Uso de equipamento auxiliar no preparo dentário para próteses

Trabalho apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária.

Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions

As described in the first paper of this two part series, the expansion of our older population and the concomitant reduction in levels of edentulism will result in an increase in the number of patients presenting in general practice with complex restorative challenges. The application of the concepts of minimal intervention dentistry and minimally invasive operative techniques may offer a powerful armamentarium to the general dentist to provide ethical and conservative treatment to older patients.

Clinical Relevance: When it is unavoidable, operative intervention should be as minimally invasive as practicable in older patients to preserve the longevity of their natural dentition.

An evidence based approach for the provision of resin-bonded bridgework

Resin bonded bridgework (RBB) is a technique often overlooked by practitioners despite a large amount of evidence supporting the technique. In Cork University Dental School an evidence-based, standardised approach for the delivery of RBB by undergraduate students has been developed over the past 10 years. The aim of this study was to evaluate the success of this standardised approach on the delivery of RBB by students. 222 bridges were reviewed which had been delivered over a 6 year time period between 2002 and 2007. A success rate of 84.1% was achieved with a mean survival time of 41 months. This study illustrates that predictable and highly successful RBB can be delivered by inexperienced clinicians using an evidence-based, standardised approach.

Caries and the older patient

Ageing of the population, together with prolonged retention of teeth, has brought new challenges to dentistry. Whereas in the past oral care for the elderly was restricted to provision of dentures, older patients are now presenting with dental caries and failed restorations. These problems may have an impact on their general health and quality of life. Poor oral hygiene, xerostomia and diet are among the risk factors for caries in older patients and need to be addressed in order to achieve control of the disease. Carious lesions can be treated conservatively in many cases or may need surgical management.

CLINICAL RELEVANCE: Caries is an oral health issue among older patients and can result in tooth loss. Oral health has a great impact on general health and quality of life of elderly people.

A systematic review and meta-analysis of the survival of non-feldspathic porcelain veneers over 5 and 10 years

PURPOSE: This systematic review aimed to report and explore the survival of dental veneers constructed from non-feldspathic porcelain over 5 and 10 years.

MATERIALS AND METHODS: A total of 4,294 articles were identified through a systematic search involving all databases in the Cochrane Library, MEDLINE (OVID), EMBASE, Web of Knowledge, specific journals (hand-search), conference proceedings, clinical trials registers, and collegiate contacts. Articles, abstracts, and gray literature were sought by two independent researchers. There were no language limitations. One hundred sixteen studies were identified for full-text assessment, with 10 included in the analysis (5 qualitative, 5 quantitative). Study characteristics and survival (Kaplan-Meier estimated cumulative survival and 95% confidence interval [CI]) were extracted or recalculated. A failed veneer was one which required an intervention that disrupted the original marginal integrity, had been partially or completely lost, or had lost retention more than twice. A meta-analysis and sensitivity analysis of Empress veneers was completed, with an assessment of statistical heterogeneity and publication bias. Clinical heterogeneity was explored for results of all veneering materials from included studies.

RESULTS: Within the 10 studies, veneers were fabricated with IPS Empress, IPS Empress 2, Cerinate, and Cerec computer-aided design/computer-assisted manufacture (CAD/CAM) materials VITA Mark I, VITA Mark II, Ivoclar ProCad. The meta-analysis showed the pooled estimate for Empress veneers to be 92.4% (95% CI: 89.8% to 95.0%) for 5-year survival and 66% to 94% (95% CI: 55% to 99%) for 10 years. Data regarding other non-feldspathic porcelain materials were lacking, with only a single study each reporting outcomes for Empress 2, Cerinate, and various Cerec porcelains over 5 years. The sensitivity analysis showed data from one study had an influencing and stabilizing effect on the 5-year pooled estimate.

CONCLUSION: The long-term outcome (> 5 years) of non-feldspathic porcelain veneers is sparsely reported in the literature. This systematic review indicates that the 5-year cumulative estimated survival for etchable non-feldspathic porcelain veneers is over 90%. Outcomes may prove clinically acceptable with time, but evidence remains lacking and the use of these materials for veneers remains experimental.

Comparação dos valores de desgaste abrasivo e de microdureza de 13 resinas compostas usadas em odontologia através do método do disco retificado

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

The effect of CO 2 laser irradiation on failed implant surfaces

The aim of this investigation was to evaluate the cleaning effect of CO 2 on surface topography and composition of failed dental implant surfaces. Ten failed dental implants were retrieved from nine patients (mean age, 46.33 ± 5.81 years) as a result of early or late failure. The implants were divided into two parts: one side of the implant was irradiated with a CO 2 laser (test side), while the other side did not receive irradiation (control side). The CO 2 laser was operated at 1.2 W in a continuous wave for 40 seconds (40 J energy). The handpiece of the CO 2 laser was kept at a distance of 30 mm from the implant surface, resulting in a spot area of 0.031415 cm 2 (38.20 W/cm 2; 1559 J/cm 2) in scanning mode (cervical-apical). One unused dental implant was used as a negative control for both groups. All implant surfaces were examined by scanning electron mi croscopy (SEM) and energy-dispersive spectrometer x-ray (EDS) for element analysis. SEM showed that the surface of the test sides consisted of different degrees of organic residues, appearing mainly as dark stains similar to those observed on the control sides. None of the test surfaces presented alterations such as crater-like alterations, lava-like layers, or melting compared with the nonirradiated surfaces. Foreign elements such as carbon, oxygen, sodium, calcium, and aluminum were detected on both sides. These results suggest that CO 2 laser irradiation does not modify the implant surface, although the cleaning effect was not satisfactory.

Histomorphometric evaluation of a threaded, sandblasted, acid-etched implant retrieved from a human lower jaw: A case report

The purpose of this study was to histomorphometrically evaluate the bone-to-implant contact and bone area around a titanium implant retrieved from a human lower jaw. A screw-shaped titanium implant (sandblasted and acid-etched surface) was removed from a 68-year-old male after having been in function for 40 months because of a fracture of the abutment screw. Following the implant removal, an undecalcified section was obtained. The histomorphometric analysis showed a rate of 75.40% of bone-to-implant contact and 89.30% of bone area filling within the limits of the implant threads. The surrounding bone healed in a well-organized pattern and could not be differentiated from the anginal alveolus. The histologic evidence showed a high degree of osseointegration in a threaded, sandblasted, and acid-etched implant retrieved from a human lower jaw after functional loading for 40 months. Copyright © 2005 by Lippincott Williams & Wilkins.

Effect of resin luting film thickness on fracture resistance of a ceramic cemented to dentin

Purpose: The aim of this study was to evaluate the fracture resistance of ceramic plates cemented to dentin as a function of the resin cement film thickness. Materials and Methods: Ceramic plates (1 and 2 mm thicknesses) were cemented to bovine dentin using resin composite cement. The film thicknesses used were approximately 100, 200, and 300 μm. Noncemented ceramic plates were used as control. Fracture loads (N) were obtained by compressing a steel indenter in the center of the ceramic plates. ANOVA and Tukey tests (α = 0.05) were used for each ceramic thickness to compare fracture loads among resin cement films used. Results: Mean fracture load (N) for 1-mm ceramic plates were: control - 26 (7); 100 μm - 743 (150); 200 μm - 865 (105); 300 μm - 982 (226). Test groups were significantly different from the control group; there was a statistical difference in fracture load between groups with 100 and 300 μm film thicknesses (p < 0.01). Mean fracture load for 2-mm ceramic plates were: control - 214 (111); 100 μm - 1096 (341); 200 μm - 1067 (226); 300 μm - 1351 (269). Tested groups were also significantly different from the control group (p < 0.01). No statistical difference was shown among different film thicknesses. Conclusions: Unluted specimens presented significantly lower fracture resistance than luted specimens. Higher cement film thickness resulted in increased fracture resistance for the 1-mm ceramic plates. Film thickness did not influence the fracture resistance of 2-mm porcelain plates. Copyright © 2007 by The American College of Prosthodontists.

Fatigue resistance of bovine teeth restored with resin-bonded fiber posts: Effect of post surface conditioning

This study evaluated the effect of post surface conditioning on the fatigue resistance of bovine teeth restored with resin-bonded fiber-reinforced composite (FRC). Root canals of 20 single-rooted bovine teeth (16 mm long) were prepared to 12 mm using a preparation drill of a double-tapered fiber post system. Using acrylic resin, each specimen was embedded (up to 3.0 mm from the cervical part of the specimen) in a PVC cylinder and allocated into one of two groups (n = 10) based on the post surface conditioning method: acid etching plus silanization or tribochemical silica coating (30 μm SiOx + silanization). The root canal dentin was etched (H2PO3 for 30 seconds), rinsed, and dried. A multi-step adhesive system was applied to the root dentin and the fiber posts were cemented with resin cement. The specimens were submitted to one million fatigue cycles. After fatigue testing, a score was given based on the number of fatigue cycles until fracture. All of the specimens were resistant to fatigue. No fracture of the root or the post and no loss of retention of the post were observed. The methodology and the results of this study indicate that tribochemical silica coating and acid etching performed equally well when dynamic mechanical loading was used.

Comparison of resin push-out strength to root dentin of bovine- and human-teeth

Aim : To compare the push-out strength of bovine- and human-root dentin and, thus, evaluate the suitability of bovine-root dentin to substitute human-root dentin for bond strength testing. Materials and Methods : Ten single-rooted human-teeth and ten bovine incisors were prepared using a #3 bur of a fiber post system (12 mm long). The posts were duplicated with resin cement (Duolink). The root canals were treated with All Bond 2 adhesive system and the resin posts were cemented using Duolink. The specimens were cut perpendicular to their long axis, yielding disc-specimens with 1.5 mm thickness, which were submitted to a push-out test (1 mm/min). Ten bond strength values per group (n = 10) were used for statistical analysis (Student t test, a =.05). Results : Statistically significant differences were found for the bond strength values between bovine- (4.1 1.3 MPa) and human-root dentin (8.6 5.7 MPa) (P =.0001). Conclusion : The push-out strengths of bovine- and human-root dentin were statistically different.

Bond strength of a composite resin to an adhesive luting cement

This study evaluated the influence of surface treatment on the shear bond strength of a composite resin (CR), previously submitted to the application of a temporary cement (TC), to an adhesive luting cement. Eight-four CR cylinders (5 mm diameter and 3 mm high) were fabricated and embedded in acrylic resin. The sets were divided into 6 groups (G1 to G6) (n=12). Groups 2 to 6 received a coat of TC. After 24 h, TC was removed and the CR surfaces received the following treatments: G2: ethanol; G3: rotary brush and pumice; G4: air-abrasion; G5: air-abrasion and adhesive system; G6: air-abrasion, acid etching and adhesive system. G1 (control) did not receive TC or any surface treatment. The sets were adapted to a matrix and received an increment of an adhesive luting cement. The specimens were subjected to the shear bond strength test. ANOVA and Tukey's tests showed that G3 (8.53 MPa) and G4 (8.63 MPa) differed significantly (p=0.001) from G1 (13.34 MPa). The highest mean shear bond strength values were found in G5 (14.78 MPa) and G6 (15.86 MPa). Air-abrasion of CR surface associated with an adhesive system provided an effective bond of the CR to the adhesive luting cement, regardless the pre-treatment with the phosphoric acid.

Complete denture wearing and fractures among edentulous patients treated in university clinics

Objective: The prevalence of wearing and fracture of complete dentures was evaluated among edentulous patients treated in two dental schools in Brazil. Background: Acceptance and wearing of complete dentures are related to adaptive behaviour of edentulous patients. However, one reason that could interfere with the wearing dentures is their potential to fracture, which is still a common complication in denture rehabilitation practice. Material and methods: Two hundred and twenty-four edentulous patients rehabilitated with complete dentures from 2000 to 2005 in Araçatuba and Araraquara Dental School, University of State of São Paulo, were assessed in 2006 and 2007 to answer a questionnaire about wearing and fracture of their dentures. Statistical analysis were performed using Epi Info software and chi-squared test to compare maxillary and mandibular data (α = 0.05). Results: Almost 26% of the patients did not wear their dentures, and among the remainder, the majority wore the maxillary denture. About 30% of the dentures were fractured, with higher prevalence in the maxillary arch (p = 0.003). Conclusions: Discontinuation of wearing dentures was quite high, especially considering the treatment which was carried out in university clinics. Prevalence of fractures was also high, greater for the maxillary denture, and was one of the main reasons for non-wearing of complete dentures. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

Effects of cement-curing mode and light-curing unit on the bond durability of ceramic cemented to dentin

The aim of this study was to evaluate the effects of different light-curing units and resin cement curing types on the bond durability of a feldspathic ceramic bonded to dentin. The crowns of 40 human molars were sectioned, exposing the dentin. Forty ceramic blocks of VITA VM7 were produced according to the manufacturer's recommendations. The ceramic surface was etched with 10% hydrofluoric acid/60s and silanized. The dentin was treated with37% phosphoric acid/15s, and the adhesive was applied. The ceramic blocks were divided and cemented to dentin according to resin cement/RC curing type(dual-and photocured), light-curing unit (halogen light/QTH and LED), and storage conditions (dry and storage/150 days + 12,000 cycles/thermocycling). All blocks were stored in distilled water (37°C/24h) and sectioned (n = 10): G1-QTH + RC Photo, G2-QTH + RC Dual, G3-LED + RC Photo, G4-LED + RC Dual. Groups G5, G6, G7, and G8 were obtained exactly as G1 through G4, respectively, and then stored and thermocycled. Microtensile bond strength tests were performed (EMIC), and data were statistically analyzed by ANOVA and Tukey's test (5%). The bond strength values (MPa) were: G1-12.95 (6.40)ab; G2-12.02 (4.59)ab; G3-13.09 (5.62)ab; G4-15.96 (6.32)a; G5-6.22 (5.90)c; G6-9.48 (5.99)bc; G7-12.78 (11.30)ab; and G8-8.34 (5.98)bc. The same superscript letters indicate no significant differences. Different light-curing units affected the bond strength betweenceramic cemented to dentin when the photocured cement was used, and only after aging (LED>QTH). There was no difference between the effects of dual-and photo-cured resin-luting agents on the microtensile bond strength of the cement used in this study.