Reconstrução da papila interdental usando enxerto de tecido conjuntivo / Reconstruction of the interdental papilla with an underlying subepithelial connective tissue graft. Case report

A literatura odontológica apresenta vários trabalhos relatando técnicas cirúrgicas de reconstrução da papila interdental e quão grande são os desafios para a Periodontia atual, pois este problema está relacionado à perda do septo ósseo interdental e, consequentemente, à perda da papila. Esta ausência pode acarretar limitações estéticas, dificuldade na fonética e impactação de alimentos. Este relato de caso descreve a aplicação clínica de uma técnica, na qual um retalho avançado coronalmente, associado a um enxerto de tecido conjuntivo, é utilizado para reconstrução da papila interdental. Apesar do resultado satisfatório obtido ao final deste caso, ainda são necessários estudos longitudinais em que possamos nos basear e avaliar a previsibilidade das técnicas cirúrgicas que envolvem a reconstrução da papila interdental.

Influence of polishing procedures on the surface roughness of dental ceramics made by different techniques.

The aim of this study was to evaluate the influence of 2 different surface polishing procedures-glazing and manual polishing-on the roughness of ceramics processed by computer-aided design/computer-aided manufacturing (CAD/CAM) and conventional systems (stratification technique). Eighty ceramic discs (diameter: 8 mm, thickness: 1 mm) were prepared and divided among 8 groups (n = 10) according to the type of ceramic disc and polishing method: 4 GZ and 4 MP. Specimens were glazed according to each manufacturer's recommendations. Two silicone polishing points were used on the ceramic surface for manual polishing. Roughness was measured using a surface roughness tester. The roughness measurements were made along a distance of 2 mm on the sample surface and the speed of reading was 0.1 mm/s. Three measurements were taken for each sample. The data (µm) were statistically analyzed using analysis of variance (ANOVA) and Tukey's test (α = 0.05). Qualitative analysis was performed using scanning electron microscopy (SEM). The mean (± SD) roughness values obtained for GZ were: 1.1 ± 0.40 µm; 1.0 ± 0.31 µm; 1.6 ± 0.31 µm; and 2.2 ± 0.73 µm. For MP, the mean values were: 0.66 ± 0.13 µm; 0.43 ± 0.14 µm; 1.6 ± 0.55 µm; and 2.0 ± 0.63 µm. The mean roughness values were significantly affected by the ceramic type (P = 0.0001) and polishing technique (P = 0.0047). The SEM images confirmed the roughness data. The manually polished glass CAD/CAM ceramics promoted lower surface roughness than did the glazed feldspathic dental ceramics.

Plataforma switching em região estética: relato de caso / Platform switching in the esthetic zone: case report

A remodelação óssea cervical ao redor de implantes com plataforma convencional, conhecida como saucerização, pode comprometer a manutenção dos tecidos duros e moles peri-implantares, gerando comprometimentos estéticos como recessões e/ou perda de papilas. O conceito de plataforma switching, com o posicionamento da união implante-abutment mais internamente, aumentando o distanciamento entre o osso e a plataforma protética, parece minimizar ou impedir essa reabsorção óssea. O presente trabalho tem o objetivo de apresentar um relato de caso clínico de reabilitação estética anterior, com a utilização de um implante plataforma switching associado a recursos plásticos e protéticos peri-implantares que maximizassem o resultado final. Os resultados clínicos e radiográficos demonstraram preservação dos picos ósseos proximais e das papilas, manutenção da espessura de tecido mole e adequado resultado estético final. A escolha do uso de implantes com essas características de plataforma switching pode ser favorável em áreas estéticas.

Marginal and internal discrepancies related to margin design of ceramic crowns fabricated by a CAD/CAM system.

PURPOSE: The aim of this study was to evaluate the marginal discrepancy (MD) and internal discrepancy (ID) of ceramic crowns manufactured by a CAD/CAM system, having different finish lines. The hypotheses tested were that the finish line type would not influence the MD or ID of the crowns, and ID would not change in different regions. MATERIALS AND METHODS: Three aluminum master dies (height: 5.5 mm, Ø: 7.5 mm, conicity: 6°) with different finish lines (TC: tilted chamfer; LC: large chamfer; RS: rounded shoulder) were manufactured. Ten impressions were made from each master die using a modified parallelometer. Impressions were poured in type IV dental stone, and 30 ceramic crowns (IPS Empress CAD, Ivoclar) were subsequently milled. The crowns were fixed on their respective metallic die using a metallic fixation device. The distance between the external edges of the crown to the edge of the cervical preparation was performed at 50 points on the respective metallic die (MD analysis). With the replica technique, the ID values of each crown were further evaluated at 12 points equidistant to each other in three regions: radius (R), axial (A), and occlusal (Occl). The measurements were performed using an optical microscope (250×). The data (µm) were analyzed using ANOVA and Tukey's test (5%). RESULTS: The RS group (28.24 ± 11.42 µm) showed significantly lower MD values (p= 0.001) than those of TC (99.92 ± 18.32 µm) and LC (64.71 ± 25.64 µm) groups, both of which also differed statistically from one another. The ID results demonstrated significantly lower values in the LC group (183.01 ± 62.82 µm) (p= 0.0014) than those of TC (216.26 ± 83.23 µm) and RS (219.12 ± 87.24 µm) groups. ID results of TC and RS were not significantly different. Additionally, the ID results showed significant differences among the regions (p= 0.0001). The null hypotheses were rejected. CONCLUSION: The RS finish line produced MD values significantly lower than tilted and large chamfer, but large chamfer presented the lowest internal discrepancy values. Independent of the finish line type, internal discrepancy was the lowest in the axial region followed by radius and occlusal regions.

Planejamento integrado em odontologia estética / Integrated treatment planning for aesthetic dentistry

Este relato de caso clínico descreve uma abordagem multidisciplinar para a melhoria da previsibilidade dos resultados estéticos de um tratamento com restaurações convencionais e sobre implantes no segmento anterior, integrando procedimentos cirúrgicos e restauradores avançados. Previamente à extração dental, foi realizada uma erupção dentária forçada, com a movimentação de tecidos periodontais duros e moles, sendo realizada uma extração dental a traumática e a colocação de um implante.

This clinical case report decribes a multidisciplinary approach used to enhance the pre- dictability of the aesthetics results of a treatment with conventional and implant-supported restorations in the anterior segment, combining advanced restorative and surgical procedures. Prior to tooth extraction, an orthodontic forced eruption was conducted to coronally displace the periodontal hard and soft tissues, and an atraumatic tooth extraction and the placement of an implant were performed.

Opaque layer firing temperature and aging effect on the flexural strength of ceramic fused to cobalt-chromium alloy.

PURPOSE: To evaluate the effect of the opaque layer firing temperature and mechanical and thermal cycling on the flexural strength of a ceramic fused to commercial cobalt-chromium alloy (Co-Cr). The hypotheses were that higher opaque layer temperatures increase the metal/ceramic bond strength and that aging reduces the bond strength. MATERIALS AND METHODS: Metallic frameworks (25 x 3 x 0.5 mm(3); ISO 9693) (N = 60) were cast in Co-Cr and airborne-particle abraded (Al(2)O(3): 150 mum) at the central area of the frameworks (8 x 3 mm(2)) and divided into three groups (N = 20), according to the opaque layer firing temperature: Gr1 (control)-900 degrees C; Gr2-950 degrees C; Gr3-1000 degrees C. The opaque ceramic (Opaque, Vita Zahnfabrick, Bad Säckingen, Germany) was applied, and the glass ceramic (Vita Omega 900, Vita Zahnfabrick) was fired onto it (thickness: 1 mm). While half the specimens from each group were randomly tested without aging (water storage: 37 degrees C/24 hours), the other half were mechanically loaded (20,000 cycles; 50 N load; distilled water at 37 degrees C) and thermocycled (3000 cycles; 5 degrees C to 55 degrees C, dwell time: 30 seconds). After the flexural strength test, failure types were noted. The data were analyzed using 2-way ANOVA and Tukey's test (alpha= 0.05). RESULTS: Gr2 (19.41 +/- 5.5 N) and Gr3 (20.6 +/- 5 N) presented higher values than Gr1 (13.3 +/- 1.6 N) (p= 0.001). Mechanical and thermal cycling did not significantly influence the mean flexural strength values (p > 0.05). Increasing the opaque layer firing temperature improved the flexural bond strength values (p < 0.05). The hypotheses were partially accepted. CONCLUSION: Increasing of the opaque layer firing temperature improved the flexural bond strength between ceramic fused to Co-Cr alloy.

Influence of surface treatment on the shear bond strength of ceramics fused to cobalt-chromium.

PURPOSE: To evaluate the influence of surface treatment on the shear bond strength between a Co-Cr alloy and two ceramics. MATERIALS AND METHODS: Forty-eight metal cylinders were made (thickness: 4 mm, height: 3.7 mm) according ISO TR 11405. The 48 metallic cylinders were divided into four groups (n = 12), according to the veneering ceramic (StarLight Ceram and Duceram Kiss) and surface treatments: air-particle abrasion with Al(2)O(3) or tungsten drill (W). Gr1: StarLight + Al(2)O(3); Gr2: StarLight + W; Gr3: Duceram + Al(2)O(3); and Gr4: Duceram + W. The specimens were aged using thermal cycling (3000x, 5 to 55 degrees C, dwell time: 30 seconds, transfer time: 2 seconds). The shear test was performed with a universal testing machine, using a load cell of 100 kg (speed: 0.5 mm/min) and a specific device. The bond strength data were analyzed using ANOVA and Tukey's test (5%), and the failure modes were analyzed using an optical microscope (30x). RESULTS: The means and standard deviations of the shear bond strengths were (MPa): G1 (57.97 +/- 11.34); G2 (40.62 +/- 12.96); G3 (47.09 +/- 13.19); and G4 (36.80 +/- 8.86). Ceramic (p= 0.03252) and surface treatment (p= 0.0002) significantly affected the mean bond strength values. CONCLUSIONS: Air-particle abrasion with Al(2)O(3) improved the shear bond strength between metal and ceramics used.

Sealing ability of castor oil polymer as a root-end filling material

OBJECTIVE: The purpose of this study was to evaluate the sealing ability of castor oil polymer (COP), mineral trioxide aggregate (MTA) and glass ionomer cement (GIC) as root-end filling materials. Forty-five single-rooted human teeth were cleaned and prepared using a step-back technique. The apical third of each root was resected perpendicularly to the long axis direction. All teeth were obturated with gutta-percha and an endodontic sealer. After, a root-end cavity with 1.25-mm depth was prepared using a diamond bur. The specimens were randomly divided into three experimental groups (n=15), according to the root-end filling material used: G1) COP; G2) MTA; G3) GIC. The external surfaces of the specimens were covered with epoxy adhesive, except the root-end filling. The teeth were immersed in rhodamine B dye for 24 hours. Then, the roots were sectioned longitudinally and the linear dye penetration at the dentin/material interface was determined using a stereomicroscope. ANOVA and Tukey's tests were used to compare the three groups. The G1 group (COP) presented smaller dye penetration, statistically different than the G2 (MTA) and G3 (GIC) groups (p<0.05). No statistically significant difference in microleakage was observed between G2 and G3 groups (p>0.05). The results of this study indicate that the COP presented efficient sealing ability when used as a root-end filling material showing results significantly better than MTA and GIC.

Sealing ability of castor oil polymer as a root-end filling material.

OBJECTIVE: The purpose of this study was to evaluate the sealing ability of castor oil polymer (COP), mineral trioxide aggregate (MTA) and glass ionomer cement (GIC) as root-end filling materials. Forty-five single-rooted human teeth were cleaned and prepared using a step-back technique. The apical third of each root was resected perpendicularly to the long axis direction. All teeth were obturated with gutta-percha and an endodontic sealer. After, a root-end cavity with 1.25-mm depth was prepared using a diamond bur. The specimens were randomly divided into three experimental groups (n=15), according to the root-end filling material used: G1) COP; G2) MTA; G3) GIC. The external surfaces of the specimens were covered with epoxy adhesive, except the root-end filling. The teeth were immersed in rhodamine B dye for 24 hours. Then, the roots were sectioned longitudinally and the linear dye penetration at the dentin/material interface was determined using a stereomicroscope. ANOVA and Tukey's tests were used to compare the three groups. The G1 group (COP) presented smaller dye penetration, statistically different than the G2 (MTA) and G3 (GIC) groups (p<0.05). No statistically significant difference in microleakage was observed between G2 and G3 groups (p>0.05). The results of this study indicate that the COP presented efficient sealing ability when used as a root-end filling material showing results significantly better than MTA and GIC.

Pônticos ovais: considerações biológicas, funcionais e estéticas / Ovate pontics: biologic, functional and esthetic considerations

Os pônticos ovais são uma alternativa viável aos tradicionais pônticos em plano inclinado, principalmente em casos estéticos em que a quantidade de tecido presente permite o condicionamento tecidual, por meio de um elemento provisório altamente polido e com adequado perfil de emergência. Esse elemento provisório determina a formação de um sítio receptor para o futuro pôntico, que é recoberto por um epitélio escamoso estratificado, resultante da compressão tecidual realizada. Este artigo apresenta um relato de caso clínico com os procedimentos necessários para a formação desse sítio, considerando suas indicações, contra-indicações e os resultados biológicos, funcionais e estéticos dessa opção de tratamento protético.

The influence of cervical finish line, internal relief, and cement type on the cervical adaptation of metal crowns.

OBJECTIVE: The aim of this investigation was to evaluate the cervical adaptation of metal crowns under several conditions, namely (1) variations in the cervical finish line of the preparation, (2) application of internal relief inside the crowns, and (3) cementation using different luting materials. METHOD AND MATERIALS: One hundred eighty stainless-steel master dies were prepared simulating full crown preparations: 60 in chamfer (CH), 60 in 135-degree shoulder (OB), and 60 in rounded shoulder (OR). The finish lines were machined at approximate dimensions of a molar tooth preparation (height: 5.5 mm; cervical diameter: 8 mm; occlusal diameter: 6.4 mm; taper degree: 6; and cervical finish line width: 0.8 mm). One hundred eighty corresponding copings with the same finish lines were fabricated. A 30-Microm internal relief was machined 0.5 mm above the cervical finish line in 90 of these copings. The fit of the die and the coping was measured from all specimens (L0) prior to cementation using an optical microscope. After manipulation of the 3 types of cements (zinc phosphate, glass-ionomer, and resin cement), the coping was luted on the corresponding standard master die under 5-kgf loading for 4 minutes. Vertical discrepancy was again measured (L1), and the difference between L1 and L0 indicated the cervical adaptation. RESULTS: Significant influence of the finish line, cement type, and internal relief was observed on the cervical adaptation (P <.001). The CH type of cervical finish line resulted in the best cervical adaptation of the metal crowns regardless of the cement type either with or without internal relief (36.6 +/- 3 to 100.8 +/- 4 Microm) (3-way analysis of variance and Tukey's test, a = .05). The use of glass-ionomer cement resulted in the least cervical discrepancy (36.6 +/- 3 to 115 +/- 4 Microm) than those of other cements (45.2 +/- 4 to 130.3 +/- 2 Microm) in all conditions. CONCLUSION: The best cervical adaptation was achieved with the chamfer type of finish line. The internal relief improved the marginal adaptation significantly, and the glass-ionomer cement led to the best cervical adaptation, followed by zinc phosphate and resin cement.

Implantodontia estética – O desenvolvimento de um novo pilar cerâmico / Esthetic implantolog

Muitos problemas estáticos, relacionados à reabilitação da região anterior comimplantes, têm sido solucionados po meio da utilização de pilares cerâmicos, especialmente desenvolvidos para esse fim. O nosso objetivo, neste trabalho foi mostrar e apresentar um novo conceito em pilar cerâmico, bem como os estudos e avaliações de suas propriedades mecãnicas, os quais mostraram e comprovaram suas adequadas características para suprir as necessidades funcional e estética.

Effect of surface treatments on the resin bond to zirconium-based ceramic.

PURPOSE: This study tested the hypothesis that the tribochemical silica coating on ceramic surfaces increases the bond strength of resin cement to a glass-infiltrated zirconium-based ceramic. MATERIALS AND METHODS: Fifteen blocks of In-Ceram Zirconia from CEREC InLab (5 per group) and 15 composite blocks (Z-250) 5 mm x 5 mm x 4 mm were made. The ceramic surfaces were polished, and the blocks were divided into three groups: (1) airborne abrasion with 110-microm aluminum oxide particles; (2) Rocatec system, tribochemical silica coating; and (3) CoJet system, tribochemical silica coating. The ceramic blocks were cemented to the composite blocks using Panavia F according to the manufacturer's specifications. All samples were stored in 37 degrees C distilled water for 7 days and later sectioned in two axes using a diamond disk under cooling to obtain specimens with a cross-sectional area of approximately 1 mm2 (n = 45). Each specimen was then attached with cyanoacrylate glue to an adapted device for the microtensile test, which was carried out on a universal testing machine. RESULTS: The results were subjected to ANOVA and Tukey's test. Group 2 (23.0+/-6.7 MPa) and group 3 (26.8+/-7.4 MPa) showed greater bond strength than group 1 (15.1+/-5.3 MPa). There was no significant difference between groups 2 and 3. All failures were in the adhesive zone. CONCLUSION: The hypothesis was confirmed--the tribochemical systems increased the bond strength between Panavia F and In-Ceram Zirconia.

Avaliação radiográfica de retentores intra radiculares metálicos fundidos / Radiographic analysis of cast posts

A confecção de retentores intra-radiculares metálicos fundidos é de fundamental importância para a longevidade do tratamento protético restaurador. A mesma pode se tornar crítica, se não observados princípios fundamentais, podendo se tornar causa de insucessos. O propósito neste trabalho foi avaliar radiograficamente a situação clínica de retentores intra-radiculares metálicos fundidos, e a coerência dos mesmos com os princípios para sua confecção. Para tal, 447 radiografias de dentes uniradiculados portadores de retentores intra-radiculares fundidos foram selecionadas a partir do arquivo da Faculdade de Odontologia de São José dos Campos e de consultórios particulares da cidade de São Paulo. As mesmas foram escaneadas, e analisadas no software para medições Image Tool for Windows 1.28, a partir de medidas pré-estabelecidas. Estes valores obtidos foram tabulados e, a partir de fórmulas matemáticas, foram verificados cinco fundamentos necessários à classificação de um tratamento como aceitável: regra dos dois terços, espaço vazio entre material obturador e porção mais apical do retentor, quantidade de material obturador remanescente, distância do mate-rial obturador ao ápice dentário e regra do fulcro dentário. Foram convencionados os parâmetros para classificar como aceitáveis ou não, verificando prevalência para todas as classes analisadas. Foram considerados inaceitáveis os fatores: comprimento do retentor intra-radicular, espaço entre retentor e material obturador, quantidade de raiz não obturada e comprimento do retentor em relação à implantação óssea da raiz. Apenas o material obturador remanescente foi con-siderado como aceitável dentre a população analisada neste estudo. Conclui-se que maior cuidado deve ser tomado na realização de retentores intra-radiculares pós-tratamento endodôntico.

Evaluation of the marginal fit of electroformed copings in function of the cervival preparation / Avaliação da adaptação marginal de copings eletroformados

O objetivo deste trabalho foi avaliar a adaptação marginal de copings eletroformados variando o término cervical (ombro arredondado e chanfro largo). Dois modelos padrão em aço inoxidável foram usinados simulando preparo de coroa total, sendo um com término cervical em chanfro largo e o outro em ombro arredondado. As moldagens foram feitas com polivinilsiloxano pela técnica da dupla moldagem, obtendo-se dez moldes para cada preparo. Para padronizar a moldagem foi confeccionado um alívio com uma placa de acetato com 1,4mm de espessura. Um delineador foi preparado para manter constante o eixo de inserção e remoção do modelo padrão durante as moldagens. Os moldes foram vazados com gesso do tipo IV e sobre os modelos aplicado espaçador de troquel 1mm aquém da margem. Estes troquéis foram duplicados com silicone de laboratório para a obtenção de um segundo troquel em gesso especial, o qual recebeu uma ligação com fio de cobre e uma cobertura com laca de prata, permitindo a passagem de corrente galvânica e a deposição do ouro. Após limpeza e ajuste, os copings retornaram ao modelo padrão que estava fixado numa base octogonal, iniciando-se a leitura em microscópio óptico Olympus com mesa digital e 30 vezes de aumento. Os dados obtidos foram submetidos ao teste "t" e Mann-Whitney com nível de significância de 5 porcento. Os valores médios do chanfro largo e ombro arredondado foram, respectivamente, 29,77um e 26,77um, com p=0,657 para o teste "t" e p=1,00 para o teste Mann-Whintney. Com os resultados obtidos, concluiu-se que não houve diferença estatisticamente significante, com ambas configurações marginais podendo ser empregadas durante o preparo dental.

Nova opção para confecção de coroas metalocerâmicas, com copings obtidos por eletrodeposição de ouro puro: seqüência clínica e laboratorial / A new option for metal ceramic crowns, with pure gold electroplating copings: clinical and laboratorial report

Este trabalho tem por objetivo mostrar a seqüência clínica e laboratorial para a confecção de coroas metalocerâmicas, com copings obtidos por eletrodeposição de ouro puro. Esta nova técnica possui algumas vantagens, como a estética, a adaptação marginal, a resistência à compressão, a ausência de corrosão marginal, a infra-estrutura com espessura uniforme e a biocompatibilidade com os tecidos adjacentes

Evaluation of knowledge and experience of dentists of São Paulo State, Brazil about cardiopulmonary resuscitation.

This work describes the knowledge and experience of dentists about cardiopulmonary resuscitation (CPR). A total of 182 dentists from São Paulo State, Brazil were interviewed: 59% judged themselves able to define CPR, although only 46% had a correct concept; 54% believed himself to be able to perform CPR, however, none of them referred to have received practical training in CPR; 3% of the interviewed professionals mentioned the occurrence of cadiopulmonary arrest in their dental office. It was concluded that dental surgeons in Brazil should be better trained for medical emergencies that can occur in the dental office.

Evaluation of knowledge and experience of dentists of São Paulo State, Brazil about cardiopulmonary resuscitation

Este trabalho descreve o conhecimento e experiência dos cirurgiões dentistas em reanimação cárdio-respiratória (RCR). Foram entrevistados 182 cirurgiões dentistas do Estado de São Paulo, Brasil: 59 por cento julgava-se capaz de definir RCR, embora somente 46 por cento tivesse um conceito correto; 54 por cento acreditava ser capaz de realizar RCR, no entanto nenhum deles referiu ter recebido treinamento prático em RCR; 3 por cento dos entrevistados mencionou a ocorrência de parada cárdio-respiratória no consultório odontológico. Concluiu-se que os cirurgiões dentistas brasileiros deveriam ser melhor treinados em emergências médicas que podem ocorrer nos consultórios odontológicos.

Intrauterine dentistry: an integrated model of prevention

A Odontologia intra-uterina é um tema de alta relevância no panorama atual. A adoção de medidas preventivas na fase intra-uterina pode prevenir várias doenças, dentre estas, a cárie dentária. A OMS preconiza que a partir do 4º mês, as gestantes devem evitar a ingestão de açúcar, para que o feto, futura criança, não desenvolva uma atração exagerada por estes alimentos, ficando mais suscetível a doença cariosa. Este trabalho se propôs investigar, através de entrevistas, junto a médicos ginecologistas obstetras (GO) e cirurgiões-dentistas clínicos gerais (CD), quais as informações que têm sobre este tema e como orientam suas pacientes, bem como investigar junto a mulheres gestantes, quais as orientações recebidas para prevenção de doenças bucais dos seus fetos. Setenta e um por cento dos CD e 80 por cento dos GO orientavam a gestante a diminuir a ingestão de açúcares. No entanto, apenas 13,6 por cento dos CD e nenhum dos GO orientavam esta redução entre a 12¬ e 18¬ semanas de gestação. 42,2 por cento das gestantes referiram esta orientação, mas nenhuma recebeu a orientação específica sobre o período entre a 12¬ e 18¬ semana. Um modelo ideal de atendimento à gestante deve compreender um atendimento integrado e multiprofissional, no qual atuem CD clínicos gerais e GO e tenha a participação do paciente.