Comparative analysis of biomechanical response between zygomatic implant and Facco technique through the three-dimensional finite element method.

Background: The placement of zygomatic implants is an alternative used for rehabilitation of edentulous patients with atrophic maxilla. However, the complexity of the various techniques suggested in the literature requires high skill from surgeons. Aim: The objective of this research was to compare the biomechanical performance of traditional technique of zygomatic implant placement in relation to a new proposal, the Facco technique, through finite element analysis. Material and Methods: A three-dimensional geometric model of the maxilla was input into computer-aided design software (Rhinoceros version 4.0 SR8). STL file of the geometric models of implants and components supplied by the company Implacil De Bortoli was converted to volumetric solids through reverse engineering by RhinoResurf software (Rhinoceros version 4.0 SR8). Three groups were modeled: traditional technique, Facco technique without frictional contact and Facco technique with frictional contact, following the recommended position in each technique for implant placement. All models received a maxillary bar. Groups were exported to the computer-aided engineering software ANYSYS 19.2, in step format. Mechanical static structural analysis was requested with occlusal load of 120N. All elements were considered isotropic, homogeneous, and linearly elastic. Contacts were considered ideal and system fixation was considered at the bone tissue base. Results: There is similarity between the techniques. Microdeformation values capable of generating undesirable bone resorption were not observed in both techniques. Highest values in the posterior region of Facco technique were computed at the angle of part B close to the posterior implant. Conclusions: Biomechanical behaviors of the two evaluated zygomatic implant techniques are similar. Prosthetic abutment (pilar Z) modifies the distribution of stresses over the zygomatic implant body. Highest stress peak was found in the pilar Z, but it is within acceptable physiological limits. Key words:Atrophic maxilla, zygomatic implants, surgical techniques, pilar Z, dental implants.

Fatigue survival of endodontically treated teeth restored with different fiber-reinforced composite resin post strategies versus universal 2-piece fiber post system: An in vitro study.

STATEMENT OF PROBLEM: Various strategies have been proposed to reduce the cement space of foundation restorations for endodontically treated teeth. However, they may add more operative steps, or the dentist must keep different sizes of drills and posts in stock. A 2-piece universal adjustable post system has been developed to overcome this problem, but whether the system has acceptable fatigue survival performance is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the fatigue survival and stress distribution of endodontically treated teeth without a ferrule and restored with different glass fiber post strategies versus a recently introduced universal 2-piece fiber post system. MATERIAL AND METHODS: Bovine incisor roots were randomly assigned to 3 groups as per the post used (n=13): adapted glass fiber post with post space preparation of the same size, composite resin-custom glass fiber post (CTM), and universal 2-piece glass fiber-reinforced composite resin post (UNI). The posts were adhesively luted, the composite resin core was added, and a composite resin crown was produced with computer-aided design and computer-aided manufacturing (CAD-CAM), and then adhesively luted to each core. A fatigue test was performed with the stepwise stress method (10 000 cycles/step; 20 Hz; load=100 N to 750 N; step=50 N) until fracture, and the failure mode analyzed. The stress distribution was evaluated by finite element analysis with the maximum principal stress criteria by following the parameters of the in vitro test. The solids were considered homogeneous, linear, and isotropic, except for the glass fiber post (orthotropic), and a load of 450 N at 30 degrees was applied. The fatigue failure load and the number of cycles for failure were analyzed with Kaplan-Meier and Mantel-Cox (log rank test) (α=.05). The finite element analysis results were analyzed with colorimetric graphs. RESULTS: The highest fatigue failure load and the number of cycles for failure were found in the UNI system, whereas the lowest results were found in the CTM group. All groups exhibited repairable failures. The finite element analysis showed the lowest stress in root dentin in the UNI system. The CTM system had the largest stress regions at the dentin and dentin-core interface. CONCLUSIONS: The use of a 2-piece universal glass fiber post system resulted in more fatigue behavior compared with composite resin-custom glass fiber posts.

Assessment of patient and dentist preference between conventional and digital diagnostic waxing.

Patient expectations for rehabilitations of a high esthetic standard as well as the demand for fast but efficient care have provided new work perspectives in dentistry. Dentists also have to choose between conventional and digital workflows. The aim of the present randomized restorative trial was to compare diagnostic waxing (DW) performed conventionally with its digital counterpart and to assess the two approaches from the point of view of both patient and dentist. Twenty patients with esthetic complaints were selected to undergo molding processes to obtain conventional study models on the one hand, and intraoral scanning to obtain virtual models on the other. Both the 2D planning and 3D virtual models were sent to the laboratory for the performance of DW. The restorative trial was evaluated by one evaluator dentist, while patient opinion was determined through customized questionnaires. The results show that although 80% of patients rated the digital method to be more convenient in terms of execution time and comfort and indicated that scanning was the most reliable way to obtain an impression, 65% chose the conventional DW for their esthetic restoration after the mock-up tests were performed and analyzed. The evaluating dentist preferred the conventional DW technique in 50% of cases assessed. The conclusion is that although digital technology has its advantages, the final esthetic result does not always meet the expectations and demands of patients and dentists.

Influence of different restorative material and cement on the stress distribution of ceramic veneer in upper central incisor.

AIMS: Considering new ceramic systems, doubts about the appropriate combination of ceramics and cement are common. SETTINGS AND DESIGN: To evaluate the influence of the elastic modulus (E) of cement agents associated with different indirect veneers on the stress distribution using finite element analysis. METHODS AND MATERIALS: The finite element analysis was applied to evaluate the stress distribution on the structures. For that, a computer-aided design software was used for a three-dimensional (3D) modeling of an upper central incisor with preparation for an indirect veneer. The model was imported into the analysis software in STEP (Standard for Exchange of Product data) format. Tetrahedral elements formed the mesh. Solids were considered isotropic, linearly elastic, homogeneous, and with ideal contacts. Load application (100N, 45°) occurred on the lingual face. Cement agents have their E classified as low, intermediate, and high. The ceramic materials used were a hybrid ceramic, a zirconia reinforced lithium silicate and a lithium disilicate. RESULTS: It was observed that none of the factors significantly influenced the stress concentration in dentine. Groups with high E cementing agent showed the highest stress peaks. The E of restorative material was significant for the stress generated in the veneer, and groups with hybrid ceramic presented more homogeneous stress results. CONCLUSIONS: The higher E of the cement agent and the ceramic, the higher the stress concentration, suggesting that hybrid ceramic associated with low elastic modulus resinous cement has superior biomechanical behavior.

Influence of the addition of glass fibers reinforcements in the flexural strength of acrylic resin / Influência da adição de reforço de fibra de vidro na resistência flexural de resina acrílica

Objective: To evaluate the influence of glass fiber reinforcements used in nautical and sports products on the flexural strength of acrylic resin. Materials and methods: Thirty thermos activated acrylic resin bars (25 x 10.5 x 3.3 mm) were used. The samples were shared in 3 groups: bars with no glass fiber (control group, n = 10), bars reinforced with glass fiber and 0.18 mm thickness (group F1, n = 10) and bars reinforced with glass fiber and 0.80 mm thickness (group F2, n = 10). After 48 hours, samples were submitted to compression test in order to evaluate flexural strength. Obtained data were statistically analyzed with significance level of 5 %. Results: It was observed that the use of glass fiber effectively increased the flexural strength compared to the control group; the thickness of the glass fiber, however, did not present statistical differences. Conclusion: The use of fiber glass is a simple and cost-effective alternative to improve acrylic resin performance. (AU)

Objetivo: Avaliar a influência do reforço de fibra de vidro usada em produtos esportivos náuticos na resistência flexural da resina acrílica. Materiais e métodos: Trinta barras de resina acrílica termoativadas (25 x 10.5 x 3.3 mm) foram confeccionadas. As amostras foram divididas em 3 grupos: barras sem fibra de vidro (grupo controle, n = 10), barras com reforço de fibra de vidro com espessura de 0.18 mm (grupo F1, n = 10) e barras com reforço de fibra de vidro com espessura de 0.80 mm (grupo F2, n = 10). Após 48 horas, as amostras foram submetidas ao ensaio de compressão para avaliar a resistência flexural. Os dados obtidos foram analisados estatisticamente com nível de significância de 5%. Resultados: Foi observado que o uso de fibra de vidro aumentou efetivamente a resistência à compressão comparado com o grupo controle; a espessura da fibra de vidro, no entanto, não apresentou diferença estatisticamente significante. Conclusão: O uso de fibra de vidro é uma alternativa simples e de baixo custo para aprimorar a performance das resinas acrílicas. (AU)

Effect of glass-fiber post on the biomechanical behavior of teeth with direct veneers / Efeito do pino de fibra de vidro no comportamento biomecânico de dentes com facetas diretas

Objective: This study aimed to evaluate the biomechanical behaviour of endodontically treated teeth with direct veneer that received or not intra-radicular glass fiber post by finite elements analysis. Material and methods: Six models were designed, varying the presence or absence of glass fiber post and the thickness of direct veneer (0.5, 0.7 and 1 mm). Tridimensional models of maxillary central incisors were obtained with CAD software, Rhinoceros 4.0, and transferred to CAE software, ANSYS 17.2, which a 100N load was applied in a 45° on the lingual surface to simulate functional movements. Geometry contacts were bonded, and the structures were isotropic, linear, elastics, and homogeneous. After coherence and convergence analysis of mashes, the chosen fail criterion was the maximum principal stresses. Results: For cement, glass fiber post, the stress distribution was similar independently of glass fiber post presence or veneer thickness. Models with glass fiber post had better stress distribution and lower values of maximum stress for inner dentin and veneers. Veneers with 0.5 and 1 mm had higher stress concentration areas. Conclusions: It can be concluded that glass fiber post is favorable for restored teeth with direct veneers, and very thin or very thick preparations can damage the biomechanical behavior of restorations.(AU)

Objetivo: Este estudo teve como objetivo avaliar o comportamento biomecânico de dentes tratados endodonticamente com faceta direta que receberam ou não pinos de fibra de vidro intrarradicular através de análise de elementos finitos. Material e métodos: Foram desenhados seis modelos, variando a presença ou ausência do pino de fibra de vidro e a espessura da faceta direta (0,5, 0,7 e 1 mm). Modelos tridimensionais de incisivos centrais superiores foram obtidos com o software CAD, Rhinoceros 4.0, e transferidos para o software CAE, ANSYS 17.2, cuja carga de 100N foi aplicada a 45° na superfície lingual para simular movimentos funcionais. Os contatos geométricos foram colados e as estruturas eram isotrópicas, lineares, elásticas e homogêneas. Após análise de coerência e convergência de malhas, o critério de falha escolhido foi a tensão principal máxima. Resultados: Para cimento e pino de fibra de vidro, a distribuição de tensões foi semelhante independentemente da presença do pino de fibra de vidro ou da espessura da faceta. Os modelos com pinos de fibra de vidro apresentaram melhor distribuição de tensão e menores valores de tensão máxima para dentina interna e facetas. Facetas com 0,5 e 1mm apresentaram maiores áreas de concentração de estresse. Conclusões: Pode-se concluir que o pino de fibra de vidro é favorável para dentes restaurados com facetas diretas, e preparações muito finas ou muito espessas podem prejudicar o comportamento biomecânico das restaurações.(AU)

Processamento de vitrocerâmicas a base de dissilicato de lítio com gradiente funcional de porosidade / Processing of glass-ceramic based of lithium disilicate with functional gradient of porosity

O desempenho das cerâmicas odontológicas é um aspecto bastante explorado na literatura, uma vez que o aprimoramento das suas características permite desenvolver materiais com maior longevidade. Trincas, delaminações, lascamentos e fraturas catastróficas são as falhas mais encontradas em restaurações cerâmicas. O objetivo dessa pesquisa foi conhecer o comportamento mecânico de coroas monolíticas gradadas e avaliar a possibilidade de produzir uma vitrocerâmica experimental a base de dissilicato de lítio com gradiente funcional de porosidade. Este trabalho foi dividido em duas partes: a primeira, teórico/computacional e a segunda, a fabricação do produto. 1) Através de software CAD foi modelado um molar inferior com preparo tradicional para coroa total e uma coroa total monolítica com camada de cimento resinoso entreposto. Quatro grupos foram compostos pela variação da composição das coroas totais: Coroa rígida (E=80 GPa), flexível (E=30 GPa), gradação bioinspirada (de 80 até 30 GPa) e gradação inversa (de 30 até 80 GPa). O modelo foi exportado para o software de análise. Os materiais foram considerados isotrópicos, linearmente elásticos e homogêneos, com contatos ideais. Uma força de 300N foi aplicada na face oclusal, a base do modelo foi fixada em todas as direções. A tensão máxima principal, tensão de Von-Mises e deslocamento foram utilizadas para observar o comportamento mecânico. 2) Uma mistura de óxidos foi homogeneizada e submetida à fusão. As fritas obtidas por resfriamento foram moídas e passaram por diferentes tratamentos térmicos, seguido das análises de DSC e DRX. Seis grupos experimentais foram obtidos: DL-E (vitrocerâmica densa a base de dissilicato de lítio simulando esmalte); DL-D (vitrocerâmica densa a base de dissilicato de lítio simulando dentina); DLGrad (vitrocerâmica gradada a base de dissilicato de lítio); YTZP-E (vitrocerâmica densa reforçada por YTZP simulando esmalte); YTZP-D (vitrocerâmica densa reforçada por YTZP simulando dentina); YGrad (vitrocerâmica gradada reforçada por YTZP). Suspensões aquosas contendo 23 e 30%-vol. de pó de vidro foram preparadas e submetidos à técnica de gel casting para formar um gradiente funcional. As vitrocerâmicas com e sem gradiente funcional de porosidade foram caracterizadas pelas técnicas de DRX, FEG, densidade e porosidade aparentes. Também foram realizados ensaios mecânicos de resistência à flexão biaxial e fractografia. Os resultados obtidos foram estatisticamente avaliados por Anova 1 fator e Tukey (p<0,05). As micrografias mostraram formação de gradiente funcional de porosidade apenas nas vitrocerâmicasa base de dissilicato de lítio. Não houve diferença entre as densidades de todos as vitrocerâmicas estudadas, porém YTZP-E, YTZP-D e YTZP-Grad apresentaram porosidade 10% maior do que as vitrocerâmicassem zircônia. Os defeitos críticos na superfície das vitrocerâmicas são semelhantes em todas condições estudadas, porém a aleatoriedade de poros internos das vitrocerâmicas contendo YTZP proporcionaram diminuição da resistência à flexão, com diferença estatisticamente significante em relação às vitrocerâmicas sem YTZP. Entre as vitrocerâmicas densas e gradadas não houve diferença na resistência à flexão. Conclui-se que a adição de zircônia em sistema a base de SiO2-Li2O alterou a temperatura de sinterização, o padrão de porosidade, a resistência flexural e comprometeu a formação do gradiente funcional de porosidade. O comportamento mecânico das vitrocerâmicas à base de dissilicato de lítio densas e gradadas são similares(AU)

The performance of dental ceramics is very explorated at literature, once the enhancement of yours features allow the development of materials with higher longevity. Cracks, delamination, chipping and catastrophic fracture are the faillures most finds at ceramics restorations. The aim of this research was knew the mechanical behavior of monolithics graded crows and it was evaluated the possibility to produce a glass ceramic based of lithium disilicate with gradient of porosity. This research was divided into two parts: the first one, theoretical computational and the second, the manufacturing product. 1) Using a CAD software, a lower molar received a full-crown preparation. The monolithic crown was modeled with a resin cement layer of 0.1 mm. Four groups were distributed according to the full crown elastic modulus (E):(a)Bioinspired crown with regressive elastic gradation (from 80 to 30 GPa); (b) Crown with regressive elastic gradation (from 30 to 80 GPa); (c) Rigid crowns and (d) Flexible crown. The model was exported to the analysis software and meshed into 385,240 tetrahedral elements and 696,310 nodes. Materials were considered isotropic, linearly elastic, and homogeneous, with ideal contacts. A 300-N load was applied at the occlusal surface and the base of the model was fixed in all directions. The results were required in Maximum principal stress, Von-Mises Stress and Displacement. 2) A mixture of oxides was homogenized and it was melted at fusion. The glass frits get by cooling were grinded and passed through heat treatment accordin to CSD and RXD. Six groups were obtained: DL-E (glass ceramic dense based of lithium disilicate simulating enamel); DL-D (glass ceramic dense based of lithium disilicate simulating dentin); DL-Grad (glass ceramic graded based of lithium disilicate); YTZP-E (glass ceramic dense reforced by YTZP simulating enamel); YTZP-D (glass ceramic dense reforced by YTZP simulating dentin); YTZP-Grad (glass ceramic graded and reforced by YTZP). Twenty-three and 40% of glass powder were prepared through dispersion water and it was submitted for techinique of gel casting to form functional gradient. The samples with and without functional gradient of porosity were characterized by RXD, FEG, density of all the groups, however YTZP-E, YTZP-D and YTZP-Grad showed porosity 10% greater the groups without zirconia. The critical flaw at surface of the ceramics were similar to the groups, however the random of internal pores at groups with YTZP get the flexural strength lower, with statistical difference with the groups without YTZP. Among the dense and graded groups were not statistical differences at flexural strength. It concluded that add of zirconia at ceramic system based of SiO2-Li2O changed the temperature of sintering, the standard of porosity, flexural strength and compromised the development of functional gradient of porosity. The mechanical behavior of ceramics based at lithium disilicate dense and graded were similar(AU)

Color assessment in dental prostheses: the use of smartphones as process tools / Tomada de cor em prótese dentária: Uso de celular como auxílio do processo

Accurate color selection of direct or indirect dental restorations is a subjective task. Mobile phones are tools that may minimize color assessment errors. The objective was to use photographs taken with smartphones to guide the dental surgeon in choosing the right color in oral rehabilitation. A tooth was photographed for color assessment and the VITA Toothguide 3D-MASTER® shade guide was used. Photographs were submitted to an image editing software for full saturation removal. Images of the tooth and scale in black and white were compared. This method allowed to select the tooth's value, which is considered the most subjective dimension in color choice. Although it is an auxiliary and complementary method to traditional methods, smartphones are tools capable of reducing the range of color possibilities and minimizing possible failures (AU)

A correta seleção da cor das restaurações dentais diretas ou indiretas é uma atividade subjetiva. Os celulares são ferramentas que podem minimizar os erros da tomada de cor. O objetivo foi utilizar fotografias realizadas com smartphones para orientar o cirurgião-dentista na escolha da cor em reabilitação oral. Foi fotografado um dente para tomada de cor e a escala Vita 3D Master. As imagens foram submetidas a um software de edição de imagem para remoção total da saturação. As imagens em preto e branco do dente e da escala foram comparadas. A metodologia permitiu selecionar o valor do dente que é o aspecto considerado mais subjetivo na escolha da cor. Apesar de ser um método auxiliar e complementar aos métodos tradicionais é uma ferramenta capaz de diminuir o leque de possibilidades de cores e minimizar possíveis falhas (AU)

Stress distribution and failure load of multilayer and monolayer glass ceramic / Distribuição de tensão e carga para fratura de cerâmica vítrea em multicamada e em monocamada

This short report evaluated the differences in stress concentration and the load to fracture of multilayered and monolayer glass ceramic discs. Using a simulated static structural analysis, the 3D model of the samples received a load of 150 N and results in maximum principal stress were obtained. For the in vitro analysis, the samples (ø 12 mm) were submitted to a compressive test (100 kgf, 1 mm/min). The data was analyzed using one-way analysis of variance and Tukey test (α = 5%). The monolayer group showed a lower stress peak (129.24 MPa) and higher load to fracture (118.38 N) than the multilayered group with 211.04MPa and 48.34N, respectively. All samples presented catastrophic failure with its origin on the tensile surface. Therefore, the monolayer ceramic group showed superior mechanical behavior than the multilayered group. (AU)

Este relato avaliou a diferença na concentração de tensão e a carga para fratura de discos de cerâmica vítrea em multicamada e monocamada. Usando uma análise estática estrutural simulada, o modelo 3D das amostras recebeu uma carga de 150 N e resultados de tensão máxima principal foram obtidos. Para a análise in vitro, as amostras (ø 12 mm) foram submetidas a um teste de compressão (100 kgf, 1 mm / min). Os dados foram analisados por análise de variância e teste de Tukey (α = 5%). O grupo em monocamada mostrou um menor pico de tensão (129,24 MPa) e maior carga para fratura (118,38N) do que o grupo multicamada com 211,04 MPa e 48,34 N, respectivamente. Todas as amostras apresentaram falha catastrófica com sua origem na superfície de tração. Portanto, o grupo em monocamada apresentou comportamento mecânico superior ao grupo multicamadas. (AU)

Influence of ceramic material, thickness of restoration and cement layer on stress distribution of occlusal veneers.

The aim of this study was to evaluate stress distribution in an occlusal veneer according to the restorative material, restoration thickness, and cement layer thickness. A tridimensional model of a human maxillary first molar with an occlusal veneer preparation was constructed using a modeling software of finite element analysis. The model was replicated 9 times to evaluate the factors: restoration thickness (0.6, 1.2, and 1.8 mm) and cement layer thickness (100, 200, and 300 µm). Then, each model received different restorative materials (High Translucency Zirconia - [YZHT], Lithium Disilicate - [LD], Zirconia Reinforced Lithium Silicate - [ZLS], Feldspathic - [F], and Hybrid Ceramic - [HC]), totaling forty-five groups. An axial load (600 N) was applied on the occlusal face for static structural analysis. Solids were considered isotropic, homogeneous, and linearly elastic. Contacts were considered perfectly bonded. Fixation occurred in the dental root and a mechanical static structural analysis was performed. Descriptive statistical analysis and one-way ANOVA (α =10%) were performed for tensile stress peak values in the restoration and cement layer. The difference between groups was compared using the Tukey's test with 10% significance to match the percentage of the mesh convergence test. According to the results, the cement layer thickness did not influence stress distribution in the restoration (p ≥ 0.10). The thicker the restoration, the higher the tensile stress concentration in the restoration. The graphs showed higher stress concentration in the YZHT, followed by LD, F, ZLS, and HC. Also, the restorative material influenced stress concentration on the cement layer, which decreased according to the sequence HC>YZHT>ZLS>LD>F. HC stood out for causing the least stress concentration in the restoration. Cement layer thickness did not interfere in the mechanical performance of the restorations.

Effect of different surface treatments on the ceramic veneer surface: morphological analysis / Efeito de diferentes tratamentos na superfície da cerâmica de revestimento: análise morfológica

Objective: The aim of this study was to evaluate the effect of different surface clinical treatments on the roughness (Ra) of a lithium disilicate ceramic veneer. Material and Methods: Forty-eight lithium disilicate discs with ceramic veneer and glaze layer were manufactured and distributed into six groups (n=8) according to the surface treatment performed: G1, glaze layer (control group); G2, diamond bur 4138F; G3, diamond bur 4138F + 4138FF; G4, diamond bur 4138F + new glaze layer; G5, diamond bur 4138F + ceramic polishing kit; G6, diamond bur 4138F + rubber cup with diamond paste + felt with diamond paste. Surface Ra measurement (µm) was performed using a profilometer before and after surface treatments, and one specimen from each group was subjected to Scanning Electron Microscopy (SEM) after treatment. Two-way ANOVA and Tukey's test (5%) were used for data analysis. Results: Group 2 (3,00 ± 0,61)b showed higher values of Ra, followed by Group 3 (1,93 ± 0,45)c , Group 6 (1,56 ± 0,22) ac, Group 5 (1,14 ± 0,68)a and Group 4 (0,90 ± 0,26)a . G4, G5 and G6 were not different between each other and control group (1,11 ± 0,21)a . SEM imaging revealed surface smoothness in G1, G4 and G5, and presence of irregularities in G2, G3 and G6. Conclusion: it is possible to conclude that different surface clinical treatments influences the roughness of a lithium disilicate ceramic veneer (AU)

Objetivo: o objetivo deste estudo foi avaliar o efeito de diferentes tratamentos clínicos de superfície na rugosidade (Ra) de uma cerâmica de cobertura de dissilicato de lítio. Material e Métodos: foram fabricados e distribuídos quarenta e oito discos de dissilicato de lítio com cerâmica de revestimento e vitrificação em seis grupos (n = 8) de acordo com o tratamento de superfície realizado: G1, camada vitrificada (control group); G2, ponta diamantada 4138F; G3, ponta diamantada 4138F + 4138FF; G4, ponta diamantada 4138F + nova camada vitrificada; G5, ponta diamantada 4138F + kit de polimento cerâmico; G6, ponta diamantada 4138F + taça de borracha com pasta diamantada + feltro com pasta diamantada. A análise da superfície Ra (µm) foi realizada usando-se um perfilômetro antes e depois dos tratamentos de superfície, e uma amostra de cada grupo foi à Microscopia Eletrônica de Varredura (MEV) após o tratamento. Two-way ANOVA e o teste de Tukey (5%) foram utilizados para análise de dados. Resultados: O Grupo 2 (3,00 ± 0,61)b apresentou valores mais altos de Ra, seguido do Grupo 3 (1,93 ± 0,45) c , Grupo 6 (1,56 ± 0,22)ac, Grupo 5 (1,14 ± 0,68)a e Grupo 4 (0,90 ± 0,26)a . G4, G5 e G6 não eram diferentes entre si e entre grupo de controle (1,11 ± 0,21)a . A imagem de MEV revelou suavidade da superfície em G1, G4 e G5, e presença de irregularidades em G2, G3 e G6. Conclusão: é possível concluir que diferentes tratamentos clínicos de superfície influenciam a rugosidade de uma cerâmica de revestimento de dissilicato de lítio.(AU)

Crepping attachment tardio ­ relato de caso com três anos de acompanhamento / Delayed creeping attachment occurence ­ a case report with 3 years of follow-up

O objetivo desse artigo foi apresentar, através de um caso clínico, o efeito do creeping attachment com acompanhamento constante até três anos após a cirurgia de recobrimento radicular. Paciente do sexo masculino relatava sensibilidade na região inferior do lado esquerdo e buscava resolução para sua queixa. Em exame físico, foram observadas recessões gengivais dos dentes 32 ao 35. Optou-se então pelo tratamento cirúrgico. Após incisão tipo sulcular e rebatimento do retalho de espessura parcial, realizou-se regularização das raízes dos dentes 33 ao 35. As papilas foram mantidas e em seguida foi realizado o enxerto de tecido conjuntivo heterógeno; o retalho foi posicionado coronariamente e suturado nas papilas remanescentes. Foi realizado o acompanhamento pós-cirúrgico nos períodos de sete, 30, 60 e 180 dias, dois e três anos. Com 180 dias já era possível notar a presença de tecido queratinizado bem definido e fixado na linha mucogengival. O fenômeno de creeping attachment foi observado dois anos e oito meses após a cirurgia. A partir do caso clínico, concluiu-se que, quando há pouca ou nenhuma perda de papila interproximal classificada em classe I e II de Miller, o creeping attachment certamente ocorrerá, desde que haja uma manutenção adequada da região.

The purpose of this article was to present, through a clinical case, the effect of creeping attachment with constant recalls up to three years after root coverage surgery. A male patient reported tenderness in the lower left mandibular side and sought resolution for his complaint. On physical examination, gingival recessions of the teeth 32 to 35 were observed. Then, the surgical treatment was proposed. After a sulcular type incision and partial-thickness flap elevation, the roots of the teeth 33 to 35 were regularized. The papillae were maintained and the heterogeneous connective tissue graft was performed. The flap was positioned coronally and sutured in the remaining papillae. Post-surgical follow-up was performed after 7, 30, 60 and 180 days, two and three years later. At 180 days it was already possible to notice the presence of a well-defi ned keratinized tissue attached to the mucogingival line. The creeping attachment phenomenon was observed after two years and eight months. From this clinical case, it was concluded that, when there is little or no loss of interproximal papilla (Miller's Class I and II), the creeping attachment will certainly occur, provided that there is adequate maintenance of the region.

Reabilitação estético funcional ­ conjugação de restaurações em resina direta, laminados ultrafinos e onlays cerâmicas / Functional aesthetic rehabilitation ­ conjugation of restorations in direct resin, ultra-thin laminates and ceramic onlays

A dinâmica clínica em reabilitação oral requer um planejamento criterioso para conduzir o sucesso do tratamento, exemplificado pela atenção às características individuais de cada paciente, auxiliando na escolha de materiais restauradores que possibilitem a preservação da estrutura dental e que apresentem propriedades favoráveis para funções biomecânicas similares aos dentes naturais. Uma opção válida é propiciar o restabelecimento estético e funcional através de restaurações cerâmicas, primordialmente associadas ao correto diagnóstico e planejamento. O objetivo deste trabalho foi abordar os principais aspectos relacionados à reabilitação oral, utilizando cerâmicas odontológicas, por meio do relato de um caso. Para maior previsibilidade do mesmo e para otimização do tempo de trabalho, utilizou-se DSD, enceramento diagnóstico e matriz de silicone translúcida associada com resina composta flow. A harmonização e o equilíbrio do sistema pelo restabelecimento da oclusão através do trabalho baseado na DVO e nos desgastes oclusais também são de extrema importância para um resultado final efetivo. Assim, respaldando-se também pela literatura atual, nota-se que laminados oclusais ultrafinos, resinas compostas e cerâmicas são capazes de satisfazer os requisitos biomiméticos, salvando tecidos dentários e restaurando estética.

The clinical dynamics of oral rehabilitation requires careful planning to conduct the sucess of a clinical case, which is exemplified by the attention to the individual characteristics of each patient. Giving support for the choice of the restorative materials which enable dental structure preservation and show favorable properties for biomechanical functions similar to the natural tooth. A valid option is to provide the aesthetic and functional restoration through ceramic restorations, primarily associated to correct diagnosis and planning. The aim of this research is to approach the main aspects related to oral rehabilitation, using dental ceramics through this case report. For a greater predictability of the case and optimization of the working time, DSD, mock-up and translucent silicone matrix approached with flow composite resin were used. The standardization and balance of the system through the occlusal reestablishment according to the VOD and dental attrition are extremely important for an effective end result. Thus, based on the current literature, it is noticed that ultrathin occlusal laminate, composite resin and ceramics are able to meet the biomimetic requeriments, preserving dental tissues and restoring aesthetics.

Cirurgia peri-implantar com o uso de ultrassom cirúrgico piezoelétrico / Peri-implant surgery with ultrasound piezoelectric device

O objetivo deste artigo foi relatar um caso clínico com uso do instrumento piezoelétrico e enxertia no seio maxilar na mesma sessão clínica. Uma paciente do sexo feminino, 71 anos de idade, apresentou-se com queixa de desconforto na região maxilar direita, motivo da fratura radicular no dente 26. Após a análise tomográfica, a altura óssea residual era de 3 mm. Assim, através de uma janela cirúrgica vestibular e pelo levantamento da membrana do seio maxilar com dispositivo piezoelétrico, foi instalado um implante dentário. O procedimento foi completado pela colocação de uma membrana reabsorvível e um biomaterial liofilizado associado ao PRP. As potencialidades do dispositivo piezoelétrico (diminuição do aquecimento no corte, não perfuração da membrana Schneideriana, bem como o sangramento reduzido) o tornam ideal do ponto de vista regenerativo e para colocação dos implantes dentários no seio maxilar.

The aim of this article was to report a clinical case using the piezoelectric device for simultaneous maxillary sinus lifting and dental implant placement. A 71 years-old female patient presented to the clinics with discomfort at the region of tooth 26 due to root fracture. After CBCT examining, the residual bone height was 3 mm. Thus, it was decided to open a lateral buccal window and to lift the sinus membrane using the piezosurgical unit, followed by dental implant placement. The procedure was completed by insertion of a collagen resorbable membrane associated to lyophilized bone and PRP. The potentials of piezosurgery (less heating, less membrane perforation, and reduced bleeding) make it ideal for regenerative procedures involving implant placement at the maxillary sinus region.