance was set at p < 0.05. RESULTS: The mean and standard deviation for apical transportation was 0.93 ± 2.48 for the Reciproc Group, 0.84 ± 1.94 for the Preflaring + Reciproc Group, 0.40 ± 1.14 for the WaveOne Group, and 0.83 ± 2.20 for the Preflaring + WaveOne Group. No statistically significant differences were found among the groups (p = 0.9509). CONCLUSIONS: Under the conditions of this study, cervical preflaring did not influence apical transportation in curved root canals instrumented using Reciproc R25 and the WaveOne Primary files. Based on the in vitro measurements of apical transportation, the reciprocating files may be used without preflaring in curved root canals.

Adhesion and formation of tags from MTA Fillapex compared with AH Plus® cement

Introduction and Objective: The aim of this study was two-fold: 1) to evaluate, in vitro, the shear bond strength of two sealers by push-out test and 2) to assess the failures after displacement. Additionally, the formation of tags was observed by SEM. Material and methods: Forty mandibular premolars were selected and the canals were subjected to biomechanical preparation with rotary instruments. These specimens were divided into two groups according to the sealer (n = 20): GI - MTA Fillapex and GII - AH Plus. All roots were filled with sealer only, without gutta-percha. After a period corresponding to three times the setting time of the sealer, the roots were sectioned transversely into slices of 1 mm thickness, to obtain one slice from the cervical third, to be used in the push-out test. Following, two slices of each group were randomly chosen for ultrastructural analysis by scanning electron microscopy (SEM). The data obtained in shear bond strength test were subjected to statistical analysis. Results: AH Plus cement exhibited higher shear bond strength values (1.332±0.75 MPa) than MTA Fillapex (0.071±0.07 MPa), with statistically significant differences. Conclusion: MTA Fillapex has a low bond strength with less formation of tags than AH Plus.