Fabiana Scarparo Naufel

Clinical strategies for esthetic excellence in anterior tooth restorations: understanding color and composite resin selection

Direct composite resin restorations have become a viable alternative for patients that require anterior restorative procedures to be integrated to the other teeth that compose the smile, especially for presenting satisfactory esthetic results and minimum wear of the dental structure. Technological evolution along with a better understanding of the behavior of dental tissues to light incidence has allowed the development of new composite resins with better mechanical and optical properties, making possible a more artistic approach for anterior restorations. The combination of the increasing demand of patients for esthetics and the capacity to preserve the dental structure resulted in the development of different incremental techniques for restoring fractured anterior teeth in a natural way. In order to achieve esthetic excellence, dentists should understand and apply artistic and scientific principles when choosing color of restorative materials, as well as during the insertion of the composite resin. The discussion of these strategies will be divided into two papers. In this paper, the criteria for color and material selection to obtain a natural reproduction of the lost dental structures and an imperceptible restoration will be addressed.

Effect of the Polishing Procedures on Color Stability and Surface Roughness of Composite Resins

Objectives. To evaluate the polishing procedures effect on color stability and surface roughness of composite resins. Methods. Specimens were distributed into 6 groups: G1: Filtek Supreme XT + PoGo; G2: Filtek Supreme XT + Sof-Lex; G3: Filtek Supreme XT + no polishing; G4: Amelogen + PoGo; G5: Amelogen + Sof-Lex.; G6: Amelogen + no polishing. Initial color values were evaluated using the CIELab scale. After polishing, surface roughness was evaluated and the specimens were stored in coffee solution at 37°C for 7 days. The final color measurement and roughness were determined. Results. Sof-Lex resulted in lower staining. Amelogen showed the highest roughness values than Filtek Supreme on baseline and final evaluations regardless of the polishing technique. Filtek Supreme polished with PoGo showed the lowest roughness values. All groups presented discoloration after storage in coffee solution, regardless of the polishing technique. Conclusion. Multiple-step polishing technique provided lower degree of discoloration for both composite resins. The final surface texture is material and technique dependent.

Effect of deproteinization and tubular occlusion on microtensile bond strength and marginal microleakage of resin composite restorations.

Dentin adhesion procedure presents limitations, especially regarding to lifetime stability of formed hybrid layer. Alternative procedures have been studied in order to improve adhesion to dentin. Objective: The aim of this study was to evaluate in vitro the influence of deproteinization or dentin tubular occlusion, as well as the combination of both techniques, on microtensile bond strength μTBS) and marginal microleakage of composite resin restorations. Material and Methods: Extracted erupted human third molars were randomly divided into 4 groups. Dentin surfaces were treated with one of the following procedures: (A) 35% phosphoric acid gel (PA) + adhesive system (AS); (B) PA + 10% NaOCl + AS; (C) PA + oxalate + AS and (D) PA + oxalate + 10% NaOCl + AS. Bond strength data were analyzed statistically by two-way ANOVA and Tukeys test. The microleakage scores were analyzed using Kruskal-Wallis and Mann-Whitney non-parametric tests. Significance level was set at 0.05 for all analyses. Results: μTBS data presented statistically lower values for groups D and B, ranking data as A>C>B>D. The use of oxalic acid resulted in microleakage reduction along the tooth/restoration interface, being significant when used alone. On the other hand, the use of 10% NaOCl alone or in combination with oxalic acid, resulted in increased microleakage. Conclusions: Dentin deproteinization with 10% NaOCl or in combination with oxalate significantly compromised both the adhesive bond strength and the microleakage at interface. Tubular occlusion prior to adhesive system application seems to be a useful technique to reduce marginal microleakage.

Influence of Photoinitiator and Light-Curing Source on Bond Strength of Experimental Resin Cements to Dentin

This study evaluated the bond strength (BS) of experimental resin cements formulated with different photoinitiators when activated by two kinds of light-curing units (LCUs) through a ceramic material. Seven resin blends with different camphorquinone (CQ) and/or phenylpropanedione (PPD) concentrations (weight) were prepared: C5: 0.5% CQ; C8: 0.8% CQ; P5: 0.5% PPD; P8: 0.8% PPD; C1P4: 0.1% CQ and 0.4% PPD; C4P1: 0.4% CQ and 0.1% PPD; C4P4: 0.4% CQ and 0.4% PPD. Two LCUs were used: one quartz-tungsten-halogen (QTH - 850 mW/cm²) and one light-emitting diode (LED - 1300 mW/cm²). The microtensile bond strength of each blend was assessed. Data were submitted to two-way ANOVA and Tukeys test (α=0.05). The BS values did not exhibit significant differences for LCUs, regardless of the photoinitiator type. Three cements showed significant differences: P5 and C5 had higher BS with QTH, and C4P1 with LED. For QTH, P5 showed the highest and C1P4 the lowest BS. For the LED, C4P1 showed the highest BS of all the cements. The results indicated that PPD was a viable alternative in the formulation of photocured resin cements, reducing or eliminating CQ that is yellowish without impairing the bond strength. Furthermore, both LED and QTH were effective in curing resin cements that contain PPD or CQ.

Influence of Photoinitiator on Accelerated Artificial Aging and Bond Strength of Experimental Resin Cements

The goal of this study was to evaluate in vitro the effect of the photoinitiator phenylpropanedione (PPD), alone or combined with camphorquinone (CQ), on color stability of photoactivated resin cements and their bond strength to ceramics using a micro-shear test. Four resin cements were used: a commercial brand cement (RelyX Veneer®) and 3 experimental cements with different types and concentration of photoinitiators. For color analysis, ceramic discs were cemented on bovine dentin specimens to simulate indirect restorations (n=8) and were exposed to UV for 120 h and tested for color alteration using a reflectance spectrophotometer and the CIEL*a*b* system. Data were analyzed by Anova and Tukeys test at 5% significance level. The color test results did not present statistically significant difference for the ∆E for all the studied cements, neither for ∆L, ∆a and ∆b. For the bond strength, all the studied cements showed statistically significant differences to each other, with the highest result for the RelyX Veneer® (29.07 MPa) cement, followed by the cement with CQ (21.74 MPa) and CQ+PPD (19.09 MPa) cement; the lowest result was obtained by the cement using only PPD as a photoinitiator (13.99 MPa). So, based on the studied parameters, PPD was not advantageous as photoinitiator of resin cements, because it showed a low value of bond strength to the ceramics and no superior color stability.