Incidence of Fracture in Single Ceramic Crowns in Patients with Chronic Tooth Wear: A Clinical Follow-up

ABSTRACT: The aim of this study was to identify the incidence of fractures in single crowns placed in individuals with chronic tooth wear. The sample selection was performed based on the evaluation of 218 patient records rehabilitated with single crowns placed by the same professional from a private clinic. After exclusion criteria, 43 individuals (18 males and 25 females) were included and a total of 112 single crowns distributed in both jaws. Three ceramic systems were evaluated: 34 feldspathic all-ceramic, 38 metal-ceramic with a core in gold electropositive alloy, and 40 In-Ceram Alumina. The intraoral photograph analysis adopted a diagnosis method of tooth wear according to the morphological variations of the teeth. Of the 112 crowns evaluated, 47 were placed in male and 65 in female patients, aged between 21 to 74 years (mean 27.5 years old). The variables gender (p = 0.83), presence of chronic tooth wear (p = 0.91), ceramic system (p = 0.24) and crown location (p = 0.86) did not present a statistically difference. However, the variables pulp vitality (p = 0.04) and survi val time (p = 0.01) presented a statistically significant difference. The evaluated ceramic systems can be considered as alternativ es of restorative material, even in individuals with clinical characteristics suggestive of chronic tooth wear.

RESUMEN: El objetivo de este estudio fue identificar la incidencia de fracturas en coronas individuales colocadas en individuos con desgaste dental crónico. La selección de la muestra se realizó en base a la evaluación de 218 registros de pacientes rehabilitados con coronas individuales colocadas entre 1999 y 2009 por el mismo profesional de una clínica privada. Después de analizar los criterios de exclusión, se incluyeron 43 individuos (18 hombres y 25 mujeres) y un total de 112 coronas individuales distribuidas en ambas mandíbulas. Este estudio evaluó coronas hechas de tres sistemas cerámicos: 34 de cerámica totalmente feldespática, 38 de cerámica de metal con un núcleo de aleación electropositiva de oro y 40 de alúmina enceram. El análisis de la fotografía intraoral adoptó un método de diagnóstico del desgaste dental de acuerdo con las variaciones morfológicas de los dientes. De las 112 coronas evaluadas, 47 se colocaron en hombres y 65 en mujeres, con edades comprendidas entre 21 y 74 años (media de 27,5 años). Con respecto a las coronas individuales, las variables género (p = 0,83), presencia de desgaste dental crónico (p = 0,91), sistema cerámico (p = 0,24) y ubicación de la corona (p = 0,86) no presentaron una diferencia estadísticamente significativa. Sin embargo, las variables vitalidad pulpar (p = 0.04) y tiempo de supervivencia (p = 0.01) presentaron una diferencia estadísticamente significativa. Los sistemas cerámicos evaluados pueden considerarse como alternativas de material restaurador, incluso en individuos con características clínicas que sugieren desgaste dental crónico.

Evaluation of peri-implant condition in periodontally compromised patients.

AIMS: The aim of the study is to evaluate the profile of peri-implant tissues in periodontally compromised patients. SETTINGS AND DESIGN: In vivo - cross sectional study design. MATERIALS AND METHODS: Fifty-eight implants were evaluated, clinically and radiographically, installed in seven individuals treated by the same team of professionals, during the years 1997 and 2005 in a private dental clinic in Vitória, ES, Brazil; that time of data collection, all implants were at least 10 years of functional loading. The variables related to the dental implants evaluated were: visible Plaque Index, Gingival Bleeding Index (GBI), probing pocket depth, bleeding on probing, and bone level, to relate them to the classification of dental implants. STATISTICAL ANALYSIS USED: The Chi-square and Kruskal-Wallis test were adopted. RESULTS: The total of 58 implants were classified: 11 (18.9%) as healthy and 12 (20.7%) as clinically stable. The other 35 implants (60.4%) had some type of peri-implant inflammation, 20 of them (34.5%) were diagnosed with peri-implant mucositis and 15 (25.9%) with peri-implantitis. Among the variables studied, the results showed statistically significant differences for implant location (P = 0.001) and GBI (P = 0.03). Most of the maxillary implants (85.7%) were classified for some type of peri-implant disease. For the implants which resulted in Score 1 for GBI, most of them (75.0%) were also classified for some type of peri-implant disease. CONCLUSIONS: Dental implants placed in periodontally compromised patients may have high long-term survival rates. However, most implants were classified with some type of peri-implant inflammation.

Esthetic perception of smiles with different gingival conditions.

This study aimed to compare the perceptions of smile esthetics among general practitioners, periodontists, and laypeople. Photographs of smiles were taken and digitally modified to create different gingival conditions: gingival asymmetry, unilateral gingival recession, and bilateral gingival recession. These photographs were evaluated by 150 volunteers (19-70 years old) using a 100.0-mm visual analog scale. The volunteers consisted of 50 laypeople with no knowledge of dentistry, 50 general dentists, and 50 periodontists. Analysis of variance and Student t test were performed when data presented a normal distribution. If the hypothesis of normality was rejected, the Newman-Keuls test was applied to the data. Results showed that laypeople noticed gingival asymmetry only when it reached 2.0 mm, while periodontists and general dentists noticed it at 1.0 mm. Periodontists and general dentists considered smiles with unilateral recession of ≥1.0 mm to be less attractive, while the smallest modification that was deemed unesthetic by the laypeople was 2.0 mm. In the evaluation of bilateral gingival recession, general dentists and periodontists found smiles with a 1.0-mm modification less attractive, while the changes were not noticed by laypeople until the modification reached 1.5 mm. It can be concluded that laypeople perceived changes in smile esthetics differently than did dental professionals, which suggests that laypeople may be less concerned about the esthetic effects of minor gingival alterations than are dental professionals. Therefore, it is important for the dentist to understand the individual patient's perception of what constitutes an esthetic smile before recommending a dental treatment plan.

Etiología de las Pérdidas Dentales en Pacientes Rehabilitados con Prótesis sobre Implantes / Etiology of Tooth Loss in Patients Rehabilitated with Dental Implants

RESUMEN: El objetivo de esta investigación fue analizar la etiología de las pérdidas dentales en pacientes rehabilitados con prótesis sobre implantes. Se realizó un estudio transversal con informaciones de 93 pacientes de una clínica privada que recibieron tratamiento con implantes en el período de 2000 a 2009. Los datos fueron recolectados a través de las fichas clínicas, documentaciones radiográficas y fotografías de los casos clínicos. Se levantaron datos sobre género, edad, nivel de escolaridad, hábito de fumar, tipo de diente extraído y razón de la extracción. Los resultados mostraron que la razón periodontal fue el principal motivo de las pérdidas dentales, representando el 24,7 %, seguida por las fracturas radiculares con pines metálicos (23,7 %) y caries secundarias (15,1 %). En los pacientes menores de 40 años, los traumatismos dentales y las fracturas radiculares con pino fueron responsables de la mayoría de las pérdidas. Las razones de las pérdidas dentales mostraron significancia estadística con la variable edad (p<0,05). El género, el hábito de fumar y el grado de escolaridad no mostraron asociación significativa (p>0,05) con las razones de las pérdidas dentales.

ABSTRACT: The aim of this study was to analyze the etiology of tooth loss in patients rehabilitated with dental implants. Was conducted a cross-sectional study with data from 93 patients from a private clinic who were treated with implants from the year 2000 until 2009. Data were collected through medical records, radiographic documentation and photographs of clinical cases. Data on sex, age, education level, smoking habits, teeth loss localization and extraction ratio were analyzed. The results showed that periodontal disease was the main reason for tooth loss, accounting for 24.7 %, followed by root fractures with posts (23.7 %) and secondary caries (15.1 %). In patients below 40 years, dental trauma and root fractures were responsible for most of the losses. The reasons for tooth loss showed statistical significance with the age (p<0.05). Sex, smoking habits and education showed no significant association (p>0.05) with the reasons of the tooth loss.

Aesthetic perception of gingival smiles / Percepção estética do sorriso gengivoso

Introduction: Dentists have shown interest in learning new techniques to create more attractive smiles, but with little concern for understanding the reasons why the patient is dissatisfied. Objective: To evaluate the aesthetic perception of laypersons in dentistry in comparison with general practitioner dentists and periodontists regarding the gingival smile, and to compare this aesthetic perception between the male and female genders. Methodology: A photograph of a standard smile was taken and was digitally modified to create the periodontal conditions of a gingival smile from 0.5 mm to 2.5 mm. The photographs were judged by 150 individuals (25-65 years of age), 81 female and 69 male, divided into three groups: 50 laypersons, 50 general practitioners and 50 periodontists. The evaluation was performed using a visual analog scale. The statistical evaluation tests used were the Pearson Chi squared test, Student's t-test, ANOVA and Newman-keuls. Result: The aesthetic perceptions among the professionals are similar, and they observe more subtle changes in the aesthetics of the smile than the laypersons observe. The general practitioners and periodontists were similarly sensitive to changes generated in the gingival smile when these reached 1.5 mm, while laypersons only perceived them when these changes reached 2.5 mm. There was no significant difference in the aesthetic perception of male and female evaluators in any of the groups. Conclusion: The aesthetic perception of the gingival smile between general practitioner dentists and periodontists was similar, and dental professionals were more demanding than the layperson. There was no difference between female and male aesthetic perceptions.

Introdução: Cirurgiões-dentistas têm mostrado interesse em conhecer novos meios para a construção de sorrisos mais atraentes, porém com pouca preocupação em entender os motivos pelos quais o paciente está insatisfeito. Objetivo: Avaliar a percepção estética de pessoas leigas em odontologia em comparação com dentistas clínicos gerais e periodontistas quanto ao sorriso gengivoso, e comparar esta percepção estética do gênero masculino e feminino. Metodologia: Foi realizada fotografia de um sorriso padrão e modificada digitalmente para criar as condições periodontais de sorriso gengivoso de 0,5mm até 2,5mm. As fotografias foram avaliadas por 150 indivíduos (25-65 anos), 81 do gênero feminino e 69 do masculino, divididos em três grupos: 50 leigos, 50 clínicos gerais e 50 periodontistas. A avaliação foi realizada por escala analógica visual. Os testes de avaliação estatística utilizados foram Quiquadrado de Person, t de Student, ANOVA e Newman-keuls. Resultado: As percepções estéticas entre os profissionais são semelhantes, e percebem mudanças na estética do sorriso mais sutis que leigos. Os clínicos gerais e os periodontistas foram sensíveis de forma semelhante às mudanças geradas no sorriso gengivoso quando estas chegaram a 1,5 mm, enquanto que os leigos só perceberam quando estas modificações chegaram a 2,5 mm. Em todos os grupos não houve diferença significativa da percepção estética de avaliadores do gênero masculino e feminino. Conclusão: A percepção estética do sorriso gengivoso entre dentistas clínicos gerais e periodontistas foi semelhante, e os profissionais de odontologia foram mais exigentes do que os leigos. Não houve diferença na percepção estética feminina e masculina.

Condição bucal e qualidade de vida em pacientes alcoolistas e não alcoolistas ­ estudo caso-controle / Buccal condition and quality of life in alcoholic and non-alcoholic patients ­ case-control study

Objetivo: estudar as concepções dos pacientes alcoolistas, alcoolistas cirróticos e cirróticos não alcoolistas quanto à percepção de qualidade de vida, condição periodontal, perda dentária e uso ou não de prótese dentária. Material e métodos: estudo caso-controle com 194 pacientes, com idades entre 25 e 73 anos, atendidos no Serviço de Gastroenterologia do Hospital Universitário Cassiano Antônio de Moraes (Hucam/Ufes), quanto aos parâmetros: profundidade de sondagem, nível de inserção clínica, índice de placa visível, sangramento gengival, sangramento a sondagem, supuração, mobilidade dentária, lesões de furca e questionário OHIP-14. Resultados: a condição clínica dos pacientes mostrou predomínio de má qualidade de vida marcada por perda dentária extrema. Foram observadas perdas de inserção periodontais, predominância de placa dentária (p=0,002) e bolsas periodontais profundas (< 6 mm) no grupo-caso (p=0,035). Alguns parâmetros do OHIP-14 com significância (p < 0,001) foram observados com a condição clínica médica, especialmente nas categorias dos problemas ao falar, sentimento de constrangimento social e mastigação. Uma comparação foi realizada para avaliar a percepção dos pacientes alcoolistas e desdentados em relação ao OHIP-14, utilizando apenas as primeiras (nunca) e as últimas (sempre) respostas. A resposta "nunca" apresentou maiores percentuais nas questões 1 (91,8%); 2 (82,7%); 6 (69,4%); 7 (70,7%); 8 (88,3%); 9 (80,0%); 12 (90,4%); 13 (69,2%); e 14 (89,8%). A pergunta 5 obteve a resposta "sempre" como a maior porcentagem (73,3%) para o mesmo grupo. Conclusão: a condição clínica dos pacientes mostra efeitos significativos ao se correlacionar os parâmetros do OHIP-14 com a condição periodontal deteriorada e ausência considerável de próteses dentárias.

Objective: in the present study we studied the conceptions of alcoholic, cirrhotic alcoholic and non-alcoholic cirrhotic patients regarding perception of quality of life, periodontal condition, tooth loss and use of dental prosthesis. Material and methods: we evaluated 194 patients aged 25-73 years, attending the Gastroenterology Department of the University Hospital Cassiano Antônio de Moraes (Hucam/Ufes), regarding the parameters: probing pocket depth, clinical attachment loss, visible plaque, marginal gingival bleeding, bleeding on probing, suppuration, dental mobility, furcation lesions, and OHIP-14 questionnaire. Results: the clinical condition of the patients showed a predominance of poor quality of life marked by extreme dental loss. Periodontal attachment losses, predominance of dental plaque (p=0.002) and signifi cant deep pockets ( 6 mm) were observed in the case group (p=0.035). Some OHIP-14 parameters with signifi cance (p < 0.001) were also observed with the medical clinical condition, especially in the categories of speech problems, feeling of social embarrassment and chewing. A comparison was made to evaluate the perception of alcoholic and edentulous patients in relation to OHIP-14 using the fi rst (never) and the last (always) answers. The answer "never" presented higher percentages in questions 1 (91.8%); 2 (82.7%); 6 (69.4%); 7 (70.7%); 8 (88.3%); 9 (80.0%); 12 (90.4%); 13 (69.2%); and 14 (89.8%). Question 5 obtained the answer "always" as the highest percentage (73.3%) for the same group. Conclusion: the clinical condition of patients shows signifi cant effects when correlating with OHIP-14 parameters with the medical clinical condition, deteriorated periodontal condition and considerable absence of dental prostheses.

A 3-Year Retrospective Evaluation of the Clinical Performance of Fiber Posts

This retrospective study evaluated the clinical outcome of 139 teeth restored with carbon fiber posts after 3 years of placement, considering the amount of remaining dentin as the main variable. Eighty-one patients received the fiber posts within a period of 16 months and were recalled after 3 years. The tooth type, amount of remaining dentin, and prosthetic crown material were evaluated. No loss of post or core retention was detected after 3 years of follow up. During the observed time, root or post fracture and secondary caries were not recorded. Only one failure concerning endodontic treatment was detected. The amount of remaining dentin was not an important characteristic in the restorative failure of endodontically treated teeth restored with carbon fiber posts within 3 years.

Resumo Este estudo avaliou de forma retrospectiva o desfecho clínico de 139 dentes restaurados com pinos de fibra de carbono após 3 anos em função, considerando a quantidade de dentina coronária remanescente como principal variável. Oitenta e um indivíduos receberam a cimentação dos pinos entre Janeiro de 2004 e Janeiro de 2005, e foram chamados para reavaliação após 3 anos. O tipo de dente restaurado, quantidade de dentina remanescente e material restaurador coronário foram avaliados. Nenhum caso de perda de retenção do pino e/ou núcleo foi encontrado durante o período de avaliação. Fraturas na raiz ou no pino e cáries secundárias também não foram registrados. Uma única falha foi encontrada em relação ao tratamento endodôntico. A quantidade de dentina remanescente não foi um fator importante para falha na restauração de dentes tratados endodonticamente, restaurados com pinos de fibra de carbono, após 3 anos de serviço clínico.

A 3-Year Retrospective Evaluation of the Clinical Performance of Fiber Posts.

This retrospective study evaluated the clinical outcome of 139 teeth restored with carbon fiber posts after 3 years of placement, considering the amount of remaining dentin as the main variable. Eighty-one patients received the fiber posts within a period of 16 months and were recalled after 3 years. The tooth type, amount of remaining dentin, and prosthetic crown material were evaluated. No loss of post or core retention was detected after 3 years of follow up. During the observed time, root or post fracture and secondary caries were not recorded. Only one failure concerning endodontic treatment was detected. The amount of remaining dentin was not an important characteristic in the restorative failure of endodontically treated teeth restored with carbon fiber posts within 3 years.

Association between intra-radicular posts and periapical lesions in endodontically treated teeth

Introduction: A significant number of endodontically treated teeth restored with posts have associated periapical lesions, and several authors have discussed the probable causes of the development of these. Attention has been focused on restorative procedures performed after endodontic treatment and their association with the prognosis of endodontic therapy because a number of root-filled teeth will require post- and core-retained restorations. Purpose: The purpose of this study was to evaluate, by examination of periapical radiographs, whether the placement of intra-radicular posts in endodontically treated teeth may act as a risk factor for development of periapical lesions. Material and Methods: This case-control study analyzed periapical radiographs of 72 endodontically treated teeth with coronal restorations. All radiographs were obtained from a single private practice. Specimens were assigned to 2 groups: Group 1 (control) was composed of teeth without periapical lesions and Group 2 (case) was composed of teeth with periapical lesions. The number of teeth with and without posts in each group was recorded. Three calibrated examiners analyzed the radiographs visually under X4 magnification. Results: In Group 1, 28 (65.1 percent) out of 43 teeth were restored with posts. In Group 2, 24 (82.8 percent) out of 29 teeth had intra-radicular posts. The interpretation of chi-square test showed that these percentages were not significantly different (x²=2.687; p=0.101). Odds ratio was 2.571 (0.815-8.118), which indicates that there was no statistically significant association between periapical lesions and posts. Conclusion: Intra-radicular posts placed in endodontically treated teeth were not a significant risk factor for development of periapical lesions in the practice where the cohort of patients was treated.

Association between intra-radicular posts and periapical lesions in endodontically treated teeth.

INTRODUCTION: A significant number of endodontically treated teeth restored with posts have associated periapical lesions, and several authors have discussed the probable causes of the development of these. Attention has been focused on restorative procedures performed after endodontic treatment and their association with the prognosis of endodontic therapy because a number of root-filled teeth will require post- and core-retained restorations. PURPOSE: The purpose of this study was to evaluate, by examination of periapical radiographs, whether the placement of intra-radicular posts in endodontically treated teeth may act as a risk factor for development of periapical lesions. MATERIAL AND METHODS: This case-control study analyzed periapical radiographs of 72 endodontically treated teeth with coronal restorations. All radiographs were obtained from a single private practice. Specimens were assigned to 2 groups: Group 1 (control) was composed of teeth without periapical lesions and Group 2 (case) was composed of teeth with periapical lesions. The number of teeth with and without posts in each group was recorded. Three calibrated examiners analyzed the radiographs visually under X4 magnification. RESULTS: In Group 1, 28 (65.1%) out of 43 teeth were restored with posts. In Group 2, 24 (82.8%) out of 29 teeth had intra-radicular posts. The interpretation of chi-square test showed that these percentages were not significantly different (x(2)=2.687; p=0.101). Odds ratio was 2.571 (0.815-8.118), which indicates that there was no statistically significant association between periapical lesions and posts. CONCLUSION: Intra-radicular posts placed in endodontically treated teeth were not a significant risk factor for development of periapical lesions in the practice where the cohort of patients was treated.

Pinos de fibras de carbono para a restauração de dentes tratados endodonticamente / Carbon fiber posts for the restoration of endodontically treated teeth

A restauração de dentes tratados endodonticamente utilizando os sistemas de pinos e núcleos ainda é um procedimento realizado com frequência na clínica odontológica. Os diferentes sistemas de pinos e núcleos que são comercializados apresentam diferença em suas propriedades dependendo do comportamento mecânico do material utilizado para a confecção desses sistemas. Por esta razão, Assif et al., Freedman e Duret et al. acreditam que alguns tipos de fraturas radiculares estão associadas com a presença de pinos intra-radiculares que possuem o módulo de elasticidade diferente ao da dentina, logo, podem concentrar tensões na estrutura radicular. Como o módulo de elasticidade dos pinos de fibra de carbono tem sido descrito como semelhante ao da dentina, este estudo se propõe a apresentar, por meio de uma revisão de literatura, as características dos pinos de fibra de carbono para a restauração de dentes tratados endodonticamente

Principais causas de fratura em dentes tratados endodonticamente / Main reasons for fracture in endodontically treated teeth

Um problema freqüentemente associado a dentes tratados endodonticamente é a fratura de dentes. Devido ao prognóstico duvidoso de dentes fraturados, este trabalho verificou na literatura quais seriam as principais causas de fratura em dentes tratados endodonticamente, para que estes fatores possam ser contornados e a restauração destes dentes possa ser executada de forma mais favorável. Entre as principais causas citadas na literatura, a diminuição da quantidade de estrutura dentária parece ser a mais significativa e a utilização de pinos intra-radiculares deve ser feita com cautela. Fatores como alteração das propriedades mecânicas e do conteúdo de água, técnica de condensação lateral e corrosão de pinos intra-radiculares apresentaram importância secundária...

Materiais de moldagem do grupo dos elastômeros: um levantamento racionalizado de suas aplicações clínicas / Elastomeric impression materials: a rationale survey of its clinical applications

Os materiais de moldagem do grupo dos elastômeros estão cada vez mais difundidos entre os clínicos e representam grande parte dos materiais de moldagem disponíveis no mercado. Devido ao grande número de opções, a seleção do material de moldagem ideal para cada situação clínica tornou-se um processo complicado. Consiste num levantamento realizado entre professores das áreas de prótese e materiais dentários por meio de um questionário, com o objetivo de apurar os materiais do grupo dos elastômeros mais indicados em diversas situações clínicas propostas, sua respectiva marca comercial, a técnica aplicada e a justificativa apresentada para a indicação. Essas informações podem auxiliar o clínico em sua prática diária. As siliconas e os polissulfetos foram os elastômeros mais indicados. A capacidade de reprodução de detalhes e as propriedades mecânicas do material, relacionadas com fatores, como rapidez e praticidade da técnica associada, foram aspectos bastante considerados pelos profissionais

Avaliaçäo do desajuste cervical de coroas metalocerâmicas, obtidas a partir da fundiçäo com cinco ligas de Ni-Cr e duas porcelanas odontológicas / Evaluation of the cervical disadjustment of metal ceramic crowns, by casting with five Ni-Cr alloys and two dental porcelains

O presente trabalho teve como objetivo avaliar o desajuste cervical de infra-estruturas para coroas metalocerâmicas, antes e após a aplicaçäo de porcelana. Cinco marcas comerciais de liga de Ni-Cr foram usadas (Biobond II, Durabond II, Kromalit, Nicrodent e Resistal P). Cem troquéis de gesso foram obtidos a partir de um outro metálico com características de um preparo para coroa metalocerâmica. Cinco conjuntos troquel/matriz de gesso foram confeccionados para padronizar a forma e espessura dos padröes de cera que, a seguir, foram fundidos e divididos aleatoriamente em dois grupos de cinquenta casquetes, sendo dez para cada liga estudada. O desajuste cervical foi entäo avaliado em microscópio comparador. Após esse procedimento, a porcelana foi aplicada e uma matriz de silicona (Provil P) foi usada para padronizar a forma e espessura da porcela...

Escultura negativa: aplicaçäo clínica / Negative carving technique: clinical application

Técnica de escultura negativa para obtençäo de superfícies oclusais de coroas provisórias ou metálicas fundidas, com o objetivo de satisfazer os princípios oclusais envolvidos nos diferentes tipos de trabalhos de prótese (fixa, total ou removível)