Journal of Esthetic and Restorative Dentistry最新文献

Objective: This case report illustrates a clinical scenario of a patient with insufficient crowns, gold onlays and localized tooth pain in the posterior teeth, treated with partial and full coverage lithium disilicate restorations.

Clinical considerations: A female patient presented in the clinics, complaining about tooth pain and unesthetic metal restorations. After a thorough examination, diagnosis and treatment plan, the existing restorations were removed, and a defect-oriented preparation was done to preserve as much as possible of the remaining tooth structure. Final partial and full coverage lithium disilicate restorations were delivered. After a 10-year follow-up no biological complications were observed. Nevertheless, one major chipping was observed in one of the upper molars. This technical complication was resolved with the fabrication of a new ceramic restoration.

Conclusion: Lithium disilicate ceramic posterior full- or partial-coverage restorations are a reliable and predictable treatment option not only for the replacement of tooth structure lost due to caries but also for the replacement of insufficient restorations.

Clinical significance: The following key factors are to be considered to pursue long-term success with ceramic restorations: patient selection, minimal invasive tooth preparation, appropriate material selection and cementation. Nevertheless, complications are to be expected, and the patient should be informed accordingly.

Objectives: To review the factors that impact the accuracy of intraoral scanners (IOSs) when fabricating tooth-supported restorations.

Overview: Factors can have a different impact on IOS accuracy depending on the scanning purpose. If the goal is to fabricate tooth-supported restorations, it is essential to review the following operator-related factors: IOS technology and system, scan extension and starting quadrant, scanning pattern, scanning distance, and rescanning methods. Additionally, it is critical to interpret the following patient-related factors differently: edentulous spaces, presence of existing restorations on adjacent teeth, and characteristics of the tooth preparation (build-up material, geometry, total occlusal convergence [TOC], finish line location, and surface finishing), and interdental spaces (between tooth preparations or between preparation and the adjacent tooth).

Conclusions: For crown or short-span fixed dental prostheses, a reduced scan extension is recommended. For complete-arch scans, it is advisable to start the scan in the same quadrant as the preparation. If the IOS permits locking the scan, rescanning may be indicated. Restorations on tooth preparations and adjacent teeth reduce accuracy. The simpler the geometry and the larger the TOC, the higher the IOS accuracy. Intracrevicular finish lines result in lower accuracy than equigingival or supragingival positions. Air-particle procedures showed better accuracy than coarse and fine grit and immediate dentin sealing. The greater the space between a preparation and the adjacent tooth, the better the accuracy.

Clinical implications: Dental professionals must understand and handle the factors that impact the scanning accuracy of intraoral scanners differently depending on the purpose of the scan.

Objectives: This systematic review aimed to assess the impact of printing orientation on the accuracy and properties of additively manufactured provisional restorations.

Materials and methods: A systematic literature search databases (PubMed, Scopus, Web of Science, and Cochrane) were conducted in July 2024 without language restrictions. The included studies were evaluated using the modified CONSORT checklist, and the effect measures and synthetic methods were employed to assess the accuracy of resin provisional restorations printed at various orientations.

Results: The web search resulted in 8228 records, and 15 records were ultimately included in the analysis. The printing orientation of provisional restorations has an impact on various factors such as the internal and marginal gap, trueness, precision, and accuracy. To achieve optimal results, it is recommended to utilize printing orientations of 180°, 150°, and 210°, as they showed lower marginal and internal gaps and higher accuracy. Caution should be exercised during the virtual positioning of supporting pillars, as this may also influence the overall accuracy.

Conclusions: Horizontally and slightly tilted orientations have demonstrated superior accuracy. To achieve optimal results, factors such as printing layer thickness, printing technology, materials, and supportive pillars should be taken into consideration, besides the printing orientations.

Clinical significance: The selection of the optimum printing parameters overall printing orientations, layer thickness, and supportive pillar position can generate prosthetic and restorative dental parts with a long survival rate, saving time and effort by avoiding fracture, loss of retention, and consequent clinical complications.

Objectives: This web-based survey, conducted across multiple countries, sought to explore the factors that impact the decision-making of clinicians when it comes to managing defective direct restorations.

Methods: A survey consisting of 14 questions was sent out to dentists in 21 countries through various online platforms. The survey consisted of two sections. The first contained five questions about demographic information, while the second involved eight clinical scenarios. In the second part, participants were tasked with deciding whether to repair or replace defective composite and amalgam restorations.

Results: Three thousand six hundred eighty dental practitioners completed the survey. For composite restorations, repair was preferred in scenarios like partial loss or fracture (RR:0.72; 95% CI: 0.58, 0.89; p = 0.002), whereas replacement was favored for secondary caries (RR:2.43; 95% CI: 1.87, 3.16; p < 0.001) and open/defective margins (RR:3.93; 95% CI: 2.68, 5.76;p < 0.001). Amalgam restorations were mostly replaced across all scenarios. The main factors influencing decision-making were caries risk, restoration size, and patient oral hygiene. Substantial heterogeneity was observed across countries.

Conclusion: This study underscores the complexity of the decision-making process and the need for evidence-based guidelines to inform clinicians' decisions regarding restoration management. Patient-level factors predominantly influence decision-making, emphasizing the need for individualized approaches.

Clinical significance: The study reveals that the material type in the original restoration is a critical determinant, with composite restorations being repaired in specific scenarios, while amalgam restorations are consistently replaced across different countries. Key patient and tooth-level factors, such as high caries risk, poor oral hygiene, and restoration size, significantly impact clinicians' decisions, often favoring replacement over repair. These findings underscore the necessity for evidence-based guidelines to assist clinicians in making informed choices, ultimately enhancing the quality of patient care.

Objectives: To measure difference in tooth shade and color achieved via two different over-the-counter bleaching agents with and without their associated light-emitting diodes (LEDs).

Methods: A total of 84 extracted human anterior teeth were randomly divided into seven groups. Gypsum models were made with 6 extracted teeth in an arch form (n = 12; 2 arches/group). Samples were kept hydrated throughout treatment (25°C). Bleaching treatment followed manufacturers' instructions with at least 1-h of rehydration between treatments. Control tooth arches were left untreated. L*a*b* values were measured with a Vita Easyshade (VITA North America, Yorba Linda, CA) three times per tooth using white and black backgrounds. ∆E (CIE 2000) was compared between and within treatment groups over time with ANOVA and post hoc Tukey (a = 0.05).

Results: Subgroup testing confirmed the data were normally distributed. Two-way ANOVA showed significant interaction between product (Control, Crest, Snow) and treatment (light only, product only, light and product) on ∆E values for black (p-value < 0.001, F = 15.28) and white (p-value < 0.001, F = 13.62) backgrounds. Post hoc pairwise Tukey tests showed a significant effect of light-and-product treatments in contrast to light- or product-only treatments. Repeated measures ANOVA of between-treatment change (∆E) by product showed significant interaction between time and treatment for Snow products (p < 0.001, F = 10.9) and independent effects of time and treatment for Crest products (Time: p-value < 0.001, Treatment: p-value < 0.01, F = 7.21) on a black background. On white backgrounds, only a significant effect of treatment was reported for both Snow (p-value < 0.01, F = 5.427) and Crest (p-value < 0.001, F = 5.61).

Conclusions: Overall, a combination of light and gel produces significantly higher tooth color and shade change over time, with the highest change seen for Snow products.

Statement of significance: Many patients use over-the-counter tooth bleaching products because they are more cost effective and easier to access than in-office bleaching. However, these products may have adverse effects, such as increased sensitivity with repeated use, in addition to increased consumption of time and money. This project measured tooth shade between treatments which can help determine which product is most effective for at home use.

Objective: This study aimed to evaluate, through a case report combined with in vitro study, whether a new diagnostic white tip for the transillumination technique during resin infiltration influences the procedure and degree of conversion (DC).

Materials and methods: A clinical case report demonstrated resin infiltration using the transillumination technique with a new white diagnostic tip (Radii Xpert LED diagnostic tip, SDI, Bayswater, VIC, AU) along with a light-curing device to enhance aesthetic results. An in vitro study assessed the DC of two diagnostic white tips (Radii Xpert LED diagnostic tip [SDI, Bayswater, VIC, AU] and Valo Grand White Light Lens [Ultradent Prod., South Jordan, UT, USA]) compared to that achieved using conventional tips of both light-curing devices. Statistical analysis was performed using two-way ANOVA and Tukey's test (α = 0.05).

Results: The clinical case achieved complete masking of the white spot lesion. In vitro, the diagnostic white tips exhibited significantly lower DC values compared to conventional tips (p = 0.001), regardless of the light-curing unit.

Conclusions: The diagnostic white tip used in the transillumination technique improves resin infiltration visibility without compromising the degree of conversion.

Clinical significance: The transillumination technique with the diagnostic white tip enables monitoring of resin infiltration while maintaining effective polymerization.

Objective: This clinical case describes a digital workflow using face scans and CAD/CAM technology for a full-mouth rehabilitation with increased vertical dimension of occlusion (VDO) with adhesive lithium disilicate restorations after 9 years.

Clinical considerations: A healthy, 46-year-old man displaying severe tooth wear, underwent an extensive full-mouth rehabilitation involving an increase of the VDO through laminate veneers and adhesive partial coverage lithium disilicate restorations. Anatomical landmarks of the face and reference planes were captured using a digital face scanning system. The anatomical position of the maxilla was registered with a transfer device. Digital data sets of the intraoral situation combined with a facial scan enabled precise virtual planning, guiding minimally invasive preparations. Long-term provisional restorations, milled from high-performance polycarbonate, were used to test the novel VDO before the final lithium disilicate restorations were fabricated. This approach provided a time- and cost-efficient treatment solution. No failures were observed at the 9-year follow-up.

Conclusions: Utilizing face scans and design software enable a virtual visualization and comprehensive quality control for patients with dental wear, resulting in significant time savings and increased predictability for the dental technician, dentist and patient.

Clinical significance: The described digital workflow optimizes the planning and implementation of a comprehensive adhesive full-arch rehabilitation with an increase of the VDO. The clinical long-term follow up result of CAD/CAM assisted minimally invasive lithium disilicate restorations after 9 years demonstrates to clinicians a reliable treatment concept for patients with dental wear.

Objective: To evaluate the safety and effectiveness of alveolar bone reconstruction simultaneous to implant removal due to peri-implantitis.

Material and methods: Partial or fully dentulous patients subjected to implant removal due to advanced peri-implantitis (≥ 50% of bone loss) lesions and seeking to have the failed implant replaced for esthetic or functional reasons were consecutively included. Guided bone regeneration was performed by means of a mixture of xenograft and autogenous bone and a ribose cross-linked barrier membrane. Re-entry for implant placement was performed at 4-month follow-up. Overall, six radiographic variables were assessed before (T0) and after (T1) alveolar bone reconstruction at four levels in ridge width (RW) and height (RH). Peri-implant conditions were evaluated at latest follow-up. Simple and multiple binary logistic regression models were calculated using generalized estimation equations to evaluate the effect of baseline upon reconstructive outcomes.

Results: In total, 20 patients (n_implant = 39) met the inclusion criteria. Alveolar RW and RH were augmented from T0 to T1 at all levels. All implants achieved primary stability. Only ~13% were subjected to ancillary bone regeneration simultaneous to implant placement. After a mean follow-up period after loading of ~2.2 years, ~70% implants demonstrated peri-implant health, while mucositis was diagnosed in the remaining implants.

Conclusion: The performance of alveolar bone reconstruction in residual partially contained defects simultaneous to implant removal due to peri-implantitis lesions demonstrates being safe and effective for implant site development.

Objective: This article aims to describe a new technique for predicting the results of resin infiltration procedure in molar incisor hypomineralization lesions, named Infiltration Monitoring by Transillumination. The technique involves the use of transillumination together with ethanol application during the steps of lesion body opening and resin penetration. It provides color contrast that enhances the removal of the less porous surface layer and controls the effectiveness of resin infiltration within the lesion.

Clinical considerations: The clinical procedure presented illustrates the steps involved in the resin infiltration procedure for color masking of molar incisor hypomineralization lesions in anterior teeth, highlighting the use of transillumination both for monitoring the lesion body opening step and the resin infiltration process.

Conclusions: The monitoring with transillumination during the ethanol test can assist the removal of the enamel external layer over the lesion, necessary to expose the inner porosity to be infiltrated, in a very precise and conservative way. In addition, it can effectively help to determine the moment when the infiltrant resin has fully penetrated the lesion.

Clinical significance: The Infiltration Monitoring by Transillumination technique offers the possibility to precisely control the infiltration procedure in molar incisor hypomineralization lesions, thereby improving the predictability of the esthetic outcome.

Objective: In extensive prosthetic rehabilitations and in those involving the anterior area, a correct 3D spatial position is of fundamental importance for effective communication between the clinician and the dental technician. The aim of this article is to analyze the different methods used to position in space and/or in an articulator the maxillary arch in analog workflows highlighting shortcomings and difficulties in order to understand how to overcome them when employing digital workflows.

Overview: Traditional mechanical devices, such as anatomical, kinematic, esthetic and postural facebows, have clear indications, but also limitations, especially in cases of skeletal asymmetries. Modern digital tools, including photography, CBCT, facial scanners and jaw recording devices, are here critically analyzed to illustrate the advantages of working in a virtual space.

Conclusions: The adoption of digital tools in the prosthetic workflow represents a significant improvement compared to traditional techniques, as it reduces errors and artifacts of registration and transfer of the position of the maxillary arch in the articulator space. This contributes to more predictable esthetic and functional results, with a positive impact for clinicians and technicians, improving clinical-laboratory communication, operational efficiency and overall quality of work.

Clinical significance: The integration of digital tools into prosthetic workflows represents an important advancement in clinical practice since they reduce human error and facilitate communication between the clinician and the laboratory. When carrying out rehabilitations involving changes in esthetics or occlusal plane orientation, the proper and accurate positioning of the upper arch in space is particularly relevant.