Direct Resin Composite Restoration in Anterior Tooth: 10 Years of Clinical Follow-Up

The emergence and development of resin-based materials, such as resin composites and adhesive systems, have shifted the restorative treatment of anterior teeth with caries lesions and/or fractures. Thus, based on the disadvantages of indirect restorations, direct esthetic restorations are restorative options even for anterior teeth with exten sive loss of hard tissues. This study aimed to describe and discuss the direct resin composite restoration performed to solve the esthetic and functional impairments of the upper anterior teeth with diastemas. The upper left central incisor received total crown preparation for indirect restoration. Clinical results after 10 years were recorded. Considering the clinical characteris tics of dental restorations, it is possible to conclude that direct resin composite restorations reestablished the esthetic and functional properties satisfactorily, even in a tooth with extensive coronal destruction. The success of the restorative treatm ent was dependent on factors related to the materials´ properties, oral habits of the patient, and mostly the clinical skills of th e dental clinician.

La aparición y el desarrollo de materiales con base de resina, como las resinas compuestas y los sistemas adhesivos, han cambiado el tratamiento restaurador de los dientes anteriores con lesiones de caries y/o fracturas. Por lo tanto, en base a las desventajas de las restauraciones indirectas, las restauraciones estéticas directas son opciones de restauración, incluso para los dientes anteriores con una gran pérdida de tejidos duros. Este estudio tuvo como objetivo describir y discutir la restauración directa con resina compuesta, realizada para solucionar las deficiencias estéticas y funcionales de los dientes anteriores superiores con diastemas. El incisivo central superior izquierdo recibió preparación de corona total para restauración indirecta. Se registraron los resultados clínicos después de 10 años. Considerando las características clínicas de las restauraciones dentales, es posible concluir que las restauraciones directas en resina compuesta restablecieron las propiedades estéticas y funcionales satisfactoriamente, incluso en un diente con destrucción coronal extensa. El éxito del tratamiento restaurador dependió de factores relacionados con las propiedades de los materiales, los hábitos bucales del paciente y, sobre todo, las habilidades clínicas del odontólogo.

Color and surface gloss stability of bis-acryl and resin composite after exposure to cigarette smoke / Estabilidade de cor e brilho superficial de resinas compostas e bisacrílicas após exposição por fumaça de cigarro

Objective: To evaluate color and surface gloss stability of bis-acryl resins and resin composites, submitted to artificial staining with cigarette smoke. Material and Methods: Specimens of each material were prepared (n=15). Two resin composites (GrandioSO [RCG], Filtek Supreme [RCZ]) and five bis-acryl resins (Luxatemp Star [BisLUX], Protemp4 [BisPRO], Structor3 [BisSTR], Visalys Temp [BisVIS] and Yprov [BisYPR]) were tested. Initial color was assessed using a spectrophotometer and surface gloss with a glossmeter. Samples were submitted to smoke exposure (10 cigarettes under 8 minutes per cycle). After 3 and 6 cycles, color and gloss were reassessed. Final readings were performed after brush prophylaxis. Data were analyzed using two-way repeated ANOVA and Tukey's test (p<0.05). Results: Differences and interaction of factors (p<0.01) were detected for both color and gloss readings. Resin composites were the least affected by aging, with gloss reduction after prophylaxis. Differences were detected among bis-acryl resins, with better results for BisLUX and BisPRO. BisPRO and BisSTR, showed reduction in gloss after 60 cigarettes, while BisYPR gloss decreased at all evaluated periods. Conclusion: Resin composites are less susceptible to changes after smoke exposure, while bis-acryl resins results are brand-dependent. Prophylaxis negatively influenced the surface gloss of most of the tested materials (AU)

Objetivo: Avaliar a estabilidade de cor e brilho superficial de resinas compostas e bisacrílicas, submetidos ao manchamento artificial por fumaça de cigarro. Material e Métodos: Foram preparados espécimes de cada material (n=15). Duas resinas compostas (GrandioSO [RCG], Filtek Supreme [RCZ]) e cinco resinas bisacrílicas (Luxatemp Star [BisLUX], Protemp4 [BisPRO], Structor3 [BisSTR], Visalys Temp [BisVIS] e Yprov [BisYPR]) foram testados. A cor inicial foi avaliada usando um espectrofotômetro e o brilho de superfície com um medidor de brilho. As amostras foram submetidas à exposição de fumaça de cigarro (10 cigarros com até 8 minutos por ciclo). Após 3 e 6 ciclos, a cor e o brilho foram reavaliados. As leituras finais foram realizadas após a profilaxia escova de robinson. Os dados foram analisados usando de medidas repetidas e teste de Tukey (p<0,05). Resultados: Foram detectadas diferenças e interação de fatores (p<0,01) tanto para leituras de cor quanto para leituras de brilho. As resinas compostas foram as menos afetados pelo envelhecimento, com redução do brilho após a profilaxia. Foram detectadas diferenças entre as resinas bisacrílicas, com melhores resultados para BisLUX e BisPRO. BisPRO e BisSTR, mostraram redução de brilho após 60 cigarros, enquanto que o brilho da BisYPR diminuiu em todos os períodos avaliados. Conclusão: As resinas compostas são as menos suscetíveis a mudanças após a exposição à fumaça, enquanto os resultados das resinas bisacrílicas são dependentes da marca. A profilaxia influenciou negativamente o brilho de superfície da maioria dos materiais testados.(AU)

Direct composite resin restorations for teeth with dental erosion: a case report.

Acid erosion should be treated according to its multifactorial etiology. This case report describes a patient with tooth wear caused by daily intake of acidic carbonated beverages. After meticulous clinical and radiographic analysis, the clinician restored the teeth temporarily with chemically cured glass ionomer cement. Afterward, the patient underwent basic periodontal therapy with scaling and coronal polishing. The patient received guidance regarding daily oral hygiene and eating habits to control the ingestion of acidic drinks. After reestablishing adequate oral conditions, the clinician placed direct composite resin restorations on the maxillary anterior teeth that displayed dental erosion. The clinical procedures improved the patient's oral health as well as the form, esthetics, and function of the worn teeth.

Auxiliary UV light devices for removal of fluorescent resin residues after bracket debonding.

OBJECTIVE: The purpose of this clinical report was to describe the detection of fluorescent resin residue after orthodontic bracket debonding with two UV light devices and analyze the surface morphology of enamel after 1 year. CLINICAL CONSIDERATIONS: A 22-year-old woman had orthodontic brackets removed by a previous dentist; however, resin residue was left on the enamel of the maxillary teeth. After confirming the fluorescent property of the resin, different protocols were used for each half of the maxillary arch. The first method, a black light lens was attached to a light-curing device to detect resin fluorescence, followed by polishing with silicone rubber tips. The second method used a light emitting diode light system attached to and activated by a high-speed handpiece, followed by polishing with discs. Both methods were completed with diamond polishing paste applied with felt discs. Polyvinyl siloxane impressions were made initially, after residue removal, after finishing and after polishing for morphologic analysis. The results were evaluated with photographs and the scanning electron microscope images made of resin casts from the impressions. A follow-up was made after 1 year. CONCLUSIONS: Both methods yielded a satisfactory clinical outcome, with a smooth surface, acceptable surface gloss and minimal tooth wear. The use of a UV device that excites fluorescence is recommended for the controlled removal of resin residue on enamel. CLINICAL SIGNIFICANCE: The controlled removal of resin residue from enamel after orthodontic treatment is challenging but can be improved with auxiliary methods for detecting resin residues. This clinical report describes two types of devices that excite fluorescent resins in a more rapid and precise technique to guide the practitioner in the controlled removal of residual resin on teeth.

Effect of light-curing protocols on the mechanical behavior of bulk-fill resin composites.

OBJECTIVE: To investigate the effect of two light-curing protocols on mechanical behavior of three bulk-fill resin composites (BFRC) considering their optical properties. METHODS: One increment of 4 mm thickness of the bulk-fill resin composites Opus Bulk Fill, Tetric N-Ceram and Filtek Bulk Fill Flow were submitted to two different light-curing protocols: Sp - irradiance of 1000 mW/cm2 (20 s); Xp - irradiance of 3200 mW/cm2 (6 s). To assess the influence on the mechanical behavior it was studied polymerization shrinkage by X-ray microtomography (n = 3), Vickers hardness (n = 10) at the top and bottom surfaces of the samples, irradiance reaching the bottom surface (n = 3) and absorbance spectrum during the light-curing time interval (n = 3). Data were analyzed by two-way ANOVA test for parametric data and Kruskal Wallis test, followed by Wilcoxon or Mann-Whitney U post-test, for non-parametric data. RESULTS: All BFRCs contracted when light-cured, with greater contraction for Xp. Filltek Bulk Fill Flow showed highest polymerization shrinkage, for both Sp and Xp. All BFRCs showed minor hardness values on the bottom surface, with greater reduction for Xp. All BFRCs exhibited a decrease in irradiance at 4 mm depth. A decrease in absorbance intensity throughout the light-cure was observed, except for Opus Bulk Fill. CONCLUSIONS: Regardless BFRCs composition, the light-curing protocol with lower irradiance and longer exposure time results in lower polymerization shrinkage and higher hardness. The higher irradiance in a shorter time interval compromises the mechanical behavior of the resin composites, which may result in undesirable clinical outcomes.

A utilização do DSD (Digital Smile Design) para a otimização da estética dental / The use of DSD (Digital Smile Design) for the optimization of the dental esthetics

Atualmente, o DSD (digital smile design) tem sido utilizado como um recurso de grande destaque para a Odontologia Estética. O uso de um software pode facilitar e implementar através de simulações o tratamento reabilitador estético, fazendo com que haja maior entendimento do paciente sobre o procedimento e seus resultados, bem como evitando equívocos que possam ocorrer durante o tratamento. A técnica consiste em analisar as proporções faciais e dentárias de cada paciente e suas relações com dentes, lábios e gengivas por meio de fotografias digitais e vídeos. Com isso, são realizados desenhos seguindo métodos específicos que podem ser apresentados de maneira simples, compreensível e cativante para o paciente(AU)

Nowadays, the DSD (digital smile design) has been used as a great resource for aesthetic restorative dentistry. Through simulations, the use of a software can facilitate and implement aesthetics rehabilitation treatment, helping the patient to have a better understanding of the procedure and its outcomes, and also avoiding misunderstandings that may occur during the treatment. This technique consists in analyzing facial and dental proportions of each patient and the relations with their teeth, lips and gum through digital photograph and movies. Therefore, designs are made following specific methods that can be presented in a simple way, understandable and engaging for the patient(AU)

Efficacy of auxiliary devices for removal of fluorescent residue after bracket debonding.

OBJECTIVE: To evaluate four protocols for removal of fluorescent materials after bracket debonding. MATERIALS AND METHODS: Resin removal from 40 bovine enamel surfaces was performed according to groups (n = 10): conventional (C), white LED (W), LED that evidenced fluorescence (F), and fluorescent lens (FL). The following analyses were performed: sample thickness, superficial area of resin residue, and areas of resin residue or worn enamel in depth. ANOVA and Tukey tests were used to analyze sample thickness (P ≤ .05). Area measurements were analyzed by Kruskal-Wallis and Dunn's tests (P ≤ .05). RESULTS: The FL group showed the highest reduction in enamel thickness. F group final thickness was similar to that of other groups. The largest superficial areas of resin residue were found for the C and W groups, while the FL group had the greatest removal of resin residue. The C group exhibited the largest area in depth of resin residue. The FL and F groups exhibited the most loss of enamel with the least amount of resin residue; in contrast, the C and W groups presented the fewest areas of worn enamel and the most areas of resin residue. CONCLUSION: Auxiliary devices were useful for removal of fluorescent residue after bracket debonding.

Avaliação do esmalte dental na remoção de resíduos resinoso fluorescente com diferentes fontes luminosas / EvaluaLon of dental enamel in the removal of fluorescent resin residues with different light sources

Objetivo: Avaliar através de simulação clínica a efetividade da remoção de resíduos fluorescentes do esmalte dental bovino, após remoção de bráquetes ortodônticos, utilizando dispositivos emissores de luz branca e fluorescente. Materiais e Métodos: 180 dentes bovinos anteriores hígidos foram seccionados em discos de esmalte/dentina. A remoção do material resinoso cimentante foi realizada por três operadores. Os dentes foram divididos em quatro grupos de estudo. Os fatores em estudo foram: a fonte de iluminação empregada durante a remoção dos materiais resinosos cimentantes de bráquetes ortodônticos em 4 níveis (n = 45): Convencional (C), LED branco (W), LED fluorescente (F) e fotopolimerizador com filtro fluorescente (FL). Foram consideradas como variáveis de resposta: o tempo para remoção dos resíduos das amostras; a área de remanescente resinoso fluorescente superficial e a mensuração da altura de material adesivo fluorescente remanescente (PICO) e a profundada de esmalte desgastado (VALE). Na comparação entre as técnicas empregou-se o teste Kruskal-Wallis seguido do pós-teste Mann-Whitney U (P≤0,05). Resultados: As Técnicas F e FL apresentaram-se, estatisticamente, semelhantes e as menores medianas de tempo consumido para a remoção do resíduo resinoso. As técnicas C e W apresentaram estatisticamente, a presença de maiores e semelhantes medianas de áreas fluorescentes remanescentes e de PICO (altura do remanescente), com relação as técnicas F e FL; enquanto que as técnicas FL e F postaram, estatisticamente, uma maior mediana de VALE que a técnica C. Conclusões: A associação de emissor de luz fluorescente com um material resinoso fluorescente, colaborou significativamente e de forma eficaz, na redução do tempo consumido para remoção e evidenciação dos resíduos resinosos cimentantes fluorescentes, possibilitando uma remoção efetiva, após a remoção dos bráquetes ortodônticos(AU)

Objective: Evaluate, through clinical simulation, the effectiveness on the removal of fluorescent resin residues from bovine dental enamel after brackets debonding using white and fluorescent light emitting devices. Materials and Methods: 180 healthy anterior bovine teeth were sectioned on enamel / dentin disks. The removal of the resinous material was performed by three operators. The teeth were divided into four groups. The factors studied were: the light source used to remove orthodontic resin residue in 4 levels (n = 45): Conventional (C), white LED (W), fluorescent LED (F) and photocuring unit with Fluorescent filter (FL). Response variables were: the time spent to remove the sample residues; The surface area of the fluorescent remaining resin and the depth measurement of the remaining fluorescent adhesive thickness (PEAK) and the enamel thickness removed (VALLEY). In the comparison between the techniques, the Kruskal-Wallis test was used, followed by the Mann-Whitney U post-test (P≤0.05). Results: In terms of time, the groups F and FL were similar to each other and statistically different for groups C and W. The techniques C and W presented statistically, the presence of larger and similar medians of remaining fluorescent areas, in relation to the F and FL techniques. The techniques C and W presented, statistically, a larger and similar median of peaks than the F and FL techniques. The FL technique statistically demonstrated a higher median of valleys than the C technique. The W, F and FL techniques were statistically similar to each other, as were C and W techniques. Conclusions: Fluorescent light with a fluorescent resinous material, significantly and effectively collaborated in the reduction of the time consumed for evidencing and removal of fluorescent resin residues, allowing an efficient removal after removal of orthodontic brackets(AU)

Surface effects after a combination of dental bleaching and enamel microabrasion: An in vitro and in situ study.

This study evaluated the effects of combining enamel microabrasion and dental bleaching on the physical properties of enamel, using in vitro and in situ conditions and evaluating surface roughness, enamel microhardness and scanning electron microscopy images. One hundred sound bovine teeth were sectioned and cut into discs and randomly divided into 10 study groups (n=10). The results were submitted to Analysis of Variance (ANOVA) for repeated measures, followed by the Tukey test, with significance at 5%. Enamel surface roughness was significantly influenced by microabrasion, regardless of being combined with dental bleaching, for both HS (Human Saliva) or AS (Artificial Saliva) condition. Enamel microhardness was significantly decreased in the groups in which enamel microabrasion was performed, regardless its combination with dental bleaching; although storage in HS reestablished the initial enamel microhardness. It was concluded that dental bleaching does not cause major damage to microabraided enamel, and that only human saliva recovered the initial enamel microhardness.

Visagismo na odontologia: a personalização do sorriso / Visagism in dentistry: smile personalization

A odontologia está em constante evolução na área da estética, com a utilização de procedimentos e materiais inovadores, associados à tecnologias avançadas. Uma das técnicas que está em foco na atualidade é o visagismo, o qual pode ser conceituado como a arte de criar uma imagem que reflita as características da personalidade de uma pessoa de acordo com as formas de seu rosto, pois sua aparência pode dizer muito em relação à imagem que deseja ser transmitida. Diante disso, o objetivo desse estudo é demonstrar como o visagismo se incorporou à odontologia, por meio da literatura científica. Dentro do visagismo há uma interrelação entre a saúde e arte, há uma busca pela valorização dos aspectos positivos de traços marcantes, bem como a influência destes na identidade e arcada dentária de cada indivíduo, valorizando a arquitetura do sorriso de acordo com sua personalidade individual. Verifica-se que a utilização do conceito de maneira metódica é eficaz no planejamento prévio, que é realizado por meio de uma consultoria no qual o profissional tem por finalidade buscar uma melhor compreensão do paciente e suas particularidades, esse técnica permite analisar o temperamento de uma pessoa de acordo com o formato do rosto e feições. Categorizando a personalidade em quatro categorias: colérico, melancólico, sanguíneo e fleumático, que visa buscar alcançar seus anseios para que após esta etapa possa restabelecer uma estética dental em concordância com suas características físicas e emocionais, propiciando uma melhora da qualidade de vida e autoestima do paciente

Dentistry is constantly evolving in the aesthetics aspect, with the use of innovative procedures and materials, associated with advanced technologies. One technique that is in focus at present is the visagism, which can be defined as the art of creating an image that reflects the characteristics of a person’s personality according to their face shape, since your appearance can say a lot in relation to the image you want to be transmitted. Thus, the aim of this study is to demonstrate how the visagism was incorporated to Dentistry, through scientific literature. Within the visagism there is an interrelationship between health and art, in a search by the appreciation of the positive aspects of outstanding features, as well as their influence on identity and dental arch of each individual, valuing the smile’s architecture according to their individual personality. It appears that the use of the concept in a methodical manner is effective in preplanning, which is conducted by a consultancy in which the professional is intended to seek a better understanding of the patient and their particularities, this technique allows to analyze the temperament of a person according to your face shape and features. Categorizing personality into four categories: choleric, melancholic, phlegmatic and sanguine, aimed toward achieving their aspirations restoring dental aesthetics in accordance with their physical and emotional characteristics, providing an improved patient’s quality of life and self-esteem

Avaliação por ressonância paramagnética eletrônica da concentração de radicais livres gerados em um cimento resinoso dual utilizado na cimentação de um pino de fibra de vidro / Evaluation by electron paramagnetic resonance of the concentration of free radicals generated in a dual resin cement used on the cementing of translucent glass fiber post

Foi analisado por espectro de Ressonância Paramagnética Eletrônica (RPE), a concentração de radicais livres (RL) formados quando da cimentação de pino de fibra de vidro (PFV), com cimento resinoso dual (CRD), bem como a influência da forma anatômica do PFV (cônico ou cilíndrico). A primeira etapa foi composta de 3 grupos, de acordo com o método de cimentação do PFV numa matriz de silicone: G1- CRD fotopolimerizado por 40 segundos, com aparelho fotopolimerizador de diodo emissor de luz (LED), com potência de 1.500mW/cm2, encostado à superfície externa do pino; G2- CRD não recebeu ativação física; G3- tratamento semelhante ao G1, mas com bloqueio da interface pino/silicone. Na segunda etapa, os PFV foram seccionados de forma a obter dois pinos: PFVCl, cilíndrico e PFVCn cônico, de 9,5mm de comprimento cada, cimentadas semelhantemente ao G1. A concentração de radicais livres foi avaliada em: T0-10 minutos após espatulação do cimento e T1-24 horas após, em secções obtidas em diferentes profundidades do PFV. A análise do espectro das ressonâncias indicou que G1 e G3, apresentaram maior CRL. A translucidez do pino não influenciou na concentração de RL em profundidades acima de 12mm. Os pinos cilíndricos apresentaram maior concentração de RL. A concentração de radicais livres é influenciada pelo método de polimerização, bem como pela forma anatômica do PFV; a capacidade de condução da luz pelo PFV não interfere no grau de conversão do CRD nas regiões de maior profundidade.

The free radical concentration (FR) formed during GFP cementation, using dual cure resin cement (DCRC), as well as the influence of the anatomical shape of the GFP (conical or cylindrical), were analyzed by Electron Paramagnetic Resonance (EPR) spectrum. The first stage consisted of 3 groups, according to the GFP cementation method in a silicone matrix: G1- DCRC light cured for 40 seconds, with light emitting diode (LED), with intensity of 1.500mW/cm2 , leaning against the outer surface of the post; G2 - DCRC without light activation; G3- treatment similar to G1, but blocking the post/matrix interface. In the second stage, GFP were sectioned to obtain two sections: PFVCl, cylindrical and PFVCn, conical, 9,5mm in length each, cemented similarly to G1. The FRC was evaluated in: T0-10 minutes after cement's spatulation e T1-24 hours after, in sections obtained from different GFP depths. The resonance spectrum analysis indicated that G1 and G3 had a greater FR concentration. Post translucency did not influenced the FRC at depths greater than 12mm. Cylindrical posts presented greater FRC. The FR concentration is influenced by the polymerization method, as well as the GFP anatomical shape; GFP capacity to conduct light does not interferes in the degree of conversion on DCRC in regions of greater depth.

A microinfiltração coronária em dentes tratados endodonticamente e preparados para pino: revisão de literatura / The coronal microleakage in endodontically treated teeth and prepared to intracanal pin: literature review

A microinfiltração coronária favorece a penetração microbiana no interior do canal radicular, levando, muitas vezes, ao fracasso da terapia endodôntica. Tal fato pode ser agravado quando há a necessidade de remoção de parte do material obturador para instalação de pino. No intuito de prevenir o insucesso terapêutico e manter a saúde perirradicular, existem barreiras que impedem o intercâmbio fluídico entre a cavidade bucal e o canal radicular. Diante da importância deste tema no tratamento odontológico se realizou uma revisão de literatura com a finalidade de se estabelecer qual o melhor protocolo de tratamento para evitar a microinfiltração. Foram selecionados artigos científicos e livros a fim de reunir materiais e técnicas que amenizem ou evitem a penetração marginal de microrganismos, principalmente em dentes preparados para receber retentores intra-radiculares. Dentre as variáveis pertinentes à infiltração microbiana, a pesquisa analisa os materiais restauradores provisórios e suas atribuições, os tipos de cimentos endodônticos e requisitos de um agente cimentante de pino ideal. Faz referência à importância da qualidade dos retentores e principalmente do remanescente de material obturador no vedamento marginal, além de avaliar o grau de eficácia de alguns materiais impermeabilizantes ou de preenchimento. A literatura reportada destaca o Cavit, o Bioplic e a associação de dois materiais seladores provisórios como os mais eficazes e os cimentos que contém hidróxido de cálcio com resultados mais satisfatórios. Ainda enfatiza a boa qualidade dos pinos e um remanescente obturador de cinco milímetros como imprescindíveis para a saúde periapical

The coronal microleakage favors microbial penetration on root canal interior, often leading to endodontic therapy failure. This fact may exacerbate when is necessary to remove part of the filling material to install an intracanal metal cast pin. In order to prevent therapeutic failure and maintain periradicular health, there are barriers that prevent fluid exchange between oral cavity and root canal. Given the importance of the theme during dental treatment a literature review was conducted in order to establish the best treatment protocol to prevent microleakage. Books and scientific studies were selected to gather material and techniques that mitigate or avoid the marginal penetration of microorganisms, mainly in teeth prepared to receive intracanal retainers. Among variables relevant to microbial infiltration, the paper analyzes the temporary restorative materials and assignment, types of endodontic cements and requirement of an ideal pin cementing agent. It refers to the importance of retainers’ quality and mainly the remnant of filling material on marginal sealing, addition to evaluate the degree of effectiveness of impermeability or filling materials. Literature reported highlights the Cavit, the Bioplic and the association of two temporary sealing materials as the most effective and the cements containing calcium hydroxide with the most satisfactory results. It also emphasizes the high quality of pins and a remaining filling of five millimeters as indispensable to periapical heath