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BACKGROUND/AIM: Crown fractures are common traumatic dental injuries and tooth fragment reattachment is a viable option for restoring a fractured tooth. The aim of this study was to assess the knowledge and experience of dentists in the Federal District regarding the tooth fragment reattachment technique for enamel and dentin fractures. MATERIALS AND METHODS: For the cross-sectional observational study, an electronic form was designed with objective and self-report questions for dentists. The data were analyzed using descriptive statistics, with their absolute and relative frequencies. For the analysis of categorical variables, the nonparametric chi-squared or Fisher exact association tests were used in the statistical software R (version 4.2.1). RESULTS: A total of 416 dentists participated in the study (58.9% female and 41.1% male). Of these, 70% declared they knew about fragment reattachment, but only 42.3% reported previous experience with this procedure. The most common storage medium used for the fractured fragment was milk (78.1%), and the bonding material used for reattachment was light-cured composite resin (86.3%). A majority (66.3%) reported that for a patient with enamel and dentin fracture, with the crown fragment in good condition, they would choose to do the reattachment. CONCLUSION: Dentists demonstrated that they had adequate knowledge about the tooth fragment technique, although many did not have previous experience with this procedure.

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Macroabrasion is a technique for the removal of localized white spots using a high-speed, intermittent high speed turbine finishing diamond tip. It is fast, safe, efficient, and an alternative to enamel microabrasion. However, when the stain is deeper, these localized intrinsic stains or defects can be treated with partial direct veneers. A conservative preparation should be done and that allows stratification of the resin to mask the hypoplasia and provide naturalness to the tooth. Thus, the objective of this work is to demonstrate, through a clinical case, macroabrasion and a partial veneer from the preparation, restoration, to the finishing and polishing to remove hypoplastic stains.

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The pretreatment of dentin with cross-linking agents during bonding procedures has been proposed to improve the mechanical properties of the collagen in the hybrid layer and reduce the biodegradation of the adhesive interface. The aim of this study was to evaluate the influence of pretreatment with two carbodiimides on the dentin bond strength of universal adhesives, after thermocycling. Three universal adhesives in the self-etching mode were used (Single Bond Universal-SBU, Clearfil Universal-CLU and Ambar Universal-ABU). A self-etching adhesive system (Clearfil SE Bond-CSB) was used as control. Two carbodiimides, 1-ethyl-3-(3'-dimethylaminopropyl)-carbodiimide (EDC) and N,N'-dicyclohexylcarbodiimide (DCC), were applied for 1 min. The excess solution was removed with absorbent paper and the universal adhesives were applied. The specimens were stored for 24 h in distilled water at 37 °C or 10,000 thermal cycles (5-55 °C, 30 s) and then were prepared for microtensile bond strength test (n = 4 teeth, average of 21 sticks per group). Data were analyzed using three-way ANOVA and Tukey's (α = 5%). After 24 h, SBU and CSB had statistically similar bond strength values for the control groups (22.07 ± 9.03 and 19.82 ± 7.28 MPa), with EDC (30.21 ± 11.30 and 19.67 ± 5.36 MPa) and DCC (30.12 ± 13.43 and 19.82 ± 7.28 MPa) pretreatments (p > 0.05). The use of EDC (32.57 ± 9.60 MPa) and DCC (24.71 ± 9.87 MPa) showed statistically higher bond strength for CLU than for the control group (14.62 ± 6.16 MPa; p < 0.05). After thermocycling, the SBU, CLU, and CSB groups showed statistically similar bond strengths with the use of EDC (27.08 ± 8.44; 18.74 ± 5.41; and 24.55 ± 10.43 MPa) and without the use of cross linkers (20.06 ± 7.99; 22.55 ± 9.04; and 26.54 ± 10.13 MPa; p > 0.05). Groups tested after 24 h in distilled water presented higher bond strength than those submitted to thermocycling. It can be concluded that the use of cross linkers influenced the immediate bond strength of the universal adhesives, and this was dependent on the combination of the adhesive system and type of carbodiimide. The use of EDC increased the immediate bond strength of CLU. DCC increased the bond strength of ABU at 24 h, but the values were lower than those of the control group after aging for three out of the four adhesives.

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Introduction: This study evaluated the influence of sonic vibration and thermocycling on the bond strength of fiberglass posts using conventional dual-cured and self-adhesive resin cements. Material and Methods: Ninety-six single-rooted endodontically treated teeth were divided randomly into eight groups according to the cement used (dual-cured or self-adhesive resin cement), use of sonic vibration during post accommodation, and aging conditions (24h in distilled water or 5,000 thermal cycles). The fiberglass posts (White Post DC1, FGM) were cleaned with alcohol, treated with silane and cemented with dual-cured (Allcem Core, FGM) or with self-adhesive resin cement (seT, SDI). For groups in which sonic vibration was used, the posts were accommodated, and sonic vibration was applied for 10 s using a special tip placed on top of the post (Sonic Smart Device, FGM). Pull-out tests were performed after storage in distilled water for 24h at 37°C or after thermocycling (5000 cycles, at 5°C and 55°C). The results were evaluated using three-way ANOVA and Tukey's test (α=0.05). Results: Significant differences were not observed between the bond strengths of dual-cured (87.93±41.81 N) and self-adhesive cement (82.53±41.43 N). Bond strength for the sonic vibration groups (100.36±42.35 N) was significantly higher than for groups without sonic vibration (70.13±34.90 N). There were significant differences between specimens subjected to thermocycling (98.33±39.42 N) and those stored for 24h in distilled water (72.16±39.67 N). Conclusion: It can be concluded that both sonic vibration and thermocycling significantly improved bond strength of fiberglass posts with the two evaluated resin cements.

Introducción: Este estudio evaluó la influencia de la vibración sónica y el termociclado en la fuerza de unión de los postes de fibra de vidrio utilizando cementos de resina autoadhesivos y de curado dual convencionales Material y Métodos: Se dividieron aleatoriamente noventa y seis dientes tratados endodónticamente de raíz única en ocho grupos según el cemento utilizado (cemento de resina de curado dual o autoadhesivo), el uso de vibración sónica durante la acomodación posterior y las condiciones de envejecimiento (24 horas agua destilada o 5.000 ciclos térmicos). Los postes de fibra de vidrio (White Post DC1, FGM) se limpiaron con alcohol, se trataron con silano y se cementaron con cemento de curado dual (Allcem Core, FGM) o con cemento de resina autoadhesivo (seT, SDI). Para los grupos en los que se utilizó vibración sónica, se acomodaron los postes y se aplicó la vibración sónica durante 10 s utilizando una punta especial colocada en la parte superior del poste (Sonic Smart Device, FGM). Las pruebas de extracción se realizaron después del almacenamiento en agua destilada durante 24 horas a 37ºC o después del termociclado (5000 ciclos, a 5ºC y 55ºC). Los resultados se evaluaron mediante ANOVA de tres vías y la prueba de Tukey (α = 0.05). Resultados: No se observaron diferencias significativas entre las resistencias de adhesión del cemento de curado dual (87,93 ± 41,81 N) y el cemento autoadhesivo (82,53 ± 41,43 N). La fuerza de unión para los grupos de vibración sónica (100,36 ± 42,35 N) fue significativamente mayor que para los grupos sin vibración sónica (70,13 ± 34,90 N). Hubo diferencias significativas entre los especímenes sometidos a termociclado (98,33 ± 39,42 N) y los almacenados durante 24 h en agua destilada (72,16 ± 39,67 N). Conclusión: Se puede concluir que tanto la vibración sónica como el termociclado mejoraron significativamente la fuerza de unión de los postes de fibra de vidrio con los dos cementos de resina evaluados.

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Amelogenesis imperfecta is a group of conditions caused by over 15 different genes that affects the development of dental enamel and poses some challenges to dentists. An adult patient with amelogenesis imperfecta with severe changes in tooth color and reduction of occlusal vertical dimension sought dental treatment. Diagnostic wax-up was carried out to guide the stratification of a nanoparticulate resin for the restorative treatment. Direct composite resin restorations were applied on all teeth for modification of both esthetics and occlusion. After a 2-year follow-up, the findings appear to suggest that composite resin is a low-cost alternative when compared with indirect ceramic restorations, provides a good esthetic outcome, and offers considerable longevity for cases like the one reported herein.

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Direct composite resin restorations are commonly provided because of their satisfactory esthetics and minimal wear of opposing tooth structure. Recent restorative systems may not follow the nomenclature of the classical VITA shade guide, using instead a simplified resin color system. A better understanding of these systems and their behavior regarding the incidence of light is an excellent approach to anterior restorations, especially for fractured anterior teeth. This paper demonstrates the color selection and clinical sequence for the natural reproduction of tooth structure using a resin system that does not follow the VITA classical scale.

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The influence of curing mode and shade of resin cements on the color stability of minimum-thickness ceramic veneers after a three-year storage time in distilled water was evaluated in this study. Ninety-six 0.5-mm-thick feldspathic ceramic veneers (Mark II) were luted onto resin composite substrates (Filtek Z350 XT, shade A2E) with two light-cured (NX3 Light-cure and AllCem Veneer) and dual-cured resin cements (NX3 dual-cure and AllCem) in various shades. The specimens were stored in distilled water at 37°C. Color measurements were performed with a spectrophotometer at the following times: 1h and 24h; 7, 30, and 180 days; and 1, 2, and 3 years. Data for color difference (ΔEab) light-cured and dual-cured resin cements were analyzed by two-way ANOVA with repeated measures and Tukey's test (α = 0.05). For the light-cured cements, the ΔEab values were as follows: NX3-Yellow (2.37±1.35) = ACV-A1 (2.40±1.21) = ACV-Trans (2.52±1.46) = ACV-E-Bleach M (2.56±1.42) = NX3-White (2.69±1.49) = NX3-Clear (2.98±1.68). The lowest ΔE values were found for 1 h (0.61±0.36)a, followed by 24 h (1.15±0.55)b and 30 days (2.48±1.11)c. One year, 180 days, and 2 and 3 years presented higher ΔEab values (3.34±0.94, 3.52±1.04, 3.52±0.95 and 3.55±1.14, respectively)d. For the dual-cured cements, the ΔEab values varied as follows: NX3-Clear (2.32±1.24)a = NX3-Yellow (2.37±1.32)a = NX3-White (2.76±1.43)a < AC-Trans (3.77±1.91)b = AC-A3 (4.13±2.11)b < AC-A1 (5.38±2.92)c. Considering time, the lowest ΔEab values were found for 1 h (0.48±0.25)a, followed by 24 h (2.13 ±0.83)b, 30 days (3.54±1.31)c, and 180 days (3,70±1.73)c. The follow-up times of 1 (4.43±2.15)d, 2 (5.02±1.74)e, and 3 years (4.90±2.12)e presented higher ΔEab values. This study demonstrated that light-cured resin cements were less susceptible to color change than dual-cured cements. After 2 years of follow-up, all cements presented ΔEab values above the acceptability threshold.

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STATEMENT OF PROBLEM: The association between tooth type, location in the dental arch, and selection of a post-and-core system for endodontically treated teeth is unclear. Information on the influence of these parameters on the failure rate of teeth treated with post-and-core restorations is needed. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the available evidence on the failure rates of anterior and posterior teeth treated with post-and-core restorations. MATERIAL AND METHODS: A search was performed in PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library, and Gray literature for randomized clinical trials comparing the failure rates of anterior and posterior teeth treated with post-and-core restorations. The risk of bias tool from the Cochrane Collaboration was used for quality assessment of the studies. RESULTS: The search strategy identified 2526 articles, and 6 studies were included in the meta-analysis. No difference in the failure rate of post-and-core restorations placed in anterior and posterior teeth was found in most studies. The risk ratio for anterior versus posterior teeth was 1.06 (95% confidence interval [CI], 0.69-1.64; P=.79). The risk ratio for incisors versus canines was 3.08 (95% CI, 0.56-17.04; P=.20) and that for premolars versus molars was 0.45 (95% CI, 0.12-1.74; P=.25). The risk ratio for prefabricated glass fiber posts on anterior versus posterior teeth was 1.13 (95% CI, 0.61-2.09; P=.70) and that for metal posts was 1.10 (95% CI, 0.64-1.91; P=.72). CONCLUSIONS: The failure rates in anterior and posterior teeth treated with post-and-core restorations were similar at short- to medium-term follow-up. More well-designed clinical trials comparing the survival and failure rates of anterior and posterior teeth treated with post-and-core restorations with longer follow-up times are needed.

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CONTEXT: The aim was to evaluate the cutting efficiency of different diamond burs after successive cuts and repeated sterilization in an autoclave. The morphology and grit sizes were analyzed and correlated to cutting efficiency. MATERIALS AND METHODS: Ten medium-grit diamond burs of five different manufacturers were investigated (KG, KG Sorensen; TH, Tri-Hawk; KM, Komet; HC, Heico; and FD, Frank Dental). Changes in the cutting efficiency of diamond burs on composite resin blocks were measured after five repeated cuts and after five sterilization cycles. Grit sizes were analyzed by scanning electron microscopy (SEM) and correlated to cutting efficiency. The data were statistically analyzed using 3-way ANOVA and Tukey's test (α = 0.05). RESULTS: Significant differences were observed for diamond burs (P < 0.0001) and condition (P < 0.0001). FD presented the lowest mean cut time (21.88s), followed by KM (36.08s). TH (40.18s), HC (41.65s), and KG (42.23s) had the highest cut times. The number of cuts was not statistically significant. New burs had a significantly shorter cutting time (33.38s) when compared with the ones after sterilization cycles (39.55s). A moderate to strong positive correlation was found between diamond size and cutting time (Pearson's coefficient of 0.77). CONCLUSION: All diamond burs demonstrated lower cutting efficiency after repeated autoclaving. Cutting efficiency did not decrease as the number of cuts increased.

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Treatment of the anterior teeth is challenging. Computer resources and software are available to facilitate a digital smile approach, thus allowing the dentist to plan and predict an esthetic result for a patient, particularly when an integrated multidisciplinary approach is necessary. Digital smile design has emerged as a tool in cosmetic dentistry that helps both professionals and the patient to visualize the result, in addition to facilitating a discussion between the two before establishing a final treatment decision. Here, we present a case involving a 27-year-old female who underwent multidisciplinary treatment initiated by digital planning using specific software, namely Cara Smile. The patient presented with complaints of maxillary tooth malalignment, staining, and fractures. To obtain the correct width-to-height ratio, a simulated gingival procedure was performed in the software. Gingivectomy was performed using digital simulation, and 90 days after surgery, cast and wax-up models maintaining the previously planned width-to-height ratio for the maxillary anterior teeth were made. Esthetic crowns and veneers were fabricated using the digital planning protocol. Therefore, Cara Smile is useful to facilitate the diagnosis through digital photos, improve communication between the various professionals involved in treatment, and guide the predictability of treatment and patient acceptance.

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