Influence of ceramic veneer on the transdentinal cytotoxicity, degree of conversion and bond strength of light-cured resin cements to dentin.

OBJECTIVES: To investigate the transdentinal cytotoxicity (TC), degree of conversion (DC), and micro shear bond strength (µSBS) to dentin of light-cured resin cements (LCRCs) photoactivated directly or through a ceramic veneer( ± CV). MATERIALS AND METHODS: The TC was assessed using human dentin discs adapted into artificial pulp chambers. Odontoblast-like cells were seeded on the pulp surface of the discs, then three LCRCs( ± CV) were applied on their etched and hybridized occlusal surface (n = 8/group). The adhesive systems of each LCRCs and sterile phosphate-buffered saline were used as positive and negative controls, respectively. After 24 h, the viability and morphology of cells adhered on discs were assessed. The extracts (culture medium + components of the materials diffused through the discs) were applied on the MDPC-23 to evaluate their viability, adhesion/spreading (A/S), alkaline phosphatase activity (ALP), and mineralized nodule formation (MN). LCRCs( ± CV) specimens were evaluated concerning the DC and µSBS to dentin. Data were analyzed by one-, two-, or three-way ANOVA/Dunnett, Sidak, and Games-Howell tests (α = 5%). RESULTS: All LCRCs( ± CV) reduced cell viability, A/S, ALP, MN, and DC. Except for µSBS, the intensity of reduction was dependent on the LCRC used. LCRCs+CV resulted in lower DC and µSBS but did not increase the TC. SIGNIFICANCE: Besides the presence of CV between the light source and LCRCs reduces the degree of conversion and bond strength to dentin, these materials cause variable level of transdentinal toxicity to pulp cells. Thus, the composition and curing protocols of LCRCs should be revisited and reinforced to prevent mechanical and biological drawbacks.

Interdisciplinary planning as a landmark for treatment: Case report with a 2-years follow-up

Abstract Case report: young adult woman with esthetic complaints regarding her smile and frontal teeth aspect. At first glance, the problem seemed to be only the shape of the lateral upper incisors and a small diastema between the central incisors. The diagnosis shared between the orthodontist and the prosthetist led us to consider some other important aspects, such as the deep bite, the teeth inclination and the lips support. All these findings led us to consider that the right way to improve the esthetics of the patient's smile was to plan an orthodontic treatment. This would serve not only for the distribution of the spaces, but mostly it would improve all other problems, before the restoration of the upper lateral teeth with two ceramic veneers. Results: the treatment plan achieved the right distribution of spaces for upper lateral incisors, significant correction of the incisors inclination with important reduction of overbite and better lip support, upper laterals restorations with ceramic feldspathic veneers, obtaining a good integration with natural teeth satisfying patient complaint. Conclusion: in cases which involve interdisciplinary approach, the fundamental step comes from the beginning, when only an initial diagnosis shared among the team of specialists can define the patient problems from different points of view. In this way, we can better understand the competency fields and plan the right treatment and time sequence.

Resumo Relato de caso: paciente adulta jovem, sexo feminino, buscou tratamento devido à queixa com a estética do sorriso e o aspecto dos dentes anteriores. À primeira vista, o problema parecia ser apenas o formato dos incisivos laterais superiores e um pequeno diastema entre os incisivos centrais. O diagnóstico conjunto do ortodontista e do protesista fez com que considerássemos outros aspectos importantes, tais como mordida profunda, inclinação dentária e suporte labial. A partir de todas essas constatações, consideramos que a maneira mais adequada de melhorar a estética do sorriso seria planejar o tratamento ortodôntico. Assim, o tratamento serviria não apenas para melhor distribuição dos espaços, mas também melhoraria todos os outros problemas antes da restauração dos dentes laterais superiores ser realizada com duas facetas de cerâmica. Resultados: o tratamento planejado levou à correta distribuição dos espaços nos incisivos laterais superiores, com correção significativa da inclinação dos incisivos, importante redução da sobremordida e um melhor suporte labial, com restauração dos laterais superiores usando facetas de cerâmica feldspática, obtendo-se uma integração ideal com os dentes naturais, resolvendo as reclamações da paciente. Conclusão: em casos envolvendo abordagem multidisciplinar, as etapas iniciais são fundamentais, e apenas um diagnóstico inicial discutido entre a equipe de especialistas pode determinar os problemas do paciente sob diferentes perspectivas. Dessa forma, podemos compreender melhor os campos de competência e planejar a sequência e o tempo de tratamento mais adequados.

Esthetic and functional management of an ankylosed central incisor with a conservative restorative approach.

In this case report, we share a conservative and simple restorative management approach for a relatively complex esthetic situation on an adult patient with an ankylosed maxillary central incisor in infra-occlusion. A 37-year-old healthy female patient presented for a consultation with a chief complaint of an unappealing smile. The intraoral exam revealed tooth #8 (FDI 11) was in obvious and significant infra-occlusion due to altered eruption. Periapical radiographs of this area were non-contributory and all teeth responded within normal limits to pulp vitality tests. After review of several treatment options, the patient opted for a conservative restorative approach in which a partial ceramic veneer was planned for the ankylosed tooth, while composite resin was used on the contralateral central incisor to achieve a symmetric and pleasant result. CLINICAL SIGNIFICANCE: A relatively complex clinical problem was satisfactorily resolved with a very conservative option in which composite resin and a ceramic veneer were used to restore an asymmetric smile.