Journal of Esthetic and Restorative Dentistry最新文献

Objectives: To histologically evaluate peri-implant inflammatory responses associated with varying restorative emergence angles and to assess differences between buccal and lingual implant sites.

Materials and methods: Six healthy male mongrel dogs received four bone-level implants (3.8 × 7 mm) per hemi-mandible in the posterior mandible. Customized abutments with standardized restorative angles of 20°, 40°, 60°, and 80° were immediately connected. After 24 weeks, all implants were retrieved for histological processing and quantitative analysis of inflammatory cell infiltration within three defined peri-implant soft tissue regions. A linear mixed-effects model was used to compare the groups to account for within-subject correlations.

Results: Histological sections were obtained for all specimens (N = 48). Inflammatory cell counts increased progressively with wider restorative angles, demonstrating a significant dose-dependent relationship (p < 0.001). At buccal sites, inflammation remained low up to 40° (20° = 3%; 40° = 6%) but increased sharply at 60° (≈10%) and 80° (≈13%) (p < 0.001), indicating a threshold beyond which wider emergence angles markedly intensified the inflammatory response. Lingual sites exhibited a similar, though less pronounced pattern. Values were stable up to 40° (20° = 4%; 40° = 3.1%), followed by a moderate rise at 60° (≈7%) and a pronounced increase at 80° (≈12%) (p < 0.001). When both aspects were analyzed together, significant angle-by-site interactions emerged at 40° and 60°, indicating a consistently higher inflammatory response on the buccal compared with the lingual side.

Conclusions: Wider restorative emergence angles (> 40°) are associated with increased peri-implant inflammatory cell infiltration, particularly at buccal sites.

Clinical relevance: Wide restorative emergence angles (> 40°) favor peri-implant inflammation, potentially compromising the long-term stability of peri-implant tissues.

Objective: This study evaluated the effect of chlorinated water on the color stability of different resin composites, simulating prolonged exposure experienced by frequent swimmers.

Materials and methods: Sixty disk-shaped samples of microhybrid (Arabesk Top), nanohybrid (Grandio) and Ormocer-based (Admira Fusion) composites (n = 20) were prepared. Each group was randomly divided into two subgroups, immersed in either chlorinated (≈3.5 ppm) or distilled water. Spectral reflectance was measured at baseline, 2 weeks, and 2 months using a Datacolor 600 spectrophotometer, and CIE L*a*b* coordinates were calculated using the 2° standard observer. Color stability was assessed with CIEDE2000 (ΔE₀₀) and the Whiteness Index for Dentistry (WI_D). Two-way MANOVA analyzed the effects of composite type, storage medium, and their interaction with Bonferroni-adjusted post hoc tests (α = 0.05).

Results: All ΔE₀₀ and ΔWI_D values were below the acceptability thresholds, though several exceeded perceptibility. Composite type and storage medium significantly influenced ΔE₀₀ and ΔWI_D (p < 0.05) with interactions. Overall, at 2 weeks, Admira (p < 0.001) and Grandio (p = 0.008) showed greater ΔE₀₀ in chlorine; Admira exhibited higher ΔWI_D in chlorine than control (0-2 m p = 0.001; 2 w-2 m p < 0.001).

Conclusion: Chlorinated water caused greater short-term discoloration in the Ormocer-based composite, whereas the nanohybrid showed superior long-term stability. The microhybrid composite presented progressive ΔE₀₀ increase with highest ΔWI_D.

Objectives: To evaluate the influence of head posture on the accuracy of occlusal contacts at maximum intercuspal position (MIP) recorded by an intraoral scanner.

Methods: Occlusal contacts of 46 individuals were initially located using articulating film (8 μm, Accufilm, FastCheck; Parkell). The located contacts were digitized with an intraoral scanner (IOS, Trios 4; 3Shape) by obtaining maxillary and mandibular scans. Bilateral virtual occlusal records in MIP were acquired by setting the dental chair in two different positions: upright (90° to the horizontal plane) and supine (0° to the horizontal plane). In both positions, occlusal contacts were also recorded using a digital occlusal analysis system (T-Scan Novus, Tekscan). Two calibrated examiners evaluated occlusion attribution, using the digitized contacts from the articulating film as the reference. Statistical analysis was performed using one-way ANOVA followed by pairwise multiple comparisons (α = 0.05).

Results: Head posture did not significantly affect the proportion of coinciding occlusal contacts at MIP between the reference and those identified by the IOS and the digital occlusal analysis system, both for the full arch and individual sections. The digital occlusal analysis system, however, recorded a higher number of false occlusal contacts in the supine position compared to the upright position.

Conclusions: The use of IOS to locate the occlusal contacts at MIP was not impacted by the evaluated head postures. In contrast, head posture had a significant effect on the recordings obtained with the digital occlusal analysis system.

Clinical significance: Intraoral scanning provides reliable MIP acquisition in both upright and supine positions. However, digital occlusal analysis is sensitive to changes in head posture; therefore, recording in the upright patient position is recommended for greater accuracy.

Objective: This study aimed to evaluate the tensile bond strength of polyetheretherketone (PEEK) hybrid abutments bonded to titanium (Ti) and chromium-cobalt (Cr-Co) bases using two adhesive systems or the heat-pressing technique.

Materials and methods: Ninety PEEK abutments were fabricated using titanium or cobalt-chromium bases: 60 milled from BioHPP blocks and cemented with MKZ Primer-DTK or Monobond Plus-Multilink Hybrid (n = 15) and 30 produced by heat-pressing technique. Tensile bond strength was measured and failure modes were evaluated under a stereomicroscope. Statistical analysis was performed using two-way robust ANOVA with Bonferroni correction (α = 0.05).

Results: Both the bonding method and the interaction between method and base materials had a statistically significant effect on bond strength (p < 0.001). The heat-pressing technique resulted in higher bond strength than the resin cement groups (p < 0.001). The highest bond strength was observed in the Cr-Co heat-pressed group (124 MPa) (p < 0.001). All failures in the cemented groups were adhesive type. In the Cr-Co heat-pressed group, failures were cohesive and mixed. In the titanium heat-pressed group, failures were adhesive and mixed.

Conclusion: The heat-pressing technique significantly improved the bond strength of PEEK abutments compared with resin cementation. Cr-Co bases also demonstrated favorable bonding with PEEK using the heat-pressing technique.

Clinical significance: The heat-pressing technique improved the bond strength of PEEK abutments to titanium and cobalt-chromium bases.

Objective: To examine which prosthetic factors, including design, materials, and cleansability, may influence the onset of peri-implant diseases.

Materials and methods: The Spanish Society of Periodontology (SEPA) convened a group of experienced periodontists, prosthodontists, and laboratory technicians to develop clinical recommendations based on expert consensus.

Results: Emerging evidence highlights the importance of prosthetic design, implant positioning, and material selection in mitigating biological complications. Notably, access for self-performed oral hygiene is a significant predictor of peri-implant health, and designs that facilitate cleaning and prosthetic configurations that minimize plaque accumulation are favored. Additionally, the use of less porous materials, such as zirconia, has been shown to improve soft tissue integration and plaque control. Other critical considerations include minimizing prosthetic manipulation and ensuring optimal implant-abutment connections to prevent bone loss.

Conclusions: This review presents clinical recommendations on prosthetic design, material selection, and implant placement in order to reduce the risk of peri-implant diseases. Future research should focus on refining these strategies and evaluating the long-term effectiveness of digital manufacturing techniques in improving prosthetic accuracy and reducing the incidence of disease.

Clinical significance: Peri-implant diseases, including peri-implantitis, are major concerns in implant dentistry, often linked to suboptimal prosthetic designs and maintenance. This review underscores the importance of prosthetic design in preventing such diseases. Clinicians should prioritize prosthetic configurations that enhance accessibility for self-performed oral hygiene. Furthermore, proper implant positioning in a 3D prosthetically driven position is essential for preventing peri-implant complications. Additionally, the choice of materials, such as ceramic-based and zirconia prostheses, can influence plaque accumulation and soft tissue health. Regular follow-ups and patient education on maintaining good oral hygiene are critical for the prevention of peri-implant diseases. Finally, the increasing use of digital technologies in implant placement and prosthesis manufacturing offers the potential for improving accuracy and minimizing prosthetic misfits, which may further reduce the risk of disease. Future research is needed to explore the impact of digital tools on peri-implant health and to refine best practices in prosthetic design and material selection.

Objective: Comprehensive rehabilitation for multifactorial dental disease requires coordinated planning across restorative/prosthodontic, periodontal, endodontic, and orthodontic disciplines. Existing tooth-level prognostic tools typically focus on single domains and therefore offer limited guidance for interdisciplinary decision-making or for communicating expected effort and cost.

Overview: This paper proposes the Restorative Value Score (RVS), an objective 0-5 tooth-level index that summarizes, in one number, the amount and complexity of care needed to return a tooth to predictable function and esthetics within a comprehensive plan (with 0 indicating no treatment and 5 indicating extraction). The intermediate categories reflect the breadth of disciplinary involvement and the requirement for more advanced interventions. These interventions are linked to greater time, cost and procedural risk. The RVS is intended to complement-rather than replace-patient-level risk assessment, and should be interpreted in light of systemic, behavioral, and socioeconomic determinants, clinician expertise, and adherence to supportive care. This paper outline the construct and scoring logic, offer guidance for implementation, and propose prospective validation to assess discrimination, calibration, and clinical utility relative to existing tooth- and implant-based alternatives.

Conclusion: By making effort and complexity explicit at the tooth level, the RVS seeks to reduce unwarranted variability, improve predictability and cost-effectiveness, and furnish a common language for clinicians, educators, and patients engaged in multidisciplinary dental care.

Objective: This article aims to describe the clinical execution and management of a full-mouth rehabilitation in a patient with severe tooth wear, utilizing partial and full-contour lithium disilicate restorations, with a long-term follow-up of 11 years and 6 months.

Clinical considerations: Over a follow-up of more than 11 years, this case provides in-depth clinical insight into identifying etiological factors, reestablishing the vertical dimension of occlusion, and implementing lithium disilicate restorations in both partial- and full-contour designs. It also addresses the management of underlying conditions and outlines the challenges encountered during long-term follow-up of a full-mouth rehabilitation for severe tooth wear.

Conclusions: The full-mouth rehabilitation using partial and full-contour lithium disilicate restorations for severe tooth wear demonstrated a favorable outcome. At 11+-year follow-up, the case exhibited appropriate mechanical behavior, preserved esthetic outcomes, and functional integrity, addressing the complex multifactorial etiological factors associated with tooth wear.

Clinical significance: Long-term success in rehabilitating patients with severe tooth wear relies not only on appropriately indicated and executed restorative treatment but also on an interdisciplinary approach that includes effective management of underlying etiological factors and parafunctional habits.

The cover image is based on the article From Virtual Maxillomandibular Relationship Determination to Clinical Implementation for Digital Functional-Esthetic Rehabilitation in Severe Generalised Tooth Surface Loss by Yiqiao Wang et al., https://doi.org/10.1111/jerd.70014.

Objectives: The masking ability of printed zirconia over discolored backgrounds is unknown. This study assessed the impact of method of manufacturing, thickness, and the method of surface treatment on the color masking ability of zirconia.

Materials and methods: Forty 0.5 mm × 10 mm and 40 1 mm × 10 mm zirconia disks (Dental Direct Medical Zirconia, Germany) were designed, fabricated using a milling machine (DWX-51D, Roland DGA, Irvine, CA) and a 3D printer (AON 3D printer; ZIPRO dentistry; South Korea), and divided into eight groups: (1) printed-polished, (2) printed-glazed, (3) milled-polished, and (4) milled-glazed. ΔE₀₀ values between each group and substrates made of natural die composite resin (IPS, IvoclarVivadent, Schaan, Liechtenstein) in shades of ND₁ (control), ND₃, ND₅, and ND₉ were measured. Data were analyzed using three-way ANOVA and Games-Howell tests (α = 0.05).

Results: Printed zirconia with either thickness showed a better masking ability as compared to their milled zirconia. Milled zirconia (0.5 mm) showed the highest ΔE₀₀ values (ND_3-1: 1.70, ND_5-1: 3.62, ND_9-1: 6.46), while 1 mm printed zirconia had the lowest ΔE₀₀ values (ND_3-1: 0.73, ND_5-1: 1.71, ND_9-1: 3.04). Moreover, ΔE₀₀ values of printed zirconia were below the acceptability threshold (< 1.8) for ND₃ and ND₅ substrates, except for 0.5 mm zirconia against the ND₅ substrate.

Conclusion: All zirconia specimens showed clinically acceptable masking ability against a normal dentin shade (ND₃) (< 1.8). Also, printed zirconia (1 mm) against ND₃ substrate showed the highest masking ability. Moreover, only 1 mm printed zirconia over a darker shade of dentin (ND₅) showed a clinically acceptable color difference. However, no zirconia specimen could mask severely discolored dentin (ND₉).

Objective: This review summarizes recent advances in three-dimensional (3D) printing for removable prosthodontics, including complete dentures, removable partial dentures, implant-retained overdentures, and occlusal splints. The aim is to provide clinicians with an overview of current technologies, clinical performance, and future perspectives.

Overview: While subtractive methods are well established, additive manufacturing has recently gained exponential importance, especially in removable restorations. Vat-photopolymerization resins are widely applied for denture bases, teeth, and occlusal splints, while laser sintering enables fabrication of metal frameworks and implant attachments with high accuracy. Clinical studies indicate that printed complete dentures achieve outcomes in adaptation and patient satisfaction comparable to conventional or milled prostheses, with reduced appointment numbers and digital reproducibility. Removable partial denture frameworks and implant-overdenture attachments fabricated by selective laser melting demonstrate promising accuracy and mechanical properties, though process variability and post-processing remain critical aspects. Printed occlusal splints are widely adopted and offer adequate fit and comfort, though material-related challenges and limited long-term data are concerns.

Conclusions: 3D printing emerges as a reliable option for removable dentures, frameworks, and occlusal devices. Future developments in multi-material printing, durable and bioactive resins, and standardized clinical protocols will further define its role in prosthodontics.

Clinical significance: 3D printing is transforming removable prosthodontics. Clinicians can already benefit from streamlined workflows, a standardized process chain, reduced treatment time, and the ability to reproduce dentures, while patients gain from improved comfort and fewer visits. Awareness of material limitations and processing-related specifics remains essential for long-term success. Looking ahead, multi-material printing-allowing simultaneous fabrication of denture bases, teeth, and maybe frameworks-holds promise for improving structural integrity, esthetics, and overall clinical efficiency.