Marginal adaptation and fracture resistance of feldspathic and polymer-infiltrated ceramic network CAD/CAM endocrowns for maxillary premolars.

OBJECTIVE: The aim of this study was to evaluate the marginal adaptation and fracture resistance of feldspathic and Polymer-Infiltrated Ceramic Network (PICN) CAD/CAM endocrowns for maxillary premolars. MATERIALS AND METHODS: Twenty extracted human permanent maxillary premolars were randomly divided into two groups (n = 10); Group CEREC (GC), which was produced by feldspathic ceramic and the Group Enamic (GE), which was produced by PICN. All teeth were endodontically treated and decoronated horizontally at 2 mm above the cemento-enamel junction. Endocrown preparations were done with 4 mm depth into the pulp chamber. Endocrowns were manufactured using CAD/CAM from ceramic blocks. Following adhesive cementation, all specimens were subjected to thermocycling. Marginal adaptation evaluated under SEM at 200 × magnification. Each specimen was fixed in a universal testing machine and a compressive load was applied at 45° to long axis of the teeth until failure. Failure load was recorded and failure modes were evaluated. Statistical analyses were performed with SPSS 19.0 software and data were compared using Mann-Whitney U test. RESULTS: There were no significant differences in the marginal adaptation between two groups (P > 0.05). GE presented significantly higher fracture resistance when compared to GC (P < 0.05). Failure pattern was similar and characterized by the tooth-ceramic fracture on the force-applied side. CONCLUSIONS: CAD/CAM fabricated feldspathic ceramic and PICN endocrowns provide sufficient marginal adaptation, but the PICN endocrowns shows higher fracture resistance than the feldspathic ceramic endocrowns.

Lesões cervicais não cariosas: uma abordagem no controle da dor e tratamento

Objetivo: o objetivo deste trabalho é relatar um caso clínico de hipersensibilidade severa associada a múltiplas lesões cervicais não cariosas, entender o mecanismo de ação e a eficácia dos agentes dessensibilizantes. Relato de caso: paciente do gênero masculino, 38 anos de idade, compareceu à clínica da Faculdade Morgana Potrich com um quadro de hipersensibilidade em vários elementos, bem como, a presença de lesão cervical não cariosa em alguns desses elementos. Durante a anamnese o paciente relatou o hábito de escovar os dentes várias vezes ao dia logo após se alimentar, exercendo muita força durante o ato, relatou também fazer consumo diário de cerveja que possui um pH ácido. Ao realizar análise da oclusão notou-se um desequilíbrio oclusal e contato prematuro nos dentes 24 e 34. O tratamento de escolha para esse caso foi o ajuste oclusal seguido do uso de dessensibilizantes e restaurações em resina composta nos dentes que havia a presença de lesões cervicais não cariosas com perda de estrutura dentária. Considerações finais: após esse tratamento, realizado em várias sessões, foi possível devolver ao paciente a função e eliminar a dor provocada pela hipersensibilidade, proporcionando uma melhor qualidade de vida para esse paciente.

Objective: This study aims to report a clinical case of severe hypersensitivity associated with multiple non-carious cervical lesions and to understand the mechanism of action and the efficacy of desensitizing agents. Case report: A 38-year-old male patient attended the clinic at Faculdade Morgana Potrich with the hypersensitivity of several elements and the presence of non-carious cervical lesion in some of these elements. During anamnesis, the patient reported the habit of toothbrushing several times a day soon after eating, exerting a lot of force in such activity; he also reported the daily consumption of beer, which has an acidic pH. The occlusal analysis showed occlusal disorder and premature contact in teeth 24 and 34. The treatment of choice for this case was the occlusal adjustment followed by the use of desensitizers and composite resin restorations on the teeth with non-carious cervical lesions with loss of dental structure. Final considerations: After this treatment, which was performed in several sessions, it was possible to return function to the patient and eliminate the pain caused by hypersensitivity, providing a better quality of life for this patient.(au)

Lesiones cervicales no cariosas / Non-carious cervical lesions

El objetivo de este trabajo consiste en describir las distintas lesiones cervicales no cariosas, la abrasión, la erosión y la abfracción. Se desarrollarán en detalle su etiología, localización y características clínicas. Se mencionarán los diferentes procedimientos a realizar para su prevención y los materiales a utilizar para su restauración.

This article describes the different types of non-cariouscervical lesions, for example abrasion, erosionand abfraction. We will discuss their etiology, location and clinical features in detail. We will describe the procedures to prevent them, aswell as the materials used for their restoration.

Invasive cervical resorption following orthodontic treatment: Two cases involving the same patient.

Invasive cervical resorption (ICR), a destructive form of external root resorption, is characterized by invasion of the fibrovascular tissue. This phenomenon is very rare and appears in 0.02% of the general population where the leading factors are orthodontics in addition to trauma, restorations, and bleaching. Heavy orthodontic force may increase the incidence to 1%. One of the main concerns regarding ICR is that it is often misdiagnosed with conventional diagnostic tools. In recent decades, a cone beam computed tomography (CBCT) imaging technique has become more common and can lead to a more accurate diagnosis and treatment plan. This case report describes a possible association between orthodontic treatment and ICR of a 14-year-old male, 18 months post orthodontic treatment. ICR in the mandibular right canine was diagnosed and verified by CBCT, and underwent combined endodontic-periodontal treatment. However, after orthodontic forced eruption was performed on this tooth to improve the bone defect, ICR was diagnosed on the mandibular right second premolar. The possible association between orthodontic treatment and ICR is discussed, as ICR was noted following orthodontic treatment on both occasions. This case report stresses the importance of ICR early detection by close attention to periodic radiographic checkups during orthodontic treatment. The use of modern diagnostic tools is highly recommended in suspicious cases. CONCLUSION: A case is described in which the patient underwent two types of orthodontic treatment in the mandible at different time periods and developed ICR in two different teeth.

Hemisection: A Treatment Option for an Endodontically treated Molar with Vertical Root Fracture.

Vertical root fractures (VRF) in endodontically treated teeth have long been reported and pose diagnostic difficulties. A hemisection/root resection procedures removes the fractured fragments completely, and retains a portion of the compromized tooth offers a predictable treatment option. The key to this rests in ideal case selection involving balancing all indications and contraindications. The success of the treatment depends on careful case selection based on a firm set of guidelines. This article presents a case with VRF in an endodontic treated molar. This article describes the case of a 65-year-old man with a VRF on the mesial root and a healthy periodontium supporting the distal root making it ideal for retention as well as restoration and support of the final prosthesis. Also, the patient was motivated to try and save as much of the tooth as possible. Postoperatively no untoward complication was reported making it an alternative treatment option in patients with VRF in a molar, willing to retain the remaining tooth portion. With all other factors balanced, it allows for retaining the remaining intact portion of the tooth structure.

Effects of cyclic loading and toothbrush abrasion on cervical lesion formation.

This study sought to determine the effect of cyclic loading and toothbrush abrasion (with and without abrasive slurries) on cervical lesion formation. The roots of extracted human third molars were embedded in acrylic resin, leaving 2 mm of root structure and crowns exposed. Teeth were divided into 6 groups (n = 10) with the following treatments: no treatment (control), cyclic load in distilled water, brushing with distilled water, cyclic load followed by brushing with distilled water, brushing with toothpaste slurry, and cyclic load followed by brushing with toothpaste slurry. Cyclic loading and toothbrushing machines subjected the teeth to 1.6 million cyclic loads and 30,000 brushing strokes, the equivalent of 4 years of function and brushing for an average patient. The teeth were scanned with a 3-dimensional optical profilometer to determine the volumetric loss of tooth structure. Load cycling had no significant effect on cervical tooth loss. Brushing with toothpaste resulted in significantly greater cervical tooth loss than brushing with water, which in turn was significantly greater than no treatment at all.

The clinical meaning of external cervical resorption in maxillary canine: transoperative dental trauma

External Cervical Resorption in maxillary canines with pulp vitality is frequently associated with dental trauma resulting from surgical procedures carried out to prepare the teeth for further orthodontic traction. Preparation procedures might surgically manipulate the cementoenamel junction or cause luxation of teeth due to applying excessive force or movement tests beyond the tolerance limits of periodontal ligament and cervical tissue structures. Dentin exposure at the cementoenamel junction triggers External Cervical Resorption as a result of inflammation followed by antigen recognition of dentin proteins. External Cervical Resorption is painless, does not induce pulpitis and develops slowly. The lesion is generally associated with and covered by gingival soft tissues which disguise normal clinical aspects, thereby leading to late diagnosis when the process is near pulp threshold. Endodontic treatment is recommended only if surgical procedures are rendered necessary in the pulp space; otherwise, External Cervical Resorption should be treated by conservative means: protecting the dental pulp and restoring function and esthetics of teeth whose pulp will remain in normal conditions. Unfortunately, there is a lack of well-grounded research evincing how often External Cervical Resorption associated with canines subjected to orthodontic traction occurs.

A reabsorção cervical externa em caninos superiores com vitalidade pulpar em sua quase totalidade está associada a traumatismo dentário decorrente de procedimentos cirúrgicos associado à preparação desse dente para ser tracionado ortodonticamente. Nessa preparação pode se manipular cirurgicamente a junção amelocementária ou luxar o dente com forças excessivas ou com testes de movimentação além dos limites de tolerância estrutural do ligamento periodontal e tecidos cervicais. A exposição dentinária na junção amelocementária é o estopim para se iniciar uma reabsorção cervical externa a partir de uma inflamação induzida na região seguida de reconhecimento antigênico das proteínas dentinárias. A reabsorção cervical externa é indolor, não induz pulpites e tem uma evolução lenta. Em geral, a lesão está associada e recoberta por tecidos moles gengivais que mantêm, por longos períodos, os aspectos clínicos normais, induzindo diagnósticos tardios, quando o processo se aproxima dos limites pulpares. O tratamento endodôntico está indicado apenas em função de procedimentos operatórios que se fazem necessários no espaço pulpar; caso contrário, a reabsorção cervical externa deve ser tratada de forma conservadora, protegendo a polpa dentária e restaurando a função e estética do dente que permanecerá com sua polpa normal. Infelizmente, não sabemos, com base em pesquisas de casuísticas bem estabelecidas, qual é a frequência da reabsorção cervical externa associada a caninos ortodonticamente tracionados.

Understanding root resorption with diagnostic imaging.

This article presents the clinical, radiographic and histopathologic features of various types of tooth root resorption. Tooth resorption may occur in a tooth internally or externally with distinctively different treatment approaches for each type of resorption. Given that proper diagnosis of the type of resorption is important, the use of cone beam computed tomography (CBCT) and conventional 2-D intraoral images in evaluation of resorptive lesions is discussed.

Treatment outcome of the teeth with cemental tears.

INTRODUCTION: A cemental tear is a special type of surface root fracture noted in combination with periodontal and/or periapical bony destruction. We hypothesized that clinical characteristics and treatment techniques may affect the prognosis of teeth with cemental tears. METHODS: Treatment outcome for the teeth with a cemental tear was assessed in a multicenter cemental tear study project. Of the 71 teeth with cemental tears, 38 teeth (53.5%) were extracted. The remaining 33 teeth (46.5%) were examined for a treatment outcome of healed, questionable, or failed. RESULTS: Outcome assessment found that 51.5% (17/33), 42.4% (14/33), and 6.1% (2/33) of teeth were classified as healed, questionable, and failed, respectively. Additive bivariate analysis indicated a significant difference between treatment outcome and the length (P = .01) and apicocoronal location (P = .02) of the separated root fragments. Logistic regression analysis found that treatment technique and apicocoronal location of cemental tears may affect the treatment outcome. The percentage of healed cemental tear cases located in the apical, middle, and cervical third of roots was 11.1%, 66.7%, and 60.0%, respectively. By surgical management, 57.7% of cemental tears were healed, whereas only 28.6% cases were healed after nonsurgical treatment. CONCLUSIONS: Most teeth with cemental tears can be retained to function by nonsurgical and surgical periodontal and endodontic treatment. Clinical diagnosis and treatment of cemental tears should also consider the apicocoronal location and the type of treatment technique to improve outcomes.

The clinical meaning of external cervical resorption in maxillary canine: transoperative dental trauma.

External Cervical Resorption in maxillary canines with pulp vitality is frequently associated with dental trauma resulting from surgical procedures carried out to prepare the teeth for further orthodontic traction. Preparation procedures might surgically manipulate the cementoenamel junction or cause luxation of teeth due to applying excessive force or movement tests beyond the tolerance limits of periodontal ligament and cervical tissue structures. Dentin exposure at the cementoenamel junction triggers External Cervical Resorption as a result of inflammation followed by antigen recognition of dentin proteins. External Cervical Resorption is painless, does not induce pulpitis and develops slowly. The lesion is generally associated with and covered by gingival soft tissues which disguise normal clinical aspects, thereby leading to late diagnosis when the process is near pulp threshold. Endodontic treatment is recommended only if surgical procedures are rendered necessary in the pulp space; otherwise, External Cervical Resorption should be treated by conservative means: protecting the dental pulp and restoring function and esthetics of teeth whose pulp will remain in normal conditions. Unfortunately, there is a lack of well-grounded research evincing how often External Cervical Resorption associated with canines subjected to orthodontic traction occurs.

Fracture resistance of endodontically treated teeth restored with glass fiber reinforced posts and cast gold post and cores cemented with three cements.

STATEMENT OF PROBLEM: Dental fractures can occur in endodontically treated teeth restored with glass fiber reinforced posts and cast gold posts. PURPOSE: The objective of this study was to record the fracture strength of endodontically treated teeth restored with glass fiber reinforced or cast gold post and cores cemented with 3 cements. MATERIAL AND METHODS: Forty-two single-rooted premolars with standardized weakened roots were endodontically treated and allocated to 6 experimental groups (n=7) defined by the 2 factors investigated: post system and cement. Three groups were restored with glass fiber posts and resin-modified glass ionomer cement, dual-polymerizing resin cement, or chemically active autopolymerizing resin cement. The other 3 groups were restored with cast gold post and cores and the same 3 cements. The cores of the glass fiber post groups were fabricated with composite resin core material. Metal crowns were cemented on the cores in the 6 groups. The entire system was subjected to continuous compression in a universal testing machine, and fracture limit and location (cervical third, middle third, or apical third) were noted. Two-way ANOVA and the Scheffé test were used to analyze the data and compare the groups (α=.05). RESULTS: Two-way ANOVA showed significant differences in the post type (P<.001) and the cements (P<.001). The interaction between them (P<.001) was statistically significant in the fracture resistance of the endodontically treated teeth. The greatest interaction between post and cement was the glass fiber post with resin-modified glass ionomer cement, followed by the cast gold post and core with resin-modified glass ionomer cement. CONCLUSIONS: The use of a glass fiber reinforced post and resin-modified glass ionomer cement increased the fracture resistance of endodontically treated teeth.

Simplificando la adhesión con un sistema adhesivo universal: reporte de casos / Clinical application of a new universal adhesive system: case reports

Los sistemas adhesivos tienden a ser cada vez más simplificados y versátiles. Hasta el presente, el clínico todavía debe elegir entre adhesivos autoacondicionantes o convencionales. Objetivo: mostrar la aplicación clínica de un nuevo sistema adhesivo considerado universal, debido a que puede ser usado como adhesivo autoacondicionante o como uno convencional. Caso clínico: fueron realizadas restauraciones cervicales en lesiones no cariosas con varias posibilidades de utilización de un nuevo adhesivo (Scotchbond(TM) Universal, 3M Espe), aplicando el ácido fosfórico en toda la cavidad y dejando la dentina seca o húmeda, o aplicando el ácido fosfórico solamente en el esmalte, o aplicando sólo el adhesivo sin grabado previo con ácido fosfórico. Después de restaurar con resina compuesta, todos los casos fueron evaluados clínicamente en el inicio del tratamiento y a los 6 meses. Conclusión: los resultados demostraron un excelente desempeño clínico de este nuevo sistema adhesivo, utilizado con cualquiera de las distintas técnicas clínicas propuestas. No obstante, deben realizarse estudios de larga duración en un mayor número de casos clínicos, a fin de comprobar los resultados aquí presentados

Simplificando la adhesión con un sistema adhesivo universal: reporte de casos / Clinical application of a new universal adhesive system: case reports

Los sistemas adhesivos tienden a ser cada vez más simplificados y versátiles. Hasta el presente, el clínico todavía debe elegir entre adhesivos autoacondicionantes o convencionales. Objetivo: mostrar la aplicación clínica de un nuevo sistema adhesivo considerado universal, debido a que puede ser usado como adhesivo autoacondicionante o como uno convencional. Caso clínico: fueron realizadas restauraciones cervicales en lesiones no cariosas con varias posibilidades de utilización de un nuevo adhesivo (Scotchbond(TM) Universal, 3M Espe), aplicando el ácido fosfórico en toda la cavidad y dejando la dentina seca o húmeda, o aplicando el ácido fosfórico solamente en el esmalte, o aplicando sólo el adhesivo sin grabado previo con ácido fosfórico. Después de restaurar con resina compuesta, todos los casos fueron evaluados clínicamente en el inicio del tratamiento y a los 6 meses. Conclusión: los resultados demostraron un excelente desempeño clínico de este nuevo sistema adhesivo, utilizado con cualquiera de las distintas técnicas clínicas propuestas. No obstante, deben realizarse estudios de larga duración en un mayor número de casos clínicos, a fin de comprobar los resultados aquí presentados (AU)

Utilization of different management concepts in fractured tooth fragment reattachment: a report of three cases.

Traumatic injuries of teeth involve varying degrees of damage to the supporting soft tissues or the teeth itself. A very common injury to the permanent dentition affecting children and adolescents during their growing years is the anterior crown fracture. Recent developments in restorative material, placement techniques, preparation designs, and an adhesive protocol allow clinicians to predictably restore fractured teeth. With the advent of adhesive dentistry the process of fragment reattachment has become simplifed and more reliable. This procedure provides an improved function, is relatively faster to perform and at the same time provides long lasting esthetics. This paper discusses various innovative techniques of fracture reattachment depending on the complexity of the case.

Mandibular molar rehabilitation using orthodontic extrusion associated with odontoplasty.

The aim of this clinical report is to describe the successful treatment of a mandibular first molar presenting an extensive fracture at the buccal aspect in a young patient. The extension of the fracture was a negative prognostic factor for tooth maintenance. An alternative clinical treatment was proposed since the patient was young and presented with good oral hygiene and periodontal health. The treatment was based on orthodontic forced eruption associated with odontoplasty. A 3-year follow-up after the surgical procedure demonstrated the maintenance of periodontal health and good plaque control. It can be concluded that orthodontic forced eruption associated with odontoplasty promoted favorable conditions for prosthetic rehabilitation and is a feasible procedure in the treatment of tooth fracture extended below the cementoenamel junction.

Root fractures: the influence of type of healing and location of fracture on tooth survival rates - an analysis of 492 cases.

AIM: The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed. MATERIAL AND METHODS: Long-term survival rates were calculated using data from 492 root-fractured teeth in 432 patients. The cause of tooth loss was assessed as being the result of either pulp necrosis (including endodontic failures), new traumas or excessive mobility. The statistics used were Kaplan-Meier and the log rank method. RESULTS AND CONCLUSIONS: The location of the root fracture had a strong significant effect on tooth survival (P = 0.0001). The 10-year tooth survival of apical root fractures was 89% [95% confidence interval (CI), 78-99%], of mid-root fractures 78% (CI, 64-92%), of cervical-mid-root fractures 67% (CI, 50-85%), and of cervical fractures 33% (CI, 17-49%). The fracture-healing type offered further prognostic information. No tooth loss was observed in teeth with hard tissue fracture healing regardless of the position of the fracture. For teeth with interposition of connective tissue, the location of the fracture had a significant influence on tooth loss (P = 0.0001). For teeth with connective tissue healing, the estimated 8-year survival of apical, mid-root, and cervical-mid-root fractures were all more than 80%, whereas the estimated 8-year survival of cervical fractures was 25% (CI, 7-43%). For teeth with non-healing with interposition of granulation tissue, the location of the fracture showed a significant influence on tooth loss (P = 0.0001). The cause of tooth loss was found to be very dependent upon the location of the fracture. In conclusion, the long-term tooth survival of root fractures was strongly influenced by the type of healing and the location of the fracture.

Interproximal cervical lesions caused by incorrect flossing technique.

UNLABELLED: This case report describes an interproximal cervical lesion caused by the incorrect use of dental floss. A 58-year-old man who was asymptomatic, presented with unusual notch-like cervical lesions. After clinical and radiographical examinations, it was concluded that the aetiology of these lesions was an incorrect flossing technique. The treatment plan included extraction of maxillary 3rd molars and re-education of the patient in oral hygiene technique. CONCLUSION: These lesions are irreversible and often go undiagnosed; therefore, it is important for the clinician to be familiar with the clinical presentation and aetiology.