Restauração estética de dentes anteriores escurecidos com sistema / Componeer Esthetic restoration of darkened anterior teeth using the Componeer system

Como a Odontologia minimamente invasiva tornou-se mais conhecida, diferentes tratamentos estéticos também foram colocados em prática. Um novo tratamento restaurador estético para dentes anteriores é a técnica semidireta usando facetas pré-fabricadas de resina nano-híbrida. Trata-se de um método restaurador alternativo e minimamente invasivo que apresenta confiabilidade estética e cosmética, além de ser uma solução financeiramente vantajosa graças à diminuição de etapas, como procedimentos de moldagem e trabalho laboratorial. Assim, o objetivo deste artigo é demonstrar a utilização de sistema Componeer para o restabelecimento estético de dentes anteriores escurecidos.

As minimally invasive Dentistry has become more known, new aesthetics treatments are also being used. One new esthetic restorative treatment for anterior teeth is the semi-direct technique using pre-fabricated nanohybrid resin composite veneers. It is a minimally invasive alternative restorative method that presents cosmetic and aesthetic reliability and it is a financially advantageous solution due to reduction of stages such as impression procedures and laboratory work. So the purpose of this article is to demonstrate the use of the Componeer system to reestablish the aesthetics of anterior darkened teeth.

Estratégias para o aumento da previsibilidade na abordagem multidisciplinar da Odontologia estética / Strategies to increase predictability in cosmetic dentistry multidisciplinary approach

O planejamento estético multidisciplinar traz conceitos de excelência na resolução de casos complexos e desafiadores em Odontologia. O presente relato de caso clínico aborda os princípios, indicações e técnica operatória para a resolução estética de dentes escurecidos, com restaurações extensas insatisfatórias e pigmentadas e arranjo periodontal desarmônico, através de uma abordagem interdisciplinar guiada. O planejamento estético digital foi delineado para orientação do enceramento diagnóstico e confecção de guia cirúrgico para a gengivoplastia. Os dentes anteriores foram clareados e considerando a condição dos mesmos após remoção das restaurações insatisfatórias foram propostas restaurações cerâmicas indiretas, uma faceta unitária no elemento 11 e um laminado cerâmico no elemento 12. Diante do resultado alcançado, revela-se importante a correta indicação e a utilização de estratégias clínicas que guiem os procedimentos operatórios no objetivo de prover conservadorismo e biomimetismo (AU).

The multidisciplinary aesthetic planning brings excellence concepts in the resolution of complex and challenging cases in dentistry. This case report addresses the principles, indications and the surgical technique for aesthetic resolution of darkened teeth, with extensive unsatisfactory and pigmented restorations, and disharmonious periodontal arrangement through a guided interdisciplinary approach. Digital aesthetic planning was designed to guide the wax-up diagnosis and to make surgical guide for gingivoplasty. Anterior teeth whitening was performed and considering their condition after removal of the unsatisfactory restorations, indirect ceramic restorations were proposed, a unitary ceramic veneer (11) and a laminate veneer (12). Considering the result achieved, it is important to consider the correct indication and the use of clinical strategies that guide the surgical procedures in order to provide conservatism and biomimicry (AU).

Pulp Chamber Heating: An In Vitro Study Evaluating Different Light Sources and Resin Composite Layers.

The aim of the present in vitro study was to evaluate the temperature variation inside the pulp chamber during light-activation of the adhesive and resin composite layers with different light sources. Cavities measuring 8x10 mm were prepared on the buccal surface of bovine incisors, leaving a remaining dentin thickness of 1 mm. Specimens were placed in a 37±1 °C water bath to standardize the temperature. The temperature in the pulp chamber was measured every 10 s during 40 s of light activation of the adhesive system (SBMP-3M/ESPE) and in the three consecutive 1-mm-thick layers of resin composite (Z250-3M/ESPE). Three light source devices were evaluated: Elipar 2500 (QTH), LD Max (LED low irradiance) and VALO (LED high irradiance). The results were submitted to one-way ANOVA with repeated measures and Tukey's test, both with p<0.001. The exothermic reaction warming was observed in the Z250 increments, but not in the SBMP. The high irradiance LED showed a higher temperature average (42.7±1.56 °C), followed by the quartz-tungsten-halogen light (40.6±0.67 °C) and the lower irradiance LED (37.8±0.12 °C). Higher temperature increases were observed with the adhesive and the first resin composite increment light-activation, regardless of the employed light source. From the second increment of Z250, the restorative material acted as a dispersive structure of heat, reducing temperature increases. Regardless the light source and restorative step, the temperature increased with the irradiation time. It may be concluded that the light source, irradiation time and resin composite thickness interfered in the temperature variation inside the pulp chamber.

Pulp Chamber Heating: An In Vitro Study Evaluating Different Light Sources and Resin Composite Layers

Abstract The aim of the present in vitro study was to evaluate the temperature variation inside the pulp chamber during light-activation of the adhesive and resin composite layers with different light sources. Cavities measuring 8x10 mm were prepared on the buccal surface of bovine incisors, leaving a remaining dentin thickness of 1 mm. Specimens were placed in a 37±1 °C water bath to standardize the temperature. The temperature in the pulp chamber was measured every 10 s during 40 s of light activation of the adhesive system (SBMP-3M/ESPE) and in the three consecutive 1-mm-thick layers of resin composite (Z250-3M/ESPE). Three light source devices were evaluated: Elipar 2500 (QTH), LD Max (LED low irradiance) and VALO (LED high irradiance). The results were submitted to one-way ANOVA with repeated measures and Tukey's test, both with p<0.001. The exothermic reaction warming was observed in the Z250 increments, but not in the SBMP. The high irradiance LED showed a higher temperature average (42.7±1.56 °C), followed by the quartz-tungsten-halogen light (40.6±0.67 °C) and the lower irradiance LED (37.8±0.12 °C). Higher temperature increases were observed with the adhesive and the first resin composite increment light-activation, regardless of the employed light source. From the second increment of Z250, the restorative material acted as a dispersive structure of heat, reducing temperature increases. Regardless the light source and restorative step, the temperature increased with the irradiation time. It may be concluded that the light source, irradiation time and resin composite thickness interfered in the temperature variation inside the pulp chamber.

Resumo O objetivo do presente estudo in vitro foi avaliar a variação de temperatura dentro da câmara pulpar durante a fotoativação de um sistema adesivo e de camadas de resina composta com diferentes fontes de luz. Cavidades com dimensões de 8x10 mm foram preparadas na superfície vestibular de incisivos bovinos deixando uma espessura de dentina remanescente de 1 mm. Os espécimes foram inseridos em uma cuba térmica com água à temperatura de 37±1 °C. A temperatura no interior da câmara foi medida a cada 10 s durante 40 s de ativação de luz do sistema adesivo (SBMP; 3M/ESPE) e três camadas de 1 mm de espessura consecutivas de resina composta (Z250; 3M/ESPE ). Três fonte de luz foram avaliadas: Elipar 2500 (QTH), LD Max (LED de baixa densidade de potência), VALO (LED alta densidade de potência). Os resultados foram submetidos a ANOVA de medidas repetidas a um critério e teste de Tukey (ambos com p<0,01). O aquecimento da reação exotérmica foi observado nos incrementos de resina composta, mas não no sistema adesivo. O LED de alta densidade de potência mostrou uma média de temperatura mais elevada (42,7±1,56 °C) seguido pela luz halogéna (40,6±0,67 °C) e o LED de menor densidade de potência (37,8±0,12 °C). Maiores aumentos de temperatura foram observados na fotoativação do sistema adesivo e do primeiro incremento de resina composta, independente da fonte de luz utilizada. A partir do segundo incremento de resina composta, o material restaurador agiu como estrutura dispersiva de calor, reduzindo o aumento de temperatura. Independente da fonte de luz e da etapa restauradora, a temperatura aumentou com o tempo de irradiação. Pode-se concluir que a fonte de luz, o tempo de irradiação, a espessura resina composta interferiram na variação de temperatura no interior da câmara pulpar.

Whitening gel and light source influence on pulp chamber temperature

Introduction: The chemical injury caused to the pulp by the penetration of the whitening gel is already known, but another possible cause may be the heat generated by the irradiation of the whitening gel with light sources to accelerate the whitening reaction. Objective: To evaluate in vitro the temperature increasing in the pulp chamber during in-office bleaching with different gel concentrations and light sources. Material and methods: A maxillary human central incisor was used in the 6 groups evaluated. The specimen was sectioned 3 mm apical to the cementoenamel junction. The root canal and pulp chamber were cleaned and widened with a diamond bur to receive the sensor of a thermocouple thermometer. The following hydrogen peroxide gel concentrations were evaluated: 35%, 25%, 15%, and 10%; and the following light sources were applied: blue hybrid LED/laser and violet hybrid LED/laser. The specimen bleaching was repeated 6 times per group. As a control, the temperature was measured with the application of light, without applying any gel. Results were evaluated with one-way ANOVA and Tukey's test (α = 5%). Results: Significant differences between groups were observed (p < 0.05). The blue LED without the gel induced the smallest heat (37.5 ± 0.2) and the blue LED with 15% gel caused the highest heat (38.2 ± 0.3). The combination of violet LED with the 10% gel caused no significant increase in temperature compared to the control in which light was used without gel (p> 0.05). Conclusion: No increase in pulp chamber temperature was higher than 2°C.

Variação da temperatura no interior da câmara pulpar em função de diferentes fontes de luz e camadas de resina composta. In vitro / In vitro temperature variation inside the pulp chamber regard different light sources and composite layers

Este estudo in vitro avaliou a variação da temperatura no interior da câmara pulpar durante a fotoativação do sistema adesivo e incrementos de resina composta em função de diferentes fontes de luz, testando as hipóteses nulas de que estes fatores não interferem na temperatura intra câmara pulpar. Foram selecionados 10 incisivos bovinos, seccionados na região radicular 3 mm além da junção amelocementária. Uma cavidade retangular (10X8mm) foi confeccionada no centro da face vestibular, com espessura padronizada do remanescente dentinário da parede axial em 1 mm. A câmara pulpar foi preenchida com pasta térmica e o sensor termopar tipo K foi introduzido na câmara em contato com o remanescente dentinário. A elevação da temperatura foi aferida durante 40s de fotoativação do sistema adesivo (SBMP) e dos 3 incrementos consecutivos de 1mm de resina composta (Z250), com diferentes fontes de luz. As fontes utilizadas foram: Luz Halógena 755mW/cm2 (Curing Light XL 3000 3M), Luz emitida de diodo (LED) de baixa densidade de potência 400 mW/cm2 (OptiLight LD Max - Gnatus), e LED de alta densidade de potência 1500mW/cm2 (VALO Ultradent). O LED de alta densidade de potência proporcionou os maiores aumentos de temperatura, seguido da luz halógena e do LED de baixa densidade de energia. A polimerização do sistema adesivo seguido do primeiro incremento de resina determinou os maiores aumentos de temperatura. A partir do segundo incremento da resina composta, o material restaurador atuou como isolante térmico reduzindo o aumento de temperatura. Independente da fonte de luz e etapa restauradora, o aumento no tempo de polimerização foi determinante no aumento de temperatura, rejeitando as hipóteses nulas testadas.

This In vitro study evaluated the temperature variation inside the pulp chamber during the curing of the adhesive and composite layers with different light sources, testing the null hypothesis that these factors do not affect the temperature of the intra pulp chamber. Ten bovine incisors were selected and sectioned beyond the root region at 3 mm of the cementoenamel junction. A rectangular cavity (10x8mm) was made in the center of the buccal surface, with the remaining 1mm dentin thickness standardized at the axial wall. The pulp chamber was filled with thermal paste and a type K thermocouple sensor was introduced into the chamber in contact with the remaining dentin. The temperature was measured for 40s during the curing of the adhesive system (SBMP) and 3 consecutive layers of 1mm composite resin (Z250) was applied with three different light sources. The sources used were: Halogen Light 755mW/cm2 (Curing Light XL 3000 - 3M), Light emitted diode (LED) low power density 400 mW/cm2 (Optilight LD Max - Gnatus), and high power density LED 1500mW/cm2 (VALO Ultradent). For all light sources, the temperature readings decreased as the cavity was filled, with statistically significant differences until the second layer of composite resin. The high power density LED showed a significantly higher temperature average (42.78+1.56oC) than the other light sources, and the lowest was the average of the low power density LED (37.81+0.12oC). It could be concluded that both the light source, and the number of layers interfered with the temperature variation, rejecting the null hypotheses tested.