Recovering the function and esthetics of fractured teeth using several restorative cosmetic approaches. Three clinical cases

The teeth most commonly affected by trauma are the maxillary central incisors. The most frequent types of traumatic dental injuries to permanent teeth are enamel fractures, enamel and dentine fractures, and enamel and dentine fractures with pulp involvement. This article describes three clinical cases with different levels of traumatized maxillary incisors and several cosmetic approaches for recovery of the esthetics and the masticatory function, as well as the social/psychological aspects of treatment. All cases involved young adult men. The three clinical cases involve dentin and enamel fractures, dentin and enamel fractures with pulp exposure, and dentin and enamel fractures with pulp exposure associated with root fracture. The cosmetic treatments used to resolve fractures were direct composite resin by layering technique, indirect all-ceramic restorations (laminate veneer and ceramic crowns over the teeth), and immediate implant after extraction followed by immediate loading (ceramic abutments with ceramic crown over implant). In all three cases, excellent functional and esthetic results were achieved by use of these treatment modalities. The patients were very satisfied with the results.

Multidisciplinary approach for the treatment of a complicated crown-root fracture in a young patient: A case report

Crown-root fractures in permanent teeth cause esthetic and functional problems. This paper reports the case of a complicated crown-root fracture in the maxillary right central inc sor of a young patient who was treated with a multidisciplinary approach in two phases. A modified Widman flap, root canal therapy, glass fiber post cementation, and adhesive tooth fragment reattachment were performed shortly after an accident. Satisfactory esthetic and functional outcomes were obtained. However, the patient did not attend follow-up visits and returned after 7 years. During this second phase, the clinical and radiographic examination showed stability and adaptation of the fragment and good periodontal health conditions, but crown darkening and a radiolucent image associated with the root apex of the fractured tooth were also observed. The periapical lesion was surgically removed by apicoectomy, and the esthetics were recovered with a direct composite res n veneer on the traumatized tooth. (Quintessence Int 2011;42:729-735)

Effect of Metal-Ceramic or All-Ceramic Superstructure Materials on Stress Distribution in a Single Implant-Supported Prosthesis: Three-Dimensional Finite Element Analysis

Purpose: This three-dimensional finite element analysis study evaluated the effect of different material combinations on stress distribution within metal-ceramic and all-ceramic single implant-supported prostheses. Materials and Methods: Three-dimensional finite element models reproducing a segment of the maxilla with a missing left first premolar were created. Five groups were established to represent different superstructure materials: GP, porcelain fused to gold alloy; GR, modified composite resin fused to gold alloy; TP, porcelain fused to titanium; TR, modified composite resin fused to titanium; and ZP, porcelain fused to zirconia. A 100-N vertical force was applied to the contact points of the crowns. All models were fixed in the superior region of bone tissue and in the mesial and distal faces of the maxilla section. Stress maps were generated by processing with finite element software. Results: Stress distribution and stress values of supporting bone were similar for the GP, GR, TP, and ZP models (1,574.3 MPa, 1,574.3 MPa, 1,574.3 MPa, and 1,574.2 MPa, respectively) and different for the TR model (1,838.3 MPa). The ZP model transferred less stress to the retention screw (785 MPa) than the other groups (939 MPa for GP, 961 MPa for GR, 1,010 MPa for TP, and 1,037 MPa for TR). Conclusion: The use of different materials to fabricate a superstructure for a single implant-supported prosthesis did not affect the stress distribution in the supporting bone. The retention screw received less stress when a combination of porcelain and zirconia was used. Int J Oral Maxillofac Implants 2011;26:1202-1209

Effect of Superstructure Materials and Misfit on Stress Distribution in a Single Implant-Supported Prosthesis: A Finite Element Analysis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Surface Roughness Analysis of Four Restorative Materials Exposed to 10% and 15% Carbamide Peroxide

The aim of this study was to evaluate the effects of carbamide peroxide (CP) on surfaces of different restorative materials. Porcelain, composite resin, glass ionomer, and amalgam were analyzed in this study. Surface roughness (Ra) was measured before and after treatment with 10% and 15% CP. Fifteen percent CP increased Ra values in both the glass ionomer and amalgam subgroups, while 10% CP increased Ra values in the glass ionomer subgroup only. Changes in restorative material surfaces can be more severe when bleaching is completed without a clinician's supervision. Hence, thorough patient examinations must be done before, during, and after bleaching treatment. Int J Prosthodont 2011;24:155-157

Shear bond strength of aesthetic materials bonded to Ni-Cr alloy

Objectives. This study was undertaken to evaluate the shear bond strength of four materials used as aesthetic material bonded to Ni-Cr alloy.Methods. Sixty-eight alloy discs were prepared and divided equally into four groups, and received four treatments for veneering: conventional feldspathic porcelain (Noritake EX-3) and three light-cured prosthodontic composite resins (Artglass, Solidex and Targis). The aesthetic materials were applied after metal structure conditioning in accordance with the manufacturers' recommendations. The specimens were stored in distilled water at 37 degreesC for 7 days. A universal testing machine was used to measure the shear bond strength of the specimens at a cross head speed of 0.5 mm/min. Fractured specimens were examined by using both optical and scanning electron microscope.Results. The analysis of variance and Tukey's test showed that the strongest mean shear bond was obtained with Noritake EX-3 (mean shear bond strength 42.90 +/- 7.82 MPa). For composites, the highest mean shear bond strength was observed for Targis (12.30 +/- 1.57 MPa); followed by Solidex (11.94 +/- 1.04 MPa) and Artglass (10.04 +/- 0.75 MPa). Optical analysis of the fractured surf aces indicated that for Targis and Noritake EX-3 all failures were a mixture of both cohesive and adhesive patterns. As for Artglass and Solidex, the fractures were mainly adhesive in nature.Conclusions. The Solidex system was equivalent to the Targis system in bond strength and exhibited greater strength than the Artglass system. The porcelain fused-to-metal showed considerably higher shear bond strength than the three metal-resin bonding techniques. (C) 2003 Elsevier B.V. Ltd. Ali rights reserved.

Single crowns versus conventional fillings for the restoration of root filled teeth

BackgroundEndodontic treatment, involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth which may influence long term survival and cost. The comparative in service clinical performance of crowns or conventional fillings used to restore root filled teeth is unclear.ObjectivesTo assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials.Search methodsWe searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME and the reference lists of articles as well as ongoing trials registries. There were no restrictions regarding language or date of publication. Date of last search was 13 February 2012.Selection criteriaRandomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth which have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration, as well as indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any.Data collection and analysisTwo review authors independently assessed trial quality and extracted data.Main resultsOne trial judged to be at high risk of bias due to missing outcome data, was included. 117 participants with a root filled premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. At 3 years there was no reported difference between the non-catastrophic failure rates in both groups. Decementation of the post and marginal gap formation occurred in a small number of teeth.Authors' conclusionsThere is insufficient evidence to support or refute the effectiveness of conventional fillings over crowns for the restoration of root filled teeth. Until more evidence becomes available clinicians should continue to base decisions on how to restore root filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.

Effect of Static and Cyclic Loading on Ceramic Laminate Veneers Adhered to Teeth with and Without Aged Composite Restorations

Purpose: Existing composite restorations on teeth are often remade prior to the cementation of fixed dental prostheses. The aim of this study was to evaluate the effect of static and cyclic loading on ceramic laminate veneers adhered to aged resin composite restorations.Materials and Methods: Eighty sound maxillary incisors were collected and randomly divided into four groups: group 1: control group, no restorations; group 2: two Class III restorations; group 3: two Class IV restorations; group 4: complete composite substrate. Standard composite restorations were made using a microhybrid resin composite (Anterior Shine). Restored teeth were subjected to thermocycling (6000 cycles). Window preparations were made on the labial surface of the teeth for ceramic laminate fabrication (Empress II). Teeth were conditioned using an etch-and-rinse system. Existing composite restorations representing the aged composites were silica coated (CoJet) and silanized (ESPE-Sil). Ceramic laminates were cemented using a bis-GMA-based cement (Variolink Veneer). The specimens were randomly divided into two groups and were subjected to either static (groups 1a, 2a, 3a, 4a) or cyclic loading (groups 1b, 2b, 3b, 4b). Failure type and location after loading were classified. Data were analyzed using one-way ANOVA and Tukey's test.Results: Significantly higher fracture strength was obtained in group 4 (330 +/- 81 N) compared to the controls in group 1 (179 +/- 120 N) (one-way ANOVA, p < 0.05). Group lb survived a lower mean number of cyclic loads (672,820 cycles) than teeth of groups 2b to 4b (846x10(3) to 873x10(3) cycles). Failure type evaluation after the fracture test showed predominantly adhesive failures between dentin and cement, but after cyclic loading, more cohesive fractures in the ceramic were seen.Conclusion: Ceramic laminate veneers bonded to conditioned aged composite restorations provided favorable results. Surface conditioning of existing restorations may eliminate the necessity of removing aged composite restorations.

Evaluation of interface characterization and adhesion of glass ceramics to commercially pure titanium and gold alloy after thermal- and mechanical-loading

Objectives. This study evaluated the effect of thermal- and mechanical-cycling on the shear bond strength of three low-fusing glassy matrix dental ceramics to commercial pure titanium (cpTi) when compared to conventional feldspathic ceramic fused to gold alloy.Methods. Metallic frameworks (diameter: 5 min, thickness: 4 mm) (N = 96, n = 12 per group) were cast in cpTi and gold alloy, airborne particle abraded with 150 mu m aluminum oxide. Low-fusing glassy matrix ceramics and a conventional feldspathic ceramic were fired onto the alloys (thickness: 4mm). Four experimental groups were formed; Gr1 (control group): Vita Omega 900-Au-Pd alloy; Gr2: Ticeram-cpTi; Gr3: Super Porcelain Ti-22-cpTi and G4: Vita Titankeramik-cpTi. While half of the specimens from each ceramic-metal combination were randomly tested without aging (water storage at 37 C for 24h only), the other half were first thermocycled (6000 cycles, between 5 and 55 C, dwell time: 13 s) and then mechanically loaded (20,000 cycles under SON load, immersion in distilled water at 37 C). The ceramic-alloy interfaces were loaded under shear in a universal test machine (cross-head speed: 0.5 mm/min) until failure occur-red. Failure types were noted and the interfaces of the representative fractured specimens from each group were examined with stereo microscope and scanning electron microscope (SEM). in an additional study (N = 16, n = 2 per group), energy dispersive X-ray spectroscopy (EDS) analysis was performed from ceramic-alloy interfaces. Data were analyzed using ANOVA and Tukey's test.Results. Both ceramic-metal combinations (p < 0.001) and aging conditions (p < 0,001) significantly affected the mean bond strength values. Thermal- and mechanical-cycling decreased the bond strength (MPa) results significantly for Gr3 (33.4 +/- 4.2) and Gr4 (32.1 +/- 4.8) when compared to the non-aged groups (42.9 +/- 8.9, 42.4 +/- 5.2, respectively). Gr1 was not affected significantly from aging conditions (61.3 +/- 8.4 for control, 60.7 +/- 13.7 after aging) (p > 0.05). Stereomicroscope images showed exclusively adhesive failure types at the opaque ceramic-cpTi interfacial zone with no presence of ceramic on the substrate surface but with a visible dark titanium oxide layer in Groups 2-4 except Gr1 where remnants of bonder ceramic was visible. EDS analysis from the interfacial zone for cpTi-ceramic groups showed predominantly 34.5-85.1% O(2) followed by 1.1-36.7% Aland 0-36.3% Si except for Super Porcelain Ti-22 where a small quantity of Ba (1.4-8.3%), S (0.7%) and Sn (35.3%) was found. In the Au-Pd alloy-ceramic interface, 56.4-69.9% O(2) followed by 15.6-26.2% Si, 3.9-10.9% K, 2.8-6% Na, 4.4-9.6% Al and 0-0.04% Mg was observed.Significance. After thermal-cycling for 6000 times and mechanical-cycling for 20,000 times, Triceram-cpTi combination presented the least decrease among other ceramic-alloy combinations when compared to the mean bond strength results with Au-Pd alloy-Vita Omega 900 combination. (c) 2008 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Bond strength durability of a resin composite on a reinforced ceramic using various repair systems

Objectives. This study compared the durability of repair bond strength of a resin composite to a reinforced ceramic after three repair systems.Methods. Alumina-reinforced feldspathic ceramic blocks (Vitadur-alpha(R)) (N=30) were randomly divided into three groups according to the repair method: PR-Porcelain Repair Kit (Bisco) [etching with 9.5% hydrofluoric acid + silanization + adhesive]; CJ-CoJet Repair Kit (3M ESPE) [(chairside silica coating with 30 mu m SiO2 + silanization (ESPE(R)-Sil) + adhesive (Visio(TM)-Bond)]; CL-Clearfil Repair Kit [diamond surface roughening, etching with 40% H3PO4 + Clearfil Porcelain Bond Activator + Clearfil SE Bond)]. Resin composite was photo-polymerized on each conditioned ceramic block. Non-trimmed beam specimens were produced for the microtensile bond strength (mu TBS) tests. In order to study the hydrolytic durability of the repair methods, the beam specimens obtained from each block were randomly assigned to two conditions. Half of the specimens were tested either immediately after beam production (Dry) or after long-term water storage (37 degrees C, 150 days) followed by thermocyling (12,000 cycles, 5-55 degrees C) in a universal testing machine (1 mm/min). Failure types were analyzed under an optical microscope and SEM.Results. mu TBS results were significantly affected by the repair method (p=0.0001) and the aging conditions (p=0.0001) (two-way ANOVA, Tukey's test). In dry testing conditions, PR method showed significantly higher (p < 0.001) repair bond strength (19.8 +/- 3.8 MPa) than those of CJ and CL (12.4 +/- 4.7 and 9.9 +/- 2.9, respectively). After long-term water storage and thermocycling, CJ revealed significantly higher results (14.5 +/- 3.1 MPa) than those of PR (12.1 +/- 2.6 MPa) (p < 0.01) and CL (4.2 +/- 2.1 MPa) (p < 0.001). In all groups when tested in dry conditions, cohesive failure in the composite accompanied with adhesive failure at the interface (mixed failures), was frequently observed (76%, 80%, 65% for PR, CJ and CL, respectively). After aging conditions, while the specimens treated with PR and CJ presented primarily mixed failure types (52% and 87%, respectively), CL group presented mainly complete adhesive failures at the interface (70%).Significance. Hydrolytic stability of the repair method based on silica coating and silanization was superior to the other repair strategies for the ceramic tested. (C) 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Mechanical and thermal cycling effects on the flexural strength of glass ceramics fused to titanium

This study evaluated the effects of mechanical and thermal cycling on the flexural strength (ISO 9693) of three brands of ceramics fused to commercially pure titanium (cpTi). Metallic frameworks of 25 x 3 x 0.5 mm dimensions (N = 84) were cast in cpTi, followed by 150-mu m aluminum oxide airborne particle abrasion at a designated area of the frameworks (8 x 3 mm). Bonder and opaque ceramic were applied on the frameworks, and then the corresponding ceramic (Triceram, Super Porcelain Ti-22, Vita Titankeramik) was fired onto them (thickness: 1 mm). Half of the specimens from each ceramic-metal combination were randomly tested without aging (only water storage at 37 degrees C for 24 hours), while the other half were mechanically loaded (20,000 cycles under 10 N load, immersion in distilled water at 37 degrees C) and thermocycled (3,000 cycles, between 5-55 degrees C, dwell time of 13 seconds). After the flexural strength test, failure types were noted. Mechanical and thermal cycling decreased the mean flexural strength values significantly (p<0.05) for all the three ceramic-cpTi combinations tested when compared to the control group. In all the three groups, failure type was exclusively adhesive at the opaque ceramic-cpTi interfacial zone with no presence of ceramic on the substrate surface except for a visible oxide layer.

Strength of a feldspar ceramic according to the thickness and polymerization mode of the resin cement coating

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Redução da susceptibilidade à deformação piroplástica das argilas do Pólo Cerâmico de Santa Gertrudes através da adição de matérias-primas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Investigação da Interface Metal-Porcelana da Liga Ni-Cr-Mo Soldada a LASER

The interface formed between the metal and the porcelain of a LASER welded Ni-Cr-Mo alloy was studied. The characterization was carried out through optical microscopy, scanning electron microscopy, X-ray dispersive spectroscopy-EDS and mechanical testing by three-point flexion test-TPE in the region LASER welded with and without the porcelain. The porcelain adhesion with the alloy alone is possible after the oxidation of the metallic surface and subsequent application of an adhesive called opaco. The applied porcelain, on the base metal and fusion zone presented some distinct behaviors. After the TPF test the base metal presented fractures while that in the fusion zone was completely gone. One noticed that the region submitted to the LASER welding showed less porcelain adhesion than the region of the base metal due to the microestructural refinement of the fusion zone. These results can be evidenced by the EDS of the studied regions. The TPF had demonstrated that the Ni-Cr-Mo alloy submitted to the LASER welding, undergone significant alterations in its mechanical properties after the application of the porcelain.

Efeito alelopático de plantas daninhas e concentrações de capim-braquiária (Brachiaria decumbens) no desenvolvimento inicial de eucalipto (Eucalyptus grandis)

Com o objetivo de verificar possível efeito alelopático de 18 espécies de plantas daninhas sobre o crescimento inicial de Eucalyptus grandis, realizaram-se dois experimentos em casa de vegetação. No primeiro experimento, dentre 18 espécies de plantas daninhas testadas, Brachiaria decumbens (BRADC) demonstrou acentuada capacidade de reduzir o crescimento de Eucalyptus grandis, quando incorporada ao solo. No segundo experimento avaliou-se o efeito da adição no substrato de concentrações de matéria seca de BRADC sobre o crescimento inicial de mudas de E. grandis. A matéria seca triturada de BRADC foi incorporada ao solo nas concentrações de 0% (testemunha), 0,5%, 1,0%, 2,0% e 3,0% (p/p). Instalou-se também uma réplica do experimento, com adição de idênticas quantidades totais de carbono entre os tratamentos. O ajuste da quantidade de carbono foi feito através da adição de Sphagnum. Extraiu-se a solução do solo por meio de cápsulas de porcelana introduzidas nos vasos quando do transplante das mudas de eucalipto. As soluções foram coletadas ao final do experimento (39 dias após o transplante das mudas), sendo utilizadas para a determinação de pH, condutividade elétrica, potencial osmótico e para análise de teores de nutrientes. As mínimas proporções de BRADC, com efeito inibitório, foram de 0,5 e 1,0%, com e sem Sphagnum, respectivamente. Nestas duas condições, a área foliar média do eucalipto foi reduzida em 24 e 23%, respectivamente. As análises de solução do solo dos tratamentos permitiram concluir que os teores de nutrientes e as características químicas destes foram pouco alterados pelos tratamentos, sendo pouco provável que a redução do crescimento do E. grandis se deva às restrições nas quantidades de nutrientes disponíveis.