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OBJECTIVE: This case report described the use of a stamping technique associated with a bulk fill composite to restore an ICDAS 4 carious lesion on a posterior tooth. The 4-year follow-up is also presented. CLINICAL CONSIDERATIONS: A 32-year-old patient presented a carious lesion on tooth 36 with an underlying dark shadow at the dentin seen from the noncavitated enamel occlusal surface, which was compatible with an ICDAS 4 carious lesion. The lesion was radiographically detected and the caries disease was treated with dietary and hygiene habits orientations. Before accessing the lesion and selectively removing the carious tissue, an occlusal stamp was made by applying a flowable resin composite to copy the anatomy of the noncavitated enamel surface. The cavity was restored using a bulk fill resin composite (Opus Bulk Fill, FGM) with 4-mm-thick increments. Before curing the last increment, a Teflon band was adapted at the uncured bulk fill composite surface and the occlusal stamp made with the flowable composite was pressed against it to reproduce the natural characteristics and initial occlusal anatomy. The top surface was light-activated for 40 s. After 4 years, small wear could be seen in the restoration, but still within clinically acceptable levels. CONCLUSION: The occlusal stamp technique allows reproduction of the natural anatomy of teeth affected by ICDAS 4 carious lesions with good clinical longevity over 4 years. CLINICAL SIGNIFICANCE: This case report presents the use of the stamp technique to restore a tooth affected by an ICDAS 4 lesion, in which a carious process reached the dentin and the enamel anatomy was still preserved. The bulk fill resin composite associated with the occlusal stamp was chosen to quickly restore the cavity with clinical predictability. Bulk fill composites allow the insertion of up to 4-mm-thick increments and offer lower shrinkage stress, good clinical longevity and a less time-consuming procedure in cases of posterior teeth, especially if associated with the stamp technique.

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Bulk-fill composites were introduced in dentistry to accelerate clinical procedures while providing adequate outcomes. Concerns regarding the use of bigger composite increments rely on the polymerization shrinkage and shrinkage stress, which may generate gaps on the adhesive interface and result in a reduced success rate. OBJECTIVE: To evaluate the polymerization shrinkage stress of different bulk-fill resin composites and their elastic modulus. MATERIALS AND METHODS: Fourteen specimens were made for each of the nine different resin composites (seven with 12 mm3 and seven with 24 mm3): Surefill SDR flow (SDR), X-tra Base (XB), Filtek Bulk Fill Flowable (FBF), Filtek Z350XT Flow (Z3F); Tetric Evo Ceram Bulk Fill (TBF), X-tra Fil (XF), Filtek Bulk Fill (FBP), Admira Xtra Fusion (ADM) and Filtek Z350 XT (Z3XT). Linear shrinkage stress was evaluated for 300 s with the aid of a linear shrinkage device adapted to a Universal Testing Machine. For each composite group, seven additional specimens (2x2x25 mm) were made and Young's modulus was evaluated with a 3-point bending device adapted in a Universal Testing Machine with 0.5 mm/min crosshead speed and 50 KgF loading cell. RESULTS: For 12 mm3 specimens, three-way ANOVA showed that only SDR and TBF generated lower stress after 20 s. Considering 300 s, TBF, SDR, and XF generated the lowest stress, followed by ADM, FBP, XB, and FBF, which were similar to Z3XT. Z3F generated the highest stress values for all time points. Considering 24 mm3 specimens after 20 s, all bulk fill composites generated lower stress than Z3XT, except XB. After 300 s, SDR, FBP, and ADM generated the lowest stress, followed by TBF and XF. For elastic modulus, one-way ANOVA showed that FBF, SDR, Z3F, and ADM presented the lowest values, followed by XB and TBF. FBP, Z3XT, and XF presented the highest elastic modulus among the evaluated composites. CONCLUSIONS: Bulk-fill resin composites presented equal to lower shrinkage stress generation when compared to conventional composites, especially when bigger increments were evaluated. Bulk-fill composites showed a wide range of elastic modulus values, but usually similar to "regular" composites.

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OBJECTIVES: The aim of this in vitro study was to evaluate the bonding strength of non-simplified dentin bonding systems (DBS) to dentin irradiated with a diode laser (970 nm) immediately and after 12 months of water storage following either primer or bond application. MATERIAL AND METHODS: The experimental design included three different factors: DBS type [AdperTM Scotchbond Multipurpose (MP) and Clearfil™ SE Bond (CSE)], irradiation [without irradiation - control (C), irradiation after primer application (AP), and irradiation after bond application (AB)], and time [initial (I) and after 12 months of water storage (12 m)]. Sixty sound human third molars (n = 10) were obtained, and their flat occlusal dentin areas were prepared and standardized. Laser irradiation was performed in the contact mode perpendicular to the dental surface over an automatically selected scanning area at a pulse energy of 0.8 W, frequency of 10 Hz, and energy density of 66.67 J/cm2. After 7 days of treatment, the specimens were cut, and half of them were subjected to microtensile testing (500 N/0.05 mm/min), whereas the remaining sticks were examined after 12 months of water storage. The obtained data were analyzed by three-way analysis of variance (ANOVA) followed by a Tukey test (p<0.05). The observed fracture modes were investigated using a portable digital microscope with a magnification of 40x. RESULTS: Among the utilized DBS, MP generally exhibited higher bond strengths, but did not always differ from CSE under similar conditions. The irradiation factor was statistically significant only for the MP/AB groups. After 12 months of storage, all groups demonstrated a significant reduction in the bond strength, whereas the results of fracture analysis showed a predominance of the adhesive type. CONCLUSIONS: The laser treatment of non-simplified DBS was not able to stabilize their bonding characteristics after 12 months.

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BACKGROUND: The use of hybrid-light (HL) during in-office teeth bleaching can provide faster and reliable results after a single bleaching session, especially if associated with previous acid etching. The present in vivo, interventional, split-mouth, triple-blinded and randomized study evaluated the efficiency of a HL, with and without prior enamel acid etching, assessing the gel application time, degree of color change, sensitivity and treatment stability up to 12 months. METHODS: Thirty-four patients were selected and randomly divided into four groups. The color was evaluated using a spectrophotometer with the CIELab color system, and a VAS questionnaire was used to evaluate the sensitivity. Both upper and lower hemiarches (GI and III) received enamel acid etching with 37% phosphoric acid for 15 s prior to the application of 35% hydrogen peroxide gel (HP). For GI and II, HP was applied on both dental arches for 3-4 consecutive applications and activated by HL (2 × 3' activations with 1' interval); and 3 × 15' (HP) for GIII and IV without HL. Patients returned in 24 h, 1 week, 1-, 6- and 12-months intervals. The clinical operator was different from the clinical measurements operator. RESULTS: After 3-way ANOVA, Tukey's, Wilcoxon and Mann-Whitney tests, all with p < 0.05, no statistical differences were observed between the groups regarding color change (ΔE) and sensitivity in all evaluations. The lowest gel application time was observed for GII (acid etch + HL), followed by GI (HL). CONCLUSIONS: The present study's results reveal the advantages of HL associated with acid etching prior to in office bleaching.

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PURPOSE: To evaluate the color change caused by post-irradiation conversion (ΔE24h and ΔE8 days ) and artificial aging (ΔEAGING ) of resin cements light activated through ceramics of different opacities immediately and 6 minutes after manipulating the material. MATERIALS AND METHODS: Resin cement disks (Allcem and LuxaCore) were light activated through ceramics (without ceramic, e.max HT, LT, and MO) immediately and 6 minutes after the manipulation (n = 10). Spectrophotometry was used to evaluate ΔE24h and ΔE8 days after 37˚C-dry-dark-storage for 24 hours and 8 days, and ΔEAGING after 60˚C-water-storage for 24 hours. Data were analyzed with three-way ANOVA and Tukey's HSD (α = 0.05). RESULTS: Regarding the post-irradiation color change, significant differences were found between the cements (p < 0.0001), light activation protocols (p = 0.037), and ceramics (p < 0.001). The immediate activation (16.2 ± 0.1) showed lower ΔE values than the delayed activation (16.5 ± 0.1). Ceramics influenced the ΔE values as follows: MO (14.0 ± 1.2) < LT (14.9 ± 1.2) ≈ HT (15.4 ± 1.2) < control (21.2 ± 1.2). Regarding ΔEAGING , significant differences were found between cements (p < 0.001), light activation (p = 0.006), and ceramics (p < 0.001). The delayed activation (8.4 ± 0.1) showed lower values than the immediate activation (8.9 ± 0.1). Ceramic spacers influenced ΔEAGING as follows: control (5.6 ± 0.2) < MO (6.6 ± 0.2) < HT (11.0 ± 0.2) ≈ LT (11.5 ± 0.2). CONCLUSION: The delayed light activation resulted in increased color stability, while the ceramic interposition resulted in lower color stability.

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OBJECTIVE: This study aimed to investigate the effect of laser diode irradiation on the degree of conversion (DC), water sorption (WS), and water solubility (WSB) of these bonding systems in an attempt to improve their physico-mechanical resistance. MATERIAL AND METHODS: Two bonding agents were tested: a two-step total-etch system [Adper™ Single Bond 2, 3M ESPE (SB)] and a universal system [Adper™ Single Bond Universal, 3M ESPE (SU)]. Square-shaped specimens were prepared and assigned into 4 groups (n=5): SB and SU (control groups - no laser irradiation) and SB-L and SU-L [SB and SU laser (L) - irradiated groups]. DC was assessed using Fourier transform infrared spectroscopy with attenuated total reflectance. Additional uncured resin samples (≈3.0 µL, n=5) of each adhesive were also scanned for final DC calculation. For WS/WSB tests, similar specimens (n=10) were prepared and measured by monitoring the mass changes after dehydration/water storage cycles. For both tests, adhesive fluids were dropped into standardized Teflon molds (6.0×6.0×1.0 mm), irradiated with a 970-nm laser diode, and then polymerized with an LED-curing unit (1 W/cm2). RESULTS: Laser irradiation immediately before photopolymerization increased the DC (%) of the tested adhesives: SB-L>SB>SU-L>SU. For WS/WSB (µg/mm3), only the dentin bonding system (DBS) was a significant factor (p<0.05): SB>SU. CONCLUSION: Irradiation with a laser diode improved the degree of conversion of all tested simplified dentin bonding systems, with no impact on water sorption and solubility.

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Abstract Simplified dentin-bonding systems are clinically employed for most adhesive procedures, and they are prone to hydrolytic degradation. Objective This study aimed to investigate the effect of laser diode irradiation on the degree of conversion (DC), water sorption (WS), and water solubility (WSB) of these bonding systems in an attempt to improve their physico-mechanical resistance. Material and Methods Two bonding agents were tested: a two-step total-etch system [Adper™ Single Bond 2, 3M ESPE (SB)] and a universal system [Adper™ Single Bond Universal, 3M ESPE (SU)]. Square-shaped specimens were prepared and assigned into 4 groups (n=5): SB and SU (control groups - no laser irradiation) and SB-L and SU-L [SB and SU laser (L) - irradiated groups]. DC was assessed using Fourier transform infrared spectroscopy with attenuated total reflectance. Additional uncured resin samples (≈3.0 µL, n=5) of each adhesive were also scanned for final DC calculation. For WS/WSB tests, similar specimens (n=10) were prepared and measured by monitoring the mass changes after dehydration/water storage cycles. For both tests, adhesive fluids were dropped into standardized Teflon molds (6.0×6.0×1.0 mm), irradiated with a 970-nm laser diode, and then polymerized with an LED-curing unit (1 W/cm2). Results Laser irradiation immediately before photopolymerization increased the DC (%) of the tested adhesives: SB-L>SB>SU-L>SU. For WS/WSB (μg/mm3), only the dentin bonding system (DBS) was a significant factor (p<0.05): SB>SU. Conclusion Irradiation with a laser diode improved the degree of conversion of all tested simplified dentin bonding systems, with no impact on water sorption and solubility.

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Often, young patients (≤30 years old) present with carious lesions that progress acutely, compromising a large amount of tooth structure. In these cases, a treatment to prevent the occurrence of pulp exposure and promote remineralization of caries-affected dentin is necessary to maintain healthy dental structure and allow more conservative interventions. The approach will be different when pulp exposure occurs: The therapeutic treatments will be focused on reparative dentin formation and prevention of microorganisms penetrating the pulp organ. Due to the different possible treatments that can be performed to avoid pulp necrosis and the various materials that can be used for this purpose, professionals may have some difficulties understanding all the indications for conservative pulp treatments. The objective of this article is to describe and discuss a successful pulp capping and stepwise excavation associated with restorative treatment for deep caries lesions of anterior upper teeth.

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Tooth wear associated with bone loss, gingival recessions and root exposure of the anterior teeth determine the characteristics of an aged smile. The present clinical case reports the aesthetic treatment of a middle-aged patient who had a prematurely aged smile. After anamnesis and physical examination, it was found that episodes of bone loss had occurred, however, previous periodontal treatment had satisfactorily controlled the disease. And yet it was also observed wear of the upper anterior teeth and fracture on tooth 11. Treatment plan included the confection of direct veneers with composite resin, without the need for tooth structure wear. At the end of the first session, it was observed that although an aesthetic result was already achieved, the ratio of height and width of the incisors had not yet been standardized. Thus, orthodontic rubbers were used for three days for tooth movement and increase of mesiodistal dimension of the central and lateral incisors. The present case demonstrates excellent aesthetic results and patient satisfaction. It was concluded that in the current case report it was possible to satisfactorily rejuvenate smile with direct application of composite resin (AU).

O desgaste dentário associado à perda óssea, recessão gengival e exposição radicular dos dentes anteriores determinam características de um sorriso envelhecido. O presente caso clínico relata o tratamento estético de uma paciente de meia idade, que apresentava sorriso precocemente envelhecido. Após anamnese e exame físico, constatou-se que episódios de perda óssea ocorreram, no entanto, o tratamento periodontal prévio já havia controlado a doença de forma satisfatória. Observou-se ainda desgaste dos dentes anteriores superiores e fratura no elemento ente 11. O plano de tratamento incluiu a realização de facetas diretas de resina composta, sem a necessidade de desgaste da estrutura dentária. Ao final da primeira sessão, observou-se que, apesar de um resultado estético já obtido, a proporção de altura e largura dos incisivos não havia ainda sido normalizada. Assim, borrachas ortodônticas foram utilizadas por três dias para movimentação dos dentes e aumento da dimensão mésio-distal dos incisivos centrais e laterais. Este caso mostra excelentes resultados estéticos e satisfação do paciente. Concluiu-se que, no presente caso clínico, foi possível rejuvenescer o sorriso de forma satisfatória com aplicação de resinas compostas diretas (AU).

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The use of light sources in the bleaching process reduces the time required and promotes satisfactory results. However, these light sources can cause an increase in the pulp temperature. Objective The purpose of the present study was to measure the increase in intrapulpal temperature induced by different light-activated bleaching procedures with and without the use of a bleaching gel. Material and Methods A human maxillary central incisor was sectioned 2 mm below the cementoenamel junction. A K-type thermocouple probe was introduced into the pulp chamber. A 35% hydrogen peroxide bleaching gel was applied to the vestibular tooth surface. The light units used were a conventional halogen, a hybrid light (only LED and LED/Laser), a high intensity LED, and a green LED light. Temperature increase values were compared by two-way ANOVA and Tukey´s tests (p<0.05). Results There were statistically significant differences in temperature increases between the different light sources used and between the same light sources with and without the use of a bleaching gel. The presence of a bleaching gel generated an increase in intra-pulpal temperature in groups activated with halogen light, hybrid light, and high intensity LED. Compared to the other light sources, the conventional halogen lamp applied over the bleaching gel induced a significant increase in temperature (3.83±0.41°C). The green LED unit with and without gel application did not produce any significant intrapulpal temperature variations. Conclusion In the present study, the conventional halogen lamp caused the highest increase in intrapulpal temperature, and the green LED caused the least. There was an increase in temperature with all lights tested and the maximum temperature remained below the critical level (5.5°C). The addition of a bleaching gel led to a higher increase in intrapulpal temperatures.

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