Harmonização estética do sorriso ­ cirurgia periodontal, clareamento dental e fechamento de diastemas ­ relato de caso / Aesthetic harmonization of the smile ­ periodontal surgery, dental whitening, and diastema closure - case report

Este estudo teve por objetivo relatar um caso clínico de harmonização estética do sorriso com abordagem multidisciplinar integrada, envolvendo cirurgia plástica periodontal, clareamento dental associado e fechamento de diastema com resina composta aplicada diretamente pela técnica "mãos livres". Após anamnese, diagnóstico e aceita da proposta terapêutica, foi realizado o procedimento cirúrgico periodontal (gengivectomia, gengivoplastia e frenectomia labial superior). Após o período cicatricial, foi realizado clareamento dental associado com as técnicas de consultório (peróxido de hidrogênio 35% - 02 sessões) e supervisionado (peróxido de carbamida 10% - 08hs/dia - 02 semanas). O tratamento foi finalizado com restaurações adesivas diretas em resina composta à mão livre para o fechamento de diastema. A terapêutica adotada evidenciou a necessidade de conhecimento científico e habilidade técnica profissional para seu emprego; mostrou-se eficaz como alternativa acessível de tratamento; permitiu melhor equilíbrio da harmonia estética do sorriso e a satisfação do paciente (AU).

This study aimed to report a clinical case of aesthetic harmonization of the smile with an integrated multidisciplinary approach, involving periodontal plastic surgery, associated to dental whitening and diastema closure with composite resin applied directly by the "hands free" technique. After anamnesis, diagnosis, and acceptance of the therapeutic proposal, the periodontal surgical procedure was performed (gingivectomy, gingivoplasty, and upper labial frenectomy). After the healing period, dental bleaching associated with the office techniques (35% hydrogen peroxide - 02 sessions) was performed and supervised (carbamide peroxide 10% - 08hs/day - 02 weeks). The treatment was finished with free hands direct adhesive composite resin restorations for diastema closure. The therapy adopted evidenced the need for scientific knowledge and professional technical skills for its use. It proved to be effective as an accessible treatment alternative; allowed better balance of the smile aesthetic harmony and the satisfaction of the patient (AU).

Restorations with Bulk Fill restorative system: case report / Restaurações com sistema restaurador Bulk Fill: relato de caso

ABSTRACT Bulk Fill Composite resins are restorative materials that present low tension and polymerization shrinkage, allowing them to be inserted in a single increment of up to 4 mm of thickness, in a restorative cavity. This paper aims to report a clinical case of restorations done on posterior teeth with Bulk Fill restorative system, using selective acid-etching with self-etch adhesive system. Patient, male, 24 years old, presented a carious lesion on the occlusal surface of dental element 37 and an occlusal unsatisfactory amalgam restoration, on element 36. A restorative treatment with Universal Bond 3M / ESPE and bulk fill composite resin (3M / ESPE) was done. According to the case described, it was possible to observe that the materials and techniques used restored the form and function of the teeth involved, preserving pulp vitality with a satisfactory aesthetic result. The bulk fill resins employed offer practicality and decrease clinical time, with satisfactory clinical applicability in the aesthetic and functional rehabilitation of posterior teeth.

RESUMO Resinas compostas do tipo Bulk fill constituem um material restaurador que apresenta baixas tensão e contração de polimerização, podendo ser inserido em incremento único, de até 4mm de espessura, numa cavidade. Este trabalho objetiva relatar um caso clínico de restaurações em dentes posteriores com o sistema restaurador Bulk fill, empregando o condicionamento ácido seletivo com sistema adesivo autocondicionante de emprego universal. Paciente, sexo masculino, 24 anos, apresentava lesão de cárie na face oclusal do elemento dentário 37 e restauração oclusal de amálgama insatisfatória, no elemento 36. Sendo proposto e realizado tratamento restaurador com Single Bond Universal 3M/ESPE e resina composta bulk fill (3M/ESPE). De acordo com o caso descrito, foi possível observar que os materiais e técnica empregados restituíram forma e função dos dentes envolvidos, preservando a vitalidade pulpar com estética considerada satisfatória. As resinas bulk fill empregadas oferecem praticidade e diminuição do tempo clínico, tendo aplicabilidade clínica satisfatória na reabilitação estética e funcional de dentes posteriores.

Complications with PMMA compared with other materials used in cranioplasty: a systematic review and meta-analysis.

Polymethyl methacrylate (PMMA) has been considered a suitable material for cranioplasty. However, no consensus has been reached concerning the best material for cranioplasty with regard to minimizing complications. Thus, this systematic review and meta-analysis aimed to compare the complication rates of PMMA with those of autologous bone and titanium mesh. This review was registered with PROSPERO (CRD42016042725). Systematic searches were conducted on PubMed/MEDLINE, Scopus, and Web of Science. The focus question was, "Do PMMA prostheses used in cranioplasty have complications rates similar to those of autologous bone and titanium mesh?" A meta-analysis of complication rates was performed on the basis of dichotomous outcomes assessed by risk ratio (RR) with corresponding 95% confidence intervals (CI). From 1014 data sources, 11 articles were selected according to eligibility criteria. These articles involved 1,256 individuals and 1,278 cranioplasties using autologous bone (n = 408), PMMA (n = 379), or titanium (n = 151). The follow-up period ranged from 63 days to 54.3 months. No difference was observed between the complication rates of PMMA and autologous bone (p = 0.94; RR, 0.98; 95%CI, 0.54-1.75) or between PMMA and titanium (p = 0.38; RR, 1.59; 95%CI, 0.57-4.48). Sub-analysis of the reasons for craniotomy (trauma/non-trauma) was conducted, which revealed no significant difference (p = 0.91; RR, 0.95; 95%CI, 0.37-2.42). The meta-analysis indicated that the use of PMMA yields complication rates that are near those of autologous bone and titanium mesh.

Complications with PMMA compared with other materials used in cranioplasty: a systematic review and meta-analysis

Abstract Polymethyl methacrylate (PMMA) has been considered a suitable material for cranioplasty. However, no consensus has been reached concerning the best material for cranioplasty with regard to minimizing complications. Thus, this systematic review and meta-analysis aimed to compare the complication rates of PMMA with those of autologous bone and titanium mesh. This review was registered with PROSPERO (CRD42016042725). Systematic searches were conducted on PubMed/MEDLINE, Scopus, and Web of Science. The focus question was, "Do PMMA prostheses used in cranioplasty have complications rates similar to those of autologous bone and titanium mesh?" A meta-analysis of complication rates was performed on the basis of dichotomous outcomes assessed by risk ratio (RR) with corresponding 95% confidence intervals (CI). From 1014 data sources, 11 articles were selected according to eligibility criteria. These articles involved 1,256 individuals and 1,278 cranioplasties using autologous bone (n = 408), PMMA (n = 379), or titanium (n = 151). The follow-up period ranged from 63 days to 54.3 months. No difference was observed between the complication rates of PMMA and autologous bone (p = 0.94; RR, 0.98; 95%CI, 0.54-1.75) or between PMMA and titanium (p = 0.38; RR, 1.59; 95%CI, 0.57-4.48). Sub-analysis of the reasons for craniotomy (trauma/non-trauma) was conducted, which revealed no significant difference (p = 0.91; RR, 0.95; 95%CI, 0.37-2.42). The meta-analysis indicated that the use of PMMA yields complication rates that are near those of autologous bone and titanium mesh.

Influência do cimento resinoso sobre a adesão de pinos intrarradiculares estéticos / Influence of resin cement on adhesion of aesthetic root posts

Introdução: O objetivo desde trabalho é avaliar a influência do tipo de agente de união e da dentina radicular (1/3 cervical; médio e apical) sobre a cimentação adesiva de pinos estéticosde fibra de vidro. Métodos - Foram utilizadas 27 raízes de dentes humanos, divididas em 03 grupos de acordo com o agente cimentante: G1- RelyX Unicem(3M / ESPE); G2- RelyXARC(3M / ESPE) + Adper Single Bond 2(3M / ESPE); G3- Cement-Post(Angelus) + AdperSingle Bond 2(3M / ESPE). Após a cimentação, as raízes foram seccionadas transversalmente em três discos (1,0 ± 0,2 mm de espessura) e submetidos a ensaio “push out”. Resultados - Os valores médios de tensão de retenção em mega pascal (MPa) foram: G1: 1/3 cervical- 7,6;1/3 médio-8,9; 1/3 apical-11,1; G2: 1/3 cervical-2,4; 1/3 médio-3,8; 1/3 apical-7,4; G3: 1/3cervical-3,3; 1/3 médio-3,2; 1/3 apical-7,8. O teste de Kruskal-Walis (α=0,05) evidenciou queapesar do G1 (RelyX Unicem - 3M / ESPE) ter apresentado maiores valores de retenção nos três terços radiculares, esta superioridade só foi estatisticamente significante nos terços cervicale médio; os valores de retenção dos Grupos 2 e 3 não foram diferentes estatisticamente entre si.Conclusão - O cimento autoadesivo RelyX Unicem (3M / ESPE) apresentou os maiores valores de resistência adesiva, com diferença estatisticamente significativa nos terços cervical e médio.

Introduction: The objective of this article is to evaluate the influence of the cement type and root dentin (1/3 cervical; medium; apical) on the adhesive cementation of glass fiber aesthetic posts. Methods - They were used 27 roots from human teeth, divided in three groups according the cement agent: G1- RelyX Unicem, 3M / ESPE; G2- RelyX ARC, 3M / ESPE + Adper SingleBond 2, 3M / ESPE; G3- Cement-Post, Ângelus + Adper Single Bond 2, 3M / ESPE. After cementation, the root were cross sectioned in three discs (1,0 ± 0,2 mm high) and submitted topush-out test. Results - Mean values of tension (MPa) of retention were: G1 cervical 1/3: 7,6;medium 1/3: 8,9; apical 1/3 11,1; G2 cervical 1/3: 2,4; medium1/3 3,8; apical 1/3: 7,4; G3cervical 1/3: 3,3; medium1/3: 3,2; apical 1/3 7,8. Kruskall-Walis Test (α=0,05) showed thatalthough G1(RelyX Unicem - 3M / ESPE) had presented higher values of retention at the three root thirds, this superiority was statistically significant only in cervical and medium thirds;the values of retention in Goups 2 and 3 didn´t were statistically different between each other.Conclusion - The self-adhesive cement RelyX Unicem (3M / ESPE) presented the highest valuesof adhesive strength, with statistically differences at cervical and medium thirds.

The importance of dentin collagen fibrils on the marginal sealing of adhesive restorations.

This study evaluated the importance of the union between dentin collagen and three different adhesive materials. Sixty Class V restorations were prepared on the buccal and lingual surfaces of 30 recently extracted human premolars, with the cervical margins in dentin and the occlusal margins in enamel. These restorations were distributed to three groups of 20 cavities each based on the employed adhesive system used: Group A: Single Bond; Group B: Prime&Bond NT; Group C: One Coat Bond. Each group was subdivided according to dentin treatment: (1) manufacturers' adhesive protocol and (2) removal of the collagens fibers (total etch + sodium hypochlorite 5% for two minutes) + adhesive protocol. After the restorations were completed, the teeth were stored in saline solution (24 hours/37 degrees C), subjected to thermal cycling, washing and scoring according to dye penetration. Dye penetration was evaluated, with the numbers ranging from 0 (no infiltration) to 3 (greatest infiltration). When the dentin microleakage scores were compared in subgroups A1XA2, B1XB2 and C1XC2, the Mann-Whitney Test revealed significant differences between groups B and C (p < 5%). The better results were shown in subgroups B2 (p = 0.0345) and C2 (p = 0.0029). The results showed that the collagen fibrils were not necessary for adhesion, and their removal positively influenced the marginal sealing of Prime&Bond NT and One Coat Bond.