Severe tetracycline dental discoloration : restoration with conventional feldspathic ceramic veneers. A clinical report

The treatment of severe tetracycline discoloration is a challenge for the dentist. There are several treatment options and one of the most effective is the use of feldspathic veneers. The aim of this clinical case was to carry out the replacement with conventional feldspathic ceramic veneers on a patient with highly stained teeth (grade IV tetracycline) by a minimally invasive approach. Clinical examination revealed gingival retraction, color change of the veneers, ceramic cracked of 1.1 and 1.3 and incisal wear in lower anterior teeth. The decision was to retreat with feldspathic ceramic veneers from 1.6 to 2.6. Premolars and first molars were included because its dark color intensifies the width buccal corridors. Also, the restoration with veneers from 3.3 to 4.3 was considered. Firstly, the veneers were removed and the color was selected by the Vitapan 3D Master guide (Vita Zahnfabrick, Bad Säckingen, Germany). Mock-up was made to evaluate aesthetic, phonetic and functional parameters. Then, teeth were prepared through the mock-up in order to reduce the minimal amount of dental tissue possible. Opaque dentine mass of microhybrid composite (Esthet-X A2O, Dentsply Sirona, Konstanz, Germany) was placed to mask the most intense stains. The definitive impressions were taken with silicone (Aquasil Ultra XLV, Dentsply Sirona, Konstanz, Germany) were taken to fabricate conventional feldsphatic ceramic veneers (Noritake kisai Co, Ltd. Japan) by the parallel stratification masking technique. For cementing, an opaque cement was selected from the try-in tests (Calibra, Dentsply Sirona, Konstanz, Germany) and the composite was silicatized with an air-abrasion device. A favorable and minimally invasive result was achieved to treat grade IV tetracycline stains, surpassing the patient?s aesthetic expectations and functional needs

Orthodontics and veneers to restore the anterior guidance. A minimally invasive approach

Tooth wear is defined as the progressive loss of a tooth?s surface due to actions other than those which cause tooth decay or dental trauma. It is a pathological condition with an increasing prevalence among young people. The aim of this article is to describe an alternative treatment modality to rehabilitate the anterior guidance by a minimally invasive interdisciplinary ortho-restorative treatment. Two patients came to the dental clinic for restorative treatment in order to rehabilitate the worn anterior dentition. Clinical analysis showed tooth surface loss located at the incisal edges by attrition due to an inadequate anterior guidance. In both cases the occlusal vertical dimension was reduced. First, following Dahl?s principle, resin attachments were placed in the upper canines. These attachments allowed the extrusion of posterior teeth in order to increase the occlusal vertical dimension. Furthermore, anterior teeth were intruded in order to create space for the restorative material. In the second phase, the restorative treatment was completed. Due to the characteristics of the case, feldspathic ceramic veneers were indicated. A diagnostic wax-up was performed to assist the treatment planning and a mock-up was prepared. Then, maxillary incisors were prepared through the mock-up to ensure a minimally invasive technique. Afterwards, silicone impressions were taken. Finally, veneers were cemented with a light-cured cement. In the present case, the functional and aesthetic parameters required by the patients were achieved, thus satisfying their needs

Incidence of traumatic dental injury in Valencia, Spain

While traumatic dental injuries (TDI) are an increasingly frequent occurrence in everyday dental practice, little research on TDIs has been published in Spain. The aim of this study was to determine the incidence of TDIs in a population in Valencia (Spain) and investigate influential variables. In addition, a protocol for TDI data collection is proposed. This retrospective study compiled data from patients attending a private dental clinic between January 2003 and December 2014. The data were collected using a specially-elaborated protocol entitled ?Emergency care of acute dental trauma?. Patients responded to each item, and data was added from case radiographs and photographs. Data were entered in a Microsoft Office Excel spreadsheet and submitted for analysis by SPSS 15.0 software (Chicago, IL) applying 2-way analysis of variance (ANOVA) (p<0.01). 481 TDIs in 251 patients were examined at a private dental practice in Valencia. The population comprised 62.5% men and 37.5% women, aged 1 to 78 years. The highest frequency of tooth injuries occurred in children aged 9 years or younger. The most frequent injury was non-complicated crown fracture (43.2%). Upper central incisors were the most commonly affected teeth. The most frequent place where TDI was produced was in the street (28.7%), tripping over an immobile object being the most common cause (29%). Thanks to the protocol elaborated for the purposes of this work, it was possible to compile a large quantity of data on TDI, facilitating future prevention and comparison with other regions. The results obtained concur with those published in the literature

Traumatic dental injuries among schoolchildren in Valencia, Spain

Aim: The aim of the present study was to identify some factors related to the occurrence of dental trauma in mixed and permanent dentition. Design of the study: Over a period of two months 1325, 6 to 18 year olds from three primary schools in Valencia were examined. Data was collected through clinical examinations and interviews and their Dental trauma was classified according to IADT´s criteria. Results: The prevalence of dental injuries was 6%; boys aged between 12-18 years old experienced more injuries than girls. There was a statistical difference between the types of fractures. Non complicated coronal fractures were the most frequent (9.18%). Games were the main cause of trauma (40%) in both sexes. In 14.3% of patients a dental colour change was observed. Angle´s class I was the most frequent in traumatized injured children (41.2%). Conclusions: The present study revealed a relatively low prevalence of dental trauma, but this figure still represents a large number of children. Therefore, educational programs are to be initiated for the community regarding causes , prevention and treatments of traumatic dental injuries

Bleaching in vital teeth : combined treatment vs in-office treatment

The aim of this study was to verify that there will be greater whitening in teeth treated with combined bleaching than in those that have been applied a clinical one and to evaluate the efficiency of the clinical treatment, those cases in which it is not able, or it is not wanted, to carry out the home phase. They were used 66 extracted anterior human teeth, which were divided into two study groups. On the one hand, the clinical group (ClG) consisted of 33 teeth, which were treated with a clinical guideline using 37.5% hydrogen peroxide in a single session of 4 applications of 8 minutes. On the other hand, the combinate group (CoG) consisted of 33 teeth, which were treated with a combined guideline, applying first a clinical treatment as in the ClG and, at home treatment with carbamide peroxide at 16% for 22 days, 90 minutes a day. The colour of the tooth was measured before and after each treatment and was made through an individualized whitening splint with a spectrophotometer. The 66 teeth were bleached, showing an increase in luminosity, a drecrease in yellow and a shift towards the green colours, where b (yellow-blue axis) was the only variable with a statistically significant change (p<0.001). The CoG obtained a significantly higher absolute value (p<0.001) than the ClG, being 12.99 for the first one and 19.70 for the second one. Combined therapy bleached more than clinical one, but both techniques were effective. In addition, it is affirmed that the clinical could be an alternative in those cases in which it is not able, or it is not wanted, to carry out the home phase

Treatment of multiple traumatized anterior teeth associated with an alveolar bone fracture in a 20-year-old patient: a 3-year follow up

Intrusive luxation is a type of recognizable luxation injury represented by a deeper axial displacement of the tooth toward the alveolar bone. Treatment strategies include waiting for the tooth to return to its position, immediate surgical repositioning, and repositioning through dental traction by orthodontic devices. The aim of this case report was to present the management of severe dental trauma and later restoration following IADT. A 20-year-old patient was presented after fainting at home four hours before, resulting in a dento-alveolar trauma. Clinical examinations revealed a traumatic intrusion, in 1.2, 1.1 and 2.1, uncomplicated crown fractures in 1.1 and 2.1 and a complicated crown-root fracture in 2.2. The diagnosis was confirmed with CBCT. Following IADT protocol, the emergency treatment consisted of the surgical repositioning and semi-rigid splinting using orthodontic wire-composite, repla - cing the buccal bone plate, and postoperative instructions to the patient regarding oral hygiene. After 2 weeks the root canal treated and filled with fiberglass posts in 1.2, 1.1, 2.1 and 2.2. Splint was removed after 4 weeks and the IADT reassessment protocol followed, with revisions at 6-8 weeks, 6 months, a year and annual reviews for 5 years. A year after the treatment, the traumatized teeth were restored with minimally invasive preparations of feldspathic ceramic. Esthetics and function were recorded with a 3-year follow-up period

An in vitro cyclic fatigue resistance comparison of conventional and new generation nickel-titanium rotary files

New designs and processing of Niquel-Titanium (NiTi) have been introduced to increase resistance to cyclic fatigue. The purpose of this study was to compare the cyclic fatigue resistance of 3 NiTi rotary instruments, ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Profile Vortex Blue (PVB; Dentsply Tulsa Dental, Tulsa, OK, USA) and ProTaper Universal (PTU; Dentsply Maillefer, Ballaigues, Switzerland). A cyclic fatigue test was conducted operating instruments from ProTaper Next X2, Profile Vortex Blue 25.06 and ProTaper F2. A total of 234 instruments were rotated in 2 simulated stainless steel curved canals with different angles of curvature (45º and 60°) and 5-mm radius of curvature. The number of cycles to fracture (NCF) was calculated. Data were compared using 2-way analysis of variance and post-hoc Bonferroni test in software (SPSS 15.0, Chicago, IL). Statistical significance was set at P<0.05. Profile Vortex Blue showed higher resistance to cyclic fatigue in both curved canals than ProTaper Next and ProTaper Universal (P<0.001). ProTaper Universal obtained the lowest resistance to cyclic fatigue in both canals (P<0.001). Profile Vortex Blue was the most resistant to cyclic fatigue failure, followed by ProTaper Next and ProTaper Universal. Anatomical complexity (angle of curvature) and manufacturing process of NiTi are important factors for resistance to cyclic fatigue

Estudio comparativo de la validez y reproducibilidad en la medición de los tamaños mesiodistales de los dientes y de la arcada dentaria con el escáner intraoral iTerotm y el método tradicional

Introducción: El objetivo de este estudio es evaluar la validez y reprodubilidad de las mediciones realizadas sobre modelos de estudio digitales en 3D, obtenidas mediante un método directo de escaneado intraoral (iTeroTM, Align Technologies, San Jose, Calif), y compararlas con el método tradicional que a día de hoy sigue siendo el “gold standard”. Material y método: Este estudio fue aprobado por el Comité de Ética en la Investigación Experimental de la Universidad de Valencia. La muestra de este trabajo de investigación fue de 60 pacientes, todos ellos acudieron al Master de Ortodoncia de la Universidad de Valencia para recibir tratamiento de Ortodoncia. A todos estos pacientes se les tomó una impresión digital mediante el escáner intraoral iTeroTM y también se obtuvieron modelos de estudio con escayola gracias a la toma de impresiones de alginato, registrándose por ambos métodos las arcadas dentarias del paciente. Los criterios de inclusión fueron: dientes erupcionados de primer molar a primer molar del lado contralateral, ausencia de alteraciones en el número o forma dentaria y ausencia de restauraciones protéticas en ningún diente. Para la medición de los modelos digitales se utilizó el programa informático OrthoCadTM, mientras que la herramienta usada para la medición de los modelos físicos fue un calibre digital. Resultados: La reproducibilidad de los modelos digitales obtenidos mediante el escáner intraoral iTeroTM es buena tanto para el error intraobservador como para el error interobservador. La validez de dichas medidas en comparación con el “gold standard” es excelente en la mayoría de casos, aunque se encontraron diferencias estadísticamente significativas para algunas medidas no siendo clínicamente significativas. Conclusiones: La medición de los tamaños mesiodistales de los dientes con el escáner intraoral iTeroTM es una excelente alternativa a los métodos tradicionales, mientras que para el cálculo de las dimensiones de arcada todavía existen ciertas diferencias estadísticas, ya que el método escáner intraoral tiende a sobreestimar las mediciones del “gold standard

Comparative Study of the SEM Evaluation, EDX Assessment, Morphometric Analysis, and Cyclic Fatigue Resistance of Three Novel Brands of NiTi Alloy Endodontic Files

In this study, we compare and analyze the scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), morphometry and cyclic fatigue resistance of Endogal, PathMax, and Smarttrack novel brands of nickel–titanium (NiTi) alloy endodontic files. Material and Methods: Thirty sterile NiTi endodontic rotary files were randomly selected and assigned to one of the following study groups: A: 25.08 F2 Endogal (EDG) (n = 10); B: 25.08 F2 Path Max Pro (PMP) (n = 10); and C: 25.06 Smarttrack (ST) (n = 10). Dynamic cyclic fatigue tests were conducted using a cyclic fatigue device in stainless steel artificial root canal systems with an apical diameter of 250 µm, curvature angle of 60°, radius of curvature of 3 mm, and taper of 6%. Additionally, we analyzed the NiTi endodontic rotary files using EDX, SEM, and morphometry after micro-CT scanning. The results were analyzed using Weibull statistical analysis and ANOVA testing. Results: SEM, EDX, and morphometric analyses showed differences between the three novel brands of NiTi endodontic rotary files. Moreover, statistically significant differences were observed between the number of cycles to failure and time to failure of the three novel brands of NiTi endodontic rotary files (p &lt; 0.001). Conclusions: Smarttrack NiTi alloy endodontic reciprocating files display greater resistance to cyclic fatigue than Endogal and Path Max Pro NiTi alloy endodontic rotary files, due to the reciprocating movement and metallurgical composition

A Comparative Study of the Validity and Reproducibility of Mesiodistal Tooth Size and Dental Arch with iTeroTM Intraoral Scanner and the Traditional Method

Introduction: The introduction of intraoral scanning offers an alternative for measuring mesiodistal tooth sizes