Stress distribution in ceramic restorations over natural tooth using finite element analysis. lithium disilicate x aluminum oxide material

Background: Data on stress distribution in tooth-restoration interface with different ceramic restorative materials are limited. The aim of this chapter was to assess the stress distribution in the interface of ceramic restorations with laminate veneer or full-coverage crown with two different materials (lithium dissilicate and densely sintered aluminum oxide) under different loading areas through finite element analysis. Materials and Methods: Six two-dimensional finite element models were fabricated with different restorations on natural tooth: laminate veneer (IPS Empress, IPS Empress Esthetic and Procera AllCeram) or full-coverage crown (IPS e.max Press and Procera AllCeram). Two different loading areas (L) (50N) were also determined: palatal surface at 45° in relation to the long axis of tooth (L1) and perpendicular to the incisal edge (L2). A model with higid natural tooth was used as control. von Mises equivalent stress (σ vM) and maximum principal stress (σ max) were obtained on Ansys software. Results: The presence of ceramic restoration increased σ vM and σ max in the adhesive interface, mainly for the aluminum oxide (Procera AllCeram system) restorations. The full-coverage crowns generated higher stress in the adhesive interface under L1 while the same result was observed for the laminate veneers under L2. Conclusions: Lithium dissilicate and densely sintered aluminum oxide restorations exhibit different behavior due to different mechanical properties and loading conditions. © 2011 Nova Science Publishers, Inc.

Laminate veneers - a review and clinical case

The laminate veneers are great choice for rehabilitation for anterior segment of the mouth. Actually, due the employment of dental cements and bonding to dentin, the uses of laminate veneers is an effective and conservative treatment, showing a high rate success rate. This paper presents a clinical case of 50 years old male, J.C.H, who have a chief complaint of an unattractive smile. After the diagnosis and planning, 10 laminate veneers were placed from the second bicuspid (15) to the second bicuspid (25). The correct indication of laminate veneers allows restorations with appropriate esthetic and patient's satisfaction with immediate effect on quality of life. © 2011 Nova Science Publishers, Inc.

Bonding all-ceramic restorations with two resins cement techniques: A clinical report of three-year follow-up

Ceramics have been widely used for esthetic and functional improvements. The resin cement is the material of choice for bonding ceramics to dental substrate and it can also dictate the final esthetic appearance and strength of the restoration. The correct use of the wide spectrum of resin luting agents available depends on the dental tooth substrate. This article presents three-year clinical results of a 41 years old female patient B.H.C complaining about her unattractive smile. Two all-ceramic crowns and two laminates veneers were placed in the maxillary incisors and cemented with a self-adhesive resin luting cement and conventional resin luting cement, respectively. After a three-year follow-up, the restorations and cement/teeth interface were clinically perfect with no chipping, fractures or discoloration. Proper use of different resin luting cements shows clinical appropriate behavior after a three-year follow-up. Self-adhesive resin luting cement may be used for cementing all-ceramic crowns with high predictability of success, mainly if there is a large dentin surface available for bonding and no enamel at the finish line. Otherwise, conventional resin luting agent should be used for achieving an adequate bonding strength to enamel.

Drug-induced gingival overgrowth: A clinical and histopathological report

Gingival overgrowth is a significant problem faced by periodontists and is particularly associated with the use of certain drugs such as nifedipine, a high-specificity calcium channel blocker used for the treatment and prophylaxis of certain cardiovascular diseases. Development of gingival overgrowth is characterized by increased collagen in gingival tissue. In general is asymptomatic, at times associated with spontaneous bleeding and ulceration and can promote aesthetic changes and compromise hygiene habits and mastication of the patient. The severity of the symptoms is associated with the presence of risk factors such association with other drugs. This paper aims to present a case report of a patient with generalized gingival overgrowth, with more severe characteristics in the anterior mandible induced by chronic use of nifedipine who underwent basic non-surgical periodontal treatment including supra and subgingival scaling and root planning in both jaws associated with rigorous oral hygiene instructions and surgical therapy in the anterior mandible, the most affected area, to remove the excess of gingival tissue. Nifedipine was replaced by the patient cardiologist to propanolol hydrochloride (40 mg/kg) in an attempt to minimize unwanted side effects. After 6 month follow-up, no recurrence was observed, oral hygiene had improved and the patient had clinical periodontal health and esthetic satisfaction.

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.

Anterior restorations in bleached teeth: Difficulty establishing the color after bleaching

It is becoming more common for patients to look for cosmetic procedures in dental offices. The search for lost or desired esthetics by patients is increasingly frequent and the professional must be able to meet this demand. To do this, dentists not only need to return the tooth back to its normal functioning state but also promote esthetic excellence. In this context, the association of cosmetic procedures, such as teeth whitening and restorative procedures, such as direct adhesive restorations is very common. The composite resins employed nowadays allow the reproduction of various optical properties of natural teeth. With these composite resins, it is possible to reproduce features such as translucency, opacity and specific features of the dental element, to bring back the esthetic harmony of the smile. This article reports a clinical case demonstrating the placement, in a stratified manner, of composite resins in bleached teeth, as well as the reproduction of optical and natural aspects of the teeth. In order to achieve esthetic and functional success of the restored procedure, it is important to be familiar with the new techniques and new materials in the marketand above all, we must know when and where to use them.

Efficacy and cytotoxicity of a bleaching gel after short application times on dental enamel

Objectives: This study aimed to evaluate and correlate the efficacy and cytotoxicity of a 35 % hydrogen peroxide (HP) bleaching gel after different application times on dental enamel. Materials and methods: Enamel/dentin disks in artificial pulp chambers were placed in wells containing culture medium. The following groups were formed: G1, control (no bleaching); G2 and G3, three or one 15-min bleaching applications, respectively; and G4 and G5, three or one 5-min bleaching applications, respectively. Extracts (culture medium with bleaching gel components) were applied for 60 min on cultured odontoblast-like MDPC-23 cells. Cell metabolism (methyl tetrazolium assay) (Kruskal-Wallis/Mann-Whitney; α = 5 %) and cell morphology (scanning electron microscopy) were analyzed immediately after the bleaching procedures and the trans-enamel and trans-dentinal HP diffusion quantified (one-way analysis of variance/Tukey's test; α = 5 %). The alkaline phosphatase (ALP) activity was evaluated 24 h after the contact time of the extracts with the cells (Kruskal-Wallis/Mann-Whitney; α = 5 %). Tooth color was analyzed before and 24 h after bleaching using a spectrophotometer according to the Commission Internationale de l'Eclairage L*a*b* system (Kruskal-Wallis/Mann-Whitney; α = 0.05). Results: Significant difference (p < 0.05) in cell metabolism occurred only between G1 (control, 100 %) and G2 (60.6 %). A significant decrease (p < 0.05) in ALP activity was observed between G2, G3, and G4 in comparison with G1. Alterations on cell morphology were observed in all bleached groups. The highest values of HP diffusion and color alterations were observed for G2, with significant difference among all experimental groups (p < 0.05). G3 and G4 presented intermediate color change and HP diffusion values with no statistically significant differences between them (p > 0.05). The lowest amount of HP diffusion was observed in G5 (p < 0.05), which also exhibited no significant color alteration compared to the control group (p > 0.05). Conclusions: HP diffusion through dental tissues and its cytotoxic effects were proportional to the contact time of the bleaching gel with enamel. However, shorter bleaching times reduced bleaching efficacy. Clinical relevance: Shortening the in-office tooth bleaching time could be an alternative to minimize the cytotoxic effects of this clinical procedure to pulp tissue. However, the reduced time of bleaching agent application on enamel may not provide adequate esthetic outcome. © 2012 Springer-Verlag Berlin Heidelberg.

Inorganic UV filters

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

Ameloblastoma mandibular rostral em um cão

Odontogenics tumors are uncommon in the dog. Ameloblastoma is considered a benign, aggressive and non-inductive odontogenic neoplasia commonly located in the incisor teeth. Its conclusive diagnosis is obtained by histopathological examination. Due to the expansive nature of this neoplasia, its resection needs to have an adequate surgical margin so it will have excellent prognostics. A canine, male, Pekingese, 8 years old had an increased volume in the rostral region of the mandible, adhered, consistency moderately firm. Radiography revealed extensive mandibular bone lysis caused by the neoplasia. Biopsy identified the tumor as ameloblastoma. Combining data from the clinical, radiographic and histopatological study and after explain to the owner regarding the postoperative esthetic it was held a bilateral rostral mandibulectomy. The fragment removed was assessed radiographically and histopathologically for evidence of tumor at its edges. The patient is active and healthy without evidence of metastasis or recurrence. The radiographic and histopathologic evaluation of edges of the fragment showed no tumor evidence. The patient is active and healthy without evidence of metastasis or recurrence since January 2010 when mandibulectomy was performed.

Undesirable effect of cosmetic lip augmentation with autologous fat tissue

Background: Facial cosmetic procedures are commonplace nowadays, especially techniques that aim to increase lip volume. Full lips provide a youthful, healthy, feminine and sensual appearance. There are many techniques and materials used to recover the loss of contour that occurs with age. Case presentation. An unusual case of fat tissue accumulation following cosmetic upper lip augmentation in a 61 year-old female was reported. Surgical treatment was performed for esthetic concerns. Microscopically, the tissue removed was composed of muscle fibers and mature adipocytes. Conclusion: Undesirable effects of esthetic treatment can occur and the clinician should be familiar with such complications to diagnose and manage them. © 2013 Kaminagakura et al.; licensee BioMed Central Ltd.

A 12-month follow-up of hypopigmentation after laser hair removal

Introduction: Laser hair removal is becoming an increasingly popular alternative to traditional methods such as shaving, waxing, among other methods. Semiconductor diode lasers are considered the most efficient light sources available and are especially well suited for clinical applications including hair reduction. The effectiveness of laser hair reduction depends on many variables, including the skin type of the patient. Material and Methods: A patient with Fitzpatrick Skin Type IV was submitted to laser hair removal of the arms with a high-power diode laser system with long pulses with a wavelength of 800 nm, a fluence of 40 J/cm2 and a pulse width of 20 ms. A 12-month follow-up assessment was performed and included photography and questionnaire. Results: Hypopigmentation was observed after a single laser hair removal section. After 6 months with the area totally covered, a gradual suntan with a sun screen lotion with an SPF of 15 was prescribed by the dermatologist. After 12 months of the initial treatment, a complete recovery of the hypopigmentation was achieved. Conclusion: Although a safe procedure, lasers for hair removal may be associated with adverse side effects including undesired pigment alterations. Before starting a laser hair removal treatment, patients seeking the eradication of hair should be informed that temporary, and possibly permanent, pigmentary changes may occur. © 2013 Informa UK, Ltd.

Clinical Satisfaction and Quality of Ceramic Fixed Dentures

It is known that several factors can affect the clinical success and durability of fixed partial dentures. Therefore, the aim of the present study was to present a literature review about the longevity, clinical success, and quality, as well as, patients' and dental surgeons' satisfaction of ceramic fixed dentures. High rate of patients' satisfaction has been observed in relation to the esthetic of ceramic crowns. In addition, the literature has shown that dental ceramics can be used in several clinical situations with high success rate and longevity. Despite of failures and complications of ceramic restorations, nowadays, with the improvement of mechanical properties of such materials, ceramic crowns present a favorable prognosis and can be used in several clinical situations with high success rate, clinical quality, and great patients' satisfaction. © 2013 The American Ceramic Society.

Influence of maxillary incisor edge asymmetries on the perception of smile esthetics among orthodontists and laypersons

Introduction: Our objective was to determine the perception of smile esthetics among orthodontists and laypeople with respect to asymmetries on the maxillary incisor edges in a frontal smile analysis. Methods: Two frontal close-up smile photos of 2 women, 1 white and 1 Afro-Brazilian, were selected for this study. Both smiles displayed healthy maxillary anterior dentitions. The images were digitally altered to create tooth wear on the maxillary left central and lateral incisors in 0.5-mm increments. The final images were randomly assembled into a photo album that was given to 120 judges, 60 orthodontists and 60 laypersons. Each rater was asked to evaluate the attractiveness of the images with visual analog scales. The data collected were statistically analyzed with 1-way analysis of variance with the Tukey post-hoc test and the unpaired Student t test. Results: The most attractive smiles in both types of smiles were those without asymmetries and the 0.5-mm wear in the lateral incisor. In general, tooth wear was considered unattractive by both groups of raters following a pattern: the more tooth wear, the more unattractive the smile; tooth wear in the central incisor was considered more unattractive than in the lateral incisor. For both group of raters, 0.5 mm of wear in the central incisor was considered unattractive, whereas the thresholds for lateral incisor discrepancies were 0.5 mm for orthodontists and 1.0 mm for laypersons. Conclusions: The result of this study corroborates the clinical assumption that symmetry between the maxillary central incisors is a paramount goal for esthetic treatments. Copyright © 2013 by the American Association of Orthodontists.

Using the bottom-up and outside-in sequence for panfacial fracture management: Does it provide a clinical significance?

Panfacial fractures usually refer to simultaneous facial fractures, which affect the upper, middle, and lower thirds of the face. The management of panfacial fracture is complex because of the lack of reliable landmarks. Literature has shown many approaches for management of panfacial fractures. Every segment of bone has a precise function in the repair. Therefore, the bottom-up and outside-in sequence is the most widely used approach in the management of panfacial fractures. These facial fractures present remarkable challenges for both experienced and inexperienced surgeons. This article aimed to report a case of a panfacial fracture (mandibular condylar and symphysis fractures associated with an atypical Le Fort III fracture) in a 48-year-old man. The patient was successfully treated using bottom-up and outside-in sequence by accessing all facial injuries. Postoperatively, radiograph examination revealed good reduction and fixation of titanium plates, and physical examination revealed good functional and esthetic outcomes. Copyright © 2013 by Mutaz B. Habal, MD.

Toxic effects of daily applications of 10% carbamide peroxide on odontoblast-like MDPC-23 cells

Background. Tooth bleaching has been widely studied, mainly due to the possible undesirable effects that can be caused by this esthetic procedure. The cytotoxicity of the bleaching agents and its components to pulp cells has been demonstrated in several researches. The aim of this study was to evaluate the toxic effects of successive applications of 10% carbamide peroxide (CP) gel on odontoblast-like cells. Materials and methods. Enamel-dentin discs obtained from bovine incisors were adapted to artificial pulp chambers (APCs). The groups were formed as follows: G1: Without treatment (control group); G2: 10% carbamide peroxide, CP (five applications/one per day); G3: 10% CP (one unique application); and G4: 35% hydrogen peroxide, HP (three applications of 15 min each). After treatment, cell metabolism (MTT), alkaline phosphatase (ALP) activity and plasma membrane damage (flow cytometry) were analyzed. Results. Reductions in cell metabolism and alkaline phosphatase activity along with severe damage of the cytoplasmic membrane were noted in G2. In G3, no damage was observed, compared to the control group. Intermediary values of toxicity were obtained after 35% HP application. Conclusion. It can be concluded that one application of 10% CP did not cause toxic effects in odontoblast-like cells, but the successive application of this product promoted severe cytotoxic effects. The daily application of the bleaching agents, such as used in the at-home bleaching technique, can increase the damages caused by this treatment to the dental pulp cells. © 2013 Informa Healthcare.