Human enamel veneer restoration: an alternative technique to restore anterior primary teeth

Restoration of severely decayed primary teeth is a clinical challenge in Pediatric Dentistry. Among the restorative treatment options, the use of prefabricated crowns and resin composite restorations, either by means of direct or indirect techniques is mentioned in the literature. The purpose of this article is to describe the rehabilitation of primary anterior teeth in a 5-year-old patient. Dental treatment consisted on an anterior space maintainer prosthesis made with natural primary teeth, plus human dental enamel veneer (facet) restorations. The advantages of this technique are better esthetics and the natural enamel has physiologic wear and offers superficial smoothness and cervical adaptation compatible with those of the surrounding teeth.     

Indirect composite onlay restorations in primary molars: a clinical report

The authors describe a clinical case of oral rehabilitation, in a 4-year-old patient, using indirect composite onlay restorations. Eight severely decayed primnary molars were restored. The clinical findings after 4 years demonstrated the efficiency of the technique as well as its indication in extensive restorations in Pediatric Dentistry, reestablishing function and aesthetics of these primary teeth. The indirect composite onlay restorations seem to wear at rate compatible with primary tooth wear and maintain a smooth, continuous anatomic form.     

Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex

PURPOSE: The purpose of this prospective and randomized in vivo study was to compare the clinical and radiographic outcomes of an adhesive resin system vs a calcium hydroxide liner for protection of the dentin-pulp complex of primary molars treated with indirect pulp treatment. METHODS: Forty-eight primary molars with deep occlusal caries, but without preoperative signs and symptoms of irreversible pulpitis, received indirect pulp treatment and were restored with a composite resin (Z100). The teeth were randomly divided into 2 groups according to the material used for protection of the dentin-pulp complex: (1) adhesive resin system (Scotchbond MultiPurpose); and (2) calcium hydroxide liner (Dycal). These teeth were evaluated clinically and radiographicaly for 2 years. RESULTS: After 2 years, 83% (19/23) of the teeth treated with calcium hydroxide and 96% (24/25) of teeth treated with only the adhesive resin system presented a successful outcome, as determined by clinical and radiographic examination. Interradicular and/or periapical lesions were the most predominant signs of treatment failure, since 3 out of 23 teeth treated with calcium hydroxide and 1 out of 25 teeth treated with only adhesive resin presented this outcome. One tooth treated with the calcium hydroxide liner was diagnosed with internal root resorption at the 18-month examination. Of the 5 teeth diagnosed from radiographs as a failure of the indirect pulp treatment, none presented clinical signs/symptoms of pulpitis or necrosis such as the presence of fistula, enhanced tooth mobility, or pain. CONCLUSIONS: This study demonstrates that protection of the dentin-pulp complex of primary molars with an adhesive resin system results in similar clinical and radiographic 2-year outcomes as compared to calcium hydroxide when indirect pulp treatment is performed in Class I composite restorations.     

Indirect composite resin crowns as an esthetic approach to treating ectodermal dysplasia: a case report.

This article presents a case report describing the indirect fabrication of composite resin crowns for the restoration of primary anterior teeth. A 3-year-old with a confirmed diagnosis of hypohidrotic ectodermal dysplasia was provided with composite resin crowns that were both esthetic and functional. The indirect method decreases clinical time, provides a durable restoration, and allows treatment of patients who lack the cooperative ability to endure prolonged direct bonding appointments. The indirect technique may be feasible for the restoration of carious teeth as well as the presented case.     

Indirect versus direct bonding: bond strength and failure location

Bond strengths and failure locations in direct and indirect bonding of orthodontic brackets with foil-mesh bonding pads were compared in an in vitro study that used extracted human premolars. The direct technique comprised bonding the attachments directly to the premolars with composite resin. The indirect technique comprised bonding the attachments to die-stone models of the teeth with composite resin, making silicone positioners to transfer the attachments from the models to the teeth, and bonding to the teeth with the use of two-part unfilled resin. One part of the unfilled resin was applied to the teeth and the other part to the composite resin that was already bonded to the attachments. Placing the positioners on the teeth brought the two parts together to initiate setting. Inspection after bonding disclosed marginal voids in two thirds of the indirect bonds. Of these, two thirds were then sealed with unfilled resin and one third were left defective. There were no significant differences in strength among direct, void-free indirect, and sealed indirect bonds. Indirect bonds with voids were only half as strong. This seems to indicate that sealing around brackets immediately after positioner removal might be a worthwhile clinical routine. Forty-four percent of the direct bonds fractured predominantly at the bracket-adhesive interface, whereas 72% of the indirect bonds failed mainly at the enamel-resin interface. Grouping the data according to failure location showed no difference in bond strength between those that failed at the enamel and those that failed at the bonding pad. Thus the indirect bonding promised similar bond strength and easier debonding because less resin was left on the teeth.     

Bond strength analysis of intracanal posts used in anterior primary teeth: an in vitro study

The purpose of this in vitro study is to assess the bond strength of three different posts used to restore primary anterior teeth. These posts were made by composite resin, 0.7 mm alpha-shaped orthodontic wire and dentin posts. Thirty roots of extracted primary anterior teeth, with initial physiological resorption, were mounted in a container filled with self cured resin and were endodontically treated Thirty posts were prepared using three different materials: 10 composite resin posts (Z100), 10 alpha-shaped orthodontic wire and 10 dentin posts. A bulk of composite resin (Z100) was made over the posts using a circular Teflon bisected strip. The specimens were stored in 37 degrees C water solution for 24 hours before tensile bond strength tests in 0.5 mm/min speed were performed (Instron model 4442 test machine--Instron Corporation). The results were submitted to the Kruskal-Wallis test and there were no significant statistical differences among the three types of posts assessed (p = 0.8666). The dentin posts technique might be considered an alternative for rehabilitation in pediatric dentistry, because of the possibility of natural resorption.     

Restoration of severely decayed primary incisors using indirect composite resin restoration technique

Caries of primary incisors is a common problem in paediatric dentistry in some countries. The restoration of primary incisors which have been severely damaged by early childhood caries or trauma is also a difficult challenge for clinicians. This case report describes an indirect technique for the restoration of primary anterior teeth using composite resin reinforced with a fibre-glass post. Over a one-year period, the crowns have demonstrated good retention and aesthetic results. The restorations were provided in two short chair-side sections, with satisfactory patient cooperation.     

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复合树脂材料用于牙科已有20余年历史。这类材料既可用于前牙也可用于后牙。复合树脂发展到今天已经出现了许多专门应用于后牙的修复材料,并已取得满意的临床效果。银汞合金的许多缺点都可以为复合树脂所克服。因此,后牙复合树脂修复已为越来越多的患者和牙科医生所接受。然而,直接充填复合树脂材料仍旧被认为有许多局限性。比如边缘缺陷、面磨损、牙尖变形以及术后的牙髓敏感等。因此,近年来发展了复合树脂的一种新技术——间接性复合树脂嵌体与高嵌体修复技术。它的临床应用在某种程度上克服了上述直接充填树脂的局限性。复合树脂嵌体或高嵌体是作为固体黏固在预备洞型中的一种修复体。这种呈固态的修复体由复合树脂材料采用间接的方法制成,最后再黏固于口内。本文将最近的有关间接性复合树脂嵌体和高嵌体方面的资料进行综述,包括它的临床应用,优缺点以及面临的问题等。     

1-Year clinical study of indirect resin composite restorations luted with a self-adhesive resin cement: effect of enamel etching

In vitro studies have recommended enamel-etching before luting indirect restorations with self-adhesive resin cement. However, there is no scientific proof that this procedure has any clinical relevance. Thus, the aim of this study was to evaluate the effect of enamel-etching on the marginal quality of indirect composite resin restorations (inlay/onlay) using the self-adhesive cement RelyX Unicem clicker. Forty-two posterior teeth were selected from 25 patients that presented one or two teeth with large restorations in need of replacement. All teeth were prepared by the same operator and impressed with polyvinylsiloxane material. The composite resin restorations were built over plaster casts using the incremental technique with a LED device for light-curing the increments. The inlays/onlays were cemented according to one of the following protocols: 1. Etched group (ETR) - selective enamel phosphoric-acid etching + RelyX Unicem clicker; 2. Non-etched group (NER) - RelyX Unicem clicker alone. Each surface was light-cured for 60 s. Recalls occurred after 1 week (baseline), 6 and 12 months when the teeth were evaluated according to previously established scores (modified USPHS criteria). The clinical analysis showed little or no visible changes in the marginal quality after 1 year, even though a probe could detect all the restorations margins. Statistical analysis (Fisher's exact test, p<0.05) detected no differences between the groups after 12 months. No restorations failed and no secondary caries were found. Enamel acid etching had no clinical relevance on the marginal quality of indirect composite resin restorations luted with RelyX Unicem clicker after 1 year of follow up.     

Fracture strength of restored premolars

PURPOSE: To evaluate the fracture resistance (axial compressive strength) of premolars restored with different dental materials under two axial loads. METHODS: Fracture strength was performed using two metal spheres with 3 mm and 9 mm diameter. Five restorative techniques were chosen for MOD cavity preparations (n = 10): (1) direct resin composite restorations (Z-250); (2) indirect resin composite restorations (Z-250 and RelyX); (3) ceramic inlays (Vitadur Alpha); (4) conventional amalgam restorations (GS-80); (5) bonded amalgam restorations. The restored teeth were compared to human caries-free premolars (Group 6/control). Enforce resin cement was used for ceramic and amalgam adhesive restorative techniques, according to the manufacturers' instructions. Whenever required, the teeth were conditioned by the total etch technique. RESULTS: The ANOVA analysis pointed out a significant difference among the groups (P < 0.01) and the "site" factor (P < 0.1). The ceramic restorations presented the highest values for fracture strength and were similar to the control group. The statistical results of direct and indirect resin composite restorations were similar but inferior to the control group. The amalgam restorations (conventional and bonded) presented the lowest values, with no difference between them. All amalgam groups displayed lower strengths when the load was applied on the central fossa (3 mm 0 sphere) compared to load applied on cusps (9 mm 0 sphere).     

Anterior composite resin crown in an adverse situation: A dental technique with a 3-year follow-up

Endodontically treated teeth often exhibit severe coronal structure loss. Given the reversibility and tissue conservation of adhesive procedures, a conservative approach using an indirect resin crown with an adhesively cemented custom fiber-reinforced composite resin post provided a predictable and esthetic solution. The 24-hour and 3-year follow-ups of this technique showed good function, marginal adaptation, and esthetics.     

Intracanal reinforcement fiber in pediatric dentistry: a case report.

A technique for the restoration of carious primary maxillary incisors using indirect resin composite crowns and intracanal reinforcement fiber is described. Endodontic treatment was previously performed on each tooth. The advantages of using an intracanal reinforcement fiber include resin composite crown reinforcement, translucency, and relative manipulation facility. In addition, the use of indirect resin composite crowns provides good shape and esthetics, as well as reduced chair time for the child. The technique is illustrated in a case report in which indirect resin composite crowns and an intracanal reinforcement fiber are placed in a 3-year-old girl.     

三维固定式托槽的研制及性能测试

目的:探讨三维固定式托槽结合超强纤维树脂夹板对松动牙三维方向的调控作用。方法:采用三维固定式托槽结合超强纤维树脂夹板、方丝弓托槽片段弓及超强纤维树脂夹板技术进行单颌固定,记录牙齿三维方向位移情况。结果:在牙齿三维调控方向方面,三维固定式托槽结合超强纤维树脂夹板组与超强纤维树脂夹板组比较无显著性差异;与方丝弓托槽片段弓夹板组比较有显著性差异。结论:三维固定式托槽对超强纤维树脂夹板在三维方向形成"锁扣";实现了对松动牙三维方向的有效控制。     

Early implant placement for a patient with ectodermal dysplasia: Thirteen years of clinical care

Patients with ectodermal dysplasia have abnormalities of 2 or more structures that originate from the ectoderm. The oral manifestations often include the congenital absence of teeth and malformed teeth. This clinical report describes the interdisciplinary care from childhood through the definitive dental rehabilitation completed at skeletal maturation to replace the missing teeth in a patient with ectodermal dysplasia. Treatment began at 9 years of age with an implant-assisted mandibular overdenture to improve function and replace the missing mandibular teeth. Orthodontic treatment for the consolidation of space, composite resin restorations, and interim removable dental prostheses were provided to improve esthetics and replace the missing maxillary teeth. Skeletal growth was monitored, and orthognathic surgery was performed at the cessation of growth. The definitive rehabilitation consisted of a mandibular fixed dental prosthesis supported by dental implants and a maxillary removable dental prosthesis to restore the patient to esthetics and function.     

Using opaquers under direct composite resin veneers: an illustrated review of the technique

In restorative dentistry direct composite resin materials can be used to conservatively resolve many esthetic problems. Opaque resins are often necessary to mask discolorations and/or dark backgrounds when restoring anterior teeth. This article presents a direct composite resin veneer technique using opaquers. Potential problems with the tone of restorations after the use of opaquers are discussed. Advantages, limitations, and the clinical technique are presented. Training, as well as attention to the technique, contributes to an acceptable result.
CLINICAL SIGNIFICANCE
Resinous opaquers can be used as a valid adjunct to the direct composite resin veneer technique when conservatively restoring dark teeth.     

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提要：近年来具有天然牙颜色的美学嵌体在临床上的应用越来越多,主要为树脂嵌体和瓷嵌体。树脂嵌体具有美观、操作简便、弹性模量与牙本质近似、对对颌牙磨耗小等优点,是一种良好的美学嵌体材料,其临床应用越来越广。固位设计和抗力设计是树脂嵌体修复中的重点。     

Fabrication of an individual set of composite resin anterior teeth duplicated from a preserved stone cast: a clinical report

It is often difficult to satisfactorily restore the esthetics of patients' teeth if commercially available artificial acrylic or composite resin anterior teeth are used. A technique for fabrication of an individual set of composite resin teeth for an edentulous patient is described in this clinical report. A diagnostic cast, made before extraction of the original anterior teeth and kept by the patient for over 10 years, was duplicated with a silicone matrix. This technique results in an esthetic match of shape, size, and positioning of the teeth. It also enables the teeth of the prosthesis to be closer to the appearance of the patient's natural teeth than is achievable with premanufactured artificial teeth.     

后牙病理性磨损树脂修复的临床效果探讨

目的:观察用直接树脂充填法和间接树脂充填法修复后牙病理性磨损的临床效果。方法:选择后牙牙合面有病理性磨损且具有充填空间的患者48例,患牙144颗,其中有牙本质过敏症状者38例98颗牙。患者按门诊顺序随机分为直接法修复组和间接法修复组2组各24例,在不备洞的情况下分别采用可乐丽菲露复合树脂直接或间接修复,比较治疗3个月及1年后树脂充填的临床效果、牙本质敏感情况和咀嚼效率改变情况。结果:治疗后3个月时复查,直接法和间接法两组患牙树脂充填体A级率无显著性差异(卡方检验,P>0.05);治疗1年后复查,间接法组患牙树脂充填体A级率优于直接法组,两组差异有统计学意义(卡方检验,P<0.05)。间接法组牙本质敏感治疗总有效率优于直接法组,两组差异有统计学意义(卡方检验,P<0.05)。治疗3个月及治疗1年后,间接法组的咀嚼效率高于直接法,两组差异有统计学意义(t检验,P<0.01)。结论:间接树脂法比直接树脂充填法修复后牙病理性磨损有较好的临床效果。     

Biological restorations as an alternative treatment for primary posterior teeth

A case of oral rehabilitation in a 4-year-old girl, in which the posterior teeth were restored using biological restorations, is described. The tooth fragments were selected from a bank of tooth tissues and bonded with dual-cure composite cement to prepared teeth. The results were satisfactory regarding retention, aesthetic and mastication, but disadvantages included long clinical appointments, laborious technique and possible fracture or degradation between the margins of the fragment and the tooth surface.     

Restorative therapy of primary teeth severely affected by amelogenesis imperfecta.

OBJECTIVE: Primary teeth severely affected by amelogenesis imperfecta (AI) often show an extensive loss of enamel. Such defects are difficult to restore with resin composites, since neither the correct anatomic form nor the marginal fit can be guaranteed. METHODS AND MATERIALS: After clinical and scanning electron microscopic examinations were performed on replica models of 5 patients with primary teeth affected by AI, impressions were made without previous preparation by rotary instruments. Composite crowns and veneers were manufactured and luted adhesively using the total bonding technique and low-viscosity resin composite. RESULTS: The pre-restorative scanning electron microscopic analysis showed that the dentinal tubules were exposed and that the border of the residual enamel was in the process of splitting. The preoperative oral examination had revealed tooth discoloration, masticatory disturbances, hypersensitivity, and speech problems. After placement of the restorations, patients reported improvements in tooth sensitivity, articulation, and mastication. CONCLUSIONS: A new protocol for restoration of primary teeth with an extensive loss of enamel is offered. It is quick and easy to perform, highly esthetic, and can be applied in children younger than 4 years old.