International Journal of Esthetic Dentistry (EN), 02/2012

Purpose: Pyogenic granuloma is a relatively rare hyperplastic lesion of the oral tissues. Clinically it is heterogeneous and can be similar to malignant epithelial and mesenchymal neoplasms. The treatment of choice is the surgical excision of the lesion. This approach often results in unpleasant gingival defects, especially when the pyogenic granuloma is located in the esthetic zone. Materials and methods: This report describes the clinical and histological findings of pyogenic granuloma diagnosed in the maxilla of a 24-year-old female, as well as the successful treatment of the mucogingival defect that occurred following excision of the lesion, by placement of a subepithelial free connective tissue graft with the envelope-technique concurrently with the biopsy procedure. Results: One-year postoperative complete root coverage of tooth 11 was achieved with a harmonious gingival contour, and no further recurrence was noted. Conclusion: Early diagnosis of pyogenic granuloma, and consequent therapy with adequate excision in a safe distance of at least 1 mm, is essential for prevention of neighboring structures and minimizing the risk of a relapse. Histopathological evaluation is obligatory to confirm the tentative clinical diagnosis and to exclude malignant neoplasms. The immediate esthetic rehabilitation with free connective tissue grafts presents a complementary procedure in the treatment of mucogingival defects after total excision of oralmucosal diseases.

The necessity of surgical root coverage is often encountered in daily clinical practice, mainly because of esthetic reasons. Despite the variety of available surgical techniques, delicate clinical scenarios may require refined surgical therapy approaches. The presented double sliding flap technique is designed to meet the special requirements encountered in the often-fragile incisal mandibular area. This surgical approach combines two laterally repositioned flaps with the dissection of the frenulum, to cover two deep neighboring recessions in the area of the central incisors. Providing that correct indication and adequate surgical tissue handling are used, this complex and advanced technique may have the potential to achieve complete longterm root coverage and an esthetically satisfying treatment outcome.

Dental fluorosis manifests itself as white stains on the enamel of teeth exposed to excessive doses of fluoride during their formation. Fluorosis usually occurs as a result of the ingestion of dentifrices, gels and fluoridated solutions. It may be diagnosed as mild, moderate or severe, and in some cases, it may cause the loss of the surface structure of dental enamel. The aim of this study was to report the clinical case of a female patient of 18 years with moderate fluorosis, whose smile was reestablished by the use of an enamel microabrasion technique, followed by in-office bleaching. A microabrasion technique with 6% hydrochloric acid associated with silica carbide showed to be a safe and efficient method for removing white fluorosis stains, while dental bleaching was useful for obtaining a uniform tooth shade. The association of these techniques presented excellent results and the patient was satisfied. Both techniques are painless, fast and easy to perform, in addition to preserving the dental structure. Treatment showed immediate and permanent results; this technique must be divulged among professionals and their patients.

Purpose: The purpose of this systematic review was to compare the survival and complication rates of ceramic veneers produced with different techniques and materials after a minimum follow-up time of 5 years. Materials and methods: A literature search was conducted, using electronic databases, relevant references, citations and journal researching, for clinical studies reporting on the survival of ceramic veneers fabricated with different techniques and materials with a mean followup time of at least 5 years. The search period spanned from January 1980 up to October 2010. Event rates were calculated for the following complications associated with ceramic veneers: fracture, debonding, marginal discoloration, marginal integrity, and caries. Summary estimates, and 5-year event rates were reported. Comparison between subgroups of different materials, as well as statistical significance, was calculated using a mixed effects model. Results: Nine studies were selected for final analysis over an initial yield of 409 titles. No study directly compared the incidence of complications between ceramic veneers fabricated from different materials. Four of the included studies reported on the survival of ceramic veneers made out of feldspathic ceramics; four studies were on glass-ceramic veneers and one study included veneers fabricated from both materials. The mean observation time ranged between 5 and 10 years. Overall, the 5-year complication rates were low, with the exception of studies reporting on extended ceramic veneers. The most frequent complication reported was marginal discoloration (9% at 5 years), followed by marginal integrity (3.9-7.7% at 5 years). There was no statistically significant difference in the event rates between the subgroups of different materials (feldspathic vs. glass-ceramic). Conclusion: The results of this systematic review showed that ceramic veneers fabricated from feldspathic or glass-ceramics have an adequate clinical survival for at least 5 years of clinical service, with very low complication rates.

It is generally not recommended that bonded restoration treatment should be carried out immediately after bleaching treatment. However, the use of antioxidants such as sodium ascorbate can be useful to avoid a waiting period. This article is a brief review about in vitro proposals to overcome low bond strength values to bleached dental surfaces. It shows a one-year follow-up case report of a young female presenting agenesis of maxillary lateral incisors reshaped with direct resin composite immediately after dental bleaching. Teeth were bleached with a combination of in-office and athome whitening protocols, followed by the application of a 10% sodium ascorbate gel for one hour, to allow the immediate reshaping with direct resin composite restoration. After one year, the clinical performance of the restoration was successful. The use of sodium ascorbate gel can help the clinician to perform bonding procedures immediately after bleaching treatments.

The debonding of a densely sintered zirconia prosthesis is a clinically reported, and undesirable event. A standardized, affordable adhesive cementation protocol for zirconia-based restorations is not yet available. The aim of this investigation was to assess the influence of several surface treatments on the initial shear bond strength of self-adhesive resin cement to densely sintered zirconia ceramic. Thirty densely sintered zirconia cylinders were divided into three groups (n = 10). Each of them received a different surface treatment: control (No_T), with the zirconia surface unconditioned; low pressure air abrasion (Sand_S) (50 µm, 1 bar); and standardized air abrasion (Sand_H) (50 µm, 2.8 bar). Three more surface-treated only specimens were addressed to scanning electron microscope (SEM) for qualitative observations. After specimen fabrication, self-adhesive cementceramic interface was analyzed using SBS (shear bond strength) test. Mean shear bond strengths (MPa) obtained for Sand_H and Sand_S were 16.24 ± 2.95 and 16.01 ± 2.68, respectively; no statistically significant difference (P = 0.8580) was found between sandblasted groups. Low-pressure air abrasion positively affected the initial self-adhesive cement adhesion to zirconia with respect to the No_T control group; however it did not prevent scratches and the formation of microcracks on the ceramic surfaces.

Purpose: To evaluate the efficacy of tooth bleaching with high concentration agents, varying the catalyst sources and exposure times. Materials and methods: Stained human third molar fragments were randomized and placed into 8 groups (n = 5). G1: Whiteness HP Maxx (FGM, Joinville, SC, Brazil) 35% (HP)/5 min on enamel surface without external catalyst source; G2: HP/15 min without external catalyst association; G3: HP/5 min with Quartz Tungstein Halogen (QTH: Optilux 501C, Demetron/Kerr, Danbury, CT, USA) as a catalyst; G4: HP/15 min with QTH as a catalyst; G5: HP/5 min with LED/laser as a catalyst; G6: HP/15 min with LED/ laser as a catalyst; G7: HP/5 min with ultrasound as a catalyst; G8: HP/15 min with ultrasound as a catalyst. The efficacy of bleaching was measured using a spectrophotometer (initial fotoreflectance analysis, after artificial staining with black tea, and after each of the bleaching sessions). Three bleaching sessions were performed. Data were submitted to Analysis of Variance and Tukey-Kramer tests (P < 0.05). Results: No significant differences were found between the catalyst sources as related to the factor of exposure time and within each evaluation time. For the 15 min exposure, the best result was achieved in the second bleaching session, except for the LED/laser group. For the 5 min exposure, the best result was achieved in the third session, except for ultrasound. The 15 min of exposure time showed higher reflectance than 5 min for LED/laser and ultrasound in all bleaching sessions and for halogen in the second bleaching session. Conclusion: Light sources did not increase the catalytic efficiency of bleaching, and allowing a longer time for gel exposure on the enamel achieves faster results.