Clareamento dentário como etapa prévia à restauração de dentes com alteração severa de cor / Dental bleaching as a step prior to restoration of severe discolored teeth

RELATO DE CASO: Paciente do gênero masculino, 30 anos, procurou serviço odontológico especializado devido à insatisfação com o escurecimento dos elementos 11 e 21. Facetas indiretas em cerâmica foram indicadas no planejamento inicial. Previamente à realização do tratamento restaurador, foi proposta a realização de clareamento dentário dos dentes escurecidos. Após o sucesso obtido pela associação das técnicas de clareamento não vital em consultório, e clareamento caseiro, foi traçado novo planejamento, pautando a realização de facetas diretas em resina composta. Assim, foram realizadas facetas em resina composta (elementos 11, 12, 21 e 22), instalação de pinos de fibra de vidro (elementos 11 e 21), além de ajuste cosmético (elemento 23), tendo como resultado principal a estética do sorriso e a satisfação do paciente. CONCLUSÃO: O clareamento dentário, como uma etapa prévia ao tratamento restaurador de dentes escurecidos, orientou a definição do plano de tratamento e contribuiu para adoção de procedimentos menos invasivos

CASE REPORT: Male patient, 30 years, looked for specialized dental service due to dissatisfaction about darkening elements #11 and #21. Firstly, indirect ceramic veneers were indicated and in order to achieve a better aesthetic result tooth whitening was secondly proposed. As soon as the combination of non-vital and home bleaching techniques succeeded, a new treatment planning was drawn approaching the use of direct composite resin veneers. Resin veneers (elements #11, #12, #21, #22), fiber post cementation (elements #11 and #21), and cosmetic adjustment (element #23) were made, resulting in smile aesthetics and patient satisfaction. CONCLUSION: Tooth bleaching as a step prior to restorative treatment of discolored teeth guided the treatment planning design and contributed to the adoption of less invasive procedures

Effect of dentin pre-treatment with a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste on dentin bond strength in tridimensional cavities.

OBJECTIVE: This study aimed to evaluate the push-out bond strength of dimethacrylate (Clearfil SE Bond/Filtek Z250; and Adper SE Plus/Filtek Z250) and silorane-based (Filtek P90 adhesive system/Filtek P90 composite resin) restorative systems following selective dentin pre-treatment with a CPP-ACP-containing paste (MI Paste). MATERIALS AND METHODS: Sixty bovine incisors were utilized. The buccal surface was wet-ground to obtain a flat dentin area. Standardized conical cavities were then prepared. Adhesive systems were applied according to manufacturers' directions and the composites were bulk-inserted into the cavity. The push-out bond strength test was performed at a universal testing machine (0.5 mm/min) until failure; failure modes were analyzed by scanning electron microscopy. Data were analyzed by two-way ANOVA and Tukey post-hoc test (p < 0.05). RESULTS: For Clearfil SE Bond/Filtek Z250 and Filtek P90 adhesive system/Filtek P90 composite resin, the dentin pre-treatment did not influence bond strength means. For Adper SE Plus/Filtek Z250, dentin samples treated with MI Paste had statistically higher bond strength means than non-treated specimens. Adhesive failures were more frequent. CONCLUSION: Dentin pre-treatment with the CPP-ACP containing paste did not negatively affect bond strength for Clearfil SE Bond/Filtek Z250 and Filtek P90 adhesive system/Filtek P90 composite resin restorative systems and improved bond strength for the Adper SE Plus/Filtek Z250 restorative system.

Filler morphology of resin-based low-viscosity materials and surface properties after several photoactivation times.

AIM: This study aimed to characterize the morphology of filler particles and to analyze the effect of shortened and extended photoactivation times on hardness (VHN) and cross-link density (CLD) of resin-based low-viscosity materials. METHODS: Sixteen commercially available materials were tested: four fissure sealants (Alpha Seal, Fluroshield Yellowed, Bioseal and Fluroshield White) and 12 flowable composites (Opallis T, Permaflo T, Opallis A2, Natural Flow A2, Master Flow A2, Permaflo A2, Filtek Z350 A2, Natural Flow O, Master Flow OA2, Opallis OA3.5, Filtek Z350 OA3, Opallis OP) at six curing times (10 s, 20 s, 30 s, 40 s, 50 s and 60 s). Specimens were fabricated (n = 5), analyzed by Scanning Electron Microscopy, by VHN and by CLD. RESULTS: Unimodal and multimodal filler particles sizes with spherical and irregular shapes were observed. Unfilled materials were also detected. There were no differences among curing times for either VHN or CLD. Opallis A2 and Opallis OA3.5 showed the highest VHN at all curing times, whereas Master Flow A2 and Master Flow OA2 presented the lowest VHN. Opallis A2 presented the highest CLD at all curing times and Alpha Seal showed the lowest CLD. CONCLUSIONS: Filler particle morphology differed among the resin-based low-viscosity materials tested. The shortest photoactivation time tested could yield similar VHN and CLD means to those provided by the most extended photoactivation time.

O trabalho em equipe desenvolvido pelo cirurgião-dentista na Estratégia Saúde da Família: expectativas, desafios e precariedades / The teamwork developed by the surgeon dentist in the Family Health Strategy: expectations, challenges and precariousness / El trabajo en equipo desarrollado por el dentista en la Estrategia de Salud Familiar: expectativas, desafíos y debilidades

Este estudo objetivou conhecer a integração do cirurgião-dentista (CD) com os demais profissionais pertencentes à Estratégia Saúde da Família (ESF), bem como identificar o seu processo de trabalho dentro dessa equipe. O estudo desenvolveu-se no município de Parnamirim-RN, e dele participaram todos os CDs que atuam na ESF do município, num total de 30 profissionais. O Instrumento de coleta de dados utilizado foi um questionário semiestruturado e a variável dependente foi o trabalho em equipe. Os dados foram analisados por meio da estatística descritiva (distribuições absolutas e percentuais). Observou-se que os CDs não participam de forma integrada na equipe. A articulação das ações entre os membros da equipe não acontece de forma habitual e sistemática, como parte integrante de seu processo de trabalho (56,7%). Os profissionais de maneira geral mostraram-se insatisfeitos no desempenho de suas funções (63,3%). Sugere-se uma reflexão no tocante ao desenvolvimento do processo de trabalho em equipe com a participação efetiva do CD.

This study aimed to analyze the integration of the surgeon-dentist (SD) with other professionals belonging to the Family Health Strategy (FHS), as well as identify the work process within this team. The study was developed in the municipality of Parnamirim, State of Rio Grande do Norte, where all the dentists ­ in a total of 30, that work in the FHS took part in the survey. A semi-structured questionnaire was used for data collection. Teamwork was taken as dependent variable. Data were analyzed by descriptive statistics: absolute and percentage distributions. It was possible to observe that the dentists do not participate in an integrated way in the team. Joint actions among team members do not happen on a regular, systematic basis, as part of their work process (56.7%). The professionals, in general, are dissatisfied with the performance of their duties (63.3%). A reflection on the development of teamwork process in the FHS is needed.

El objetivo de este estudio fue caracterizar la integración entre el dentista y los demás profesionales pertenecientes a la Estrategia de Salud Familiar (ESF) e identificar su proceso de trabajo dentro de ese equipo. Participaron de este estudio los 30 profesionales dentistas que trabajan en la ESF del municipio de Parnamirim-RN. Los datos se recolectaron con un cuestionario semi-estructurado, siendo el trabajo en equipo la variable dependiente, y fueron analizados mediante estadística descriptiva (distribuciones absolutas y porcentuales). Se observó que los dentistas no participaban en un equipo integrado. La articulación de las actividades entre los miembros del equipo no ocurrió de forma habitual y sistemática, como parte integrante de su proceso de trabajo (56,7%). De manera general, los profesionales se mostraron insatisfechos con el desempeño de sus funciones (63,3%). Se sugiere una reflexión con relación al desarrollo del proceso de trabajo en equipo, con una efectiva participación de los dentistas.

Preliminary study of a novel in-office bleaching therapy modified with a casein phosphopeptide-amorphous calcium phosphate.

Although in-office bleaching has been proven successful for bleaching teeth, controversy exists from morphological alterations in enamel morphology due to mineral loss and tooth sensitivity. This preliminary study aimed to evaluate the efficacy of a novel in-office tooth bleaching technique modified with a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste (MI paste-MI) and its effect on the enamel morphology and tooth sensitivity. Three patients received a 35% hydrogen peroxide (Whiteness HP-HP) dental bleaching system. HP was prepared and applied on the teeth on one of the hemiarches, whilst teeth on the other hemiarch were bleached with a mixture of HP and MI. Tooth color, epoxy resin replicas, and sensitivity levels were evaluated in the upper incisors. The results were analyzed descriptively. Right and left incisors showed similar color change after bleaching. Incisors bleached with the mixture of HP and MI presented unaltered enamel surfaces and lower sensitivity levels. The currently tested tooth bleaching technique did not reduce the gel effectiveness while decreasing hypersensitivity levels and protecting the enamel against surface alterations caused by the high-concentration bleaching peroxide tested. The concomitant use of MI Paste and high-concentration hydrogen peroxide might be a successful method for decreasing tooth sensitivity and limiting changes in the enamel morphology during in-office bleaching.

Impact of adhesive and photoactivation method on sealant integrity and polymer network formation

We evaluated the influence of photoactivation method and hydrophobic resin (HR) application on the marginal and internal adaptation, hardness (KHN), and crosslink density (CLD) of a resin-based fissure sealant. Model fissures were created in bovine enamel fragments (n = 10) and sealed using one of the following protocols: no adhesive system + photoactivation of the sealant using continuous light (CL), no adhesive system + photoactivation of the sealant using the soft-start method (SS), HR + CL, or HR + SS. Marginal and internal gaps and KHN were assessed after storage in water for 24 h. The CLD was indirectly assessed by repeating the KHN measurement after 24 h of immersion in 100% ethanol. There was no difference among the samples with regard to marginal or internal adaptation. The KHN and CLD were similar for samples cured using either photoactivation method. Use of a hydrophobic resin prior to placement of fissure sealants and curing the sealant using the soft-start method may not provide any positive influence on integrity or crosslink density.

Impact of adhesive and photoactivation method on sealant integrity and polymer network formation.

We evaluated the influence of photoactivation method and hydrophobic resin (HR) application on the marginal and internal adaptation, hardness (KHN), and crosslink density (CLD) of a resin-based fissure sealant. Model fissures were created in bovine enamel fragments (n = 10) and sealed using one of the following protocols: no adhesive system + photoactivation of the sealant using continuous light (CL), no adhesive system + photoactivation of the sealant using the soft-start method (SS), HR + CL, or HR + SS. Marginal and internal gaps and KHN were assessed after storage in water for 24 h. The CLD was indirectly assessed by repeating the KHN measurement after 24 h of immersion in 100% ethanol. There was no difference among the samples with regard to marginal or internal adaptation. The KHN and CLD were similar for samples cured using either photoactivation method. Use of a hydrophobic resin prior to placement of fissure sealants and curing the sealant using the soft-start method may not provide any positive influence on integrity or crosslink density.

Progression of non-cavitated lesions in dentin through a nonsurgical approach: a preliminary 12-month clinical observation.

OBJECTIVE: Considering the minimally invasive approach to dentistry, the scientific community has focused on non-invasive treatments for caries lesions. The aim of this study was to evaluate the efficacy of a nonsurgical approach to arrest occlusal non-cavitated dentin lesions through glass ionomer sealing. METHODS: In this controlled clinical trial, 51 teeth with clinically non-cavitated occlusal caries radiographically located beneath the enamel-dentine junction (radiolucent area) were selected among patients presenting a moderate to high risk of caries. The teeth were randomly divided into two groups: an experimental group receiving an application of Vidrion-R (SS White) glass ionomer and a control group not submitted to any clinical intervention. Caries progression was monitored by clinical and radiographic examination at 4-monthly intervals over a period of one year. In addition, marginal integrity of the sealant was evaluated in the experimental group. RESULTS: Clinical examination showed no statistical difference between the groups (P=.13). On the other hand, sealed teeth presented lower caries progression when analyzed by radiographic examination (P=.004). CONCLUSION: A glass ionomer sealant over non-cavitated occlusal caries lesions in dentin may not be sufficiently effective in arresting their progression.

Effect of irradiation times on the polymerization depth of contemporary fissure sealants with different opacities.

The aim of this study was to evaluate the depth of curing of 10 contemporary blue light-activated dental flowable materials at several opacities, influenced by different irradiation times using FT-IR spectroscopy. Fifty-five specimens (n = 5) with a 5-mm diameter and 1-mm thickness of translucent (Opallis Flow T), yellowed (Master Flow A2; Opallis Flow A2; Natural Flow A2; Fluroshield Yellowed), and opaque materials (Master Flow OA2; Natural Flow O; Opallis Flow OA3.5; Opallis Flow OP; Fluroshield White) were obtained at six curing times (10s, 20s, 30s, 40s, 50s, and 60s) using a high-intensity LED (Coltolux, Coltène/Whaledent). The degree of conversion (DC) (%) was obtained using the Nexus 470 FTIR Spectrometer (Nicolet Instruments, USA). The FTIR-ATR spectra for uncured and cured samples were analyzed using a ZnSe crystal. The top and bottom surfaces of the cured specimens were analyzed to obtain the depth of curing. Two-way ANOVA was used to analyze the data. The highest curing depth was obtained by Natural Flow OA2, while the lowest was shown by Master Flow OA2. The shortest curing time generated similar depths of cure in comparison with the most extensive for Opallis Flow A2 and Fluroshield Yellowed. Therefore, depth of curing, influenced by the irradiation time, was dependent on the materials. Using the Natural Flow OA2 opaque sealant and the 10-s curing time for Opallis Flow A2 and Fluroshield Yellowed may represent alternative approaches to sealing tooth fissures.

Effect of irradiation times on the polymerization depth of contemporary fissure sealants with different opacities

The aim of this study was to evaluate the depth of curing of 10 contemporary blue light-activated dental flowable materials at several opacities, influenced by different irradiation times using FT-IR spectroscopy. Fifty-five specimens (n = 5) with a 5-mm diameter and 1-mm thickness of translucent (Opallis Flow T), yellowed (Master Flow A2; Opallis Flow A2; Natural Flow A2; Fluroshield Yellowed), and opaque materials (Master Flow OA2; Natural Flow O; Opallis Flow OA3.5; Opallis Flow OP; Fluroshield White) were obtained at six curing times (10s, 20s, 30s, 40s, 50s, and 60s) using a high-intensity LED (Coltolux, Coltène/Whaledent). The degree of conversion (DC) ( percent) was obtained using the Nexus 470 FTIR Spectrometer (Nicolet Instruments, USA). The FTIR-ATR spectra for uncured and cured samples were analyzed using a ZnSe crystal. The top and bottom surfaces of the cured specimens were analyzed to obtain the depth of curing. Two-way ANOVA was used to analyze the data. The highest curing depth was obtained by Natural Flow OA2, while the lowest was shown by Master Flow OA2. The shortest curing time generated similar depths of cure in comparison with the most extensive for Opallis Flow A2 and Fluroshield Yellowed. Therefore, depth of curing, influenced by the irradiation time, was dependent on the materials. Using the Natural Flow OA2 opaque sealant and the 10-s curing time for Opallis Flow A2 and Fluroshield Yellowed may represent alternative approaches to sealing tooth fissures.

Devolvendo estética de dente posterior por meio de restauração em técnica incremental oblíqua com compósito de baixa contração / Giving natural aesthetic to a posterior tooth by filling the cavity with a low-shrinkage composite restorative using the layering technique

Introdução: a grande exigência estética por parte dos pacientes tem motivado a busca de materiais que possam mimetizar a cor natural das estruturas dentárias com maior longevidade clínica, inclusive em dentes posteriores. O uso de um compósito de baixa contração de polimerização, e consequentemente menor quantidade de tensões geradas, poderia proporcionar uma maior longevidade do conjunto restaurado. Tradicionalmente, recomenda-se a inserção desse compósito em incrementos unindo paredes opostas. Objetivo: o presente trabalho objetiva relatar um caso clínico onde um molar posterior foi reconstruído utilizando-se esse tipo de material em incrementos sem união de paredes opostas durante o preenchimento da cavidade; além de discutir as vantagens da utilização desse tipo de técnica. Relato do caso: após diagnóstico clínico e radiográfico, realizou-se o tratamento restaurador no elemento 26. O amálgama preexistente, bem como a dentina infectada, em toda a cavidade, foram removidos, executando-se, em seguida, o processo de hibridização com o Sistema Adesivo Silorano, após condicionamento ácido seletivo do esmalte cavossuperficial. Posteriormente, incrementos do compósito Filtek P90 de, aproximadamente, 2mm, correspondentes à dentina e ao esmalte do elemento, foram inseridos e polimerizados separadamente. Finalmente, fez-se a checagem e o ajuste dos contatos oclusais. Conclusão: apesar da possibilidade de se inserir incrementos do compósito P90 unindo as paredes cavitárias, a técnica apresentada nesse caso pode ser utilizada na clínica, com a vantagem da fácil escultura e, provavelmente, ainda menor geração de tensões pela contração do material.

Amelogênese imperfeita em paciente nefropata: relato de uma reabilitação oral conservadora / Amelogenesis imperfecta in a patient with kidney disease: a report of a conservative oral rehabilitation

Amelogênese imperfeita é uma doença hereditária que afeta a formação do esmalte, tanto na dentição decídua como na permanente. Ela também pode ser associada com alterações morfológicas e bioquímicas em outra parte do corpo. O diagnóstico da amelogênese imperfeita envolve a exclusão de fatores ambientais e o estabelecimento de um provável padrão de herança genética, reconhecimento do fenótipo e correlação com a formação do esmalte. Numerosas modalidades de tratamento têm sido descritas para a reabilitação de pacientes com amelogênese imperfeita. No entanto, tem-se buscado reabilitar de maneira conservadora e com um enfoque na prevenção dos efeitos dessa patologia. Este trabalho tem por objetivo relatar um caso clínico de reabilitação estética e funcional por meio do uso de resinas compostas, em um paciente com amelogênese imperfeita e que apresentava hiperplasia gengival devido ao uso de imunossupressores. Pôde-se concluir que é possível melhorar a estética e restabelecer a função destes pacientes através de procedimentos e técnicas simples e de baixo custo.

Amelogenesis imperfecta is a hereditary disease that disrupts enamel formation, affecting both the deciduous and permanent teeth. It can also be associated with morphological and biochemical changes elsewhere in the body. The diagnosis of amelogenesis imperfecta involves the exclusion of environmental factors and the establishment of a likely pattern of inheritance, recognition of the phenotype and correlation with enamel formation. Numerous treatment modalities have been described for the rehabilitation of patients with amelogenesis imperfecta. However, rehabilitation is preferably conservative, focusing on preventing the effects of this pathology. The aim of this paper is to report a case of aesthetic and functional rehabilitation of a patient with amelogenesis imperfecta and immunosuppressant-induced gingival hyperplasia using composite resins. In conclusion, it is possible to improve the aesthetics and restore the function of these patients with simple and inexpensive procedures and techniques.

Efficacy of a pit and fissure sealant in arresting dentin non-cavitated caries: a 1-year follow-up, randomized, single-blind, controlled clinical trial.

PURPOSE: To evaluate the efficacy of conservative treatment of dentin non-cavitated caries using a resin-based fluoride-containing pit and fissure sealant. METHODS: In this controlled clinical trial, 60 teeth with clinically non-cavitated occlusal caries radiographically located beneath the enamel-dentin junction (radiolucent area) were selected among patients presenting a moderate to high caries risk. The teeth were randomly divided into two groups of 30 teeth each: an experimental group receiving an application of Fluorshield (Dentsply) sealant and a control group not submitted to any clinical intervention. Caries progression was monitored by clinical and radiographic examination at 4-month intervals over a period of 1 year. In addition, marginal integrity of the sealant was evaluated in the experimental group. RESULTS: Clinical and radiographic caries progression was significantly more frequent in control teeth when compared to the experimental group (P < 0.05).

A escola como espaço promotor de saúde bucal: cuidando de escolares por meio de ações coletivas / The school space as promoter of oral health: caring for childrenthrough collective programs

Como alternativas ao controle da cárie dentária em serviços públicos, o Tratamento Restaurador Atraumático (ART), bem como o selamento de cicatrículas e fissuras, têm sido realizados de forma a minimizar o número de extrações dentárias realizadas nos países subdesenvolvidos. Este trabalho objetivou relatar os resultados de uma ação coletiva realizada porestudantes de Odontologia da UFRN. O público alvo incluiu 120 alunos de uma Escola Municipal na cidade de Jardim de Piranhas (RN), Brasil. Foram feitas orientações quanto à saúde bucal, por meio de palestras educativas e teatro de fantoches, extensivas aos pais/responsáveis. Após exame clínico e medição do CPO-D ceo-d, todos os escolares receberam orientação de higiene bucal e aplicação tópica de flúor. Crianças de 4 a 12 anos de idade receberam restaurações atraumáticas (ART) e selamentos da superfície oclusal com cimento de ionômero de vidro. O Índice de PlacaVisível (IPV) médio e o Índice de Sangramento Gengival (ISG) médio foram 31porcento e 15 porcento,respectivamente. Foram executados 34 ARTs e 39 selamentos. Após seis meses, a média do IPV reduziu para 15 porcento (p signal minus 0.001) e a do ISG para 6 porcento (psinal de maior que 0.001). Notou-se que 40 porcento das ART?s permaneceram íntegras e 60 porcento haviam sido perdidas. Quanto aos selantes, 21,9 porcento estiveram íntegros, 25 porcento,com perda parcial e 53,1 porcento, perderam-se totalmente. Não houve incidência de cárie neste período. Percebeu-se que o programa foi efetivo na promoção e manutenção de saúde oral dos escolares envolvidos.

This work aims at reporting results of a collective program carried out by UFRN Dentistry undergraduate students. The population included 120 students of a Municipal School in Jardim de Piranhas RN, Brazil. Guidelines on oral health were presented through educative lectures and Puppets Theater, which covered also parents/guardians. Oral clinical examination, DMFT dmft Indices recording, guidelines of oral care and application of topical fluoride were performed in all schoolchildren. Atraumatic Restorative Treatments (ART) and glass ionomer pit and fissure sealants were carried out in children from 4 to 12 years old. Visible Plaque Index (VPI) and Gingival Bleeding Index (GBI) means were 31 porcent and 15 porcent, respectively. Thirty four ART's and 39 sealments were performed. After six month, the PVI reduced to 15 porcent (p signal minus 0.001) and the GBI to 6 porcent (p 0.001). It was observed that 40 porcent of the ART?s remained intact and 60 porcent had been lost. As for sealing, 21.9 porcent were intact, 25 porcent with partial loss whereas 53.1 porcent were totally lost. Decay?s incidence was none. One can suggest the program was effective in promoting and maintaining oral health among these schoolchildren.