Perception of the esthetic impact of mandibular incisor extraction treatment on laypersons, dental professionals, and dental students

Objective: To evaluate the degree of perception of laypersons, dental professionals, and dental students regarding dental esthetics in cases with mandibular central incisor extraction. Materials and Methods: Using a smile photograph of a person with normal occlusion and all teeth, modifications were made to reflect the extraction of a mandibular incisor of various compositions and sizes. For this purpose a program specifically for image manipulation (Adobe Photoshop CS3, Adobe Systems Inc) was used. After manipulation the images were printed on photographic paper, attached to a questionnaire and distributed to laypersons, dental professionals, and dental students (n = 90) to evaluate the degree of perception and esthetic using a scale of attractiveness, where 0 = hardly attractive, 5 = attractive, and 10 = very attractive. The differences between examiners were checked by the Mann-Whitney test. All the statistics were performed with a confidence level of 95%. Results: The results demonstrated the skill of the dental professionals and dental students in perceiving the difference between cases of normal occlusion and cases where an incisor was lacking (P < .05). The photograph in which the lateral incisors were shown to be larger than the central incisor was the one that obtained the highest value among the cases of extraction in all groups of evaluators. Conclusions: It can be concluded that dental professionals and dental students are more skillful at identifying deviation from normality. In addition, central incisor extraction should always be discarded when there are other treatment options available. (Angle Orthod. 2012;82:732-738.)

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.

Minimally invasive esthetic therapy: a case report describing the advantages of a multidisciplinary approach

The decision-making process for the treatment of esthetic areas is based on the achievement of a healthy, harmonious, and pleasant smile. These conditions are directly associated with a solid knowledge of tooth anatomy and proportions, as well as the smile line, soft tissue morphology, and osseous architecture. To achieve these objectives, a multidisciplinary approach may be necessary to create long-term harmony between the final restoration and the adjacent teeth, and the health of the surrounding soft and hard tissues. This case report describes the application of a minimally invasive therapy on a 33-year-old woman seeking esthetic treatment. Minimally invasive periodontal plastic surgery associated with porcelain laminate veneers yielded satisfactory esthetics and minimal trauma to dental and periodontal tissues. Such a combined approach may be considered a viable option for the improvement of "white" and "red" esthetics.

Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment

Purpose: The objective of this study was to compare the estimated cost of clinical and surgical treatment for basl cell carcinoma of the eyelid. Methods: This was a pilot study of 12 patients with basal cell carcinoma receiving treatment with 5% imiquimod cream at the ocular plastic surgery center, medical school University of Sao Paulo (HC-FMUSP, Brazil). The cost of clinical treatment was estimated based on the time of treatment and amount of medication consumed by patients in the home setting. The cost of surgical treatment was estimated by ophthalmologists with experience in reconstructive plastic surgery based on analysis of images of the same patients. Surgeons responded to a questionnaire with four questions about surgical technique, surgical materials required, estimated duration of surgery and type of anesthesia. Results: Immunotherapy lasted from 8 to 12 weeks. All patients reported each cold-stored sachet with 5% imiquimod cream lasted 3 days. According to the institution, a box with 12 sachets costs BRL 480.00. Patients required 1.58-3.11 boxes for complete treatment, corresponding to a total cost of BRL 758.40-1,492.80. Based on image analysis, surgeons evaluated surgery would require 1-3 hours. The estimated cost of surgery room and staff was BRL 263.00, to which the cost of supplies was added. Thus, the total cost of surgical treatment was BRL 272.61-864.82. On the average, immunotherapy was 57,64% more costly than surgical treatment. Conclusions: Malignant eyelid tumors are a common finding in clinical ophthalmology. Surgery is still the treatment of choice at our institution, but immunotherapy with 5% imiquimod cream may be indicated for patients with multiple lesions or high surgical risk and for patients declining surgery for reasons of fear or esthetic concerns. The ability to estimate costs related to the treatment of malignant eyelid tumors is an important aid in the financial planning of health care institutions. Further studies should evaluate the possibility of institutions equating the cost of immunotherapy and surgical treatment by acquiring similar but less expensive medications.

Implant-Supported Prosthesis Misalignment Related to the Dental Arch: A 14-Year Clinical Follow-up

The purpose of this study was to warn the dental community about a possible problem in function with partial implant-supported prostheses used for long periods. The misalignment between natural teeth and the implant-supported prosthesis on teeth 11 and 12, observed in a 14-year clinical follow-up, illustrates the fact. The metal-ceramic crowns were placed in 1995 after a rigorous occlusal adjustment. Evaluations were made at 4, 6, 9, and 14 years, when it was noticed that the restorations were positioned palatally and extruded in comparison with the natural teeth. After 9 years, a greater discrepancy was noticed, with anterior occlusion and esthetic changes. The possible causes have been discussed: occlusal problems, parafunctional habits, and natural movement. The first 2 options were discarded after clinical analysis and diagnosis. Therefore, the natural movement probably deriving from an interaction of mechanical and genetic factors might have been the cause. The implants do not have periodontal ligaments but rather ankylosis, so they do not suffer those movements. This case emphasizes the need to inform patients that implants can last more than 10 years in function, but this is not the case with restorations, which lose function and esthetics and must be replaced.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 1: overall aspects

C left lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of So Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

A Conservative Approach for Restoring Anterior Guidance: A Case Report

One of the most common dental problems in today's clinics is tooth wear, specifically when related to bruxism. In such cases, the esthetics of anterior teeth may be compromised when excessive wear to the incisal surfaces occurs. Anterior tooth wear resulting from parafunctional bruxism can be conservatively treated with the use of direct resin composite restorations. This restorative approach has the advantages of presenting good predictability, load resistance, acceptable longevity, preservation of healthy dental tissues, and lower cost when compared with indirect restorations. The use of resin composites to solve esthetic problems, however, requires skill and practice. Thus, the present article demonstrates a conservative approach for restoring the esthetics and function of worn anterior teeth with the aid of direct resin composite restorations and selective occlusal adjustment. CLINICAL SIGNIFICANCE A conservative approach to restore anterior teeth with excessive wear is possible with direct resin composites. (J Esthet Restor Dent 24:171-184, 2011)

Antimicrobial Properties and Cytotoxicity of an Antimicrobial Monomer for Application in Prosthodontics

Purpose: This study aimed to investigate the antimicrobial properties and cytotoxicity of the monomer methacryloyloxyundecylpyridinium bromide (MUPB), an antiseptic agent capable of copolymerizing with denture base acrylic resins. Materials and Methods: The antimicrobial activity of MUPB was tested against the species Candida albicans, Candida dubliniensis, Candida glabrata, Lactobacillus casei, Staphylococcus aureus, and Streptococcus mutans. The minimum inhibitory and fungicidal/bactericidal concentrations (MIC, MFC/MBC) of MUPB were determined by serial dilutions in comparison with cetylpyridinium chloride (CPC). The cytotoxic effects of MUPB at concentrations ranging from 0.01 to 1 g/L were assessed by MTT test on L929 cells and compared with methyl methacrylate (MMA). The antimicrobial activity of copolymerized MUPB was tested by means of acrylic resin specimens containing three concentrations of the monomer (0, 0.3, 0.6% w/w). Activity was quantified by means of a disc diffusion test and a quantification of adhered planktonic cells. Statistical analysis employed the Mann-Whitney test for MIC and MFC/MBC, and ANOVA for the microbial adherence test (a= 0.05). Results: MUBP presented lower MIC values when compared with CPC, although differences were significant for C. dubliniensis and S. mutans only (p= 0.046 and 0.043, respectively). MFC/MBC values were similar for all species except C. albicans; in that case, MUPB presented significantly higher values (p= 0.046). MUPB presented higher cytotoxicity than MMA for all tested concentrations (p < 0.001) except at 0.01 g/L. Irrespective of the concentration incorporated and species, there was no inhibition halo around the specimens. The incorporation of MUPB influenced the adhesion of C. albicans only (p= 0.003), with lower CFU counts for the 0.6% group. Conclusions: It was concluded that non-polymerized MUPB has an antimicrobial capacity close to that of CPC and high cytotoxicity when compared with MMA. The antimicrobial activity of MUPB after incorporation within a denture base acrylic resin did not depend on its elution, but was shown to be restricted to C. albicans.

Effect of Chlorhexidine on Denture Biofilm Accumulation

Purpose: Adequate denture hygiene can prevent and treat infection in edentulous patients, who are frequently elderly and have difficulty brushing their teeth. This study evaluated the efficacy of complete denture biofilm removal using a chlorhexidine solution in two concentrations: 0.12% and 2.0%. Materials and Methods: Sixty complete denture wearers participated in a trial for 21 days after receiving brushing instructions. They were distributed into three groups, according to the tested solution and regimen (n = 20): (G1) Control (daily overnight soaking in water); (G2) daily immersion at home in 0.12% chlorhexidine for 20 minutes after dinner; and (G3) a single immersion in 2.0% chlorhexidine for 5 minutes at the end of the experimental period, performed by a professional. Biofilm coverage area (%) was quantified on the internal surface of maxillary dentures at baseline and after 21 days. Afterward, the differences between initial and posttreatment results were compared by means of the Kruskal-Wallis test (a = 0.05). Results: Median values for biofilm coverage area after treatment were: (G1) 36.0%; (G2) 5.3%; and (G3) 1.4%. Differences were significant (KW = 35.25; p < 0.001), although G2 and G3 presented similar efficacy in terms of biofilm removal. Conclusions: Both chlorhexidine-based treatments had a similar ability to remove denture biofilm. Immersion in 0.12% or 2.0% chlorhexidine solutions can be used as an auxiliary method for cleaning complete dentures.

Orthodontic movement of a maxillary incisor through the midpalatal suture A case report

Orthodontic space closure is a treatment alternative when a maxillary central incisor is missing. The objective of this report was to present an unusual treatment in which a right maxillary central incisor was moved through the midpalatal suture to replace the absent contralateral tooth. The biologic aspects and clinical appearance of the recontoured lateral and central incisors were analyzed. The position of the examined teeth and the appearance of the surrounding soft tissues were satisfactory; however, the upper midline frenulum deviated to the left. The incisor was successfully moved with no obvious detrimental effects as observed on the final radiographs. In the radiographic and tomographic examinations, the midline suture seemed to have followed the tooth movement. The patient expressed satisfaction with the results. It was concluded that orthodontic movement of the central incisor to replace a missing contralateral tooth is a valid treatment option, and the achievement of an esthetic result requires an interdisciplinary approach, including restorative dentistry and periodontics. (Angle Orthod. 2012;82:370-379.)

Clinical Performance of Porcelain Laminate Veneers: Outcomes of the Aesthetic Pre-evaluative Temporary (APT) Technique

This article evaluates the long-term clinical performance of porcelain laminate veneers bonded to teeth prepared with the use of an additive mock-up and aesthetic pre-evaluative temporary (APT) technique over a 12-year period. Sixty-six patients were restored with 580 porcelain laminate veneers. The technique, used for diagnosis, esthetic design, tooth preparation, and provisional restoration fabrication, was based on the APT protocol. The influence of several factors on the durability of veneers was analyzed according to pre- and postoperative parameters. With utilization of the APT restoration, over 80% of tooth preparations were confined to the dental enamel. Over 12 years, 42 laminate veneers failed, but when the preparations were limited to the enamel, the failure rate resulting from debonding and microleakage decreased to 0%. Porcelain laminate veneers presented a successful clinical performance in terms of marginal adaptation, discoloration, gingival recession, secondary caries, postoperative sensitivity, and satisfaction with restoration shade at the end of 12 years. The APT technique facilitated diagnosis, communication, and preparation, providing predictability for the restorative treatment. Limiting the preparation depth to the enamel surface significantly increases the performance of porcelain laminate veneers. (Int J Periodontics Restorative Dent 2012;32:625-635.)

Arquitetura brutalista e estratégia de transportes no triângulo mineiro: estações ferroviárias da Mogiana e Terminal Rodoviário Presidente Castelo Branco

Em 1989, Brandão descrevia o Triângulo Mineiro como “fruto da ambiguidade de seu estigma de fazer parte de Minas, mas ser articulada economicamente a São Paulo.” A mesorregião do Triângulo Mineiro e Alto Paranaíba, faz fronteira com os estados de Goiás, São Paulo e Mato Grosso do Sul, interligando também com a Central Mineira e com o Oeste de Minas, sendo a característica de “rota de passagem” como principal fator do desenvolvimento de sua economia. O posicionamento estratégico da região, como eixo de ligação da capital paulista ao chamado Brasil Central, pode ser considerado um importante fator no estreitamento dos laços entre a região e São Paulo, somado ao sentimento de não pertencimento do Triângulo ao estado de Minas Gerais, o qual resultou por décadas em manifestações separatistas na região. A arquitetura moderna produzida no Triângulo Mineiro e Alto Paranaíba deu um salto significativo no momento de construção da nova capital federal, em finais da década de 1950, onde o papel de mediação, principalmente da cidade de Uberlândia, no processo de infra-estruturação da nova cidade foi determinante nos avanços construtivos do Triângulo. Esse momento coincidiu com o início do processo de verticalização das principais cidades da região e o aumento de arquitetos residentes nas cidades. Por meio, em especial, dos edifícios para as estações ferroviárias da Cia Mogiana, de Oswaldo Arthur Bratke em Uberaba e Uberlândia (déc. 1960) e do Terminal Rodoviário Presidente Castelo Branco em Uberlândia, dos arquitetos Fernando Graça, Flávio Almada e Ivan Curpertino (1970), este trabalho objetiva conduzir uma discussão acerca da produção de arquitetura moderna no Triângulo Mineiro ligada às estratégias de transportes intermunicipais como própria cultura de desenvolvimento econômico da região. Nos interessa valer do debate entre o uso da estética brutalista, e da própria escolha por uma arquitetura moderna, como artifício no plano de desenvolvimento das empresas de transporte, e dos governos locais. Sobretudo, discutir as interlocuções do Triângulo Mineiro com São Paulo, rebatendo-as na formação do conjunto arquitetonico moderno produzido na região. Este trabalho é fruto da pesquisa de mestrado da autora cujo tema central é a difusão da arquitetura moderna no Triângulo Mineiro e Alto Paranaíba, pelo Iau/Usp, e financiado pela Capes.

Reestablishment of occlusion through overlay removable partial dentures: a case report

Loss of posterior teeth may cause an imbalance in the stomatognathic system. Overlay removable partial dentures (ORPD) are a reversible and relatively inexpensive treatment for patients with severely worn teeth. This paper presents a treatment with ORPD in a 55-year-old male patient who had severe attrition in the maxillary and mandibular teeth, temporomandibular joint pain and reduced vertical dimension of occlusion (VDO). The treatment consisted in the reestablishment of the VDO using Lucia’s jig, fabricating removable partial denture with reconstruction of the worn teeth without preparation. This therapy can be used as an alternative treatment to provide esthetic, function and stable occlusion in patients with severely worn teeth.