Leonardo Fernandes da Cunha

Compromised bond strength after root dentin deproteinization reversed with ascorbic acid.

INTRODUCTION The present study evaluated the effect of a reducing agent on the bond strength of deproteinized root canal dentin surfaces when using a self-adhesive versus dual-cured cement. Regional differences were also evaluated. METHODS A total of 45 bovine incisor roots were divided into 3 groups: irrigation with physiologic solution (control), 10-minute deproteinization with 5% NaOCl, and 10-minute deproteinization with 5% NaOCl followed by 10 minutes of 10% ascorbic acid. Fiber posts were cemented with either RelyX U100 or RelyX ARC (with SingleBond 2 or Clearfil SE Bond). The push-out bond strength was evaluated after 24 hours of storage. Data were submitted to three-way analyses of variance and Dunnett T3 tests (alpha = 0.05). RESULTS No differences between cements were observed within the testing conditions, regardless of the adhesive (P < .05). Deproteinization reduced bond strengths. Subsequent treatment with ascorbic acid was capable of reversing bond strength value changes to levels similar to those of controls. Regional radicular differences were also found, where coronal > middle > apical. CONCLUSIONS The reducing agent was capable of reversing the effect of dentin deproteinization, and RelyX U100 behaved similarly to RelyX ARC.

Dental fluorosis in Brazil: a systematic review from 1993 to 2004

The current article proposes a reflection on several aspect pertaining to dental fluorosis in Brazil, based on a systematic review of epidemiological surveys. The authors assess the prevalence and degrees of severity found in different studies and show that in methodological terms, there is a need for progress in procedures for population-based studies on fluorosis. Despite the different data collection approaches, there is some consensus among the different studies as to the limited severity of fluorosis in Brazil, as well as its association with the independent variables age and socioeconomic status. The authors also highlight the importance of adding subjective aspects to the normative diagnosis as a contribution to public health policy decisions, since the use of exclusively clinical criteria gives dental fluorosis more space than society ascribes to it. There is a lack of empirical evidence to reassess the fluoride content in public water supplies, a method that is known to be necessary to improve dental caries epidemiological indicators.

Esthetic, occlusal, and periodontal rehabilitation of anterior teeth with minimum thickness porcelain laminate veneers

Ceramic veneers of minimum thickness provide satisfactory esthetic outcomes while preserving the dental structure. Dental ceramics can both improve the esthetic appearance and reestablish the strength and function of teeth. In worn anterior teeth, functional surfaces, for example, anterior and lateral guidance, can be restored effectively. The characteristics of dental ceramics, such as color stability and mechanical and optical properties, make this material a good choice for indirect restorations, especially when optimum function and esthetics are required. This clinical report presents an occlusal, periodontal, and restorative solution with minimum thickness glass ceramic veneers for worn anterior teeth with multiple diastemas.

Enamel Wetness Effects on Bond Strength Using Different Adhesive Systems

OBJECTIVE To evaluate, through the application of different dentin bonding systems, the influence of wetness on shear bond strength in enamel. METHODS This study evaluated three etch-and-rinse adhesive systems (Scotchbond MP [used with and without primer]; Singlebond; and Prime&Bond 2.1) and two self-etching adhesive systems (Clearfil SE Bond; and Xeno IV). Flat bovine enamel surfaces were either air-dried for 30 seconds or blotted with absorbent paper after acid-etching for the conventional bonding agents or before the application of self-etching bonding agents. The resin composite EsthetX was bonded to flat surfaces that had been treated with one of the adhesives, following the manufacturers instructions. After being stored in water at 37°C for one week, bonded specimens were broken in shear. Data were evaluated with two-way analysis of variance (ANOVA) and Student-Newman-Keuls tests (α=0.05). For comparing each condition individually, regardless of the adhesive or wetness condition, a one-way ANOVA and a Student-Newman-Keuls test (α=0.05) were applied. RESULTS The two-way ANOVA showed significant differences among adhesive systems. An interaction effect was also observed (p<0.05), but wetness did not influence shear bond strength (p=0.98). The one-way ANOVA showed that the all-in-one adhesive was the only material influenced by the presence of water at the enamels surface. CONCLUSION The all-in-one adhesive behaved differently depending on whether the enamel surface was dry or wet.

Effect of storage period on the accuracy of elastomeric impressions

Aims: To investigate the effect of the storage period on the accuracy of recently developed elastomeric materials. Methods: Simultaneous impressions of a steel die were taken using a polyether (I: Impregum Soft Heavy and Light body, 3M ESPE) and vinyl polysiloxane (P: Perfectim Blue Velvet and Flexi-Velvet, J.Morita). The trays were loaded with the heavy-bodied impression materials while the light-bodied impression materials were simultaneously spread on the steel die. The impressions were poured after 2 hours, 24 hours, and 7 days. Impressions were stored at approximately 55% relative humidity and room temperature. Ten replicas were produced for each experimental condition (n=60). Accuracy of the stone dies was assessed with a depth-measuring microscope. The difference in height between the surface of the stone die and a standard metallic ring was recorded in micrometers at four demarcated points, by two independent examiners. Dxata were submitted to two-way ANOVA and Tukey test (α = 0.05). Results: Significant differences were found among the groups. Smaller discrepancies were observed when pouring was performed up to 24 hours (I-2h= 65.0 ± 15.68 μm; I-24h= 81.6 ± 11.13 μm) for the polyether, and up to 7 days for the vinyl polysiloxane (P-2h= 79.1 ± 13.82 μm; P-24h= 96.8 ± 6.02 μm; P-7d= 81.4 ± 4.3 μm). Significant dimensional discrepancies, however, were observed when polyether was stored for 7 days (I-7d= 295.3 ± 17.4 μm). Conclusion: Storage may significantly affect the dimensional accuracy of impressions and, thus, a maximum period and storage condition should be specified for the recently developed materials.

Noninvasive and Multidisciplinary Approach to the Functional and Esthetic Rehabilitation of Amelogenesis Imperfecta: A Pediatric Case Report

Case Report. An 8-year-old girl with amelogenesis imperfecta (AI) reported unsatisfactory aesthetics, difficulty in mastication, and dental hypersensitivity. The intraoral examination observed mixed dentition, malocclusion in anteroposterior relationships, anterior open bite, and dental asymmetry. A hypoplastic form of AI was diagnosed in the permanent dentition. A multidisciplinary planning was performed and divided into preventive, orthopedic, and rehabilitation stages. Initially, preventive treatment was implemented, with fluoride varnish applications, in order to protect the fragile enamel and reduce the dental sensitivity. In the second stage, the patient received an interceptive orthopedic treatment to improve cross-relationship of the arches during six months. Finally, the rehabilitation treatment was executed to establish the vertical dimension. In the posterior teeth, indirect composite resin crowns were performed with minimally invasive dental preparation. Direct composite resin restorations were used to improve the appearance of anterior teeth. Follow-Up. The follow-up was carried out after 3, 6, 12, and 18 months. After 18 months of follow-up, The restoration of integrity, oral hygiene, and patient satisfaction were observed . Conclusion. Successful reduction of the dental hypersensitivity and improvement of the aesthetic and functional aspects as well as quality of life were observed.

Accuracy of Single-Step versus 2-Step Double-Mix Impression Technique

Objective. To investigate the accuracy of dies obtained from single-step and 2-step double-mix impressions. Material and Methods. Impressions (n = 10) of a stainless steel die simulating a complete crown preparation were performed using a polyether (Impregum Soft Heavy and Light body) and a vinyl polysiloxane (Perfectim Blue Velvet and Flexi-Velvet) in two consistencies, in one or two (without relief) steps. Accuracy of the stone dies was accessed at a measuring microscope, using a metallic crown with perfect fit to the reference crown preparation. Data were submitted to 2-way ANOVA and Tukey test (α = 0.05). Results. The single-step technique resulted in slightly larger dies, while the 2-step technique without relief produced significantly smaller dies, when compared to the original stainless steel die. Stone dies obtained from 2-step polyether impressions were significantly smaller when compared to dies obtained from 2-step vinyl polysiloxane impressions (Impregum 2-step: −290.94 ± 71.64 μm; Perfectim 2-step: −201.86 ± 28.58 μm). No significant differences were observed in dies obtained from either polyether or vinyl polysiloxane with the single-step technique (Impregum single-step: 63.52 ± 16.60 μm; Perfectim single-step: 79.40 ± 14.11 μm). Conclusion. Higher discrepancies were detected for the 2-step impression technique without relief for the investigated materials.

Fabrication of lithium silicate ceramic veneers with a CAD/CAM approach: A clinical report of cleidocranial dysplasia

The fabrication of minimally invasive ceramic veneers remains a challenge for dental restorations involving computer-aided design and computer-aided manufacturing (CAD/CAM). The application of an appropriate CAD/CAM protocol and correlation mode not only simplifies the fabrication of ceramic veneers but also improves the resulting esthetics. Ceramic veneers can restore tooth abnormalities caused by disorders such as cleidocranial dysplasia, enamel hypoplasia, or supernumerary teeth. This report illustrates the fabrication of dental veneers with a new lithium silicate ceramic and the CAD/CAM technique in a patient with cleidocranial dysplasia.

Ceramic veneers with minimum preparation

The aim of this article is to describe the possibility of improving dental esthetics with low-thickness glass ceramics without major tooth preparation for patients with small to moderate anterior dental wear and little discoloration. For this purpose, a carefully defined treatment planning and a good communication between the clinician and the dental technician helped to maximize enamel preservation, and offered a good treatment option. Moreover, besides restoring esthetics, the restorative treatment also improved the function of the anterior guidance. It can be concluded that the conservative use of minimum thickness ceramic laminate veneers may provide satisfactory esthetic outcomes while preserving the dental structure.

Lithium silicate endocrown fabricated with a CAD-CAM system: A functional and esthetic protocol

An endocrown restoration is an alternative approach to complete crowns with intraradicular cores or dowels for the restoration of endodontically treated teeth. Endocrowns conserve tooth structure and require fewer dental visits. This approach has been widely used, and various materials and techniques have been reported. Computer-aided design and computer-aided manufacturing (CAD-CAM) systems can generate and store libraries of teeth with various anatomies in their database, and diagnostic tooth waxing may not be required. However, occlusal adjustments after the cementation of indirect restorations are often frustrating. Thus, a rapid and efficient way of addressing this challenge is necessary. This clinical report presents a protocol for the fabrication and delivery of an endocrown by using the biogeneric design mode with lithium silicate-based ceramic adjusted before its complete sintering.