The use of fragments of thin veneers as a restorative therapy for anterior teeth disharmony: A case report with 3 years of follow-up

Aim: The present case report described the use of contact lens of thin porcelain veneers as a restorative therapy to solve anterior teeth disharmony. Background: Fragments of thin veneers are minimally invasive restorations with little or no dental preparation and present thickness ranging from 0.2 to 0.5 mm. They are used in case of diastema closure, small changes of teeth, color and restoration of teeth with small fractures. Case report: A 25-year-old man was admitted at a dental clinic complaining about the diastema presence on the upper anterior teeth. Patient was referred to an orthodontic treatment in order to provide better distribution of the diastemas and harmonious proportion of the teeth. Afterwards, contact lens of thin porcelain veneers were fabricated on the six upper anterior teeth. Conclusion: Based on the outcomes of this clinical report, we considered the use of fragments of thin veneers as a successful treatment option after 3 years of follow-up. Clinical significance: The fragments of thin veneers have been established to be an interesting alternative to esthetically restore the anterior teeth with minimal invasiveness. However, since it is a new treatment modality, longitudinal studies are necessary to understand the material's behavior.

Gingival recession associated with noncarious cervical lesions: Combined periodontal-restorative approach and the treatment of long-term esthetic complications

The combined periodontalrestorative approach (that is, a connective tissue graft for root coverage and NCCL restoration with RMGI cement) has demonstrated significant root coverage and a good esthetic outcome. In some cases, though, the color of an RMGI restoration can change over time, compromising esthetics. In this situation, applying composite resin over an RMGI restoration can be a conservative approach to satisfy the patient's esthetic complaint. Long-term observation is necessary to evaluate the stability of the results and establish the success of this approach over time.

Effects of three restorative techniques in the bond strength and nanoleakage at gingival wall of Class II restorations subjected to simulated aging

Objective: To evaluate the effects of simulated aging in bond strength and nanoleakage of class II restorations using three different restorative techniques. Materials and methods: Class II preparations (n = 12) were restored using: FS - composite resin Filtek Supreme Plus (3M/ESPE); RMGIC + FS - resin-modified glass ionomer cement Vitrebond Plus (3M/ESPE) + FS; and FFS + FS - flowable composite resin Filtek Supreme Plus Flowable (3M ESPE) + FS. The teeth were assigned into two groups: Control and Simulated Aging - Thermal/Mechanical cycling (3,000 cycles, 20-80 °C/500,000 cycles, 50 N). From each tooth, two slabs were assessed to microtensile bond strength test (μTBS) (MPa), and two slabs were prepared for nanoleakage assessment, calculated as penetration along the restoration margin considering the penetration length (%) and as the area of silver nitrate particle deposition (μm2). Data were analyzed by two-way analysis of variance (ANOVA) followed by Tukey's post hoc test (p < 0. 05). Results: FS presented the highest μTBS to dentin (22. 39 ± 7. 55 MPa) after simulated aging, while the presence of flowable resin significantly decreased μTBS (14. 53 ± 11. 65 MPa) when compared to no aging condition. Both control and aging groups of RMGIC + FS presented the highest values of silver nitrate penetration (89. 90 ± 16. 31 % and 97. 14 ± 5. 76 %) and deposition area (33. 05 ± 12. 49 and 28. 08 ± 9. 76 μm2). Nanoleakage was not affected by simulated aging. Conclusions: FS presented higher bond strength and lower nanoleakage and was not affected by simulated aging. Use of flowable resin compromised the bond strength after simulated aging. Clinical relevance: The use of an intermediate layer did not improve the dentin bond strength neither reduced nanoleakage at the gingival margins of class II restorations under simulated aging conditions. © 2012 Springer-Verlag.

Assessment of restorative treatment of patients with amelogenesis imperfecta

Purpose: The purpose of this study was to assess restorative treatment outcomes in the mixed dentition of amelogenesis imperfecta (AI) patients and determine the postrehabilitation oral health status and satisfaction of the patients. Methods: Clinical and radiographic examinations were performed on eight AI patients, who had 74 restorations placed in permanent incisors and molars, to allow evaluation of the integrity of the restorations and periodontal status post-treatment. Subjects completed a survey regarding esthetics, function, and sensitivity. Results: Among the 74 restorations evaluated, seven were lost; of the remaining restorations, 31 were posterior, and 36 were anterior. Ten were rated clinically unacceptable. Teeth with stainless steel crowns had a moderate gingival index (mean=2.3) and plaque index (mean=2.0) scores. Widening of the periodontal ligament and pulp canal obliteration were common radiographic findings. Subject's recall of satisfaction regarding esthetics (P=.002) and sensitivity (brushing-P=.03; eating-P=.01) showed a statically significant difference before and after treatment. Conclusions: During mixed dentition, teeth with amelogenesis imperfecta may be restored with conventional treatment modalities. Direct restorations should be considered interim with multiple repairs anticipated. Post-treatment, gingival inflammation and plaque accumulation were observed. Subjects were satisfied with their appearance and reported a decrease of hypersensitivity. © 2013 Publishing Technology.

The association between restorative pre-clinical activities and musculoskeletal disorders

Objective: To evaluate the risk of development of musculoskeletal disorders in the upper limbs of undergraduate dentistry students during the execution of pre-clinical laboratory activities based on gender, type of dental procedure and area of the mouth under treatment.Methods: Male and female undergraduate students in the second year of the Araraquara Dental School, UNESP, were enrolled in this study. Digital photographs were obtained whilst the subjects performed laboratory activities. The working postures adopted by each student were evaluated using the Rapid Upper Limb Assessment (RULA). The photos were analysed by a calibrated researcher (k = 0.89), and a final risk score was attributed to each analysed procedure (n = 354). Descriptive statistical analyses were performed, and the associations of interest were analysed by the chisquare test (P = 0.05).Results: During most of the laboratory procedures performed, the risk of developing musculoskeletal disorders was high (64.7%; - IC95%: 59.7-69.7%), with no significant association between the RULA final score and gender (chi(2) = 1.100; P = 0.577), type of dental procedure (chi(2) = 5.447, P = 0.244) and mouth area treated (chi(2) = 4.150; P = 0.126).Conclusions: The risk of developing musculoskeletal disorders was high in undergraduate dentistry students; this risk was not related to gender, type of dental procedure and region of the mouth being treated.

Influence of fluoride-releasing restorative material on root dentine secondary caries in situ

The usefulness of fluoride-releasing restorations in secondary caries prevention may be questioned because of the presence of other common sources of fluoride and because of ageing of the restorations. This study tested the hypothesis that glass-ionomer cement restorations, either aged or unaged, do not prevent secondary root caries, when fluoride dentifrice is frequently used. Sixteen volunteers wore palatal appliances in two phases of 14 days, according to a 2 x 2 crossover design. In each phase the appliance was loaded with bovine root dentine slabs restored with either glass-ionomer or resin composite, either aged or unaged. Specimens were exposed to cariogenic challenge 4 times/day and to fluoridated dentifrice 3 times/day. The fluoride content in the biofilm (FB) formed on slabs and the mineral loss (Delta Z) around the restorations were analysed. No differences were found between restorative materials regarding the FB and the Delta Z, for either aged (p = 0.792 and p = 0.645, respectively) or unaged (p = 1.00 and p = 0.278, respectively) groups. Under the cariogenic and fluoride dentifrice exposure conditions of this study, the glass-ionomer restoration, either aged or unaged, did not provide additional protection against secondary root caries. Copyright (c) 2006 S. Karger AG, Basel.

Interactions between restorative dentistry and periodontics: luting post nonmetallic (Part II)

Endodontically treated teeth have necessary use of intracanal posts. Due to the constant need and search for esthetic materials with properties similar to tooth structure remaining fi berglass posts esthetic came good these shortcomings and are increasingly used as a fi rst option for prosthetic rehabilitation. In this case report is described step by step how to perform the cementation of a nonmetallic post and core construction for making a piece prosthetic onlay in a simplifi ed way, by choosing the self-etching cementation technique.

Interactions between restorative dentistry and periodontics: preparation and cementation of an onlay in Empress (Part III)

The relentless pursuit by cosmetic dentistry brought the evolution of materials ceramics. The IPS-Empress system was upgrading of indirect restorations based on lithium disilicate. The ceramic restoration posterior allow a new esthetic approach due to its translucency and resistance without any weakening of the remaining dental element, being an option more conservative when compared to conventional prosthetic restorations.

In vitro study of staining agents effects on optical properties of esthetic restorative materials

The authors have studied the effect of four staining agents on the optical properties of esthetic restorative materials through translucency tests. Two commercial brands of composite resins were used: Point 4 (Kerr) and Charisma (Heraeus-Kulzer). The liquids tested were: wine, cola, chlorhexidine solution and nicotine solution. The translucency was measured at different periods of time: P0 – before immersion (baseline), P1 - 1 h after immersion, P2 - 2 h after immersion and successively, P3 – 24 h after immersion up to a period of 7 weeks. ANOVA statistical analysis was applied to the data (p < 0.05). The results lead to the following conclusions: (1) Composite resins submitted to the tested immersion mediums were stained, (2) the lower percentage of translucency was observed for nicotine containing solution, (3) The percentage of translucency decreased with the period of immersion.

Morphology of ileal and jejunal pouches used as rectal substitutes

PURPOSE: Our aim was to determine whether the mucosa of a canine jejunal pouch used as a rectal substitute after proctocolectomy retains its morphologic features better than the mucosa of a canine ileal pouch so used. METHODS: Among ten dogs that underwent proctocolectomy, five had a jejunal pouch-distal rectal anastomosis and five an ileal pouch-distal rectal anastomosis. After six months, the animals were killed, the intestinal pouches and portions of unaltered distal ileum were removed, and a blinded, mucosal morphometric analysis was performed. RESULTS: The mucosa of the jejunal pouches had an overall thickness (mean ± standard deviation, anterior and posterior walls, 1,300 ± 140 μm), villous height (286 ± 46 μm), and crypt depth (790 ± 77 μm) greater than that of the ileal pouches (920 ± 170, 208 ± 47, and 530 ± 130 μm, respectively; P < 0.05). Moreover, the mucosal thickness of the jejunal pouches was similar to that of the distal ileum proximal to the pouch (1,200 ± 200 μm; P > 0.05), whereas the mucosal thickness of the ileal pouch was thinner (P < 0.05). CONCLUSIONS: The jejunal mucosa retains its major morphometric features when the jejunum is used as a rectal substitute after proctocolectomy. In contrast, the ileal mucosa atrophies when the ileum is so used.

A comparison of microhardness of indirect composite restorative materials

The purpose of this study was to compare the microhardness of four indirect composite resins. Forty cylindrical samples were prepared according to the manufacturer s recommendations using a Teflon mold. Ten specimens were produced from each tested material, constituting four groups (n=10) as follows: G1 - Artglass; G2 - Sinfony; G3 - Solidex; G4 - Targis. Microhardness was determined by the Vickers indentation technique with a load of 300g for 10 seconds. Four indentations were made on each sample, determining the mean microhardness values for each specimen. Descriptive statistics data for the experimental conditions were: G1 - Artglass (mean ±standard deviation: 55.26 ± 1.15HVN; median: 52.6); G2 - Sinfony (31.22 ± 0.65HVN; 31.30); G3 - Solidex (52.25 ± 1.55HVN; 52.60); G4 - Targis (72.14 ± 2.82HVN; 73.30). An exploratory data analysis was performed to determine the most appropriate statistical test through: (I) Levene's for homogeneity of variances; (II) ANOVA on ranks (Kruskal-Wallis); (III) Dunn's multiple comparison test (0.05). Targis presented the highest microhardness values while Sinfony presented the lowest. Artglass and Solidex were found as intermediate materials. These results indicate that distinct mechanical properties may be observed at specific materials. The composition of each material as well as variations on polymerization methods are possibly responsibles for the difference found in microhardness. Therefore, indirect composite resin materials that guarantee both good esthetics and adequate mechanical properties may be considered as substitutes of natural teeth.

Direct restorative treatment of dental erosion caused by gastroesophageal reflux disease associated with bruxism: a case report

Gastroesophageal reflux disease (GERD) is a gastrointestinal disorder in which stomach acids are chronically regurgitated into the esophagus and oral cavity. Continual exposure of the teeth to these acids can cause severe tooth wear. Dentists are often the first healthcare professionals to diagnose dental erosion in patients with GERD. This article presents a case report of a 27-year-old male smoker with tooth wear and dentin sensitivity caused by GERD associated with bruxism. After diagnosis, a multidisciplinary treatment plan was established. The initial treatment approach consisted of medical follow-up with counseling on dietary and smoking habits, as well as management of the gastric disorders with medication. GERD management and the dental treatment performed for the eroded dentition are described, including diagnosis, treatment planning, and restorative therapy.

Influence of crown-to-implant ratio, retention system, restorative material, and occlusal loading on stress concentrations in single short implants

Purpose: The aim of this study was to assess the contributions of some prosthetic parameters such as crown-to-implant (C/I) ratio, retention system, restorative material, and occlusal loading on stress concentrations within a single posterior crown supported by a short implant. Materials and Methods: Computer-aided design software was used to create 32 finite element models of an atrophic posterior partially edentulous mandible with a single external-hexagon implant (5 mm wide × 7 mm long) in the first molar region. Finite element analysis software with a convergence analysis of 5% to mesh refinement was used to evaluate the effects of C/I ratio (1:1; 1.5:1; 2:1, or 2.5:1), prosthetic retention system (cemented or screwed), and restorative material (metal-ceramic or all ceramic). The crowns were loaded with simulated normal or traumatic occlusal forces. The maximum principal stress (σmax) for cortical and cancellous bone and von Mises stress (σvM) for the implant and abutment screw were computed and analyzed. The percent contribution of each variable to the stress concentration was calculated from the sum of squares analysis. Results: Traumatic occlusion and a high C/I ratio increased stress concentrations. The C/I ratio was responsible for 11.45% of the total stress in the cortical bone, whereas occlusal loading contributed 70.92% to the total stress in the implant. The retention system contributed 0.91% of the total stress in the cortical bone. The restorative material was responsible for only 0.09% of the total stress in the cancellous bone. Conclusion: Occlusal loading was the most important stress concentration factor in the finite element model of a single posterior crown supported by a short implant.

Caries formation around restorative composite and glass ionomer cement

This in vitro study evaluated the demineralization around restorations class V made on the buccal and lingual surfaces of teeth when using different restorative materials. Thirty extracted teeth were randomly divided into 3 groups (n=10) according to the restorative material: Group I - Fuji II LC (GC America Inc., Alsip, Illinois, USA), Group II - Tetric (Ivoclar Vivadent AG, Schaan, Liechtenstein) and Group III - Chelon Fil (3M/ESPE., Seefeld, Germany). The teeth were submitted to a pH-cycling model associated to a thermocycling model. Sections were made and the specimens were analyzed under a polarized light microscopy as for the presence of demineralization. Measurements were performed and the results were subjected to statistical analysis using Anova and Tukey´s Test (α=0.05). Mean values of demineralization depth (µm) according to each positions showed that the demineralization was significantly reduced when Chelon Fil (Group III) was used for all depths, when compared to fluoridated resin materials. Also, it was verified that non-fluoridated resin material, composite resin Tetric, had the lowest inhibitory effect on the development of demineralization.

Stability analysis of power systems described with detailed models by automatic method

The power system stability analysis is approached taking into explicit account the dynamic performance of generators internal voltages and control devices. The proposed method is not a direct method in the usual sense since conclusion for stability or instability is not exclusively based on energy function considerations but it is automatic since the conclusion is achieved without an analyst intervention. The stability test accounts for the nonconservative nature of the system with control devices such as the automatic voltage regulator (AVR) and automatic generation control (AGC) in contrast with the well-known direct methods. An energy function is derived for the system with machines forth-order model, AVR and AGC and it is used to start the analysis procedure and to point out criticalities. The conclusive analysis itself is made by means of a method based on the definition of a region surrounding the equilibrium point where the system net torque is equilibrium restorative. This region is named positive synchronization region (PSR). Since the definition of the PSR boundaries have no dependence on modelling approximation, the PSR test conduces to reliable results. (C) 2008 Elsevier Ltd. All rights reserved.