Clinical guidelines for posterior restorations based on Coverage, Adhesion, Resistance, Esthetics, and Subgingival management. The CARES concept: Part I ­ partial adhesive restorations

Important changes have occurred over the last decades in the clinical application of the strategies for posterior restorations - from amalgam to composites in direct restorations and from traditional resistance form crowns to adhesive partial restorations such as onlays. Despite much evidence available for these advances, there are still very few established guidelines for common clinical questions: When does an indirect restoration present a clinical advantage over a direct one? When should one perform adhesive cusp coverage such as an onlay? When to implement resistance form designs in adhesive restorations? Which conditions create limitations for adhesion so that a resistance form preparation with a stiffer material such as a traditional crown might be more appropriate? In order to provide clinical guidelines, the present authors consider five parameters to support and clarify decisions - Coverage of cusps, Adhesion advantages and limitations, Resistance forms to be implemented, Esthetic concerns, and Subgingival management - the CARES concept. In Part I of this three-part review article, the focus is on clinical decisions for partial adhesive restorations regarding indications for direct versus indirect materials as well as the need for cusp coverage and/or resistance form preparations based on remaining tooth structure and esthetics.

Conservative restoration of the worn dentition - the anatomically driven direct approach (ADA).

The treatment or management of tooth wear with composite resins can be challenging because significant alterations in the patient's occlusion are usually required. Comprehensive approaches include the use of facebows, articulator-mounted casts, laboratory-made wax-ups, and silicone indexes to deliver the restorations. Even though this sequence of steps is recommended, in many cases it is not applied. The reason for this is related to the complexity and time required for these steps, which are normally applied in indirect restorations like ceramics but not properly used in direct composite resin rehabilitations. Moreover, a large portion of these patients, clinicians, and technicians in many countries may not have the resources and/or tools to undertake a full comprehensive approach. In order to aid clinicians to use an exclusively direct method to manage these patients for whatever reasons, the authors propose in this article a thought process applied to diagnosis and treatment planning that allows the restoration of extensively worn dentitions in a logical clinical sequence. The first goal is to provide a clear and organized vision of the functional, biologic, and esthetic principles of treatment planning based on the most current, evidence-based notions and clarified insights from experts. These are principles that should be applied universally in any comprehensive treatment plan. The second goal is to propose the application of these principles to direct restorations even when no individualized articulator mounting or appropriate laboratory wax-ups are available - the anatomically driven direct approach (ADA).

Soluções estéticas não invasivas com resinas compostas: caso clínico / Non invasive esthetic solutions using resin composites: a case report

As abordagens não invasivas apresentam a imensa vantagem de preservação estrutural, que é fundamental para a sobrevivência a longo prazo da peça dentária. No âmbito desses tratamentos, este artigo descreve um caso clínico em que as resinas compostas foram utilizadas para otimização estética não invasiva do sorriso. Neste caso, tal como diversos autores têm demonstrado, as resinas compostas permitiram obter resultado estético satisfatório para a paciente. Além da habilidade clínica, é necessário que a equipe possa fazer diagnóstico, simulações, bem como comunicar ao paciente as possibilidades e vantagens dessas estratégias de tratamento. O facto de abordagens não invasivas serem reversíveis com relativa facilidade permite que não se excluam outras abordagens futuras, o que representa coerência interessante do ponto de vista biológico e estético.

Non-invasive dental treatments allow tissue preservation, which is important for long-term survival of teeth. The authors describe a clinical case where resin composites were used for a non-invasive esthetic optimization of a patient’s smile. In this case, similar to several authors have described, a good esthetic result was achieved. In addition to the clinical skills, it is important for the team to be able to diagnose, make simulations of the result and communicate the patients all the possibilities and advantages of these treatment possibilities. Since these non invasive approaches are easily reversible, it is possible to make other treatment options in the future, making these treatments very feasible from a biologic and esthetic point of view.

[Appropriateness of hospitalization in a ward of internal medicine--using the Appropriateness Evaluation Protocol]. / Adequação do internamento num serviço de medicina interna. Utilizando o Appropriateness Evaluation Protocol.

INTRODUCTION: The Appropriateness Evaluation Protocol (AEP) is an instrument to study the appropriate use of hospital beds based in objective criteria that classify a hospital admission as appropriate or inappropriate. OBJECT: Evaluate the appropriateness of hospital admissions and stays of the patients of our Internal Medicine Department using the concurrent version of AEP. METHOD: Transversal study where was evaluated the clinical record of the patients admitted to our Department of Internal Medicine on March 13th of 2003, excluding all these who were admitted the day of the study. We analyzed demographic and clinic parameters and the appropriateness of hospital admission and stay using the AEP. RESULTS: 22 patients fulfilled the inclusion criteria, 54.5% of male gender with a average age of 70.7 years. All the admissions were considered appropriate. The most common criteria was the need of intravenous therapy (100%), followed by the sudden lost of corporal mobility (12.3%). 27.3% of stays were considered inappropriate on the day of the study. The most common criteria of appropriateness was the need of intravenous therapy (93.7%). The most usual reason of inappropriate stay was the existence of planned discharge, but without the order written down in the clinical file (66.7%). CONCLUSIONS: The AEP allows an efficient evaluation of the appropriateness of the hospital admissions and stays in a Health Unit, being used for a better utilization of resources. In our department all admissions were justified and about a quarter of stays were considered inappropriate using the AEP.