Journal of Esthetic and Restorative Dentistry最新文献

Objective: This article aims to describe a systematic method for tooth color reproduction with ceramics restorations employing artificial intelligence (AI) software named Matisse. It provides a comprehensive analysis of the entire process, beginning with shade-taking and extending to ceramic application in a complex clinical case in the anterior region-specifically, a single central restoration supported by an implant.

Clinical considerations: The clinical case presented highlights the potential of Matisse software for generating ceramic (inSync-Jensen Dental, USA) and staining (Miyo-Jensen Dental, USA) recipes over a zirconia abutment (Katana-Noritake Dental, Japan). This approach achieves an optimal single central restoration utilizing CAD-CAM and layering techniques.

Conclusions: The systematic method employing the Matisse software achieved accurate color reproduction for a single central restoration supported by an implant. This result was achieved by the dental ceramist within the first attempt and without seeing the patient in the entire process.

Clinical significance: The Matisse AI-assisted protocol offers a systematic and scientifically grounded method for color reproduction in dentistry for indirect restorations.

Objective: To determine the clinical performance of partial coverage restorations (PCR) (onlays, occlusal veneers, and partial crowns) composed of different ceramic and ceramic-based materials to treat extended posterior defects.

Materials and methods: MEDLINE, Scopus, CENTRAL, ClinicalTrials.gov, and the International Clinical Trials Registry Platform were searched (inception-February 2024) for randomized controlled trials (RCT) comparing posterior PCRs composed of different ceramic and ceramic-based materials with a minimum follow-up of 1 year.

Results: Six RCTs were included. Resin matrix ceramic (RMC) and lithium disilicate (LDS) restorations had a 3-year survival rate of 89.3% (95% CI 76.4-95.3) and 93.7% (95% CI 83.7-97.7), respectively, and leucite-reinforced glass ceramic (LRGC) restorations a range between 96.1% (95% CI 90.1-98.9) compared with RMC and 98.3% (95% CI 90.8-100) compared with LDS. After 1-3 years of follow-up, LDS slightly outperformed RMC on restoration failure and loss of retention (1.56 more failures and 1.78 more loss of retentions for RMC per 100 restoration-years [low certainty evidence]). No statistically significant differences between ceramic and ceramic-based materials were detected in short-term follow-up (1-3 years of follow-up). The long-term performance of posterior PCRs is uncertain.

Conclusion: The survival of LDS restorations may slightly outperform RMC restorations after 3 years of follow-up across outcomes, except for bulk fracture. RCTs providing medium to long-term data are needed.

Clinical significance: Ceramic and ceramic-based PCRs are a reliable treatment option to restore extended posterior defects.

Objective: Computer-aided implant placement (CAIP) offers improved accuracy and reduced invasiveness. However, traditional static CAIP (sCAIP) protocols for complete-arch restorations often involve multiple guides and clinical steps, increasing the risk of soft tissue trauma and procedural complexity. This article introduces the B-guide technique, which integrates implant placement and interim prosthesis delivery into a single device to simplify the procedure and minimize tissue damage.

Clinical considerations: The B-guide combines the implant osteotomy and placement guide with an abutment placement and prosthesis pick-up mechanism. The guide remains in place post-implantation, allowing immediate prosthesis conversion. A 55-year-old female patient underwent complete-arch rehabilitation using the B-guide, enabling immediate implant placement and loading. The B-guide minimized soft tissue trauma and eliminated the need for multiple guides, significantly reducing treatment complexity and time.

Conclusions: The B-guide simplifies procedures and improves predictability compared with traditional systems by integrating prosthetic adaptation and implant placement, reducing cumulative errors. However, its success is heavily reliant on the operator's expertise, especially in preoperative planning and design.

Clinical significance: By integrating implant and prosthesis placement into a single guide, the B-guide reduces surgical complexity, minimizes trauma, and enhances prosthetic outcomes, improving clinical efficiency.

Objective: To investigate the surface roughness on cementoenamel junction after application of various rubber-dam retraction clamps for different durations.

Materials and methods: Fifty-four extracted human molar teeth were used. Various retraction clamps were placed on the cementoenamel junction. There are three main examination groups in the study. Group 1 (n = 6) included a polymer clamp (SoftClamp, Kerr Hawe, Switzerland), Group 2 (n = 6) included a metal clamp with a flat edge (Black Line RDCM7X, Hu-Friedy Group, USA), and Group 3 (n = 6) included a metal clamp with a serrated edge (Fiesta Color Coded, Coltene, USA). All clamps were applied for 30 min, 1, and 2 h. Surface roughness measurements were performed using a profilometer before and after the clamp application and surface morphology was assessed through the SEM images. One-way ANOVA was used to compare three or more groups. Percentage changes were evaluated using the Kruskal-Wallis test, followed by Dunn's test for post hoc analyses. The deemed significance was set at p < 0.05.

Results: Between the initial and the final roughness measurements, after 30 min of clamp application, only Group 3 showed significant increases in roughness (p = 0.001). After 1 and 2 h of clamp application, there were significant increases in roughness for all groups. No significant differences in percentage changes for all groups in 30 min and 2 h of application (p = 0.220 and p = 0.091, respectively). However, Group 1 presented significantly lower surface roughness in percentage after the 1 h of application (p = 0.040). No significant differences in the percentage changes in roughness were observed within the groups for 30 min, 1, and 2 h applications (p = 0.220, p = 0.884, and p = 0.755 for Groups 1, 2, and 3, respectively). In SEM analysis, deep point microstructure defects were seen as the clamp application time increased.

Conclusions: Rubber-dam clamp application may cause damage to the cementoenamel junction area. However, the level of damage is clamp-type-dependent. Slight scratch-type damages were observed on teeth with plastic clamps, while metal clamps generally caused cracks. The increase in the duration of the same rubber-dam clamp application was not considered an effective factor regarding the damage.

Clinical significance: During rubber-dam isolation, clamp type and duration of the application may cause damage to the tooth surface or progress an existing defect. Examining the teeth before selecting the clamp might be beneficial for minimizing dental tissue damage.

Objective: This review aims to evaluate the current understanding and clinical applications of machinable ceramic-reinforced composites (CRCs) and the emerging first generation of 3D-printed CRCs in dental restorations.

Overview: Machinable CRCs, introduced over a decade ago, have shown moderate success in short- to medium-term clinical applications, particularly in low-stress areas. However, their long-term durability limitations, such as increased wear and marginal deterioration, restrict their use in high-stress situations and full crowns. The first generation of 3D-printed CRCs offers customization advantages but is still in early development and exhibits lower mechanical strength and higher wear rates than CAD-CAM CRCs and traditional ceramics. Additionally, the classification and definitions surrounding CRCs remain ambiguous, as ADA categorizations do not clearly differentiate CRCs from ceramics, complicating clinical indication, usage, and billing practices.

Conclusion: Machinable CAD-CAM CRCs are moderately successful in low-stress applications, while 3D-printed CRCs show limitations in wear resistance and durability, raising concerns for their use in definitive restorations. Both require further research and clinical validation.

Clinical significance: Machinable CAD-CAM CRCs are best suited for low-stress applications, while 3D-printed CRCs may be more appropriate for provisional use. Until long-term clinical data are available, ceramics should be preferred for high-stress or full-coverage restorations. Clearer definitions for porcelain/ceramic and comprehensive application guidelines are urgently needed to support clinician decision-making and improve patient outcomes.

Weissheimer A, Pham J, Tong H, Akyalcin S. Esthetic outcomes in orthodontics through digital customization with a lingual appliance system. J Esthet Restor Dent. 2024;36(9):1267-1280. doi:10.1111/jerd.13244

https://onlinelibrary.wiley.com/doi/abs/10.1111/jerd.13244

Objective: This article describes a clinical protocol utilizing soft tissue augmentation alone or in combination with guided bone regeneration (GBR), introducing simultaneous application of the one abutment one time concept for three-dimensional reconstruction of the deficient ridge.

Clinical considerations: Soft and hard tissue quality and dimensions are fundamental elements for long lasting results in implant dentistry. Different techniques have been described for soft and hard tissue augmentation at time of implant placement presenting favorable results. However, multiple abutment disconnections during the prosthetic phase of treatment can compromise the results achieved during surgery. The purpose of this article is to present a surgical protocol that allows three-dimensional ridge reconstruction involving soft tissue augmentation alone, or in combination with hard tissue augmentation in one single step with the use of an one-time intermediate abutment as an anchorage device for the regenerative materials. Two clinical cases utilizing the proposed protocol are also presented, demonstrating favorable results.

Conclusions: The application of the proposed protocol simplifies the surgical phase of treatment, protects the achieved result and enables a favorable outcome in decreased time.

Clinical significance: Utilising an intermediate abutment as an anchorage device at time of surgery can be proven an easy to apply and biologically favorable alternative way to other methods of soft tissue graft stabilization proposed in the past.

Objective: To evaluate the effect of staining, glazing, and polishing of stabilized zirconia with 5 mol% of yttrium oxide (5Y-TZP) on the wear behavior of opposing tooth enamel.

Materials and methods: The plane specimens of 5Y-TZP were divided into 6 groups (n = 10), according to surface treatment: as sintered, staining, glazing, polishing, staining followed by glazing, and staining followed by polishing, and positioned against tooth enamel during the two-body wear test (20 N, 2 Hz, until completing 300,000 cycles). The wear rates of tooth enamel were evaluated using a profile projector and a digital pachymeter as a measure of vertical height loss. The data were analyzed by one-way ANOVA and a Tukey post hoc test (α = 0.05).

Results: Polishing reduced the vertical height loss (p < 0.001) while there was no difference among other groups.

Conclusion: Polishing is recommended as a finishing procedure to reduce the wear rates of tooth enamel, and finishing procedures (glazing or polishing) performed after staining did not affect the vertical height loss of tooth enamel.

Clinical significance: Polishing is the recommended finishing procedure for preshaded 5Y-TZP to reduce the wear rates of opposing tooth enamel. Staining is applied to the occlusal surface to reproduce the pigmented groove appearance, and glazing or polishing performed after staining did not affect the wear rates of opposing tooth enamel.

Objective: This study proposes an updated method for the film thickness of 21 resin composites used as cements.

Materials and methods: A load of 30 N was subjected to two glass plates stacked on a heated base to simulate clinically relevant pressure and temperature during the seating of inlays/onlays/veneers. The axial position of the actuator was recorded before and after placing 22.15 mm³ of resin composite between the glass slides. The difference between the two measurements was calculated for each specimen. A total of 18 condensable restoratives, 1 injectable restorative, and 2 resin cements were tested, 5 specimens each (n = 5, N = 105). One-way ANOVA was performed for both variables and Games-Howell post hoc test was used for pairwise comparisons.

Results: The film thickness range was 6-200 μm, with the lowest values for restorative composites (AP-X, Z250, and Herculite XRV Incisal LT with 6-8 μm), followed by Gradia Direct (25 μm) and flowable/injectable composite resins, including designated cements (15-27 μm). Inspiro, Ultradent Transcend Universal, and ENA Hri dentin stood below 50 μm (range 28-49 μm). The other materials (range 81-200 μm) cannot be recommended for thermo-modified cementation.

Conclusions: The initial viscosity of restorative composites is not an indication of the film thickness when used for thermo-modified cementation. There is a wide choice of appropriate materials available on the market.

Clinical significance: Some restorative composites are able to generate very thin films and can be used as cement with numerous advantages when compared to designated flowable or dual-cure cements.

Objective: To provide a guide for conducting systematic reviews and meta-analyses in dentistry, with emphasis on translating research findings into clinical practice.

Overview: Systematic reviews are essential tools for synthesizing research findings and translating evidence into clinical practice. These reviews help to identify the most effective treatment options and to determine areas requiring further research. A structured approach, including defining a concise research question, conducting comprehensive literature searches, and assessing the risk of bias, is critical for ensuring the review's trustworthiness. The GRADE approach facilitates the assessment of the certainty of evidence, which is crucial for formulating conclusions and making informed clinical decisions.

Conclusion: Systematic reviews provide invaluable insights into clinical decision-making by compiling, analyzing, and synthesizing multiple primary studies. Following a rigorous methodology ensures that systematic reviews are comprehensive, unbiased, and clinically relevant, ultimately contributing to better patient care and achieving better clinical outcomes.

Clinical significance: Methodologically sound systematic reviews and meta-analyses provide clinicians with high-quality, synthesized evidence, enabling informed clinical decisions and improved patient outcomes. They save time by consolidating research, informing treatment choices, and facilitating the translation of knowledge into clinical practice.