Selamento dentinário imediato em restauração semidireta: relato de caso / Immediate dentin sealing in semi-direct restoration: case report

O selamento dentinário imediato é um procedimento essencial na Odontologia, que envolve a aplicação de agentes de selamento na interface entre a dentina e o material restaurador imediatamente após a remoção da cárie e do preparo da cavidade dentária. Este processo busca selar os túbulos dentinários expostos, proporcionando proteção à polpa dentária. O presente caso foi realizado em um paciente do sexo masculino, 56 anos que se queixou de desconforto no elemento dentário 17. Após avaliação clínica e radiográfica, foi constatado uma ampla restauração desadaptada na porção mesio - oclusal do referido dente, sendo que o elemento em questão não possui tratamento endodôntico. Após planejamento e assinatura do TCLE, os seguintes passos foram realizados: remoção da lesão cariosa do dente 17, seguido da realização do levantamento marginal mesial e a realização do selamento dentinário imediato. Moldagem com silicone de adição do dente em questão e do antagonista, assim como registro da mordida. Foi confeccionada uma restauração semidireta em resina composta sob o modelo de gesso obtido. A cimentação da restauração foi feita na consulta seguinte, cumprindo os requisitos fundamentais para restaurar forma, função e estética, resultando na melhoria da qualidade de vida do paciente(AU)

Immediate dentin sealing is an essential procedure in dentistry, involving the application of sealing agents at the interface between dentin and the restorative material immediately after caries removal and cavity preparation. This process aims to seal exposed dentinal tubules, providing protection to the dental pulp. The present case involved a 56-year-old male patient who complained of discomfort in tooth number 17. After clinical and radiographic evaluation, a wide, maladapted restoration in the mesio-occlusal portion of the tooth was identified, with no endodontic treatment in the affected element. Following planning and informed consent, the following steps were taken: removal of the carious lesion from tooth number 17, followed by the execution of mesial marginal elevation and immediate dentin sealing. Silicone addition molding of the affected tooth and antagonist, along with bite registration, was performed. A semi-direct restoration in composite resin was fabricated based on the obtained gypsum model. The restoration was cemented in the subsequent appointment, meeting the essential requirements to restore form, function, and aesthetics, resulting in an improvement in the patient's quality of life(AU)

Sealing of pulp chamber dentin in endodontics: Influence of bond strategy and time-point application.

Context: Seal the dentin of the pulp chamber during endodontic treatment to avoid interfering with the restorative treatment performed afterward. Aims: The aim was to evaluate the effect of three adhesive systems applied in different bonding strategies (etch-and-rinse, self-etch, and universal adhesive) and time-point application (immediately after the cavity access preparation or after endodontic obturation) on the hybrid layer formation and dentinal penetrability. Materials and Methods: Forty-eight sound molars were randomly distributed into six groups (n = 10) according to the adhesive system used: Forty-eight sound molars were randomly distributed into six groups (n = 10) according to the adhesive system used and the time-point application: Adper Scotchbond Multi-purpose (AS), Clearfil SE (CF) and Scotchbond Universal (SU) in strategy of immediate endodontic sealing (IES) or delayed endodontic sealing (DES). In IES-AS, IES-CF, and IES-SU groups, dentin sealing was performed immediately after the cavity access, while in DES-AS, DES-CF, and DES-SU, after root canal obturation. The specimens were sectioned in the long axis, in a buccal-lingual direction, and the dentinal penetrability of the adhesive systems was evaluated using confocal microscopy images. Hybrid layer formation was analyzed by scanning electron microscopy images. Statistical Analysis Used: Dentinal penetrability data were analyzed with the ANOVA test and the Kruskal-Wallis test was performed for hybrid layer data (α = 0.05). Results: IES-CF showed the lowest dentinal penetrability (P < 0.05), while the other protocols were similar to each other (P > 0.05). No significant differences were found between groups regarding the hybrid layer formation (P > 0.05). Immediate and DES protocols do not influence the hybrid layer formation, regardless of the bond strategy used. Conclusions: Sealing the pulp chamber dentin before endodontic treatment can improve the bond strength of the final restoration but the formation of the hybrid layer was not influenced by the bond strategy.

Is immediate dentin sealing a mandatory or optional clinical step for indirect restorations?

OBJECTIVE: The use of immediate dentin sealing (IDS) following tooth preparation for indirect restorations is well-supported by laboratory studies. The inclusion of IDS as a mandatory clinical step, it must be firmly supported by evidence from randomized clinical trials (RCT). The objective of this study is to assess whether IDS should be added as a mandatory procedure in all indirect restorations, taking into consideration clinically significant outcomes for the patient, such as restoration longevity and hypersensitivity. MATERIALS AND METHODS: A bibliographic search was carried out in the PubMed. In addition, a manual search was conducted in the references of literature reviews. RESULTS: Data from four RCT were included. Two studies assessed preparations for full crowns, and two assessed preparations for partial restorations. Data from full crown preparations were subjected to a meta-analysis, revealing a reduction in hypersensitivity incidence in the IDS group 1 week after restoration cementation. With respect to hypersensitivity, IDS seems to offer advantages exclusively during the provisional phase and up to 1 week following the cementation of the final restoration. One study has shown no difference on longevity. CONCLUSION: The use of IDS should be considered as an elective clinical step during the rehabilitation with indirect restorations. CLINICAL SIGNIFICANCE: IDS is an elective clinical step that should be considered in patients and preparations with a higher risk of sensitivity between appointments.

Effect of immediate dentin sealing on load-bearing capacity under accelerated fatigue of thin occlusal veneers made of CAD-CAM glass-ceramic and resin composite material.

OBJECTIVE: The objective of this study was to assess the influence of immediate dentin sealing (IDS) on the fatigue behavior of laminate occlusal veneers fabricated with CAD/CAM lithium disilicate ceramic and resin composite. METHODS: Forty sound human molars were prepared and randomly divided into 4 groups (n = 10): RC-IDS+ (IDS and resin composite occlusal laminate veneer); RC-IDS- (resin composite occlusal laminate veneer without IDS); LD-IDS+ (IDS and lithium disilicate laminate veneer); LD-IDS- (lithium disilicate occlusal laminate veneer without IDS). The restorations were obtained using a digital workflow. After surface conditioning and bonding, thermocycling and accelerated fatigue tests (20 Hz, 5000 cycles with an initial load of 300 N, step-size of 100 N for 10,000 cycles, up to 1000 N, and then a step-size of 50 N until failure) were conducted. Fatigue data were recorded for both outcomes (crack or fracture) and statistically analyzed. Fractographic and adhesive interface analysis were conducted. RESULTS: The indirect resin composite groups showed better fatigue behavior compared to lithium disilicate. IDS only had a positive effect for the survival of resin composite restorations for the 'fracture' outcome. Evident presence of micro-gaps at the adhesive interface in the LD-IDS- group could be noted. SIGNIFICANCE: Immediate dentin sealing improved fatigue resistance behavior of resin composite occlusal veneers. However, this effect was not observed in lithium disilicate veneers.

Influence of different separating mediums applied on the immediate dentin sealing in the tensile strength of temporary restorations / Influência de diferentes agentes isolantes aplicados sobre o selamento dentinário imediato na resistência à tração de restaurações provisórias

Objective: To evaluate the ability of different separating mediums to prevent adhesion between provisional restorations and hybridized dentin surfaces when used with the Immediate Dentin Sealing technique (IDS). Material and Methods: 120 extracted human teeth ­ 40 premolars and 80 molars ­ were selected to integrate acrylics samples separated into 4 different groups (n=10) according to the separating medium used for IDS protection. Forty samples were made of three teeth mounted in a self-cure acrylic resin block (Jet, Classic, São Paulo, Brazil) arranged side by side, simulating the positioning and proximal contacts present in the dental arch between the second premolar, first molar and second molar. A standard dental preparation for ultra-thin occlusal veneer was performed and complete occlusal dentin exposure was achieved by selective removal of the occlusal enamel with a high-speed conical round burr (Code: 1801.4138 FG, KG Sorensen, Medical Burs Ind. e Com. de Pontas e Brocas Cirúrgicas Ltda, São Paulo, Brazil). Dentin hybridization were performed on the control group and 3 different groups of separating mediums (n=10): PC­commercial provisional separating agent (Pro-V Coat, Bisco, Schaumburg, USA); GG­glycerin gel (K-Y Gel; Johnson & Johnson Industry and Commerce LTDA, São Paulo, Brazil); PJ­petroleum jelly (Rioquímica, São Paulo, Brazil). Provisionalization were manufactured on the prepared teeth. After 2 weeks, the tensile test was performed, and the analysis of the failure pattern was performed by 3D laser confocal microscopy and Scanning Electron Microscopy (SEM). The data were analyzed with the 1-way ANOVA and the Tukey test (α = 0.05). Results: Significantly lower tensile strength values were found for the commercial provisional separating agent (30.39 ± 10.01 N) compared to others (p < 0.05). Conclusion: The commercial provisional separating agent showed greater effectiveness on protecting hybridized dentin against the provisional restorations (AU)

Objetivo: Avaliar a capacidade de diferentes agentes isolantes em prevenir a adesão entre as restaurações provisórias e a superfícies de dentina hibridizadas quando usados com a técnica do Selamento Dentinário Imediato (IDS). Material e Métodos: 120 dentes humanos extraídos - 40 pré-molares e 80 molares - foram selecionados para integrar as amostras de acrílico divididas em 4 grupos diferentes (n = 10) de acordo com o meio de separação usado para proteção IDS. Foram confeccionadas 40 amostras de três dentes montados em um bloco de resina acrílica autopolimerizável (Jet, Classic, São Paulo, Brasil) dispostos lado a lado, simulando o posicionamento e os contatos proximais presentes na arcada dentária entre o segundo pré-molar, primeiro molar e segundo molar. Um preparo dentário padrão para laminado oclusal ultrafino foi realizado e a exposição completa da dentina oclusal foi obtida pela remoção seletiva do esmalte oclusal com uma broca cônica arredondada de alta rotação (Código: 1801.4138 FG, KG Sorensen, Medical Burs Ind. E Com. de Pontas e Brocas Cirúrgicas Ltda, São Paulo, Brasil). A hibridização da dentina foi realizada no grupo controle e em 3 grupos diferentes de agentes isolantes (n = 10): PC - agente de separação provisório comercial (Pro-V Coat, Bisco, Schaumburg, EUA); GG ­ gel de glicerina (K-Y Gel; Johnson & Johnson Industry and Commerce LTDA, São Paulo, Brasil); PJ ­ vaselina (Rioquímica, São Paulo, Brasil). As restaurações provisórias foram fabricadas nos dentes preparados. Após 2 semanas, foi realizado o teste de tração, e a análise do padrão de falha foi realizada por microscopia confocal a laser 3D e Microscopia Eletrônica de Varredura (MEV). Os dados foram analisados com a ANOVA de 1 fator e o teste de Tukey (α = 0,05). Resultados: Valores de resistência à tração significativamente menores foram encontrados para o agente separador provisório comercial (30,39 ± 10,01 N) em comparação com os demais (p < 0,05). Conclusão: O agente separador provisório comercial mostrou maior eficácia para a proteção da dentina hibridizada contra as restaurações provisórias (AU)

Significance of immediate dentin sealing and flowable resin coating reinforcement for unfilled/lightly filled adhesive systems.

BACKGROUND: Immediate dentin sealing implies applying an adhesive system to dentin directly after tooth preparation, before impression. The technique is universal (inlays, onlays, veneers, crowns) and well documented clinically and experimentally. Different types of dentin bonding agents (DBAs) are available on the market. Major differences lie in the thickness of the hybrid layer and overlaying adhesive resin (filled vs. unfilled/lightly filled adhesives). OBJECTIVE: The objective of this work is to provide precise clinical instructions and present new experimental data about the bond strength of five DBAs (Optibond FL, Scotchbond MP, Single Bond Plus, Clearfil SE Bond, and Scotchbond Universal) used conventionally (dentin sealed at the time of restoration delivery) or with immediate dentin sealing, as well as with an additional flowable resin coating. METHODS: Seventy-five human molars were selected, restored/tested according the microtensile bond strength method. Fifteen groups (n=5) were obtained from the combination of the five DBAs and three application modes: delayed dentin sealing, immediate dentin sealing and immediate dentin sealing with flowable resin coating. RESULTS: It appears that immediate dentin sealing was confirmed to significantly improve the bond strength of all tested adhesives. The use of a flowable resin coating reinforcement after immediate dentin sealing increased the microtensile bond strength of all unfilled/lightly filled adhesives (from 233% of increase for ScotchBond MP, up to 560% for Clearfil SE Bond) and maintained the performance of the 3-step golden standard adhesive. Optibond FL used with (52.51 MPa) or without (54.75 MPa) additional flowable resin coating and Clearfil SE Bond (45.64 MPa) used with flowable resin coating provided the best results. CLINICAL SIGNIFICANCE: The original immediate dentin sealing (IDS) technique implies the use of a filled DBA. With unfilled/lightly filled adhesives, it is suggested to reinforce IDS with an additional flowable resin coating. This seems especially paramount to the performance of simplified adhesive systems to protect the thin bonding interface from oxygen inhibition and preserve IDS layer during predelivery cleaning of the preparation. The clinical reinforcement of unfilled/lightly filled IDS with flowable resin composite is encouraged for more predictable bonding.

Effect of temporary cements on the bond strength of a resin cement to a pre-hybridized dentin / Influência de cimentos temporários na resistência de união de um cimento resinoso sobre a dentina pré-hibridizada

This study assessed the bond strength of a resin cement when Immediate Sealed Dentin (ISD) was contaminated by different temporary cements applying a microshear test. Forty-eight fragments of third molar crowns were mounted in acrylic resin and worn until the dentin was exposed. The substrates were sealed with a 3-step conventional adhesive system and divided into four groups (n=12): Control (without temporary cement) and three groups that used different temporary cements - Provy, RelyX Temp NE, and Provitemp. The temporary cements were removed after 7 days of storage. Resin cement RelyX ARC was applied to the contaminated substrates. Microshear bond strength was evaluated using a universal testing machine (0.5 mm/min). Data was analyzed with ANOVA and a Dunnett post-hoc test (p<0.05). Additionally, three samples from each group were prepared for scanning electron microscope analysis. Means and standard deviations of microshear bond strength (MPa) were 17.96±1.65, 16.70±1.43, 20.43±1.30 and 33.75±4.72 for Control, Provy, RelyX Temp, and Provitemp, respectively. Statistically significant difference was observed between the Control and Provitemp samples (p=0.0002). Adhesive failures were dominant (50%), followed by cohesive failures with cement (26%), and cohesive failures with dentin (24%). Residues of Provy and Provitemp were observed on the sealed dentin. Provitemp temporary cement sealing increased the microshear bond strength of the resin cement on dentin treated with IDS.

Este estudo investigou a influência de cimentos temporários na resistência de união de um cimento resinoso em dentina selada imediatamente. Quarenta e oito fragmentos obtidos das coroas de terceiros molares foram incluídos em tubos de PVC com resina acrílica e desgastados até exposição da dentina. Os substratos foram tratados com adesivo convencional de três passos e divididos em quatro grupos: Controle (sem cimento temporário) e três grupos usando diferentes cimentos temporários ­ Provy, RelyX Temp NE e Provitemp. Após sete dias, os cimentos foram removidos e o cimento RelyX ARC aplicado sobre o substrato contaminado. A resistência de união foi avaliada em uma máquina de ensaio universal (0,5 mm/min). Os dados foram analisados pelos testes estatísticos ANOVA e Dunnet (p<0,05). Três amostras de cada grupo foram preparadas para análise em micróscopio eletrônico de varredura. Os valores médios e desvio padrão da resistência de união foram 17,96 ±1,65, 16,70 ±1,43, 20,43±1,30 e 33,75 ±4,72 para Controle, Provy, RelyX Temp e Provitemp, respectivamente. Diferença significativa foi observada entre os grupos Controle e Provitemp (p=0,0002). Com relação ao padrão de fratura, a maioria das falhas foram adesivas (50%), seguida por coesiva em cimento (26%) e coesiva em dentina (24%). Resíduos dos cimentos Provy e Provitemp foram observados na dentina selada. Cimento temporário Provitemp aumentou a resistência de união por microcisalhamento do cimento resinoso a dentina com IDS.

Does immediate dentin sealing influence the polymerization of impression materials?

OBJECTIVES: The objective of the following study is to evaluate the interaction between the resin materials used in immediate dentin sealing (IDS) techniques and impression materials with two different techniques to eliminate the oxygen-inhibition layer. MATERIALS AND METHODS: The occlusal dentin surface of 35 human molars was exposed. The teeth were used in two Groups: Group 1 - Impression with Express XT; Group 2 - Impression with Impregum. Groups 1 and 2 were divided into 14 subgroups: Groups 1a and 2a - Control groups; 1b and 2b - IDS with Clearfil SE Bond (CSE); 1c and 2c - IDS with CSE + additional polymerization with glycerin jelly; 1d and 2d - IDS with CSE + alcohol; 1e and 2e - IDS with CSE and Protect Liner F (PLF); 1f and 2f - IDS with CSE and PLF + additional polymerization with glycerin jelly; and 1g and 2g - IDS with CSE and PLF + alcohol. Five teeth were used in each experimental group, and the tooth surface was photographed using a digital camera. RESULTS: Small quantity of unpolymerized impression material remained attached to the CSE or to the PLF in Groups 1b and 1e. Groups 1c and 1d prevented the interaction. Small quantity of polymerized impression material remained attached to the CSE or to the PLF for Groups 2b and 2e. The same interaction was observed for Groups 2c and 2d. For Groups 2c and 2f, no interactions were observed. CONCLUSION: Resin materials interacted with impression materials. The application of glycerin jelly and alcohol prevented the interaction of CSE with Express XT and PLF with Impregum; however, these treatments were not completely effective in preventing the interaction of CSE with Impregum and PLF with Express XT.

Thickness of immediate dentin sealing materials and its effect on the fracture load of a reinforced all-ceramic crown.

OBJECTIVES: The objective of this study is to evaluate, in vitro, the thickness of immediate dentin sealing (IDS) materials on full crown preparations and its effect on the fracture load of a reinforced all-ceramic crown. MATERIALS AND METHODS: SIXTY PREMOLARS RECEIVED FULL CROWN PREPARATION AND WERE DIVIDED INTO THE FOLLOWING GROUPS ACCORDING TO THE IDS TECHNIQUE: G1-control; G2-Clearfil SE Bond; and G3-Clearfil SE Bond and Protect Liner F. After the impressions were taken, the preparations were temporized with acrylic resin crowns. IPS empress 2 restorations were fabricated and later cemented on the preparations with Panavia F. 10 specimens from each group were submitted to fracture load testing. The other 10 specimens were sectioned buccolingually before the thicknesses of Panavia F, Clearfil SE Bond and Protect Liner F were measured in 10 different positions using a microscope. RESULTS: According to analysis of variance and Tukey's test, the fracture load of Group 3 (1300 N) was significantly higher than that of Group 1 (1001 N) (P < 0.01). Group 2 (1189 N) was not significantly different from Groups 1 and 3. The higher thickness of Clearfil SE Bond was obtained in the concave part of the preparation. Protect Liner F presented a more uniform range of values at different positions. The thickness of Panavia F was higher in the occlusal portion of the preparation. CONCLUSIONS: The film thickness formed by the IDS materials is influenced by the position under the crown, suggesting its potential to increase the fracture load of the IPS empress 2 ceramic crowns.