Reliability of the color measurement of resin composites using images obtained using a stereoscopic loupe

Abstract This study assessed the reliability of a color measurement method using images obtained from a charge-coupled device (CCD) camera and a stereoscopic loupe. Disc-shaped specimens were created using the composite Filtek Z350 XT (shades DA1, DA2, DA3, and DA4) (n = 3). CIELAB color coordinates of the specimens were measured using the spectrophotometer SP60 over white and black backgrounds. Images of the same specimens were taken using a CCD camera attached to a stereoscopic loupe. The color of the image was measured (red-green-blue [RGB]) using an image processing software and converted to CIELAB coordinates. For each color coordinate, data from images were adjusted using linear regressions predicting those values from SP60. The whiteness index for dentistry (WID) and translucency parameter (TP00) of the specimens as well as the color differences (ΔE00) among pairwise shades were calculated. Data were analyzed via repeated-measures analysis of variance and Tukey's post hoc test (α = 0.05). Images obtained using the loupe tended to be darker and redder than the actual color. Data adjustment resulted in similar WID, ΔE00, and TP00 values to those observed for the spectrophotometer. Differences were observed only for the WID of shade DA3 and ΔE00 for comparing DA1 and DA3 over the black background. However, these differences were not clinically relevant. The use of adjusted data from images taken using a stereoscopic loupe is considered a feasible method for color measurement.

Facetas em resina composta com fechamento de diastemas para harmonização do sorriso: relato de caso / Composite resin veneers with diastema closure for smile harmonization: A case report / Facetas de resina compuesta con cierre de diastemas para harmonización de la sonrisa: Informe de caso

Introdução:A estética do sorriso é um aspecto valorizado pela sociedade atual, o que demanda que os profissionais de odontologia estejam atualizados sobre materiais dentários e novas técnicas para alcançar resultados estéticos restauradores de alta qualidade. A resina composta é frequentemente utilizada para simplificar a reabilitação oral, pois oferece facetas dentárias que combinam excelente estética e durabilidade. Objetivo:Este artigo tem como objetivo relatar um caso clínico de reabilitação estética utilizando facetas em resina composta com fechamento de diastemas.Relato de caso:Uma paciente do sexo feminino, com 24 anos de idade, procurou a clínica escola de odontologia com insatisfação em relação à estética do seu sorriso. A pacienteapresentava diastemas, restauração defeituosa e desproporção no tamanho dos dentes anteriores. O tratamento consistiu em um clareamento caseiro prévio, seguido pela confecção de facetas diretas em resina composta para fechamento dos diastemas e correção da desproporção dentária. Foram utilizados um Jig Estético e o software Digital Smile Design (DSD)para o planejamento, além de um mock-up em resina bisacrílica. Após a confecção das facetas, foi obtido um resultado estético final satisfatório. O caso incluiu um total de oito facetas,dos dentes 14 ao 24. Conclusão:O tratamento utilizando restaurações em resina composta proporcionou à paciente uma reabilitação estética, funcional e biológica (AU).

Introduction:Smile aesthetics is an aspect valued by today's society, which demands that dental professionals are up to date on dental materials and new techniques to achieve high-quality restorative aesthetic results. Composite resin is often used to simplify oral rehabilitation, as it offers dental veneers which combine excellent aesthetics and durability. Objective:This article aims to report a clinical case of aesthetic rehabilitation using composite resin veneers with diastema closure. Case report:A24-year-old female patient came to the dental school clinic with dissatisfaction regarding the aesthetics of her smile. The patient had diastemas, defective restoration and disproportionate anterior teeth size. The treatment consisted of prior at-home tooth bleaching, followed by creating direct composite resin veneers to close the diastemas and correct tooth disproportion. An Aesthetic Jig and the Digital Smile Design (DSD) software program were used for planning, in addition to a mock-up in bisacrylic resin. After treatment, a satisfactory final aesthetic result was obtained. The case included a total of eight veneers, from teeth 14 to 24. Conclusion:Treatment using composite resin restorations provided the patient with aesthetic, functional and biological rehabilitation (AU).

Introducción: La estética de la sonrisa es un aspecto valorado por la sociedad actual, hecho que demanda de los profesionales de odontología actualización constante sobre los materiales dentarios y nuevas técnicas para alcanzar resultados estéticos restauradores de altacualidad. La resina compuesta es frecuentemente utilizada para simplificar la rehabilitación oral, pues ofrece facetas dentarias que combinan excelente estética y durabilidad.Objetivo: Este artículo tiene como objetivo relatar un caso clínico de rehabilitación estética a partir de la utilización de facetas en resina compuesta con cierre de diastemas. Informe de caso: Una paciente, del sexo femenino, con 24 años de edad, buscó la clínica-escuela de odontología insatisfecha con la estética de su sonrisa. La paciente presentaba diastemas, restauración dentaria defectuosa y desproporción en el tamaño de los dientes anteriores. El tratamiento consistió en un blanqueamiento casero previo, seguido por la confección de facetas directas de resina compuesta para cierre de los diastemas y corrección de la desproporción dentaria. Fueron utilizados un Jig Estético y el software Digital Smile Design(DSD) para el planeamiento, además de un mock-upen resina bisacrílica. Tras la confección de las facetas, fue obtenido un resultado estético final satisfactorio. El caso incluyó un total de ocho facetas, de los dientes 14 al 24.Conclusión: El tratamiento a partir de restauraciones en resina compuesta proporcionó a la paciente una rehabilitación estética, funcional y biológica (AU).

Utilidad de la tecnología CAD/CAM en la fabricación de prótesis dentales

La tecnología CAD/CAM es una forma innovadora relacionada con la implementación de técnicas digitales para mejorar las restauraciones prostéticas en un paciente, entre ellas, las destinadas a la estética dental. El presente estudio tiene el objetivo de describir la utilidad de la tecnología CAD/CAM en la fabricación de prótesis dentales. Para ello se realizó una revisión de la literatura médica disponible en las bases de datos PubMed/Medline, Scopus y SciELO, mediante fórmulas de búsqueda avanzada; se seleccionaron artículos en idioma español e inglés. En la actualidad, con esta tecnología se ha logrado combinar estética, resistencia y precisión en la restauración directa, además de garantizarse una mayor duración y años de funcionalidad para cada una de las prótesis, coronas e implantes. La calidad de vida y satisfacción referidas por los pacientes portadores de piezas producidas con esta tecnología, es superior a las manifestadas por aquellos tratados con piezas de fabricación tradicional. El uso de técnicas de inteligencia artificial y biomateriales representará un cambio cualitativo y cuantitativo en el uso de los sistemas CAD/CAM.

CAD/CAM technology is an innovative way related to the implementation of digital techniques to improve prosthetic restorations in a patient, including those intended for dental aesthetics. The objective of this study is to describe the usefulness of CAD/CAM technology in the dental prostheses manufacture. A review of the medical literature available in the PubMed/Medline, Scopus and SciELO databases was carried out, using advanced search formulas; Articles in Spanish and English were selected. Currently, with this technology it has been possible to combine aesthetics, resistance and precision in direct restoration, in addition to guaranteeing greater duration and years of functionality for each of the prostheses, crowns and implants. The quality of life and satisfaction reported by patients wearing parts produced with this technology is higher than those reported by those treated with traditionally manufactured parts. The use of artificial intelligence and biomaterials techniques will represent a qualitative and quantitative change in the use of CAD/CAM systems.

Tratamiento de la transposición de incisivos inferiores / Treatment of transposition of lower incisors

La transposición es el intercambio de la posición de dos dientes adyacentes durante los primeros años de la dentición mixta. El objetivo de la investigación fue evaluar los cambios clínicos de un caso con transposición parcial bilateral de incisivos laterales mandibulares. Se atendió una paciente de 8 años de edad, femenina, de raza blanca, síndrome de Clase II división 1, con transposición de los incisivos laterales con caninos inferiores. Fue tratada con un arco lingual de cierre horizontal, de alambre 0,032 y dos muelles de NiTi comprimidos desde el cierre horizontal del arco hasta una armella soldada a la banda que se colocó en ambos incisivos laterales. Se recuperó el espacio necesario para la erupción de los caninos inferiores y así mejoró la estética dental y facial de la paciente.

Transposition is the exchange of the position of two adjacent teeth during the first years of the mixed dentition. The objective of this research is to evaluate the clinical changes of a case with partial bilateral transposition of mandibular lateral incisors. We present an 8-year-old white female patient with Class II Division 1 malocclusion and transposition of the lateral incisors with lower canines. She was treated with a 0.032 wire horizontal closure lingual arch and two NiTi springs compressed from the horizontal closure of the arch to an eyebolt welded to the band that was placed on both lateral incisors. The necessary space for the eruption of the lower canines was recovered, thus improving her dental and facial aesthetics.

Effects of surrounding and underlying shades on the color adjustment potential of a single-shade composite used in a thin layer.

Objectives: This study aimed to evaluate the surrounding and underlying shades' effect on the color adjustment potential (CAP) of a single-shade composite used in a thin layer. Materials and Methods: Cylinder specimens (1.0 mm thick) were built with the Vittra APS Unique composite, surrounded (dual specimens) or not (simple specimens) by a control composite (shade A1, A2, or A3). Simple specimens were also built only with the control composites. Each specimen's color was measured against white and black backgrounds or the simple control specimens with a spectrophotometer (CIELAB system). The whiteness index for dentistry (WID) and translucency parameters (TP00) were calculated for simple specimens. Differences (ΔE00) in color between the simple/dual specimens and the controls were calculated. The CAP was calculated based on the ratios between data from simple and dual specimens. Results: The Vittra APS Unique composite showed higher WID and TP00 values than the controls. The highest values of ΔE00 were observed among simple specimens. The color measurements of Vittra APS Unique (simple or dual) against the control specimens presented the lowest color differences. Only surrounding the single-shade composite with a shaded composite barely impacted the ΔE00. The highest CAP values were obtained using a shaded composite under simple or dual specimens. Conclusions: The CAP of Vittra APS Unique was strongly affected by the underlying shade, while surrounding this composite with a shaded one barely affected its color adjustment.

CAD-CAM natural restorations-Reproducing nature using a digital workflow.

OBJECTIVES: Natural restorations combine digital workflow and shell technique to create CAD/CAM restorations with the form and texture of natural teeth. This case report describes an interdisciplinary digital workflow combined with CAD/CAM natural restorations to achieve the naturalness of an anterior rehabilitation. CLINICAL CONSIDERATIONS: A 38-year-old patient attended to the office with esthetic issues. An interdisciplinary treatment plan was conducted, which included periodontal surgery to recreate the gingival contour, associated with bleaching and manufacturing CAD/CAM ceramic veneers to return an optimal teeth surface texture and shape. CONCLUSIONS: The design and manufacturing of CAD/CAM natural restorations using a digital workflow allowed a predictable result and overcame the limitations of conventional shell technique. CLINICAL SIGNIFICANCE: Conventional shell technique is used to create restorations with the form and texture of natural teeth. This article presents a combination of the conventional shell technique with a digital workflow, facilitating the design and manufacturing of CAD/CAM natural restorations.

Long-term evaluation (up to 7 years) of the use of a collagen matrix to treat gingival recession associated with noncarious cervical lesion: Report of two cases.

INTRODUCTION: Gingival recession (GR) is a relevant clinical condition due to its high prevalence worldwide, which leads to aesthetic demands and dentin hypersensitivity. Collagen matrices have been associated with different designs of coronally advanced flaps (CAFs) to treat GR defects. However, the literature lacks long-term follow-up of this treatment option. The aim of this study is to present the long-term follow-up (up to 7 years) of two GR defects (associated or not with noncarious cervical lesion) treated with a CAF and a collagen matrix (CM). CASE PRESENTATION: Case 1 underwent a CAF associated with a CM to treat a single GR defect. After 7 years, Case 1 presented with 3 mm of recession reduction, which corresponds with the 85.7% of root coverage. Case 2 presented two GR defects associated with noncarious cervical lesions (NCCLs). The NCCLs were partially restored with resin composite and then underwent a modified CAF for multiple defects and a CM. After 5 years of follow-up, Case 2 presented with 1.5 and 2.5 mm of recession reduction, which corresponds with the average 83.3% defect coverage. CONCLUSION: These two cases may show that CMs can provide long-term stable outcomes in the treatment of GR defects. Why is this case new information? One of the cases is the first one to describe a 7 years of follow-up after CAF+CM to treat gingival recession defects. What are the keys to successful management of this case? Correct material handling. Adequate restorative protocol and surgical technique. What are the primary limitations to success in this case? Diagnose Patient compliance.

Background and surrounding colors affect the color blending of a single-shade composite

Abstract This study evaluated the background and effect of surrounding colors on the color blending of a single-shade composite used in a thin layer. Disc-shaped specimens (1.0 mm thickness) were built with the Vittra APS Unique composite surrounded (dual specimens) or not surrounded (simple specimens) by a control composite (shade A1, A2, or A3). Simple specimens were also built with only control composites. The specimen color was measured against white and black backgrounds with a spectrophotometer (CIELAB system). The whiteness index for dentistry (WID) was calculated for simple specimens. Differences (ΔE00) in color and translucency parameters (ΔTP00) between the simple/dual specimens and the controls were calculated. The translucency adjustment potential (TAP) and color adjustment potential (CAP) were estimated based on the ratios between data from simple and dual specimens. The Vittra APS Unique composite showed higher WID values than the controls. No differences between ΔTP00_SIMPLE and ΔTP00_DUAL were observed for any of the shades. The composite shade did not affect TAP values. The lowest values of ΔE00_SIMPLE and ΔE00_DUAL were observed for shade A1 regardless of the background color. For the white background, ΔE00_SIMPLE values did not differ from those of ΔE00_DUAL for all shades. Only A1 showed ΔE00_DUAL values lower than ΔE00_SIMPLE when the black background was used. The highest modulus of CAP (negative values for the white background) was observed when shade A1 surrounded the Vittra APS Unique composite. The color blending ability of the single-shade resin composite used in a thin layer was affected by both the surrounding shade and background color.

Efetividade da ação clareadora dos dentifrícios no clareamento dental: uma revisão Integrativa / Effectiveness of teeth whitening action in dental bleaching: an Integrative review

Objetivo: Avaliar a efetividade dos dentifrícios categorizados como do tipo clareadores no clareamento dental, por meio de um levantamento da evidência científica. Métodos: Foram utilizadas as bases de dados eletrônicas Pubmed, Embase, Web of Science e Scopus para a busca dos estudos até o mês de agosto de 2021. Estudos clínicos que compararam os dentifrícios mencionados como clareadores com os dentifrícios não clareadores na mudança de cor dos dentes foram incluídos. As palavras-chaves utilizadas na estratégia de busca foram: "whiteningtoothpastes", "whiteningdentifrice", "toothpastes", "dentifrice", "color change", "colorationanalysis" e "toothbleaching". Os dados foram analisados por meio de uma síntese qualitativa, detalhando os principais resultados dos estudos incluídos. Após a etapa de leitura e seleção dos artigos, foram incluídos 5 artigos para essa revisão integrativa. Resultados: O creme dental mais utilizado foi o Close Up White Now (n = 3). A metodologia de cor mais utilizada foi a espectrofotometria, o tipo de estudo que predominou foi o ensaio clínico randomizado, avaliando o esmalte dental humano. No que se refere ao RDA (Relative Dentin Abrasitity), os dentifrícios clareadores apresentam um índice entre 60-100, por vezes superior à 100, sendo considerados abrasivos. Conclusão: Nos resultados de alguns estudos incluídos, os dentifrícios clareadores não apresentaram efeito de clareamento intrínseco, apenas o efeito de remoção de manchas extrínsecas foi observado.

Aim: To evaluate the effectiveness of dentifrices categorized as whitening in tooth whitening, through a survey of scientific evidence. Methods: The Pubmed, Embase, Web of Science, and Scopus electronic databases were used to search for studies up to August 2021. Clinical studies that compared dentifrices mentioned as whitening with non-whitening dentifrices in the change of tooth color were also included. The keywords used in the search strategy were: "whiteningtoothpastes", "whiteningdentifrice", "toothpastes", "dentifrice", "color change", "colorationanalysis", and "toothbleaching". Data were analyzed using a qualitative synthesis, detailing the main results of the included studies. After reading and selecting the articles, five articles were included in this integrative review. Results: The most used widely toothpaste was Close Up White Now (n = 3). The most commonly used color methodology was spectrophotometry, while the predominant type of study was the randomized clinical trial, evaluating human dental enamel. Regarding the RDA (Relative Dentin Abrasitity), whitening toothpastes have an index between 60-100, sometimes higher than the 100, and are considered abrasive. Conclusion: In the results of some of the included studies, whitening dentifrices did not have an intrinsic whitening effect; only the effect of removing extrinsic stains was observed.

Prevalence and influence of dental development anomalies in smile esthetics: a cross-sectional analysis

Aim: To determine the prevalence of dental development anomalies and type of influence on the smile of adolescent students. Method: This was a cross-sectional and analytical study carried out in two public (A1) and two private (A2) schools chosen by lot in the city of Parnaíba-Piauí. The sample calculation was based on the target population: number of people enrolled in public and private schools between 15 and 19 years, in the city of Parnaíba-PI, which totaled 6209 students in 2020, according to a survey carried out by the Brazilian Institute of Geography and Statistics ­ IBGE. A questionnaire on epidemiological data and aesthetic self-perception of the smile was applied to 160 adolescents between 15 and 19 years old, from August 2020 to July 2021. The clinical examination was carried out under natural light, to check for the presence of anomaly(s) in the dental development. Students who presented only one pathology would be called group 1 (G1), those who presented two would be called group 2 (G2) and those who presented 3 or more would be called group 3 (G3). On the other hand, adolescents in whom no anomaly was evidenced would participate in the control group (CG), both in A1 and A2. Results: It was observed that 37.5% of the sample had only a type of dental anomaly, corresponding to 60 individuals. The most prevalent were enamel hypoplasia, fusion, transposition, agenesis, ectopic eruption, microdent and dens-in-dent. It was possible to verify a higher prevalence in the maxilla, private schools (76.6%) and females (86.6%). In 45% of adolescents with dental anomalies, embarrassment was observed when smiling. Conclusion: The prevalence was relatively high, highlighting the enamel hypoplasia, influencing the smile esthetics of a reasonable number of adolescents, whether for acquaintances, strangers or even for photographs

Prevalence and factors associated with gummy smile in adolescents: a cross-sectional analysis

Aim: To evaluate the prevalence and factors associated with gummy smiles in adolescents aged between 15 and 18 years attending high school. Methods: The cross-sectional and quantitative study was carried out during the Covid-19 pandemic, with 160 adolescents, from two public (A1) and two private (A2) schools chosen by lottery, divided into two groups: G1 (with gummy smile) and G2 (no gummy smile). A clinical examination was carried out on the adolescents, investigating the presence or absence of a gummy smile (GS), by analyzing the variables (interlabial distance at rest, upper incisor exposure at rest, smile arc, measurement from the subnasal to the upper lip philtrum, upper lip length, upper lip thickness, hypermobility and lower/middle third ratio). Means and dispersion were obtained, and the Chi-square association test was applied, to compare the results between A1 and A2 and between G1 and G2. Results: The prevalence of GS was 33.8% (=54). It was found that no statistically significant associations were found (p > 0.05), regarding the type of school and gender with the presence of GS in adolescents. There was no statistically significant difference (χ² = 1.82; p = 0.07) between the groups and the age of adolescents. There was a significant association between the studied variables and GS (p < 0.05). Conclusion: The prevalence was high with a predominance of females. There were no statistically significant associations regarding the type of school and gender, but there was a significant association between gummy smile and lip dimensions

A clinical evaluation of zirconia reinforced lithium silicate glass-ceramic CAD/CAM onlay: a two-year case report / Avaliação clínica de onlay cerâmica do tipo CAD / CAM de silicato de lítio reforçado com zircônia: um relato de caso de dois anos

ABSTRACT The CAD/CAM technology arose from the need to develop materials with better mechanical and optical properties that could be used for making monolithic restorations. Several materials have been used for milling indirect restorations in prefabricated blocks. Among them, lithium silicate reinforced with zirconia. Due to its recent introduction in the market, this case report aimed to present a detailed clinical protocol for the execution of a ceramic onlay of this material using CAD/CAM technology. A 57-year-old female patient sought care with extensive restoration in composite resin (BOMD) of tooth 15 maintained for almost two years. However, due to bruxism, constant dental tightening, the extension of the direct restoration and the need for improved esthetics, it was proposed to replace it with an indirect ceramic onlay restoration. Prophylaxis and choice of the color of the patient's dental substrate were performed. Afterwards, the dental preparation was made and polished. Subsequently, the molding was made with addition silicone and the provisional restoration confectioned. Once the stone model was obtained, it was scanned and the ceramic onlay restoration was milled using CAD/CAM technology. Finally, the restoration was stained and cemented over the preparation. After 2 years, the restoration remained stable, with no evidence of color mismatch, marginal discoloration, marginal cleft, caries or fracture, proving the effectiveness of the treatment in this time interval. The correct indication of the ceramic material combined with the use of CAD/CAM technology facilitated the restorative process, restoring function and the esthetics desired by the patient.

RESUMO A tecnologia CAD/CAM surgiu da necessidade de desenvolvimento de materiais com melhores propriedades mecânicas e ópticas que pudessem ser utilizados para confecção de restaurações monolíticas. Diversos materiais têm sido utilizados para fresagem de restaurações indiretas em blocos pré-fabricados. Dentre eles, o silicato de lítio reforçado com zircônia. Devido a sua recente introdução no mercado, este relato de caso objetivou apresentar um protocolo clínico detalhado para a execução de uma onlay cerâmica desse material utilizando a tecnologia CAD/CAM. Paciente, 57 anos, sexo feminino, procurou atendimento com extensa restauração em resina composta envolvendo as faces (MODV) do dente 15 mantida por quase dois anos. Contudo, em virtude do bruxismo, do apertamento dental constante, da extensão da restauração direta e da necessidade de melhora na estética, foi proposto a substituição por uma restauração indireta em cerâmica do tipo onlay. Foi realizada a profilaxia e escolha da cor do substrato dental da paciente. Em seguida o preparo dental foi confeccionado e polido. Posteriormente foi feita a moldagem com silicone de adição e a confecção do provisório. Com a obtenção do modelo, este foi escaneado e fresada a onlay cerâmica pela tecnologia CAD/CAM, que posteriormente foi maquiada e cimentada sobre o preparo. Após 2 anos, a restauração permaneceu estável, sem evidência de incompatibilidade de cor, descoloração marginal, fenda marginal, cárie ou fratura, comprovando a eficácia do tratamento neste intervalo de tempo. A correta indicação do material cerâmico aliada ao uso da tecnologia CAD-CAM facilitou o processo restaurador devolvendo função e a estética desejada pela paciente.

Facetas estéticas e lentes de contato: aspectos éticos e legais a partir da análise de redes sociais / Aesthetic facets and contact lenses: ethical and legal aspects from the analysis of social networks

A crescente busca pelo fator estético por meio de procedimentos odontológicos, junto ao impacto das redes sociais na atuação do profissional e no processo de tomada de decisão do paciente, provoca questionamentos sobre a conduta ética e legal do cirurgião-dentista. Dessa maneira, o objetivo deste trabalho foi analisar os aspectos éticos e legais relacionados à conduta profissional na abordagem e proposta de tratamento odontológico com facetas estéticas e lentes de contato dental divulgados por meio da ferramenta digital YouTube®. O estudo foi realizado em duas etapas: a primeira, a partir da análise de 10 vídeos de relatos de caso de pacientes que realizaram tratamento com facetas estéticas e lentes de contato dental, e, na segunda etapa, foram analisados 10 vídeos com o tema relacionado à apresentação que os cirurgiões-dentistas (CD) fazem sobre os tratamentos estéticos. Em estudo quantitativo-qualitativo, procedeu-se a análise das percepções do profissional (que oferta serviços) e do paciente (consumidor), confrontadas em seu conteúdo, tendo como referência aspectos éticos e legais vigentes. Como resultado, tem-se que nos vídeos de CD, 3 (30%) não abordam limitações e riscos, e nenhum trata sobre Termo de Consentimento Livre e Esclarecido (TCLE) e contrato. Apesar disto, nos vídeos de pacientes foram observadas poucas reclamações sobre as informações prestadas (10%) e nenhuma menção a processos. Logo, percebe-se, a partir deste estudo, que, os vídeos analisados frequentemente ferem normas éticas e legais da categoria profissional, sendo de realização arriscada, ainda que aparentemente os pacientes não estejam queixando-se de prática abusiva, os conselhos profissionais podem agir de ofício e instaurar processos éticos contra os profissionais

The crescent search for the aesthetic factor through dental procedures, coupled with the impact of social media on professional activities and the patient's decision making process, raises questions about the dentists ethical and legal conduct. The objective of this study was analyzing the ethical and legal aspects related to the professional's conduct in their approach and proposal of dental treatment with aesthetic dental facets and contact lenses in the digital means of YouTube®. The study was performed in two stages: the first one through the analysis of 10 YouTube® videos, related to case studies from the perspective of patients who had been subject to treatment with aesthetic dental facets and contact lenses; and the second stage analyzing 10 videos related to how dentists present the aesthetic treatments through this media. In a quantitative-qualitative study the two perspectives were analyzed, the professional as treatment offered and the patient as consumer, confronted through their content, referring back to current ethical and legal aspects, observed or disregarded, and the implied risks to the professional, serving as reading reference to critical, alert, competent and responsible practice. The results show that, in the dentists videos, 3 of them (30%) do not tackle the limitations and risks, and none mention informed consent forms (ICF). Despite this, the patient videos show few complaints about the information given beforehand (10%) and no mention of lawsuits. Therefore it is noted through this study that, although publicity in health services has its risks, the professionals apparently are not incurring in abusive practices

Short-term effect of adhesive system on clinical performance of bulk fill composite: randomized clinical trial

Aim: Although bulk fill composites have been widely used as restorative material, there is no consensus regarding the best clinical protocol in terms of composite technique and adhesive system. Therefore, this clinical trial evaluated the clinical performance of bulk fill composites for class I restorations under different protocols. Methods: A randomized clinical trial including 155 class I restorations was conducted using different adhesive systems: conventional technique (phosphoric acid + conventional three-step adhesive system) (Group 1, 2 and 3); or self-etching adhesive system (Groups 4, 5 and 6). Control groups 1 and 4 were restored with conventional composite; groups 2 and 5 with low viscosity bulk fill and conventional composite as occlusal coverage; groups 3 and 6 with high viscosity bulk fill. The FDI criteria was used for clinical evaluation at baseline and after 6 months. Results: All groups showed good clinical performance. At baseline, the adhesive system did not affect postoperative hypersensitivity. After 6 months, group 5 showed a significant reduction in color and translucency; group 6 a reduction in terms of anatomical form and for postoperative sensitivity and an improvement in patient satisfaction (p<0.05). Considering the same restorative technique, the use of the self-etching adhesive system showed a significant decrease in color and translucency (p<0.05). Conclusion: All groups showed favorable clinical performance, and promising results were found for the conventional adhesive system and high viscosity bulk fill protocol

Restabelecimento estético de incisivos laterais conóides e amplas restaurações em resina composta com laminados cerâmicos: relato de caso / Aesthetic recovering of conoid side incisives and wide restoration in composed resin with ceramic laminates: case report

Introdução: As cerâmicas odontológicas são amplamente utilizadas na Odontologia, desfrutando de grande popularidade devido a sua capacidade de mimetizar as características ópticas do esmalte e da dentina. O constante desenvolvimento de pesquisas tem desencadeado o lançamento de novos sistemas cerâmicos com propriedades aprimoradas e melhores resultados clínicos em longo prazo. Objetivo: O relato de caso aqui apresentado descreve uma reabilitação da zona estética do sorriso com laminados cerâmicos por meio de uma abordagem minimamente invasiva. Relato de caso: Paciente do gênero feminino, compareceu à clínica odontológica relatando insatisfação com a aparência do seu sorriso. Durante avaliação foram observadas, na região anterossuperior, restaurações extensas em resina composta deficientes nos incisivos, com proporção, volume, forma e texturização insatisfatórias, que em conjunto comprometia a zona estética do sorriso. Diante disso, após fotografias extra e intraorais, o tratamento proposto foi a reabilitação com laminados cerâmicos nas unidades 1.2 ao 2.2. Assim, foi realizado o enceramento e o mock-up, os quais serviram de orientação para os preparos dentários, a seguir, foram moldados e as restaurações confeccionadas no sistema IPS e.max. Após prova de cor e adaptação, os preparos e a superfície interna dos laminados cerâmicos foram tratados e cimentados com cimento resino fotopolimerizável. Conclusão: Instituindo uma abordagem conservadora, o plano de tratamento realizado através da reabilitação com laminados cerâmicos nas unidades dentárias anterossuperiores, permitiu o restabelecimento da função e estética, com reprodução das características dos dentes naturais e promoção do equilíbrio, da jovialidade e da harmonia no sorriso(AU)

Introduction: Dental ceramics are widely used in dentistry, enjoying great popularity due to the ability to mimic both enamel and dentin optical characteristics. The constant research development has triggered the launch of new ceramic systems with improved properties and better long-term clinical results. Objective: The case report presented here describes the zone rehabilitation of the aesthetic smile with ceramic laminates through a minimally invasive approach. Case report: Female patient, attended the dental clinic reporting dissatisfaction with the appearance of her smile. During the evaluation, extensive restorations in composite resin were observed in the incisors in the anterosuperior region, with unsatisfactory proportion, amount, shape and texturing, which together compromised the aesthetic zone of the smile. Faced with this, after extra and intraoral photographs, the proposed treatment was the restoration with the ceramic laminates in units 1.2 to 2.2. Thus, waxing and mock-up were performed, which served as guidance for the dental preparations, then they were molded and restorations fabricated in the IPS e.max system. After shade and adaptation proof, the preparations and the inner ceramic laminates surface were treated and cemented with light-cured resin cement. Conclusion: Adopting a conservative approach, the treatment plan carried out through restoration with ceramic laminates on the upper anterior teeth allowed the recovering function and aesthetics, reproducing characteristics of natural teeth and promoting balance, joviality and harmony in the smile(AU)

Smile Transformation with Composite Resin by Semi-Direct Technique: a Case Report / Transformação Do Sorriso Com Resina Composta Por Técnica Semi-Direta: Relato De Caso

Composite veneers stand out in modern dentistry for their practicality, time-saving and excellent optical properties. This work describes the operative steps for the realization of veneers in composite resin in an academic clinical environment using a semi-direct technique. A 21-yearold female patient attended the clinic-school complaining of aesthetic dissatisfaction with her smile. In the clinical dental evaluation, multiple diastemas were observed in the upper anterior teeth, and resin cement residues from orthodontic bracket bonding. In addition, the patient expressed an interest in having bigger and whiter teeth. In view of the complaints reported by the patient, the following treatment sequence was proposed: 1. Removal of residual resin cement from all teeth; 2. Tooth whitening; 3. Confection of composite resin veneers using the semi-direct technique on the upper teeth (canine to canine). The die stone that had already been made for the home bleaching procedure was used for esthetic rehabilitation. The 6 veneers were made using a nanoparticulate resin. The veneers were cemented and adjusted. The 12-month follow-up showed an excellent marginal adaptation and an excellent aesthetic and function quality. The semi-direct technique may be considered a therapeutic option based on the conservation of sound tooth structure, minimal emotional stress during clinical work and excellent final optical and mechanical properties. Simplicity and practicality of the technique allow reproducibility and excellent results at a lower cost when compared to dental ceramics. (AU)

As facetas em resina composta destacam-se na odontologia moderna por sua praticidade, economia de tempo e excelentes propriedades ópticas. Este trabalho descreve as etapas operatórias para a realização de facetas em resina composta em ambiente clínico acadêmico utilizando a técnica semi-direta. Paciente do sexo feminino, 21 anos, compareceu à clínica-escola com queixa de insatisfação estética com seu sorriso. Na avaliação clínica odontológica, foram observados múltiplos diastemas nos dentes anteriores superiores e resíduos de cimento resinoso proveniente da colagem de braquetes ortodônticos. Além disso, a paciente manifestou interesse em ter dentes maiores e mais brancos. Diante das queixas relatadas pela paciente, foi proposta a seguinte sequência de tratamento: 1. Remoção do cimento resinoso residual detodos os dentes; 2. Clareamento dental; 3. Confecção de facetas de resina composta pela técnica semi-direta nos dentes superiores (canino a canino). O modelo de gesso já confeccionado para o clareamento caseiro foi utilizado para a reabilitação estética. As 6 facetas foram confeccionadas utilizando resina nanoparticulada. As facetas foram cimentadas e ajustadas. O seguimento de 12 meses mostrou uma excelente adaptação marginal e uma excelente qualidade estética e funcional. A técnica semi-direta pode ser considerada uma opção terapêutica baseada na conservação da estrutura dentária sadia, mínimo estresse emocional durante o trabalho clínico e excelentes propriedades ópticas e mecânicas finais. A simplicidade e praticidade da técnica permitem reprodutibilidade e excelentes resultados a um custo menor quando comparado às cerâmicas odontológicas. (AU)

Do non-clinical subjective factors influence the treatment decisionmaking of Brazilian dentists?

The literature contains little information on several non-clinical factors such as the association between graduate residency programs and the application of minimally invasive dentistry, or on dentists' clinical decision-making processes for replacing restorations for esthetic reasons. This study evaluated whether non-clinical subjective factors influence the treatment decisions made by Brazilian dentists regarding technical and esthetic matters. Dentists were invited to participate in a cross-sectional survey by answering an electronic questionnaire containing clinical cases, regarding what treatment they would select for: T1 - a molar tooth with significant crown destruction and spontaneous pain, and T2 - premolar teeth with extensive amalgam restorations and no carious lesion or associated complaint. The survey also included questions about subjective variants (sociodemographic and professional). Chi Square test and Fischer's Exact test were used toanalyzetheanswers to T1, and one-factor analysis of variance and post-hoc Tamhane were applied to T2. The significance level was set at 5% for all analyses. A total 302 professionals participated in the study. For T1, it was found that clinical decision-making was influenced by the Brazilian region of clinical practice (p=0.005). For T2, a significant association was found between increased loss of patient tooth tissues and whether the professional had completed a residency program in Operative Dentistry (p=0.035), worked in a private practice (p=0.033), or if most of his/her patients belonged to a high estimated socioeconomic level (household income above $4350) (p=0.002). In conclusion, the clinical decision-making of Brazilian dentists varies according to professional profile, mainly with relation to the replacement of restorations due to esthetic concerns.

Vários fatores não clínicos, como a associação entre programas de especialização e a aplicação da odontologia minimamente invasiva, ainda são escassos na literatura. Outro aspecto relevante é a tomada de decisão clínica do dentista quanto à substituição de restaurações em função da aparência estética. Este estudo avaliou se fatores subjetivos não clínicos influenciam na tomada de decisão clínica de dentistas brasileiros com base em questões técnicas e estéticas. Foi realizado um estudo transversal com um questionário eletrônico contendo casos clínicos que foram apresentados a uma lista de profissionais. No questionário, interrogou-se o tratamento proposto para um dente molar com destruição coronária significativa e dor espontânea (T1). Também foi questionado o tratamento proposto para dentes prémolares com extensas restaurações de amálgama e sem lesão cariosa ou queixas associadas (T2). Em seguida, foram questionadas as variantessubjetivas(sociodemográfica eprofissional). Na análise de T1, foram utilizados os testes Qui Quadrado e Exato de Fischer. Em T2, foi aplicada a análise de variância de um fator e post-hoc Tamhane. Para todas as análises, o nível de significância foi estabelecido em 5%. Um total de 302 profissionais participaram deste estudo. A tomada de decisão clínica para T1 foi influenciada pela região brasileira de prática clínica (p = 0,005). Em T2, realizar especialização em Dentística Operatória (p = 0,035), trabalhar em consultório particular (p = 0,033) e a maioria dos pacientes apresentar nível socioeconômico estimado elevado (renda familiar acima de R$10.000,00) (p = 0,002) aumentou significativamente a perda de tecidos dentários. Em conclusão, a tomada de decisão clínica dos dentistas brasileiros varia de acordo com o perfil dos profissionais, principalmente no que se refere à substituição de restaurações por questões estéticas.

Microinvasive esthetic approach for deep enamel white spot lesion.

The white spot lesion on the dental enamel is an optical alteration that compromises the esthetics of smile. It can be caused by many factors, among them, defects in mineralization and formation of tooth enamel. Resin infiltrants are agents that penetrate, by capillarity, through the pores of the demineralized or hypomineralized enamel, altering the refractive index (RI) of the tooth structure and totally or partially masking the appearance of the white spot. The aim of this work was to report the use of resin infiltration to minimize the visualization of white spot lesion, present in an upper central incisor, as a microinvasive approach for the esthetic treatment of deep enamel hypomineralization. A 20-year-old female patient sought care with the esthetic complaint of extensive white spot lesion on the buccal face of her upper right central incisor. The diagnosis established was a deep white stain associated with the incisor molar hypomineralization syndrome, and the treatment of choice for the resolution of the case was the application of the Icon® resin infiltrant (DMG, Hamburg, Germany). To reach the body of the lesion, three cycles of acid erosion, using 15% HCl, were necessary to obtain a satisfactory aspect of masking the white lesion. A camouflage effect of the deep white spot lesion was achieved with the use of the resin infiltration, without the need of additional and irreversible wear of the dental structure.

Do non-clinical subjective factors influence the treatment decisionmaking of Brazilian dentists? / Fatores subjetivos não clínicos influenciam na tomada de decisão do tratamento de cirurgiões-dentistas brasileiros?

ABSTRACT The literature contains little information on several non-clinical factors such as the association between graduate residency programs and the application of minimally invasive dentistry, or on dentists' clinical decision-making processes for replacing restorations for esthetic reasons. This study evaluated whether non-clinical subjective factors influence the treatment decisions made by Brazilian dentists regarding technical and esthetic matters. Dentists were invited to participate in a cross-sectional survey by answering an electronic questionnaire containing clinical cases, regarding what treatment they would select for: T1 - a molar tooth with significant crown destruction and spontaneous pain, and T2 - premolar teeth with extensive amalgam restorations and no carious lesion or associated complaint. The survey also included questions about subjective variants (sociodemographic and professional). Chi Square test and Fischer's Exact test were used to analyze the answers to T1, and one-factor analysis of variance and post-hoc Tamhane were applied to T2. The significance level was set at 5% for all analyses. A total 302 professionals participated in the study. For T1, it was found that clinical decision-making was influenced by the Brazilian region of clinical practice (p=0.005). For T2, a significant association was found between increased loss of patient tooth tissues and whether the professional had completed a residency program in Operative Dentistry (p=0.035), worked in a private practice (p=0.033), or if most of his/her patients belonged to a high estimated socioeconomic level (household income above $4350) (p=0.002). In conclusion, the clinical decision-making of Brazilian dentists varies according to professional profile, mainly with relation to the replacement of restorations due to esthetic concerns.

RESUMO Vários fatores não clínicos, como a associação entre programas de especialização e a aplicação da odontologia minimamente invasiva, ainda são escassos na literatura. Outro aspecto relevante é a tomada de decisão clínica do dentista quanto à substituição de restaurações em função da aparência estética. Este estudo avaliou se fatores subjetivos não clínicos influenciam na tomada de decisão clínica de dentistas brasileiros com base em questões técnicas e estéticas. Foi realizado um estudo transversal com um questionário eletrônico contendo casos clínicos que foram apresentados a uma lista de profissionais. No questionário, interrogou-se o tratamento proposto para um dente molar com destruição coronária significativa e dor espontânea (T1). Também foi questionado o tratamento proposto para dentes prémolares com extensas restaurações de amálgama e sem lesão cariosa ou queixas associadas (T2). Em seguida, foram questionadas as variantes subjetivas (sociodemográfica e profissional). Na análise de T1, foram utilizados os testes Qui Quadrado e Exato de Fischer. Em T2, foi aplicada a análise de variância de um fator e post-hoc Tamhane. Para todas as análises, o nível de significância foi estabelecido em 5%. Um total de 302 profissionais participaram deste estudo. A tomada de decisão clínica para T1 foi influenciada pela região brasileira de prática clínica (p = 0,005). Em T2, realizar especialização em Dentística Operatória (p = 0,035), trabalhar em consultório particular (p = 0,033) e a maioria dos pacientes apresentar nível socioeconômico estimado elevado (renda familiar acima de R$10.000,00) (p = 0,002) aumentou significativamente a perda de tecidos dentários. Em conclusão, a tomada de decisão clínica dos dentistas brasileiros varia de acordo com o perfil dos profissionais, principalmente no que se refere à substituição de restaurações por questões estéticas.

New Volume-Stable Collagen Matrix and Modified Coronally Advanced Flap to Treat Multiple Gingival Recessions Associated With Partially Restored Non-Carious Cervical Lesions: A Case Report.

INTRODUCTION: Gingival recession (GR) is a prevalent problem that is related to esthetic demands and dentin hypersensitivity. Frequently, GR is associated with non-carious cervical lesion (NCCLs) forming a combined defect (CD), which requires restorative and surgical treatment. Connective tissue graft procedures allow predictable root coverage but can result in patient discomfort. CASE PRESENTATION: This first case report describes multiple GRs associated with B+ NCCL at teeth #4 and #6 of a 27-year-old patient with a thin periodontal phenotype. The aim of this report was to evaluate the 6-month outcome of a new volume-stable collagen matrix (VCMX) combined with modified coronally advanced flap (MCAF) and partial restoration to treat CDs. After 6 months, significant improvement was observed regarding CD coverage (69.05%), recession reduction (2.25 mm), gingival thickness gain (0.74 mm), and keratinized tissue width gain (0.75 mm). In addition, excellent esthetic evaluation and patient comfort were achieved by using the biomaterial. CONCLUSION: VCMX associated with MCAF and partial restoration may be an option to treat multiple recession defects plus B+ NCCLs.