A case report of green pigmentation in the permanent dentition

Intrinsic green discoloration of teeth is an uncommon condition which mainly affects the primary dentition. Children can be teased about this, resulting in a loss of self-esteem and problems with social integration. The purpose of this paper was to present a case of green pigmentation in the permanent dentition caused by hyperbilirubinemia during infancy and an intermediate restorative approach to mask the esthetic deficiency arising from this.

Randomized clinical trial of the efficacy, tolerability, and long-term color stability of two bleaching techniques: 18-month follow-up

OBJECTIVE

To investigate the efficacy, tolerability, and long-term color stability of tooth whitening using two different bleaching techniques: an at-home tray technique (5.0% H2O2) and an over-the-counter strip technique (5.3% H2O2).

METHOD AND MATERIALS

Thirty subjects were included in this two-cell, parallel, examiner-blinded, randomized clinical trial. Shade evaluations were performed with a value-oriented VITA shade guide. The null hypothesis was that there would be no differences between the groups and no improvements from baseline with regard to tooth shade. Bleaching sensitivity, gingival irritation, and patient acceptance were recorded on a visual analog scale (VAS). Scanning electron microscopy (SEM) was performed to detect any enamel surface changes.

RESULTS

After bleaching, both treatments demonstrated significant improvements in tooth shade (P < .001 for both groups). At the 18-month recall, tooth shade remained significantly lighter than at baseline (P = .006 for tray group; P = .001 for strip group). However, a relapse of the tooth shade was observed compared with the immediate postbleaching result (P < .05). VAS data yielded no significant differences between groups regarding bleaching sensitivity and gingival irritation. None of the teeth studied showed detectable enamel surface changes. Patient acceptance was statistically significantly higher in the tray group compared with the strip group (P < .05).

CONCLUSION

Both techniques demonstrated significant and comparable levels of tooth shade improvement after 2 weeks and 18 months. Each treatment caused similar, transient oral adverse effects.

Re-establishing esthetics of fluorosis-stained teeth using enamel microabrasion and dental bleaching techniques

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.

Laboratory evaluation of extrinsic stain removal by a specially engineered sonic powered toothbrush with unique sensing and control technologies

OBJECTIVE

The purpose of this laboratory study was to evaluate extrinsic stain removal from teeth by a specially engineered sonic powered toothbrush with unique sensing and control technologies, using the Triple Clean and the Sensitive refill brush heads, in comparison to a manual flat-trim toothbrush.

METHODS

Twelve (12) artificially stained bovine teeth were tested with each product. The percentage of stain removed by each product was calculated by taking the ratio of the amount of stain removed by brushing for 800 strokes to the total amount of stain removed by subsequent application of a dental prophylaxis. The stain was quantified by measuring the light reflected by the stained teeth with a spectrophotometer. Data were reported as L*, lightness of the stain, and as W*, a whiteness index comprising the lightness, hue, and chroma of reflected light. Statistical analyses were performed separately for the AL* and AW* scores. Comparisons of the toothbrushes with respect to baseline-adjusted deltaL* and deltaW* scores were performed using an analysis of covariance (ANCOVA). Post-ANCOVA pair-wise comparisons of the study toothbrushes were performed using Tukey's test for multiple comparisons. All statistical tests of hypotheses were two-sided, and employed a minimum level of significance of 0.05.

RESULTS

The percentage of stain removed by the sonic powered toothbrush, using either the Triple Clean brush head or the Sensitive brush head under laboratory test conditions, is superior (p < 0.05) to the percentage of stain removed by the manual flat-trim toothbrush when analyzed for both the deltaL* and deltaW* scores. The mean percentage of stain removed was 62.10 for the power toothbrush with the Triple Clean brush head, 49.01 for the power toothbrush with the Sensitive brush head, and 30.56 for the manual flat-trim toothbrush when calculated using deltaL* scores. The mean percentage of stain removed was 59.89 for the power toothbrush with the Triple Clean brush head, 46.83 for the power toothbrush with the Sensitive brush head, and 29.25 for the manual flat-trim toothbrush when calculated using deltaW* scores.

CONCLUSIONS

This new specially engineered sonic powered toothbrush with unique sensing and control technologies effectively removes extrinsic stains from the surface of teeth under laboratory test conditions with both the Triple Clean and the Sensitive brush heads. The effectiveness of stain removal with either brush head is significantly greater than the effectiveness of stain removal of a manual flat-trim toothbrush under these conditions.

Interdisciplinary approach for esthetic management of an adult patient with reverse articulation

Prosthodontic methods to correct anterior reverse articulation (also known as anterior cross-bite) can be extremely challenging. This clinical report describes the interdisciplinary management of an adult female patient with a history of chronic periodontitis who presented with reverse articulation in the left canine region. While the patient desired a quick, highly esthetic solution, she was counseled to first undergo orthodontic treatment. After completion of orthodontics, prosthodontic treatment comprised of bleaching therapy, porcelain veneers, and all-ceramic crowns. Periodontal maintenance therapy was also performed during the treatment period. The case portrays the significance of interdisciplinary care and discusses the importance of close communication among specialties.

Multidisciplinary approach for the treatment of a complicated crown-root fracture in a young patient: a case report

Crown-root fractures in permanent teeth cause esthetic and functional problems. This paper reports the case of a complicated crown-root fracture in the maxillary right central incisor of a young patient who was treated with a multidisciplinary approach in two phases. A modified Widman flap, root canal therapy, glass fiber post cementation, and adhesive tooth fragment reattachment were performed shortly after an accident. Satisfactory esthetic and functional outcomes were obtained. However, the patient did not attend follow-up visits and returned after 7 years. During this second phase, the clinical and radiographic examination showed stability and adaptation of the fragment and good periodontal health conditions, but crown darkening and a radiolucent image associated with the root apex of the fractured tooth were also observed. The periapical lesion was surgically removed by apicoectomy, and the esthetics were recovered with a direct composite resin veneer on the traumatized tooth.

Selective masking for thin indirect restorations: can the use of opaque resin affect the dentine bond strength of immediately sealed preparations?

PURPOSE

Evaluate the dentine bond strength using different methods of application of opaque resins to mask dentine discoloration.

MATERIALS AND METHODS

Dentine was exposed on 21 extracted molars which were assigned to 3 groups: G1: immediate dentine sealing (IDS). G2: IDS+opaque. G3: IDS with adhesive resin mixed with opaque. After 1 week, teeth were restored and beams were fabricated for microtensile testing. Optical microscopy was used to analyse the failure mode.

RESULTS

Bond strength mean values were statistically different: G1 55.20MPa>G2 45.79MPa>G3 18.96MPa. Failure modes were mostly adhesive for G1 and G3. G2 presented mostly mixed failures.

CONCLUSION

The use of opaque resin to mask discoloured dentine results in a decrease of bond strength.

Extrinsic stain removal efficacy of a new dentifrice containing 0.3% triclosan, 2.0% PVM/MA copolymer, 0.243% NaF and specially-designed silica for sensitivity relief and whitening benefits as compared to a dentifrice containing 0.3% triclosan, 2% PVM/MA copolymer, 0.243% NaF and to a negative control dentifrice containing 0.243% NaF: a 6-week study

PURPOSE

This single-center, double-blind, randomized, parallel-group clinical study was designed to investigate the extrinsic stain removal efficacy of a new antisensitivity dentifrice containing 0.3% triclosan, 2% polyvinylmethyl ether/maleic acid copolymer (PVM/MA copolymer), 0.243% NaF and a new silica specially-designed to occlude dentin tubules, relative to a Positive Control dentifrice and a Negative Control dentifrice.

METHODS

117 qualifying adults were stratified by baseline Lobene Stain Index scores and randomly assigned to brush twice daily using a soft-bristled toothbrush and one of three dentifrices: (1) the Test Dentifrice; (2) a previously clinically proven dentifrice variant containing 0.3% triclosan, 2% PVM/MA copolymer, 0.243% NaF in a high cleaning silica base (Positive Control); and (3) a dentifrice containing 0.243% NaF in a silica base (Negative Control). Extrinsic stain area and stain intensity examinations were repeated after 3 and 6 weeks of product use.

RESULTS

Relative to the Negative Control group, the Test group and the Positive Control group exhibited statistically significant improvements in mean Lobene composite stain scores after 3 weeks of product use (39.8% and 40.7% respectively) and after 6 weeks of product use (58.8% and 61.8% respectively). There were no statistically significant differences observed between the stain removal performance of the Test Dentifrice and the Positive Control Dentifrice after 3 and 6 weeks of product use.

Low-risk dentistry using additive-only ("no-prep") porcelain veneers

"No-prep" porcelain veneers have been effectively in use for more than two decades, and the bonding of porcelain to 100% enamel has enjoyed extraordinary success. Today's refined techniques, new and improved materials, and better training in emulating nature have enabled additive-only veneers to rival, or in some cases even exceed, the results of traditionally prepared veneers. In this case presentation, the author uses conservative, additive-only dentistry to enhance a young woman's smile by creating improved anterior esthetics.

Conservative approach for a clinical resolution of enamel white spot lesions

Enamel white spot lesions in anterior teeth that compromise esthetics are common. Microabrasion is indicated, since it affects enamel superficially. An acid-abrasive slurry with 37% phosphoric acid with pumice was used on the enamel for a controlled time period. Home bleaching with hydrogen peroxide was then used, further improving the final result. The method is safe, easy, and conservative and provides good esthetic results.

Minimum thickness anterior porcelain restorations

Porcelain laminate veneers (PLVs) provide the dentist and the patient with an opportunity to enhance the patient's smile in a minimally to virtually noninvasive manner. Today's PLV demonstrates excellent clinical performance and as materials and techniques have evolved, the PLV has become one of the most predictable, most esthetic, and least invasive modalities of treatment. This article explores the latest porcelain materials and their use in minimum thickness restoration.

A free gingival impression for achieving optimal interdental papilla height: a case report

Failure to tend to inadequate crown contours in the crown trial can cause long-term disharmony of the free gingival form. This case report describes a novel technique for free gingival impression from a final provisional restoration to a zirconia crown. Two die casts were manufactured from a silicone impression. The first die cast was for the zirconia crown; the second die cast was for the final provisional restoration and the provisionalized transfer coping. A free gingival impression was taken using a provisionalized transfer coping, and a soft gingival model was manufactured. The proximal contact position was managed using the predicted convex curve of the interdental papillae. One year after zirconia crown placement, no inflammation was observed around the pyramidal interdental papillae, and symmetric interdental papilla heights were evident. A free gingival impression using a two die-cast technique appears to be useful for achieving optimal interdental papilla height.

Abrasion, polishing, and stain removal characteristics of various commercial dentifrices in vitro

OBJECTIVE

To evaluate, using conventional in vitro procedures, the abrasivity, enamel polishing properties, and stain removal effectiveness of various commercial dentifrices that have a variety of compositions and are marketed for cleaning, whitening, and/or polishing capabilities, and to examine their relationships between stain removal and abrasivity.

METHODS

The Relative Dentin Abrasivity (RDA) method was used to measure abrasivity, and the Pellicle Cleaning Ratio (PCR) procedure was used to evaluate stain removal performance. A Cleaning Efficiency Index (CEI) was calculated using the RDA and PCR values. Enamel polish was determined on bovine enamel specimens using a reflectometer. All treatments were performed on a V-8 cross-brushing machine using aqueous dentifrice slurries and standard nylon-bristle toothbrushes. A total of 26 dentifrices, purchased at retail, were tested against the American Dental Association (ADA) calcium pyrophosphate reference standard.

RESULTS

All dentifrices removed extrinsic stain and produced some dentin abrasion, but scores ranged widely between products (from 36 to 269 for RDA and from 25 to 138 for PCR). The majority of dentifrices contained hydrated silicas, and those with high PCR scores often, but not always, had higher RDA values. Products containing other abrasives (e.g., dicalcium phosphate, sodium bicarbonate, and calcium carbonate) generally had lower RDA values and usually lower PCR scores. There were exceptions (e.g., refined kaolin clay) that had high PCR scores and low RDA values, resulting in higher CEI values. Similarly, brushing with all dentifrices significantly increased reflectance readings of acid-dulled teeth, but polish scores also were highly variable among products (ranging from 38 to 97). The polish scores of dentifrices containing hydrated silica varied extensively (ranging from 38 to 80), and the scores of products containing other abrasives fell within this same range, except for dentifrices containing either Fuller's earth (86) or kaolin (97).

CONCLUSION

With only a few exceptions, dentifrices marketed as "whitening" products were generally more abrasive to dentin, especially for those containing silicas. Similarly, aside from two non-silica products, those dentifrices advertised for polishing ability generally were no more effective than other products. The relationship between stain-removal ability and abrasivity of dentifrices was not necessarily direct.

Smile esthetics: a methodology for success in a complex case

The clinical case presented is the demonstration of a multidisciplinary approach to a complex treatment. A precise methodology is important to ensure that the treatment objectives are clear to all the teams. The aim of the treatment is to restore dentofacial harmony to a young, 22-year-old, female patient showing severe attrition of the anterior teeth. The direct effect of this is an ageing of the smile. This type of multidisciplinary treatment, which seems complicated at first, is greatly simplified once time has been spent on the diagnosis and treatment plan: it thereby becomes a succession of clinical stages.

Smile restoration through use of enamel microabrasion associated with tooth bleaching

Enamel microabrasion can eliminate enamel irregularities and discoloration defects, improving the appearance of teeth. This article presents the latest treatment protocol of enamel microabrasion to remove stains on the enamel surface. It has been verified that teeth submitted to microabrasion acquire a yellowish color because of the thinness of the remaining enamel, revealing the color of dentinal tissue to a greater degree. In these clinical conditions, correction of the color pattern of these teeth can be obtained with a considerable margin of clinical success using products containing carbamide peroxide in custom trays. Thus, patients can benefit from combined enamel microabrasion/tooth bleaching therapy, which yields attractive cosmetic results. Esthetics plays an important role in contemporary dentistry, especially because the media emphasizes beauty and health. Currently, in many countries, a smile is considered beautiful if it imitates a natural appearance, with clear, well-aligned teeth and defined anatomical shapes. Enamel microabrasion is one technique that can be used to correct discolored enamel. This technique has been elucidated and strongly advocated by Croll and Cavanaugh since 1986, and by other investigators who suggested mechanical removal of enamel stains using acidic substances in conjunction with abrasive agents. Enamel microabrasion is indicated to remove intrinsic stains of any color and of hard texture, and is contraindicated for extrinsic stains, dentinal stains, for patients with deficient labial seals, and in cases where there is no possibility to place a rubber dam adequately during the microabrasion procedure. It should be emphasized that enamel microabrasion causes a microreduction on the enamel surface, and, in some cases, teeth submitted to microabrasion may appear a darker or yellowish color because the thin remaining enamel surface can reveal some of the dentinal tissue color. In these situations, according to Haywood and Heymann in 1989, correction of the color pattern of teeth can be obtained through the use of whitening products containing carbamide peroxide in custom trays. A considerable margin of clinical success has been shown when diligence to at-home protocols is achieved by the patient and supervised by the professional. Considering these possibilities, this article presents the microabrasion technique for removal of stains on dental enamel, followed by tooth bleaching with carbamide peroxide and composite resin restoration, if required.

Porcelain laminate veneers: restorative management

This article presents the case of a young adult woman who presented with esthetic complaints years after conventional orthodontics. The treatment plan the patient ultimately selected was the placement of 10 indirect porcelain laminate veneers.

Black stain - a review

The purpose of this review was to summarise the fundamentals about black stain, its diagnosis and possible differential diagnoses as well as its microbiology and therapy. In addition, various studies investigating the relationship between black stain and dental caries are examined. Many studies report lower caries prevalence in children with black stain, but this finding could not be confirmed by all authors. Also, a negative relation between degree of staining and caries severity has been described. Reasons for these results are not yet clear but it was speculated that they are related to the specific oral microflora described in black stain-affected individuals.

Influence of chemical or physical catalysts on high concentration bleaching agents

OBJECTIVES

The aim of this in vitro study was to evaluate the bleaching efficacy of high concentration bleaching agents activated by chemical or physical catalysts.

MATERIALS AND METHODS

This study was divided into two parts. Part 1 evaluated the efficacy of tooth whitening after treatment with 35% hydrogen peroxide (Whiteness HP Maxx) that was activated by different light-curing units: halogen lamp (conventional and bleach mode) (Optilux 501C, Demetron/Kerr), LED first generation (Ultrablue IV, DMC), LED/diode laser (Ultrablue IV, DMC), LED second generation (Bluephase 16i, Ivoclar Vivadent), and no light source (control group). Part 2 provided an analysis of the effect of chemical and physical catalysts on high concentration bleaching agents: 35% hydrogen peroxide (Whiteness HP Maxx) + 20% sodium hydroxide; 35% hydrogen peroxide + 7% sodium bicarbonate; 38% hydrogen peroxide (Opalescence Xtra Boost); 35% hydrogen peroxide + halogen lamp; 35% hydrogen peroxide + 20% sodium hydroxide + halogen lamp; 35% hydrogen peroxide + 7% sodium bicarbonate + halogen lamp; 38% hydrogen peroxide + halogen lamp; and 35% hydrogen peroxide. Blocks obtained from human molars were randomly divided into groups (n = 5) in accordance with bleaching treatments. The efficacy of bleaching was measured using a spectrophotometer. Three bleaching sessions were performed. The results were submitted to ANOVA followed by the Tukey test (5%).

RESULTS

For both parts of the study, activated vs. non-activated bleaching did not differ significantly for all sessions tested.

CONCLUSION

Activating systems did not improve the whitening effectiveness of high concentration bleaching agents.

Efficacy and persistence of tooth bleaching using a diode laser with three different treatment regimens

STATEMENT OF PROBLEM

Studies have measured the effectiveness of tooth bleaching, however there are very few studies that have measured the persistence in color change after a 6-month follow-up.

PURPOSE

This study assessed the efficacy of the laser bleaching process using different regimens, and the persistence of color change over a 6-month period.

METHOD AND MATERIALS

Sixty patients divided into three equal groups were subjected to bleaching using a diode laser with 34% hydrogen peroxide. Group 1: patients subjected to one session of laser bleaching. Group 2: patients subjected to two sessions of laser bleaching with a 1-week interval. Group 3: the same as Group 2 but followed by home bleaching once a month for 3 months. The color was assessed four times: before bleaching, directly after bleaching, 3 months after bleaching, and 6 months after bleaching.

RESULTS

All teeth had a significant color change at 6 months, but all teeth had regressed from the maximum value. There was significantly less regression in color for Group 3, followed by Groups 2 and 1, respectively.

CONCLUSION

The combined technique of in-office laser bleaching for two sessions with a 1-week interval, followed by home bleaching once a month for 3 months gave more persistence in color change.

CLINICAL SIGNIFICANCE

In-office power bleaching using a laser assisted hydrogen peroxide system repeated after a week, combined with home bleaching once a month for 3 months, is an effective bleaching regimen with less color regression after 6 months compared to a regimen of in-office bleaching alone.

Preliminary clinical reports of a novel night-guard tooth bleaching technique modified by casein phosphopeptide-amorphous calcium phosphate (CCP-ACP)

Although supervised night-guard bleaching has proved successful for whitening teeth, both mineral loss and tooth sensitivity are still common problems. The present study introduces a novel remineralizer as well as describes the utilization of a possibly low sensitivity supervised night-guard vital tooth bleaching technique. A 22% carbamide peroxide gel was mixed with the casein phosphopeptide-amorphous calcium phosphate-containing MI Paste. The peroxide/MI Paste mixture was prepared with 1 ml of each material until obtaining a homogeneous paste. Five patients were instructed to follow a home bleaching protocol for 3 weeks. The outcome was assessed visually with a Vitapan scale. All subjects presented reduction of at least two Vitapan scale units after bleaching and no sensitivity was reported. The concomitant use of MI Paste and peroxide might not affect the gel effectiveness and still reduce hypersensitivity levels.

Prefabricated composite veneers: historical perspectives, indications and clinical application

Veneering anterior teeth is a well-established technique, which was brought to Dentistry by Dr Pincus as early as 1937. From the mid-1970s, boosted by the development of composites and adhesive techniques, various concepts emerged including direct composite restorations, prefabricated composite veneers and of course, individualized porcelain indirect veneers. The prefabricated composite veneer option was however soon abandoned due to former technological limitations. Recently, the creation of a new shade guide comprising enamel shells revitalized this "old idea," and in combination with a high pressure and temperature molding process followed by a laser surface vitrification, a novel, improved composite prefabricated system (Venear, Edelweiss Dentistry) was born. This paper provides an overview of the potential indications and clinical protocol of this original veneering technique.