Abordagem estética e conservadora para fechamento de múltiplos diastemas: relato de caso / Aesthetic and conservative approach to multiple diastema closure: case report / Enfoque estético y conservador para el cierre de múltiples diastemas: relato de caso

Introdução:Na odontologia moderna, a estética vem ocupando um espaço cada vez mais expressivo, e o desejo por dentes mais brancos, a insatisfação com o alinhamento dos dentes e com a anatomia dentária, têm sido os motivos mais relevantes de procura dos pacientes nos consultórios odontológicos.Objetivo:O presente artigo tem como objetivo descrever, através de relato de caso clínico, uma abordagem terapêutica estética e conservadora para fechamento de múltiplos diastemas anterossuperiores com a utilização de facetas de resina composta.Relato de caso:Paciente do sexo masculino, 21 anos de idade, procurou atendimento queixando-se de insatisfação estética pelos diastemas apresentados. Por meio de um planejamento digital das facetas em resina, com mockup e modelo impresso em 3D, as restaurações foram feitas respeitando anatomia, forma, opacidade e cores dos dentes naturais do paciente. O resultado dos procedimentos adotados foi satisfatório, demonstrando que a técnica empregada foi eficaz, sendo capaz de devolver um sorriso estético e biológico ao paciente. A odontologia contemporânea tem ofertado cada vez mais materiais com capacidade de devolver estética e função em dentes de forma minimamente invasivas, além de passar total confiabilidade em tratamentos a longo prazo, agradando o paciente desde a apresentação digital do planejamento traçado pelo cirurgião dentista com previsibilidade dos resultados, até o momento final do tratamento.Conclusões:O recontorno estético com resina composta representa uma opção funcional e de baixo custo para o tratamento de pacientes que apresentam diastemas múltiplos, principalmente em pacientes jovens pela preservação daestrutura dentária e possibilidade de reparo, sendo considerado um procedimento reversível, rápido e de baixo custo (AU).

Introduction:Aesthetics have been occupying an increasingly significant role in modern dentistry, and the desire for whiter teeth, dissatisfaction with tooth alignment, and dental anatomy concerns have been the most relevant reasons for patients seeking dental care. Objective:This article aims to describe an aesthetic and conservative therapeutic approach for closing multiple anterior upper diastemas using composite resin veneers in a clinical case report. Case report:A 21-year-old male patient sought treatment, expressing dissatisfaction with the diastemas he had. The restorations were performed using digital planning of the resin veneers with a mockup and a 3D-printed model, while respecting the patient's natural tooth anatomy, shape, opacity, and colors. The results of the adopted procedures were satisfactory, demonstrating effectiveness of the employed technique in restoring an aesthetic and biologically harmonious smile to the patient. Contemporary dentistry has been offering increasingly more materials capable of providing aesthetics and function to teeth through minimally invasive approaches. This not only ensures long-term treatment reliability, but also pleases the patient with a digital presentation of the treatment plan outlined by the dentist, predicting the results up to the final stages of the treatment. Conclusions:Aesthetic contouring using composite resin presents a functional and cost-effective option for treating patients with multiple diastemas, especially among young patients due to its preservation of dental structure, repair potential, and being considered a reversible, fast, and low-cost procedure (AU).

Introducción: En la odontología moderna, la estética viene ocupando un espacio cada vez más destacado, y las ganas de tener dientes más blancos, la insatisfacción con el alineamiento de los dientes, y la anatomía dental son las razonesmás relevantes por las cuales los pacientes acuden a las consultas odontológicas. Objetivo:El presente artículo tiene como objetivo describir, a través de un relato de caso clínico, un abordaje terapéutico estético y conservador para el cierre de múltiples diastemas anterosuperiores mediante el uso de carillas de resina compuesta. Informe de caso:Paciente del sexo masculino, 21 años de edad, buscó atendimiento quejándose de insatisfacción estética debido a los diastemas presentados. A través de una planificación digital de las carillas en resina, con un mockup y un modelo impreso en 3D, las restauraciones fueron ejecutadas, respetándose la anatomía, forma, opacidad y colores de los dientes naturales del paciente. El resultado de los procedimientos adoptados fue satisfactorio y demostró que la técnica utilizada fue eficaz, siendo capaz de restituir una sonrisa estética y funcional al paciente. La odontología contemporánea viene ofreciendo cada vez más materiales con la capacidad de devolver estética y función a los dientes de maneras mínimamente invasivas, además de brindar total confiabilidad en tratamientos a largo plazo, satisfaciendo al paciente desde la presentación digital del plan trazado por el cirujano dentista con la previsibilidad de los resultados, hasta el momento final del tratamiento. Conclusiones:El recontorneado estético con resina compuesta representa una opción funcional y de bajo costo para el tratamiento de pacientes con múltiples diastemas, especialmente en pacientes jóvenes, debido a la preservación de la estructura dental y la posibilidad de reparación. Se considera, de este modo, que se trata de un procedimiento reversible, rápido y económico (AU).

Publication trends of the Journal of Esthetic and Restorative Dentistry: A bibliometric analysis.

OBJECTIVE: The Journal of Esthetic and Restorative Dentistry (JERD) stands out as one of the most prominent international journals publishing research in esthetic dentistry. This study analyzed articles published by JERD since the year 2000 through bibliometric analysis. METHODOLOGY: The search was conducted in January 2024 using Scopus. The following data were extracted from the articles: citation count, year, language, access type, funding agency, study design, theme (general and specific), country, institution, authors, and keywords. The VOSviewer software was used to generate collaborative network maps among the data. Dimensions were consulted to measure altmetric data. Google Trends was used to investigate the global popularity of JERD research. RESULTS: A total of 1394 articles were included in this analysis. Citation count ranged from 0 to 625 (average: 16.9). Articles were published between 2000 and 2023. Laboratory studies were more prevalent (n = 850), with the most investigated general theme being restorative procedures (n = 882), and the highlighted specific theme being the use of composite resin (n = 327). The United States had the highest number of articles (n = 640), with the diverse distribution among other countries. The most common keyword was "cad/cam" (n = 63). VOSviewer demonstrated high collaboration among countries. Intense mentions were identified primarily on Facebook. According to Google Trends, Egypt was the country that searched for JERD the most. CONCLUSIONS: JERD exhibited significant growth in the number of published articles and their diversity by topics, types, origin (country), number of citations, and impact factor. CLINICAL SIGNIFICANCE: The JERD is a journal that publishes studies influencing clinical practice. Identifying the key characteristics of this journal is essential for charting future paths.

Remineralizing potential of a fluoride varnish modified by bioactive nanoparticles / Potencial remineralizante de um verniz fluoretado modificado por nanopartículas bioativas

Objective: Evaluate a fluoride varnish modified by nanostructures with the bioactive qualities of silica (SiO2) and niobium pentoxide (Nb2O5), testing its remineralizing potential by surface hardness (SH) and energy-dispersive X-ray spectroscopy (EDX). Material and Methods: Bovine enamel specimens (6×4×2mm) were prepared and submitted to a demineralizing/remineralizing process to produce a subsurface caries-like lesion, evaluated by transversal microradiography image (TMR) and subsequently distributed randomly into three groups: fluoride varnish (VZ); fluoride varnish + silica gelatin (VZ-SiO2) and fluoride varnish + niobium nanoparticles (VZ-Nb2O5). The specimens were subjected to a pH-cycling demineralizing/remineralizing process for 7 days at 37ºC. The %SH loss and %SH recovery (after the pH-cycling regimen) were calculated (n=10/group). The Ca/P weight ratio before and after the pH-cycling regimen was evaluated through SEM/EDX. A two-way ANOVA followed by Tukey's test (p<0.05) was performed for hardness and EDX. Results: TMR image showed the formation of an artificial subsurface lesion, and a significant SH increase was observed in the VZ-Nb2O5 group (p<0.05). Regarding the %SHL and %SHR, the VZ-Nb2O5 and VZ-SiO2 were significantly different compared to the VZ group (p<0.001), but VZ-Nb2O5 presented higher values. The Ca/P ratio showed that blocks treated with VZ-SiO2 and VZ-Nb2O5 showed greater ion deposition, particularly in the presence of Nb. Conclusion: The bioactivity of niobium facilitated greater interaction between the enamel and the varnish, leading to a slow release of nanoparticles and a longer-lasting remineralizing effect (AU)

Objetivo: Avaliar um verniz fluoretado modificado por nanoestruturas com a bioatividade da sílica (SiO2) e pentóxido de nióbio (Nb2O5), testando seu potencial remineralizador pela dureza de superfície (SH) e espectroscopia de energia dispersiva de raios-X (EDX). Material e Métodos: Espécimes de esmalte bovino (6×4×2mm) foram preparados e submetidos à desmineralização/remineralização para produzir uma lesão subsuperficial semelhante a cárie, avaliada por imagem de microrradiografia transversal (TMR) sendo distribuída em três grupos: verniz fluoretado (VZ); verniz fluoretado+gelatina de sílica (VZ-SiO2) e verniz fluoretado+nanopartículas de nióbio (VZ-Nb2O5). As amostras foram submetidas à desmineralização/remineralização por ciclagem de pH durante 7 dias a 37°C. A porcentagem de perda e recuperação de SH foram calculadas (n=10/grupo). A relação em peso Ca/P antes e depois da ciclagem foi avaliada através de MEV/EDX. ANOVA a dois critérios seguida do teste de Tukey (p<0,05) foi realizada para dureza e EDX. Resultados: A TMR mostrou a formação de uma lesão subsuperficial e um aumento significativo de SH foi observado no grupo VZ-Nb2O5 (p<0,05). Em relação ao %SHL e %SHR, o VZ-Nb2O5 e o VZ-SiO2 foram significativamente diferentes em relação ao grupo VZ (p<0,001), mas o VZ-Nb2O5 apresentou valores maiores. A relação Ca/P mostrou que os blocos tratados com VZ-SiO2 e VZ-Nb2O5 apresentaram maior deposição de íons, principalmente na presença de Nb. Conclusão: A bioatividade do nióbio facilitou maior interação entre o esmalte e o verniz, levando a uma liberação lenta de nanopartículas e a um efeito remineralizante mais duradouro (AU)

Impact of COVID-19 on theoretical knowledge and clinical practice in dentistry of Piracicaba Dental School students: a cross-sectional study

Aim: To assess the opinion of the students on the impact of COVID-19 pandemic on theoretical knowledge and clinical practice in dentistry at the Piracicaba Dental School ­ FOP/UNICAMP. Methods: A questionnaire was applied using the Google Forms platform, containing 20 questions related to the impacts of the pandemic on knowledge, mental health, and clinical and laboratory practice of dentistry. The satisfaction of the students with teaching was also evaluated. A total of 120 questionnaires were analyzed using R software, through tables and graphs of absolute and relative frequencies distribution. Results: COVID-19 affected the lives of 99% students who participated in the study. Due to distance learning resulting from the COVID-19 pandemic, 50% of the students considered locking or dropping out of college. Operative dentistry was the curricular component most affected by distance and lack of clinical practice. Although most students agreed that the workload of practical disciplines was or would be replaced, 95% felt some kind of deficit in clinical and laboratory practice even with the replacement of the workload. In addition, 93.3% of the students were afraid of not becoming a qualified professional due to the deficiencies on theoretical knowledge and clinical practice caused by the pandemic. Conclusions: Students showed dissatisfaction with the deficiency of clinical and laboratory practice resulting from the pandemic in operative dentistry curricular component. They reported fear and insecurity with their future professional lives. The indication of remote classes for dentistry should only be carried out in emergencies because this is an essentially practical course that suffers losses in learning

Injectable Resin Technique as a Restorative Alternative in a Cleft Lip and Palate Patient: A Case Report.

Objective: The objective of this study is to present a case report in which the injectable composite resin technique was used as a restorative alternative for dental re-anatomization in a patient with cleft lip and palate and aesthetic complaints. Materials and Methods: The treatment plan included the re-anatomization of the maxillary premolars and canines using a flowable composite resin. This resin was injected and cured through a transparent matrix, which was a copy of the diagnostic wax-up model. Some parameters such as application time and marginal adaptation were also observed when performing the restorations. Additionally, old composite resin restorations on the upper lateral incisors were replaced using the incremental technique with conventional resins, which helped to assess color stability and fracture/wear deterioration for both restorative techniques. Results: The clinical case report shows that the injectable technique was a simple and quick method for restoring the anatomy of teeth (shape and contour) in one session, since the injectable resin can be easily applied in interproximal areas without the need to manually sculpt the resin. In this case, no clinical, visual, or photographic differences were found in marginal discoloration, color stability, and fracture/wear deterioration for the two restorative techniques after one year of follow-up. Conclusions: The professional may have another clinical option for restorative treatment in the case of small re-anatomizations. In addition, the injectable technique seems to require less operator skill and chair time and better marginal adaptation in cases of small anatomical changes.

The Effect of Ethanol Associated with Universal Adhesive on Resin Composite Adhesion to Different Dentin Depths: A Long-Term In Vitro Study.

To evaluate the ethanol wet-bonding protocol with a universal adhesive in etch-andrinse and self-etch modes on microleakage and microtensile bond strength (µTBS) of resin composite to different dentin depth. Molars were distributed into groups according to protocol and dentin depth: universal adhesive (C - control), ethanol + universal adhesive (E), and phosphoric acid etch + ethanol + universal adhesive (PA+E). All protocols were applied to dentin at superficial, middle and deep depths. The specimens (n = 10) were submitted to microleakage and µTBS tests. Half of specimens were submitted to thermocycling (10,000 cycles; 5∘C/55∘C). Data were submitted to Spearman correlation (µTBS x microleakage) and three-way ANOVA (protocol, aging and depth), followed by Bonferroni post hoc test (α=0.05). PA+E group showed highest µTBS and lowest microleakage mean values in 24h. All groups presented similar µTBS mean values after thermocycling. The deep dentin showed less stable µTBS results. PA+E group presented highest microleakage mean values after thermocycling. Spearman's correlation showed a strong correlation between microleakage and µTBS. The PA+E group improved immediate adhesion and E group promoted a more stable µTBS in the long-term adhesion of universal adhesive. The aging for all protocols jeopardized the stability of the hybrid layer. The ethanol wet bonding technique associated with universal adhesive has enhanced the immediate result of the resin composite adhesion.

The stamp technique for direct restoration in a ICDAS 4 carious lesion: A 4-year follow-up.

OBJECTIVE: This case report described the use of a stamping technique associated with a bulk fill composite to restore an ICDAS 4 carious lesion on a posterior tooth. The 4-year follow-up is also presented. CLINICAL CONSIDERATIONS: A 32-year-old patient presented a carious lesion on tooth 36 with an underlying dark shadow at the dentin seen from the noncavitated enamel occlusal surface, which was compatible with an ICDAS 4 carious lesion. The lesion was radiographically detected and the caries disease was treated with dietary and hygiene habits orientations. Before accessing the lesion and selectively removing the carious tissue, an occlusal stamp was made by applying a flowable resin composite to copy the anatomy of the noncavitated enamel surface. The cavity was restored using a bulk fill resin composite (Opus Bulk Fill, FGM) with 4-mm-thick increments. Before curing the last increment, a Teflon band was adapted at the uncured bulk fill composite surface and the occlusal stamp made with the flowable composite was pressed against it to reproduce the natural characteristics and initial occlusal anatomy. The top surface was light-activated for 40 s. After 4 years, small wear could be seen in the restoration, but still within clinically acceptable levels. CONCLUSION: The occlusal stamp technique allows reproduction of the natural anatomy of teeth affected by ICDAS 4 carious lesions with good clinical longevity over 4 years. CLINICAL SIGNIFICANCE: This case report presents the use of the stamp technique to restore a tooth affected by an ICDAS 4 lesion, in which a carious process reached the dentin and the enamel anatomy was still preserved. The bulk fill resin composite associated with the occlusal stamp was chosen to quickly restore the cavity with clinical predictability. Bulk fill composites allow the insertion of up to 4-mm-thick increments and offer lower shrinkage stress, good clinical longevity and a less time-consuming procedure in cases of posterior teeth, especially if associated with the stamp technique.

Characterization of whitening toothpastes and their effect on the physical properties of bulk-fill composites

Abstract Objective To characterize activated charcoal and 2% hydrogen peroxide-based toothpastes and investigate their effects on roughness, color change, and gloss of bulk-fill composite resin. Methodology Composite resin specimens (Aura Bulk Fill, SDI) were subjected to 5,000 brushing cycles with regular toothpaste (Colgate Total 12, [RT]), activated charcoal toothpaste (Bianco Dental Carbon, [AC]), or hydrogen peroxide-containing toothpaste (Colgate Luminous White Advanced, [HP]), with or without coffee exposure. The pH, particle characterization by scanning electron microscopy (SEM), and weight% of solid particles in the toothpaste were assessed. Roughness (Ra) was evaluated using a surface profile-measuring device, color change (∆Eab/∆E00) by reflectance spectrophotometer, and gloss unit (GU) by glossmeter. Kruskal-Wallis, Dunn, Friedman, and Nemenyi tests were used, and the correlation coefficient test was performed between Ra and GU (α=0.05). Results RT presented a higher Ra after brushing and did not change after staining with coffee; moreover, the ∆Eab/∆E00 values were higher for RT than HP. Regarding gloss, AC and HP obtained higher values compared to RT. A significant negative correlation between gloss and Ra was found for RT exposed to coffee. All toothpastes had a neutral pH; however, RT had the largest percentage of solids by weight. SEM images showed particles of many sizes: irregular shape (RT), more regular particles (AC), and spherical clusters (HP). Although surface roughness, color change, and gloss may compromise the longevity of restorations, the whitening toothpastes tested did not promote more morphology changes than regular toothpastes.

Patient care in the restorative clinic of a public dental school after COVID-19 lockdown

Aim: This study, with the aim of checking some of the changes in patients' daily habits and their reasons for needing restorative treatment was conducted at a public university immediately on return to attendance after the COVID-19 pandemic lockdown. Methods: This survey consisted of interviews held by applying 2 questionnaires to students and patients. A single researcher collected data in all the restorative dentistry clinics at the university after the return to face-to-face activities in the period between 02/02/2021 and 07/30/2021. Data obtained by means of the questionnaires were submitted to descriptive analysis. Results: Ninety (90) participants answered the patient questionnaire. When considering possible associations between being in social isolation or not, significant values were found for changed type of diet (p=0.0011), frequency of eating (p=0.011) and toothbrushing (p=0.034). Data about 417 restorations were collected and among the reasons for restorative intervention, 33.03% were restoration replacement, 31.87% treatment of primary caries and 24.40% of dental wear/non-carious lesions. Conclusion: Patients who isolated themselves during the pandemic tended to change their eating habits and frequency of oral hygiene. Toothache was the main reason for seeking dental treatment and the replacement of pre-existing restorations was the main reason for restorative treatments

Conservative smile enhancement: a case report and brief review on multidisciplinary approach in aesthetic dentistry / Tratamento conservador de sorriso: um relato de caso e breve revisão sobre abordagem multidiscplinar na odontologia estética

ABSTRACT The gingival contour, the color of the teeth and the presence of interincisal diastema are seen as unsightly factors, being highly harmful from a social point of view. The present study aimed to report a comprehensive and conservative esthetic treatment executed with a multidisciplinary approach in a 20-year-old female patient that presented darkened teeth with poor spacing and excessive gingival display while smiling, as well as present a brief literature review on multidisciplinary approach in esthetic dentistry. After clinical examination and diagnosis, a treatment plan was elaborated to meet the patient's expectations with a conservative approach. After patient consent, therapy began with supervised home-based tooth whitening with 22% carbamide peroxide applied one hour/daily for 14 days, followed with gingival recontouring surgery and, after a healing period of 30 days, diastemas closure with direct composite resin technique, occlusal adjustment, finishing, and polishing. The multidisciplinary approach was fundamental for the accomplishment of the proposed treatment, achieving satisfactory esthetic and functional results.

RESUMO O contorno gengival, a cor dos dentes e a presença de diastemas interincisivos são vistos como fatores antiestéticos, sendo altamente prejudicial do ponto de vista social. O presente estudo teve como objetivo relatar um tratamento estético conservador executado com abordagem multidisciplinar em uma paciente do sexo feminino de 20 anos que apresentava dentes escurecidos com pouco espaçamento e exposição gengival excessiva ao sorrir, bem como apresentar uma breve revisão de literatura sobre à abordagem multidisciplinar em odontologia estética. Após exame clínico e diagnóstico, foi elaborado um plano de tratamento para atender as expectativas do paciente com abordagem conservadora. Após consentimento do paciente, foi iniciada o clareamento dental supervisionado com peróxido de carbamida 22% aplicado uma hora/dia por 14 dias, seguido de cirurgia de recontorno gengival e, após um período de cicatrização de 30 dias, fechamento de diastemas com técnica de resina composta direta. Neste caso, a abordagem multidisciplinar foi fundamental para a realização do tratamento proposto, alcançando resultados estéticos e funcionais satisfatórios.

Resin Composites in Posterior Teeth: Clinical Performance and Direct Restorative Techniques.

Resin composites are the most versatile restorative materials used in dentistry and the first choice for restoring posterior teeth. This article reviews aspects that influence the clinical performance of composite restorations and addresses clinically relevant issues regarding different direct techniques for restoring posterior teeth that could be performed in varied clinical situations. The article discusses the results of long-term clinical trials with resin composites and the materials available in the market for posterior restorations. The importance of photoactivation is presented, including aspects concerning the improvement of the efficiency of light-curing procedures. With regard to the restorative techniques, the article addresses key elements and occlusion levels for restoring Class I and Class II cavities, in addition to restorative strategies using different shades/opacities of resin composites in incremental techniques, restorations using bulk-fill composites, and shade-matching composites.

THE POST TRANSFIXED IN THE CORONAL CAVITY INCREASES THE FRACTURE RESISTANCE OF WEAKENED AND DIRECTLY RESTORED TEETH? A SYSTEMATIC REVIEW

Introduction: The objective of this systematic review was to answer the question: Does the intraradicular post transfixed in the dental crown increases the fracture resistance of weakened and directly restored teeth? Methods: Electronic databases (MEDLINE/PubMed, LILACS, SCOPUS, EMBASE, Scientific Electronic Library Online - SCIELO, and Central Register of Controlled Trials - CENTRAL) were searched until March 2021, without language or year restriction. Grey literature was also searched through Google scholar and OpenGrey repository. Only in vitro stud-ies were included that evaluated the influence of the use of intraradicular post trans-fixed in the crown in the buccopalatal/lingual direction in the fracture resistance of the dental crown. Relevant results were summarized and evaluated. The risk of bias was also assessed in the studies. Results: Initial screening of databases resulted in 249 studies, of which 109 were excluded for being duplicates. Of 140 eligible pa-pers, fourteen studies met the inclusion criteria and were selected for full-text read-ing. Of these, two studies were excluded for not having access to the full article. All selected articles were classified as low risk of bias. Conclusion: Based on the studies, it is possible to conclude that the use of a transfixed post in the crown increases the fracture resistance of weakened and directly restored teeth.

Un enfoque digital para restaurar un diente anterior traumatizado durante la pandemia COVID-19: reporte del caso / A digital approach to restore a traumatized anterior tooth during the COVID-19 pandemic: A clinical report

Los profesionales de la salud oral tienen un mayor riesgo de infección con el nuevo coronavirus 2019 (COVID-19), debido a la comunicación cercana a la cavidad oral y la exposición a saliva, sangre y otros fluidos corporales. Los enfoques digitales pueden reducir el tiempo clínico y contribuir a limitar el riesgo de infección. El objetivo del presente trabajo es presentar un enfoque digital para restaurar un diente anterior traumatizado, durante la pandemia de COVID-19. Paciente sexo feminino de 28 años, con movilidad anormal de la pieza 1.1 y antecedente de traumatismo dental en la adolescencia. Se realizó una evaluación inicial para detectar signos y síntomas de una posible infección por COVID-19. Las imágenes de la tomografía computarizada mostraron fractura coronaria y presencia de reabsorción cervical externa en el incisivo central derecho. El plan de tratamiento consistió en la rehabilitación del diente fracturado a través de una restauración retenida con un poste de fibra de vidrio, usando un abordaje digital por medio de un escáner intraoral con diseño y fabricación asistido por computadora (CAD/CAM). Los enfoques digitales en odontología podrían contribuir a reducir el riesgo de infección por COVID-19 en pacientes y dentistas durante los tratamientos restauradores.

Dental professionals are at increased risk of infection with the new coronavirus 2019 (COVID-19) due to face-to-face communication and exposure to saliva, blood and other body fluids. Digital approaches can reduce clinical time and contribute to limiting the risk of infection. The objective of this work was to report a digital approach to restoring a traumatized anterior tooth during the COVID-19 pandemic. A 28-year-old female with abnormal mobility in the crown of an upper anterior tooth with history of dental trauma in the adolescence. An initial screening was performed to check for signs and symptoms of possible COVID-19 infection. Cone Beam Computed Tomography images showed a crown fracture and the presence of external cervical resorption in the right permanent central incisor. The treatment plan consisted of rehabilitation of the fractured tooth through a restoration retained with a fiberglass post with a digital approach using an intraoral scanner, and computer-aided design and fabrication - CAD/CAM. Digital approaches in dentistry including intraoral scanners and CAD/CAM could contribute to reducing the risk of COVID-19 infection in patients and dentists during restorative treatments.

Effects of shades of a multilayered zirconia on light transmission, monomer conversion, and bond strength of resin cement.

OBJECTIVE: To evaluate the influence of shades of a multilayered zirconia on light transmission, resin cement degree of conversion, and shear bond strength of resin cement. MATERIALS AND METHODS: The light transmission through opaque (OPQ) and translucent (TNS) regions of Katana UTML zirconia (Kuraray Noritake Dental) were evaluated for using a spectroradiometer (n = 5). Degree of conversion of dual-cure resin cement (Panavia V5, Kuraray Noritake Dental) was measured after light-activation through OPQ or TNS regions and direct exposure. Composition of the zirconia was analyzed with energy dispersive x-ray spectroscopy (EDS). Shear bond strength (SBS) was evaluated on the OPQ and TNS regions after 24 h and 1 year from specimen preparation (n = 15). RESULTS: The OPQ region produced higher irradiance loss (95.1%) than TNS one (92.9%), and lower degree of conversion (52.4%) than TNS (71.2%) at 24 h post-light activation. EDS analysis did not show differences on the microstructure of the OPQ and TNS regions. There were no significant differences on the SBS between zirconia regions. For both zirconia regions, a significant reduction on the SBS occurred after aging, being 31.7% for OPQ and 38% for TNS. CONCLUSION: Both OPQ and TNS regions affected the light transmission through the multilayered zirconia. The OPQ region yielded the highest light attenuation and the lowest degree of conversion of resin cement. Different regions of the zirconia did not influence the SBS. Clinical significance Although opaque and translucent regions of the multilayered zirconia reduced the light transmission from LED curing unit and the degree of conversion of resin cement, the regions did not affect the resin cement adhesion.

Relato de experiência no ensino da Dentística com base em metodologias ativas de ensino-aprendizagem: gamificação e práticas lúdicas / Experience report in teaching Dentistry based on active teaching-learning methodologies: gamification and ludic practices

O presente estudotem por objetivo demonstrar umprocesso de ensino-aprendizagemna graduação odontológica de cunho lúdicoe engajamento do estudante, no momentoem que ocorre a transição no ensino dasdisciplinas, destacando-se:do ciclo básico;percorrendo oambiente laboratorial;até o atendimento clínico aospacientes, para além do mero treinamento técnico.Prevalece noensino superioro aprendizadofragmentadopordisciplinas e áreas de especializaçãoenota-se uma ausência de conexãoentre ospropósitoslaboratorialeclínico. A aplicação de duas ferramentas, com o aporte dasMetodologias Ativas de Ensino-Aprendizagem(MAEA), converteu-seem umrelato de experiência de ensino da exitosoda Dentística,a saber: (1) demonstração tridimensional da formação de cavidades com materiaisacessíveis, com base napinturacom tinta guache das paredes cavitáriase ângulos de macromodelos de gesso,representando preparosintracoronário e extracoronárioparcial (onlay);e(2) gamificação, por meio de quebra-cabeçadeprojeçãodeimagem dos diferentestipos de preparos cavitários.O uso de recursos com basenas MAEAdemonstrou resultados promissores, interconectandoáreas de ensino da dentística, vistas como dicotômicas, teórica e prática, ensinosbásico e clínico, assimcomo promovendoo despertar, a adesão e o desenvolvimento de habilidades manuaisdo estudante (AU).

The aim of this study was to demonstrate a teaching-learning process of a ludic nature and student engagement, in a dental graduation course, at a time when the transition in the teaching of subjects is taking place. The basic cycle will be highlighted by walking through the laboratoryenvironment. Even the clinical care of patients will be considered beyond the level of mere technical training. In higher education, learning fragmented by subjects and areas of specialization prevails, and there is no connection between laboratory and clinical purposes. The application of two tools, with the contribution of Active Methods of Teaching and Learning (AMTL), became a report of successful teaching experience in Dentistry, namely: (1) three-dimensional demonstration of the formation of cavities with accessible materials, based on painting the cavity walls and angles of plaster macromodels with gouache paint, representing intracoronal and partial extracoronal (onlay) preparations; and (2) gamification, by means of projecting the images of puzzle of different types of cavity preparations. The use of resources based on the AMTL has shown promising results, by interconnecting areas of teaching dentistry, seen as dichotomous, theoretical and practical, basic and clinical teaching, as well as promoting the awakening, adherence and development of students' manual skills (AU).

Decisions about the diagnostic and treatment criteria of dental caries among a group of dental students, faculty staff and dentists within the city of Medellin, Colombia / Decisiones sobre los criterios de diagnóstico y tratamiento de la caries dental entre un grupo de estudiantes de odontología, profesores y odontólogos de la ciudad de Medellín, Colombia

Objective: To analyze the criteria for diagnosis and treatment decision-making in relation to dental caries in different participants (teachers of dentistry, dental students at dental schools, and dentists practicing at public oral health services) in the city of Medellin (Colombia). Material and Methods: A cross-sectional study was applied in the period September 2015-december 2016 by means of an international validated questionnaire in 340 participants (dental teachers: 69, dental students: 193, dentists: 78). The survey addressed several topics related to detection and restorative threshold, preferences of preparation type, restorative materials used and opinions about diagnosis and treatment for dental caries. A descriptive analysis was carried out and Chi square tests were applied to observe statistically significant differences between the study variables.Results: 340 participants were surveyed among teachers who teach cariology, health care dentists, and undergraduate final-year students. Most participants were women (70%). The age mean was higher for DDSs (46 ± 9 years). On average, practicing dentists and dental teachers had a work experience of 21 ± 9 years. In case of treatment decisions, the majority of the surveyed would use immediate operative restorative treatment for advanced carious lesions (inner one-third of the dentin for approximal and grade 5 for occlusal). In addition, respondents reported different cavities diagnosis for clinical occlusal cases and some significant statistically differences were found for restorative treatment decisions and type of materials according to the type of participant. Conclusion: Criteria for diagnosis and treatment of dental caries differed among the student, dentist and dental teachers with variety in diagnosis and treatment concepts. However, a conservative tendency for restorative treatment decisions was observed. Strategies for incorporating non-restorative and minimal measures in professional practice should be considered in curricula of universities.

Objetivo: Analizar los criterios para la toma de decisiones diagnósticas y terapéuticas en relación a la caries dental en diferentes participantes (docentes, estudiantes de odontología de las facultades de odontología y odontólogos de los servicios públicos de salud bucal) de la ciudad de Medellín (Colombia). Material y Métodos: Se aplicó un estudio transversal en el período septiembre 2015 - diciembre 2016 mediante cuestionario internacional validado en 340 participantes (profesores de odontología: 69, estudiantes de odontología: 193, odontólogos: 78). La encuesta abordó varios temas relacionados con la detección y el umbral de restauración, las preferencias del tipo de preparación, los materiales de restauración utilizados y las opiniones sobre el diagnóstico y el tratamiento de la caries dental. Se realizó un análisis descriptivo y se aplicaron pruebas de Chi cuadrado para observar diferencias estadísticamente significativas entre las variables de estudio. Resultados: Se encuestó a 340 participantes entre profesores que imparten clases de cariología, odontólogos y estudiantes de último año de pregrado. La mayoría de los participantes eran mujeres (70%). La edad media fue mayor para los odontólogos (46 ± 9 años). En promedio, los odontólogos y los profesores de odontología tenían una experiencia laboral de 21 ± 9 años. En caso de decisiones de tratamiento, la mayoría de los encuestados utilizaría tratamiento restaurador quirúrgico inmediato para lesiones cariosas avanzadas (tercio interno de la dentina para proximal y grado 5 para oclusal). Además, los encuestados informaron diferentes diagnósticos de caries para los casos clínicos oclusales y se encontraron algunas diferencias estadísticamente significativas para las decisiones de tratamiento restaurativo y el tipo de materiales según el tipo de participante. Conclusion: Los criterios para el diagnóstico y tratamiento de la caries dental fueron diferentes entre los estudiantes, odontólogos y profesores de odontología con variedad en los conceptos de diagnóstico y tratamiento. Sin embargo, se observó una tendencia conservadora para las decisiones de tratamiento restaurativo. Las estrategias para incorporar medidas mínimas y no restaurativas en la práctica profesional deben ser consideradas en los planes de estudio de las universidades.

Decision tree protocol for demineralized gingival margin extension in class II composite cavity preparations.

This study proposed the development of a protocol for class-II preparations with demineralized gingival margins for the improvement of the longevity of restorations. Evidence sources such as location/color/surface hardness/width of demineralized gingival margin with enamel/demineralized enamel (DE)/dentin/cementum were reviewed based on methodological studies and systematic reviews. A decision tree protocol was developed with criteria (i) lesion location: demineralized gingival margins in enamel must be removed, but if close to cementoenamel-junction, color should be evaluated. (ii) Color: yellow/brown lesions must be removed, but if white/opaque, then the surface hardness should be evaluated. (iii) Surface hardness: soft/demineralized gingival margin must be removed, but if adequately hard, width should be evaluated. (iv) Width: lesions less than half-enamel thickness and impenetrable by an explorer, remineralization is possible and the lesion does not need to be removed. A decision tree protocol was set up with the current available literature. Further continued investigations will be needed for the appropriate protocol updates.

Effect of different surface treatments on optical, colorimetric, and surface characteristics of a lithium disilicate glass-ceramic.

OBJECTIVE: To evaluate the effect of surface treatments on optical, colorimetric, and surface characteristics of lithium disilicate glass-ceramic. MATERIALS AND METHODS: Specimens (n = 5, IPS e.max CAD) were randomly allocated to the following treatments: mirror-polished: SiC papers; as-cut: mimicking CAD-CAM milling; ground: 90-120 µm-grit diamond bur; ground polished: ground, finished (46-30 µm-grit diamond bur), polished (diamond cups, brush and diamond paste); ground glazed: ground, glazed; ground polished glazed: association of methods. CIELAB color coordinates were obtained by a spectrophotometer. CIEDE2000 color differences (ΔE00 ) and the translucency parameter (TP00 ) were calculated. Light transmittance was assessed with a colorimeter. Surface characteristics (topography and roughness) were analyzed. Statistical differences for each condition and outcome were detected using one-way ANOVA with Tukey's post-hoc test (α = 0.05). RESULTS: TP00 data show statistical reduction after grinding (p < 0.05), which was only restored with polishing (solely or with glazing). ΔE00 shows that grinding results in perceptible variations in color (above 0.81), which were restored after all post-processing protocols (exception to only glaze application in contact with a black background). Light transmittance data corroborated such performance. Polishing and glazing reduced roughness and improved surface topography. CONCLUSION: Grinding statistically increased roughness, reduced translucency, light transmittance through the ceramic, and resulted on color differences. On contrary, polishing (followed or not by glazing) reduced roughness and enhanced ceramic translucency and light transmittance. Glaze also reduced roughness, but it still presented reduced translucency. The positioning (facing up or down) of the ceramic treated surface influenced the considered outcomes. CLINICAL SIGNIFICANCE: Grinding with diamond burs results in a deleterious impact to the optical, colorimetric and surface characteristics of lithium disilicate ceramic. Thus, polishing (followed or not by glazing) is recommended for optical and topographical enhancements when lithium disilicate monolithic restorations require occlusal adjustments.

Masking ability of bleach-shade resin composites using the multilayering technique.

OBJECTIVE: Evaluate the masking ability of bleach-shade resin composites applied by multilayering techniques over colored substrates. MATERIALS AND METHODS: Disc-shaped specimens were fabricated from bleach-shade resin composites using different multilayering techniques. Substrates were produced in opaque ceramic discs simulating colored substrates (A2, A3, A3.5, C2, C3, C4) and a bleached tooth (0M1). Color coordinates were obtained using a reflectance spectrophotometer. Color difference was calculated by CIEDE2000 using coordinates of 0 M1 ceramic as standard reference. Data were analyzed by one-way ANOVA and Tukey's post-hoc test (p ≤ 0.05). Masking ability interpretation was based on perceptibility and acceptability thresholds. RESULTS: All combinations presented ΔE00 above the acceptable threshold (ΔE00 >1.8), ranging from 2.49 to 7.42, regardless of the restorative system, multilayering strategy or substrate color. Multilayering combinations placed over A2, A3 and A3.5 were moderately (1.8<ΔE00 ≤3.6) and clearly unacceptable (3.6<ΔE00 ≤5.4), combinations associated with C2, C3 and C4 were clearly unacceptable and, extremely unacceptable (ΔE00 >5.4). Lower ΔE00 was observed for combinations with 0.5 mm extra white enamel layer (2.49), or 1.0 mm white dentin layer (2.69), over A2 and A3.5 substrates. Lightness difference showed the greatest contribution to ΔE00 . CONCLUSIONS: Bleach-shade resin composite systems applied by the multilayering technique were not able to ensure effective masking ability. CLINICAL SIGNIFICANCE: Bleach-shade resin composites applied with different combinations of the multilayering technique were not effective in masking colored substrates. Alternative strategies, techniques and dental materials should be explored to obtain acceptable masking.

Charcoal-based dentifrices: Effect on color stability and surface wear of resin composites.

OBJECTIVE: To evaluate the effect of charcoal-based dentifrices on the color change (CC) and surface wear (SW) of resin composites. MATERIALS AND METHODS: Five dentifrices, including three toothpastes: Colgate total-12 (C12), Black is the new White (CPX), and Natural (NAT); and two powders: Carvvo (CVV) and Whitemax (WMX), were evaluated. Composite blocks (5x5x2mm- Z350 3 M/ESPE, shade A2) were subjected to 417 and 5004 brushing cycles. The CC (n = 7, CIEDE2000; ΔE00 ) was evaluated using a spectrophotometer. SW (n = 5) was assessed using profilometry. The dentifrice particles were characterized by scanning electron microscopy (SEM). RESULTS: In 417 brushing cycles, resin composite exhibited higher color change upon being exposed to NAT, CVV and WMC than to C12 (p ≤ 0.05). In 5004 brushing cycles, resin composite showed higher color change values when exposed to all dentifrices, except C12 (p ≤ 0.05). The powders promoted higher SW on resin composite than C12 in both evaluation times (p ≤ 0.05). In 417 cycles, WMX caused higher SW on composite than C12, CPX, and NAT (p ≤ 0.05). No significant different SW was found between powders and charcoal-based toothpastes after 5004 brushing cycles (p > 0.05). SEM showed larger particles for powder than for toothpaste dentifrices. CONCLUSION: Within the limitations of this study, both null hypotheses have been rejected. Resin composites exposed to charcoal-based dentifrices exhibited significantly (p ≤ 0.05) higher color change and surface wear than conventional toothpastes. CLINICAL SIGNIFICANCE: Color change and surface wear shown by charcoal dentifrices may compromise the longevity of restorations.