Entries by ArcPro Support

Anatomization of dental post: The best choice for canals that are wide or have a differentiated anatomy.

Authors: Andréia Luiza Gabriel and Rayane Alexandra Prochnow

 

Teeth that undergo endodontic treatment with large coronary destruction are common in the dental practice and, in those cases, it is critical to recommend intra-radicular retainers for the reestablishment of their mechanical resistance.

Dental posts have been widely accepted and used. They present an elasticity module that is similar to that of the dentin, they absorb tensions generated by the masticatory forces and protect the radicular remains, allowing for the construction of a mechanically homogenous unit. However, the use of pre-manufactured dental post in wide canals or in canals with a differentiated anatomy may be considered critical when there is a substantial lack of adaptation and a thick line of cementation.

 

Thicker layers of cement are prone to flaws due to the presence of bubbles and to the increase in tension caused by the shrinkage of polymerization, responsible for the occurrence of fracture lines, which may lead to the dislocation of the dental post once the bonding strength is compromised. To improve the adaptation in wide canals, FGM developed the dental posts type DC-E which have a thin apical portion and a conservative cervical portion that is wider and more resistant.

In spite of the more adequate format, canals with a differentiated anatomy (exaggerated amplitude and not conical/oval) are frequently found and, in those cases, the best choice is to perform a technique called anatomic dental post. That technique involves the use of a composite to mold the root canal in order to decrease the cementation line.

 

Composites have high resistance to compression when they occupy the spaces between the wall of the canal and the dental post, leading to excellent retention. When using that technique, the polymerization of the composite happens aside from the cementation process, eliminating the risk of fractures from the polymerization shrinkage and without adding cementation lines (in cases when accessories for the adaptation of the dental post are used, for example), increasing longevity.

Check the step-by-step

Authors: Renata Paranhos Milioni, Leandro de Moura Martins, Gustavo Oliveira dos Santos and Raphael Monte Alto

After cleaning the retainer (Whitepost dental post – FGM), apply silane, apply the adhesive (Ambar Universal APS – FGM), light cure for 20 seconds.

Apply composite on the dental post and isolate the canal with hydro-soluble lubricating gel. Position the dental post inside the canal and light cure for 40 seconds. After complete light curing, make the core build-up. Remove the anatomized dental post and the core and cement with Allcem Core (FGM).

With the anatomization of the dental post, a single line of cementation with small thickness is achieved, minimizing the possibility of adhesive flaws.

Esthetic restorations in severely darkened anterior teeth using dental cement and fiberglass post

Authors: Raphael Monte Alto, Juliana Ferreira Batista Pereira, Mariana Ferreira Silva Ventura, Priscilla Carvalhal de Oliveira and Fabrício Perucelli.

 

Darkened teeth are always a challenge in the clinical routine, and when deciding the type of treatment, one should always select the most conservative one. In this context, whitening becomes an interesting alternative. However, due to the great relapse of this type of treatment, the patient usually ends up choosing a more definite solution such as crowns and veneers.

 

CASE REPORT

A female patient attended the subject of Integrated Clinic of the Fluminense Federal University (Rio de Janeiro – Brazil) indicated by the Discipline of Orthodontics with the application of an anterior crown with the appropriate format for future orthodontic finalization.

 

Endodontically treated teeth are susceptible to biomechanical failures especially when there is a significant loss of dental structure1. In such cases, the use of intraradicular retainers is necessary, mainly because the remnant structure is insufficient to adequately support and retain the final restoration2,3. Several techniques are available for the restoration of teeth with endodontic treatment and within this context choosing an inadequate method when restoring these teeth may compromise their longevity.

 

The tooth to be restored presented a good amount of coronal structure and conservative endodontic treatment, and the direct technique was indicated (see table 1).

 

The root canal was cleaned and dried with paper cones for the adhesive procedure and light-curing was performed for 40 seconds. With the aid of an insertion tip, Allcem Core dual cement (FGM) was applied in the root canal from the apical region to the coronary chamber.

 

The dental post Whitepost (FGM) DC-E 2 was inserted and the set was light cured for 40 seconds. The excess of the dental post was cut and the occlusal adjustments were performed. The patient was submitted to periodontal surgery by Professor Ronaldo Barcellos at the Fluminense Federal University (Rio de Janeiro – Brazil). After 90 days, total crown preparation and molding were performed and sent to the laboratory. A total crown was made with composite for CAD/CAM with external characterization. After tests and adjustments the crown was cemented.

 

Technique Indications Advantages Disadvantages
Direct. Teeth with a lot of coronary remnants. • Single section.
• Low cost.
Large amount of resinous cement.
Anatomical or direct modeling • Teeth with little remnants.
• Broad root canals.
• Single session.
• Low cost.
• Less quantity of cement.
• Less effect of the shrinkage stress.
• Certainty of polymerization of the composite throughout the post.
• Most critical technique.
• Need to create expulsivity in the root canal.

Table 1 – Indications, advantages and disadvantages of each technique. Table from the book “Reabilitação estética anterior: o passo a passo da rotina clínica (Raphael Monte Alto e Colaboradores)”.



CLINICAL PHOTOS

COMPOSITE RESIN SHADE SELECTION

What steps should one follow to apply the principles of optical properties and achieve the “perfect shade”? Find below a simplified step by step to help you achieve successful restorations.

 

The dental office should be lighted with “corrective” light with a color reproduction index of around 90 and average temperatures of 5500K (there are LED fixtures that hold lamps with those features). It is important to take the shade under another light source for confirmation and to avoid metamerism. Also, pay attention to other light sources to which the patients may be frequently exposed in relation to their activity profile.

 

  • Use neutral and light-colored walls, aprons and bibs, besides recommending that the patient refrain from using heavy make-up for the appointment, not to interfere or modify the perception of color by the observer.
  • Consider the effects of translucency and opacity in the distinct areas of a tooth for a balance of the optical effect of the different material thicknesses. For example, a thicker layer of enamel composite resin (more translucent) may result in a restoration with a lower value (grayish).

Vittra APS – Trans OPL (FGM) opalescent composite resin being tested on the incisal area. Note the high translucency.

 

  • In the case of using shade guides, use a single shade each time, and do not observe for more than a few seconds to avoid confusion and fatigue in the observer’s perception.
  • Anatomic shape, texture, flat areas and reflection lines should reproduce the adjacent teeth as faithfully as possible.

Fig 1 – Incisal third showing the greater proportion of light passage and lower amount of reflection. That area, as a rule, preferably should receive translucent enamel material (if necessary) and a thin layer of dentin material.

Fig 2 – Medium third: predominance of light reflection and little passage. That area, as a rule, should receive predominantly dentin material and a thinner enamel layer (0.5mm or less). Opaque material may be used for masking a darkened area.

Fig 3 – Cervical third, where there is the evident domain of light reflection with virtually no passage. In that area, it is possible to observe greater chroma or saturation and one should only use dentin material (opaque material, just to mask, if necessary, an eventual sclerotic dentin). The use of enamel material in that area may lead to a discrete graying of the restoration.

 

Simplified operatory plan:

 

  1. Prophylaxis with pumice stone paste/water for the dental surface to be clean and free of pigmented biofilm.
  2. Each and every shade taking should be prior to the isolation of the operatory field, since this installation dehydrates the dental element and temporarily increases its opacity.
  3. Select shade by value and not by hue. When placing a shade guide close to a tooth or applying composite resin increments on its surface, professionals should take a picture and digitally alter to a black and white filter. That way, the coordinates hue and chroma will be eliminated, there remaining only value or luminosity (fig. 7). In case the composite resin increment looks darker than the tooth, the professional can choose a lighter tone in the shade guide (from a value 3 shade, whatever the hue, to a value 2 one).

 

If it is lighter, the professional should do the opposite, and take a new black and white photo, until it looks right. Once the desired value is chosen, the professional may choose hue and a saturation. For example: value 2 was chosen and, if the tooth presents a whiter aspect, the choice will normally be A or B in the Vita guide (A being brownish yellow and B being yellow). If the tooth looks grayish, the professional may choose between C (gray) and D (grayish pink). With that, one avoids the confusion and doubt about different hues and a higher or lower saturation and different degrees of luminosity. The same methodology can be used in other shade guides that can be ordered by value or chroma degrees.

  1. Mapping areas of the tooth: teeth are polychromatic and may have distinct shade aspects in different regions. That should be observed clinically (higher or lower saturation) and with the aid of black and white photographs for areas of high or lower value/luminosity. Besides, professionals should note the degree of translucency in the different areas (incisal, medium and cervical). A black or light-blue piece of cardboard as a background may be used to help confirm that mapping. Many times, a second opinion is of great help before the final decision.
  2. In more complex cases, a quick direct mock-up (restoration without adhesive techniques) may help the definition of the thicknesses of each composite resin material.

Practically, all composites undergo a shade change when lightcured, going from a yellowish tone to a lighter tone. Therefore, it is important that those increments are cured before the photograph and clinical observation. Vittra APS (FGM) composite resin, thanks to its differentiated APS photoinitiators technology, does not show this perceptible shade variation between before and after light-curing. For that reason, it is possible to choose the shade before photopolymerization of the increment in real time.

Enamel (incisal third) and dentin (medium third) composite resin observed in normal photograph and in a black and white one used to help choosing the value of the composite resin.

Direct mock-up with the composites shown in figure 8, simulating the final restoration for a more refined evaluation of the selected shades.

Once the principles of optical properties are known and applied in the clinic in a simple and effective way, with the control over the thickness of the different composite resin

 

layers to be used, it is possible to achieve successful restorations that are esthetically pleasant.

Working towards the best appearance possible for restorations is common place among dental professionals. The article Shade Selection Aspects shows how you can pursue the perfect tooth shade in your office by analyzing the triad: light source, object and observer.

Wīt Essential receives “2020 Top Award Winner” by Dental Advisor

Being granted the “2020 Top Award Winner” honor is the result of a rigorous analysis process that involves 20 to 30 dental professionals responsible for the analysis of the quality and the efficiency of the product, involving many patient applications. Wīt Essential stood out in requirements such as viscosity, whitening speed, easiness of application and […]

SHADE SELECTION ASPECTS

Reaching biomimicry in a simple way with composites at the dental office. Achieving the “perfect shade” in dental clinic is always a challenge for the professional, who needs to rely on the triad: light source, object and observer. Those three factors have critical interaction in the final visual aspect that may determine or not the […]

SHADE SELECTION RECOMMENDATIONS

What steps should one follow to apply the principles of optical properties and achieve the “perfect shade”? Find below a simplified step by step to help you achieve successful restorations.   • The dental office should be lighted with “corrective” light with a color reproduction index of around 90 and average temperatures of 5500K (there […]

Whitening: The first step of any esthetic procedure

Dental whitening is a conservative treatment that offers important results in the harmonization of the patients’ smiles regardless of the technique used. Although this subject has already been extensively studied over the past two decades or more, there are always points that still cause questions and curiosity. The correct recommendation and the right timing to perform the whitening process while the patient is being submitted to a restoration treatment, are some of these questions.

 

For this reason, FGM Dental Group prepared some questions answered by specialists in the area bringing information in a straightforward way to help the readers in their day-to-day in-office procedures.

 

Do patients that will have prosthetic work done on anterior teeth demand whiter teeth? Do they ask about whitening procedures? By Dr. Carlos Francci.

 

Nowadays, in general, all the patients that require prosthetic work for the anterior teeth also seek for whiter teeth. This way it is very common to be inquired about whitening. We have to point out that there are different clinical situations. In a more simple and common situation, when classes III, IV and V restorations will be replaced on anterior teeth, it is essential to whiten teeth previously to the replacement of the restorations. It is important to point out that the restoration replacement can only be done at least one week after the last whitening application due to the reduced adhesion and to the shade stability that must be achieved. Another situation is when a partial prosthetic work is performed only in some anterior teeth. In this situation, it is mandatory to do previous whitening, to define the shade that will be used on the prosthetic pieces. One last situation is specific for prosthetic work with no-prep veneers, where the substrate shade influences the aesthetic result. We always recommend the whitening to be done before in order to obtain the whiter shade with a more translucent ceramic, with more natural chromatic effects.

 

How often do you perform whitening procedures before the prosthetic rehabilitation (crowns, veneers and implants)? By José Carlos Garófalo

 

Every time I am requested a prosthetic rehabilitation work, direct or indirect, and mainly those that do not involve all the teeth structure, it is my protocol to ask the patient if he/she intends to have a previous whitening treatment. I ask that and explain that if the previous treatment is not performed, it will be very difficult to perform it later without running the risk of the restorations color become different from the natural whitened teeth. This way, as a clinic protocol, all the indirect prosthetic rehabilitation works using crowns, veneers and implants tend to start with a dental whitening procedure.

 

Is there any case when the whitening procedure is not recommended before the rehabilitation? By Alessandra Reis Bastos de Oliveira

 

There are rehabilitation cases where some teeth have structure loss with little remainders of the crown and many restorations with indication of a treatment with the use of porcelain crowns. Whitening procedures in these cases are not feasible and unnecessary. I would not recommend whitening procedures in cases with teeth with old and severe chromatic alterations where the color change would not be effective with the whitening procedure and in which a restorative ceramic material that blocks the dark color of the dental substrate would be used.

 

In what step of the restorative treatment (direct and indirect) do you recommend whitening? By Paulo Sérgio Quagliatto

 

One of the worst problems when we intend to restore teeth directly or indirectly, after dental whitening, is the considerable technical difficulty, because the teeth become dehydrated and without the adequate chromatic stability. Another negative factor is the presence of residual oxygen for a period of 7 to 14 days1,2, which makes it difficult for adhesive techniques and consequently the failures in the restorations.

 

Although studies have reported the use of sodium ascorbate as antioxidante3 agent for the completion of restorations in less time than 14 days, it was still observed color instability of the remanescente4. The ideal, therefore, is that if we restore directly with composite resins, adhesion on enamel only, that we wait for 07 days, and if the adhesion is on enamel/dentin, that we wait 14 days after concluding the whitening technique. For indirect techniques, the whitening must be carried out beforehand, and the adhesive cementation should be done 14 days after the procedure is finished.

 

We know that whitening may interfere negatively in the adhesive cementation when

done at the same time (ex.: cementation of the prosthesis during whitening). How

long after whitening do you cement parts? By Fabiano Marson

 

The oxygen released by the whitening action promotes the decrease of the adhesive resistance of direct or indirect restorations to the dental structure, therefore, it is necessary to wait 2 weeks after the end of the whitening to carry out the restoration1. In order to reduce the waiting time from the end of the whitening to the restoration, many authors have recommended the use of different antioxidants, such as sodium ascorbate which has a great reducing potential2-5. However, we should wait a minimum of 14 days to take the shade. Clinical example: we are making ceramic veneers on anterior central teeth and I will take the shade of the adjacent teeth (lateral). If I do that right after the whitening, I would be having as reference a shade with a higher value because the color of the teeth has not stabilized. That way, veneers will be made in a standard that is lighter than the lateral teeth impeding cementation.

 

It will be necessary to send those to the lab for the adjustment of the color.

 


FGM Dental Group Offers Several Whitening Solutions for Clinicians

 

By understanding more about the whitening process, potential complications, and indications, practitioners will be better prepared to make the best recommendations to their patients. Of course, for safe and effective whitening procedures, the most effective products must be selected.

 

FGM Dental Group has developed several highly trusted whitening products for professional use:

 

  • Wīt HP Maxx has been designed as a high-strength whitening gel for in-office whitening. 35% hydrogen peroxide is the whitening agent, and this gel is packaged in pre-dosed portions for convenience. PH is neutral and is maintained throughout the whitening session. This product addresses sensitivity issues with the addition of calcium to prevent demineralization.
  • Wīt HP AutoMixx is a popular option made convenient with an automatic self-mixing system in a single-syringe applicator. The 35% hydrogen peroxide solution is safe for up to 50 minutes of contact without the need to replace the gel. pH is neutral and is maintained throughout the whitening session.
  • Wīt Essential is a take-home treatment available from FGM Dental Group. It is suited to patients who need ongoing whitening treatment at home, under advice from their dental professional. pH is close to neutral to ensure the stability of the gel and safety of the patient. Three concentrations are available, allowing practitioners to make the best recommendations based on unique patient needs. Wīt Essential uses carbamide peroxide as the base active ingredient.

In addition to advanced whitening gels based on FGM Dental Group’s proprietary formulations, Top Dam is offered as a light-curable in-office composite protective barrier that can be used in place of a rubber dam for isolation.

 

FGM Dental Group’s innovation in teeth whitening and commitment to products that are not only highly effective but also incredibly safe for patients, ensures the best solutions for both in-office and at-home whitening today.

 

References / Referencias

 

1 Dishman Mv, Covey Da, Baughan Lw. The Effects Of Per- Oxide Bleaching On Composite To Enamel Bond Strength. Dent Mater 1994; 10: 33–36.

 

2 Briso Al, Rahal V, Sundfeld Rh, Dos Santos Ph, Alexandre Rs.Effect Of Sodium Ascorbate On Dentin Bonding After Two Bleaching Techniques.Oper Dent. 2014 Mar-Apr;39(2):195-203.

Doi: 10.2341/12-054-L. Epub 2013 Jul 12.

 

3 Marson, F.C Et Al. Influencia Do Gel De Ascorbato De Sodio Na Resistencia Adesiva Entre Resina Composta E Esmalte Clareado, Revista De Odontologia Da Unesp. 2007; 36(1): 17-21.

 

4 Briso Al, Toseto Rm, Rahal V, Dos Santos Ph, Ambrosano Gm. Effect Of Sodium Ascorbate On Tag Formation In Bleached Enamel.J Adhes Dent. 2012 Feb;14(1):19-23.

 

5 Berger Sb, De Souza Carreira Rp, Guiraldo Rd, Lopes Mb, Pavan S, Giannini M, Bedran-Russo Ak. Can Green Tea Be Used To Reverse Compromised Bond Strength After Bleaching?. Eur J

Oral Sci 2013; 121: 377–381. 2013 Eur J Oral Sci

 

Esthetic Restorations in Severely Darkened Anterior Teeth using Dental Post in the Root Canal

Authors: Raphael Monte Alto, Juliana Ferreira Batista Pereira, Mariana Ferreira Silva Ventura, Priscilla Carvalhal de Oliveira and Fabrício Perucelli.

 

Darkened teeth are always a challenge in the clinical routine, and when deciding the type of treatment, one should always select the most conservative one. In this context, whitening becomes an interesting alternative. However, due to the great relapse of this type of treatment, the patient usually ends up choosing a more definite solution such as crowns and veneers. Root canal cement must be reliable to create stability for the insertion of a dental post.

 

CASE REPORT

A female patient attended the subject of Integrated Clinic of the Fluminense Federal University (Rio de Janeiro – Brazil) indicated by the Discipline of Orthodontics with the application of an anterior crown with the appropriate format for future orthodontic finalization.

 

Endodontically treated teeth are susceptible to biomechanical failures especially when there is a significant loss of dental structure1. In such cases, the use of intraradicular retainers is necessary, mainly because the remnant structure is insufficient to adequately support and retain the final restoration2,3. Several techniques are available for the restoration of teeth with endodontic treatment and within this context choosing an inadequate method when restoring these teeth may compromise their longevity.

 

The tooth to be restored presented a good amount of coronal structure and conservative endodontic treatment, and the direct technique was indicated (see table 1).

 

The root canal was cleaned and dried with paper cones for the adhesive procedure and light-curing was performed for 40 seconds. With the aid of an insertion tip, Allcem Core dual cement (FGM) was applied in the root canal from the apical region to the coronary chamber.

 

The dental post Whitepost (FGM) DC-E 2 was inserted and the set was light cured for 40 seconds. The excess of the dental post was cut, and the occlusal adjustments were performed. The patient was submitted to periodontal surgery by Professor Ronaldo Barcellos at the Fluminense Federal University (Rio de Janeiro – Brazil). After 90 days, total crown preparation and molding were performed and sent to the laboratory. A total crown was made with composite for CAD/CAM with external characterization. After tests and adjustments, the crown was cemented.

 

Technique Indications Advantages Disadvantages
Direct. Teeth with a lot of coronary remnants. • Single section.
• Low cost.
Large amount of resinous cement.
Anatomical or direct modeling • Teeth with little remnants.
• Broad root canals.
• Single session.
• Low cost.
• Less quantity of cement.
• Less effect of the shrinkage stress.
• Certainty of polymerization of the composite throughout the post.
• Most critical technique.
• Need to create expulsivity in the root canal.

Table 1 – Indications, advantages, and disadvantages of each technique. Table from the book “Reabilitação estética anterior: o passo a passo da rotina clínica (Raphael Monte Alto e Colaboradores)”.


CLINICAL PHOTOS


FGM Products for Esthetic Restoration and Root Canal

FGM Dental Group products were used in this case to provide technical benefits to clinicians as the procedure was underway. Products like Allcem Core are suited to application within the root canal.

 

Allcem Core is a dual-cure resin cement that can be used for several indications beyond the case discussed in this report. These include, preparing a crown or core build-up, or performing indirect restorations like inlays, onlays, and overlays. It’s a suitable resin cement for prosthetic crown restoration procedures and works with composite, metal, metal-ceramic, and all-ceramic crowns. Intraradicular posts, whether made from carbon, quartz and metal, or fiberglass, can be used with this highly effective dental cement.

 

Allcem core is applied directly inside of the root canal. When set, it offers superior resistance to bending and compression. Clinicians appreciate the handling properties because it adheres to any substrate used for restorative and esthetic procedures.

 

The Dental post, Whitepost DC-E 2 was detailed in the case report. Used in conjunction with dental cement, Whitepost offers a suitable base for the final crown procedure. Whitepost is an esthetically compatible product that features a double tapered design and excellent fracture resistance. It is also radiopaque, making it suited to x-ray imaging during follow up consultations to evaluate the success of a procedure.

 

FGM Dental Group provides the most reliable dental products used for procedures ranging from simple dental esthetics to complicated and intensive dental restoration. From cements used in the root canal to resinous matrix core posts like Whitepost, FGM is a reliable supplier of safe and innovative solutions for practitioners.

 

Confirmed! Wīt HP Maxx is the most stable and alkaline whitener gel in the Market

Dental whitening is one of the most wanted for procedures for the improvement of the aesthetics of smiles, and it is considered a safe, efficient and conservative method.  However, according to the literature, the application of whitening agents on the dental surface may lead to morphologic alterations on enamel surface due to the oxidizing process […]