Maria Paula Novaes Camargo Manna

Tooth discoloration is a frequent concern among dental patients. While many professionals and patients choose veneers or other invasive solutions, Minimal Intervention Dentistry (MID) recommends non- and microinvasive approaches to preserve tooth structure. Objective To assess Brazilian dentists’ knowledge and practices on tooth discoloration and how education and professional profile may influence them. Methodology A cross-sectional observational study was conducted with 384 volunteer dentists via an online series of questions on causes, diagnosis, treatment (per tissue removal), and professional-patient relationship. Answers were scored (1=correct/affirmative, 0=incorrect/negative). Descriptive and multivariate regression analyses were performed (α=0.05). Results Most respondents were female, aged 20-49, from the Southeast region. Correct answer rates: 69.9% for causes, 69.4% for diagnosis, 48.8% for treatment, 83.6% for professional-patient relationship, 56.4% overall. Graduation from public universities and holding graduate training in Operative or Pediatric Dentistry or Orofacial Harmonization were associated with better outcomes. Conclusion Knowledge of non- and microinvasive approaches to tooth discoloration remains limited. Broader educational efforts are needed, especially among specific groups of professionals who showed lower performance.

Although repair is a conservative approach that preserves healthy tooth structure, there is still no consensus on the most effective surface treatment and adhesive protocol for repairing aged bulk-fill composite resin restorations. The objective of the study was to evaluate the effect of diamond bur roughening and aluminum oxide (Al2O3) sandblasting as surface treatments combined with different adhesive protocols on the repair bond strength (BS) of aged bulk-fill composite resin.150 Filtek™ One resin discs were thermocycled (5,000 cycles of 5°/55°C) and divided into three surface treatment groups (n=50): no treatment (NT), roughening with diamond bur (B), and sandblasting with Al2O3 (Al). Each group was further subdivided according to five adhesive protocols (n=10): no adhesive (NA), Adper Single Bond 2 (SB), Single Bond Universal (SBU), Silane + Adper Single Bond 2 (S+SB), and Silane (S). Three Bulk Fill resin cylinders were fabricated for each specimen to simulate repair, followed by micro-shear bond strength testing and fracture pattern analysis after 24-hour storage in deionized water. Two-way ANOVA and Tukey's test (α=0.05) were applied. When B or Al was applied, only NA showed inferior results. No statistical differences were found between B/SB, B/SBU, B/S+SB, and B/S, as well as between Al/SB, Al/SBU, Al/S+SB, and Al/S. Al/SBU showed higher bond strength than B/SBU. The most frequent fracture patterns for B and Al were cohesive and mixed, while for NT, it was adhesive. Surface treatment with B or Al, combined with an adhesive protocol, improved bond strength. Surface treatment is crucial for bulk-fill composite resin repair, enhancing bond strength with adhesive systems, with or without silane. A universal adhesive containing silane is as effective as adhesive-silane combinations, offering superior bond strength on Al2O3 blast-treated surfaces.

Tetralogy of Fallot (TOF) is the prevalent cyanotic congenital cardiac anomaly, accounting for 80% of all cases. Despite the incidence rate, the etiopathogenesis of TOF remains unknown. Amelogenesis imperfecta (AI) is a hereditary condition that impacts enamel development, resulting in morphological and functional tooth modifications. This report aims to present the case of a young patient with TOF and AI who received direct restorative treatment, emphasizing the medical and dental factors involved in enhancing oral health and dental esthetics. The patient has a history of cardiac procedures, including the implantation of a metallic pulmonary valve, along with moderate intellectual disability and a prior seizure episode. The intraoral examination indicated extensive gingivitis, inadequate oral hygiene, hypomineralized enamel with structural deterioration, and numerous plaque retention niches, resulting in pain during mastication and oral hygiene practices. Due to the high risk of infective endocarditis, infected foci were eliminated, and antibiotic prophylaxis was administered according to the American Heart Association guidelines. Restorative therapy was conducted utilizing direct composite resin veneers to restore dental aesthetics and functionality. Post-treatment, the patient had enhanced self-esteem, maintained dental hygiene, and achieved remission of gingivitis. This case demonstrates the significance of comprehensive dental care for patients with complex congenital heart conditions and enamel developmental disorders, stressing the necessity for preventive measures, effective periodontal management, and advanced restorative techniques to reduce the risks of systemic infections.

Considering that a single passive application of hydrochloric acid (HCl) as a resin infiltration pretreatment can remove between 20 and 45 µm of enamel and cause etching that extends up to 2 mm beyond the white spot lesions (WSLs), it is plausible that its repeated and active applications could result in a greater amount of dental tissue being removed. Objective To evaluate the enamel surface loss and micromorphology after etching with 15% HCl using two application methods (passive-P and active-A) and varying numbers of applications (C-placebo – 120 s; 1x HCl – 120 s; 2x HCl – 120 s + 120 s; 3x HCl – 120 s + 120 s + 120 s). Methodology Bovine incisors with ≤0.3 µm initial curvature were randomized into eight groups (n=12) based on microhardness, followed by WSL simulation. A central window was etched according to experimental conditions, and surface loss was assessed using optical profilometry and micromorphology via scanning electron microscopy (SEM). Two-way ANOVA and Tukey's test were used for surface loss, and the chi-square test evaluated the association of experimental conditions with etching patterns (α=0.05). Results 1xP generated intermediate mean surface loss, positioned between the values observed for passive control (PC) and active control (AC), and those for 2xP and 3xP. Losses from active applications were significantly higher than passive ones and were increased by the number of applications. SEM showed Types II and III etching patterns and Type II was more frequent. There was no association between treatment and etching pattern. Conclusion Multiple and active HCl applications may raise concerns about removal of the remaining tooth structure, challenging the principles of minimal intervention dentistry.

Nos dias atuais, a estética do sorriso vem crescendo no mercado, visto que muitos consideram como parte do padrão de beleza desejável, o sorriso alinhado e os dentes brancos. Assim sendo, o clareamento dental constitui um dos procedimentos mais procurados e realizados pelos cirurgiões-dentistas, no quesito estética. Dessa forma, o cirurgião-dentista deve ter uma base sólida de conhecimento a respeito, para que faça uma avaliação clínica e o correto diagnóstico da estrutura dental, indicando a melhor técnica em cada caso. Para tanto, foi realizada uma revisão de literatura sobre os tipos de clareamento dental, comparando-os quanto à eficácia, em relação à alteração de cor, e quanto à sensibilidade, com buscas nas bases de dados, Pubmed, Scielo e Scopus, através dos descritores: Tooth bleaching; Carbamide peroxide; Hydrogen Peroxide; Dentin Sensitivity. Foram considerados elegíveis estudos em inglês, português ou espanhol, publicados entre 01/2006 a 05/2021. Assim, notou-se que as técnicas de clareamento são capazes de atingir os mesmos resultados quanto à mudança de cor, mas com variação no tempo e indicação. Quanto à sensibilidade, há uma tendência dessa ser maior, quando usado gel de maior concentração. Porém, já existem atualmente, géis clareadores contendo substâncias dessensibilizantes, e/ou protocolos que podem ser utilizados, para que se tenha uma redução da mesma. Além disso, quando realizada a técnica de clareamento caseiro, sugere-se dar preferência ao gel de Peróxido de Carbamida na menor concentração, uma vez que esse apresenta menor risco de desenvolvimento de sensibilidade dentária e é eficaz, se comparado às maiores concentrações.

A odontologia digital permite que tratamentos reabilitadores sejam realizados de forma virtual. O cirurgião-dentista deve escolher a forma de trabalho, ao inserir ou não o fluxo digital na rotina odontológica, buscando o tratamento mais adequado ao seu paciente. O objetivo deste trabalho foi revisar a literatura sobre o fluxo digital no planejamento e execução das reabilitações orais estéticas. A busca dos artigos foi realizada nas bases de dados LILACS, Pubmed, Scopus e Google Scholar, com as palavras-chave “Odontologia digital” “CAD/CAM” e “Estética dentária”. Foram considerados elegíveis estudos em inglês, português ou espanhol, publicados entre 01/2010 a 04/2021. Os avanços no fluxo de trabalho digital possibilitam o tratamento de maneira relativamente rápida e mais conveniente para o cirurgião-dentista, além de oferecerem maior conforto ao paciente. A tecnologia oferece inúmeras possibilidades aos trabalhos protéticos, com propriedades semelhantes ou superiores aos procedimentos convencionais. Embora seja de custo elevado e demande treinamento para utilização do sistema, os equipamentos se tornaram menos custosos e mais versáteis, facilitando o trabalho do profissional. Assim, com todo o processamento em consultório, do escaneamento à fresagem/impressão 3D, tornou-se possível realizar todo o procedimento restaurador em única sessão. Dessa forma, é interessante inserir a odontologia digital ao consultório odontológico, visto que esta fornece resultados superiores à odontologia analógica.