Journal of Esthetic and Restorative Dentistry最新文献

Objective: Treatment of gingival recession in the anterior mandible is more complex due to unique anatomic features including excessive tension due to frenal and muscle attachments, thin tissue, shallow vestibule, and narrow interdental space. These features are particularly limiting in the presence of deep recession and negatively impact the success most routine soft tissue grafting procedures. The recently proposed laterally closed tunnel combined the benefit of tension management from tunneling rather than incising papillae with lateral closure of deep recession to minimize the need for coronal advancement.

Clinical considerations: This is an effective, although technically demanding procedure. This report presents a method of facilitating tunnel preparation by utilizing superficial papillary access incisions bilaterally in the papilla between the lateral incisor and canine. This papilla has the least tension and most robust interdental volume and blood supply. This incision creates a mini flap that facilitates tunnel dissection and graft placement.

Conclusion: Because the mini flap is used for graft insertion, the suturing for lateral closure can be performed before graft insertion. The result is reduced technical difficulty.

Objectives: This study compares the restoration of single-tooth implants with screw-retained lithium-disilicate hybrid-abutment crowns and single-tooth lithium-disilicate crowns adhesively bonded to hybrid abutments with regard to objective clinical and subjective patient-specific evaluation criteria over a time of observation of 3 years.

Materials and methods: Two bone-level implants were placed in contralateral sides of the same jaw in 10 patients, each with two single-tooth gaps. After osseointegration, implants were uncovered and an impression was taken. In accordance with the split-mouth design, one implant in each patient was restored with a screw-retained hybrid abutment crown and the other implant with a hybrid abutment and an adhesively bonded single-tooth crown. The restorations were randomly allocated to the implants. Prefabricated titanium bases were used. The ceramic abutments and restorations were fabricated monolithically with pressed lithium-disilicate ceramic. An objective evaluation (survival, technical, or biological complications, FIPS) by the practitioner and a subjective evaluation (satisfaction, OHIP) by the patient were carried out after 3, 6, 12, 24, and 36 months after restoration placement.

Results: Both restoration types showed a survival rate of 100% after 3 years of observation. No technical or biological complications occurred. No significant difference was observed between the two types of restoration neither for objective (survival, technical or biological complications, FIPS) nor subjective (satisfaction, OHIP) evaluation criteria (p > 0.05).

Conclusion: No statistically significant differences were observed between screw-retained and cemented pressed lithium-disilicate restorations on bone-level implants for both objective and subjective evaluation criteria, respectively.

Clinical significance: Monolithic hybrid-abutment crowns (screw-retained) and monolithic hybrid abutments with single-tooth crowns (cemented) made of pressed lithium disilicate can be used to successfully restore single implants.

Introduction: This study investigated the in vivo color range of human teeth using a research-grade noncontact spectroradiometer, analyzing the effects of gender, age, ethnicity, and lifestyle factors, including diet, smoking, and oral hygiene.

Materials and methods: A total of 1004 participants were recruited at two research sites and stratified by gender, age, and ethnicity, and data on their dietary and oral habits were collected. Noninvasive color measurements of an upper central incisor were performed using a spectroradiometer and a fiber-coupled Xe-Arc light source. Color differences were computed using the CIELAB and CIEDE2000 color difference formulas, statistically analyzed, and interpreted through comparisons with 50:50% perceptibility (PT) and acceptability (AT) thresholds for dentistry.

Results: CIELAB and CIEDE2000 color coordinate values varied significantly. Female teeth appeared lighter and less yellow than men's. Age correlated with darker, more chromatic teeth, stabilizing only after Age 46. Significant ethnic differences were observed, particularly between African-American and Asian participants. Coffee consumption impacted teeth yellowness and chromaticity, while tea had no significant effect. Frequent tooth brushing led to lighter teeth, and tooth whitening considerably influenced color, emphasizing the effect of cosmetic dental treatments. Smoking showed minimal impact, with slight discoloration noted among light smokers compared to nonsmokers.

Conclusions: Color coordinate values by gender, age, and ethnicity exhibited statistically significant differences and, in most cases, noticeable color differences. With exceptions, the dietary/oral habits of the patient had a significant impact on the color of human teeth.

Clinical significance: The findings from this study provide detailed information and understanding of the color range and distribution of human teeth, which can help enhance the esthetic outcome of dental care and, consequently, the patient's satisfaction.

Objective: To examine the effects of six whitening mouthwashes on tooth color and immediate bond strength to the enamel.

Materials and methods: Human incisors were divided into seven groups (n = 10) according to mouthwashes (R.O.C.S Black Edition White, Splat White Plus, Colgate Plax White Charcoal, Signal White Now, Listerine Advanced White, Colgate Optic White, and distilled water). After the initial color measurements, the teeth were exposed to mouthwash for 4 weeks. Then, the color measurements were repeated. Then, cylindrical composite resin blocks were immediately applied to the enamel surfaces and subjected to shear bond strength tests. Data were analyzed using Kruskal-Wallis and Bonferroni tests (α = 0.05).

Results: Δ𝑏, Δ𝐿, and ΔE₀₀ values did not present significant differences among the groups. Significant differences among the groups were determined for Δ𝑎 and ΔWI_D values (p < 0.05). R.O.C.S Black Edition White and Splat White Plus produced clinically acceptable color changes. Signal White Now, Splat White Plus, and Listerine Advanced White created acceptable whiteness changes. The mouthwashes did not statistically affect the bond strength compared to the distilled water (p > 0.05).

Conclusions: Whitening mouthwash containing blue covarine revealed more acceptable color and whitening changes. Mouthwash containing charcoal led to the lowest enamel bond strength values.

Clinical significance: The content of whitening mouthwashes affected the degree of tooth whitening and shear bond strength to enamel.

Objective: To investigate whether nonthermal atmospheric plasma (NTAP) can promote bonding between commonly used adhesive monomers and zirconia.

Materials and methods: The zirconia surface and monomers (HEMA, BisGMA, TEGDMA, and MDP) were treated with different NTAP approaches (10 w, 30 s), and the surface characteristics and chemical structures between the zirconia surface and monomers were verified by the contact angle, scanning electron microscopy (SEM), attenuated total reflectance Fourier transform infrared (ATR/FT-IR) spectroscopy, and x-ray photoelectron spectroscopy (XPS). Scotchbond Universal adhesive with two different resin cements, RelyX Ultimate and RelyX Unicem 2, was applied, followed by NTAP-aided clinical procedures, and then microtensile bond strength test (μTBS) and failure mode evaluation were tested for preliminary mechanical properties assessment. One-way ANOVA was employed for the statistical analysis.

Results: The contact angle analysis, SEM, and ATR-FTIR confirmed that NTAP can promote the polymerization of BisGMA, TEGDMA, and MDP on the zirconia surface, while XPS confirmed that NTAP can induce a chemical reaction between MDP and zirconia.

Conclusions: Nonthermal atmospheric plasma can increase the affinity between selected monomers and zirconia and promote the chemical bonding strength between phosphate monomers and zirconia; besides, it can enhance the bonding strength of two different adhesive systems.

Clinical significance: The mechanism of how NTAP improved common adhesive monomers interacting with zirconia surfaces was revealed in this study. NTAP, as a relatively high energy-boosting method, could not only improve the surface affinity of zirconia and chemical bonding in-between monomers and zirconia but also enhance the polymerization of different monomers onto zirconia, resulting in improved bonding properties. Thus, further exploration of versatile bonding materials and/or onto different dental substrates could take this into account.

Objective: This systematic review aims to understand the limitations and benefits of the guided direct restorative technique, to optimize the final outcomes, considering the evolution from analog to digital, including planning, the diversification of guides, and the different resins employed.

Methodology: A search was conducted in the electronic databases PubMed, Cochrane, and through manual searches, initiated in May 2023 and updated in April 2024. The following search strategy was used: ((injectable composite resin) OR (direct pressed composite)) OR (3D-guided), utilizing the PICO framework.

Results: Initially, 739 articles were retrieved. After applying inclusion and exclusion criteria, 33 studies were considered suitable for data extraction, including 12 in vitro studies and 21 case reports or technique descriptions. The articles focused on comparisons of techniques, flowable, heated, and conventional resins, as well as various technique reports with variations in guides, materials, and planning, potentially aiding clinicians in more effective and safer execution of this restorative technique.

Conclusion: The utilization of digital workflows presents greater solutions to the challenges of the guided direct restorative technique. Understanding the properties of the resins used is crucial for the results and should be chosen according to the patient's needs.

Clinical significance: A guided direct restorative procedure can deliver previously planned dental treatment based on individualized planning. This method ensures greater reproducibility in aesthetics and occlusion, resulting in superior quality work for the patient.

Objective: The aim of the present study was to investigate the relation of the implant position to the implant crown and analyze the location and magnitude of bite force.

Materials and methods: The dimensions of 49 posterior implant-supported restorations were recorded in terms of: 1. implant diameter, 2. crown length, 3. crown width, 4. crown height, 5. occlusal surface of the restoration. The crown/implant height was measured and the distance between the implant center and the restoration center revealed the size of intra-coronal cantilevers. The occlusal force analysis determined the point and magnitude of loading. Correlation coefficient r was used for the statistical process and statistical control was carried out with the aid of t-test with minimum level of significance p < 0.05.

Results: - The mean crown-to-implant ratio was 0.9 and in short implants (< 10mm) the ratio was 1.28. - Intra-coronal cantilever extensions ranged from 2.1 mm to 6.35 mm depending on crown size. - Occlusal loading was identified in cantilever areas of the crown.

Conclusions: - Implant center deviates from crown center in 71%-82% of the cases depending on site location. - Implants with non-ideal position may support a functionally occluding crown.

Clinical significance: Intra-coronal cantilevers are a critical factor to avoid clinical complications and should be taken under consideration both in the planning and fabrication phase of implant restorations.

Objectives: Platelet-rich fibrin (PRF) has had a marked impact on regenerative medicine due to its widespread ability to promote angiogenesis to defective tissues. Particularly in the dental field, evidence from randomized clinical trials has further shown that PRF facilitates greater soft-tissue regeneration when compared with hard tissues.

Clinical considerations: Recently, the fibrin-assisted soft-tissue promotion (FASTP) technique has been developed as a means to promote soft-tissue regeneration of mucogingival recessions utilizing PRF. Within the present case report, a 28-year-old male presented with multiple adjacent mucogingival recessions in the maxilla ranging in probing depths (1-3 mm) and gingival recessions (1-5 mm). For optimal regenerative outcomes, the use of advanced PRF (A-PRF; 1300 RPM for 8 min) has been utilized to enhance regenerative outcomes by fully taking advantage of the low-speed centrifugation concept (LSCC).

Conclusions: This case report highlights the latest surgical concepts, centrifugation protocols, and use of the LSCC to regenerate multiple adjacent mucogingival recessions in the esthetic zone.

Objectives: To report on soft tissue contour changes at pontic sites with or without soft tissue grafting over an observation period of 15 years.

Methods: Fourteen patients received a fixed dental prosthesis (FDP) in the posterior zone in a controlled clinical study and were available at the 15-year follow-up. Eight patients received a subepithelial connective tissue graft in the pontic area (test) while six received the FDP without soft tissue grafting (control). Impressions were taken after FDP cementation and at 15 years. Casts were digitized and a profilometric analysis was performed (mean distance) and the pontic height (PH) and ridge width (RW) were analyzed at the mid-buccal area. A descriptive analysis and Wilcoxon-Mann-Whitney test was performed (level of significance: 5%).

Results: Profilometric changes (mean distance) from baseline to 15 years amounted to -0.68 mm (test) and to -0.33 mm (control) (p = 0.208), 95% CI for group difference (0.290; -0.750). PH measured -0.47 mm (test) and 0.0 mm (control) (p = 0.079) and RW amounted to -1.05 mm (test) and -0.38 mm (control) (p = 0.138).

Conclusion: Remodeling of the soft tissue contour at pontic sites of FDPs was evident in both groups, but slightly more accentuated following soft tissue grafting.

Clinical significance: This study is the first to report on soft tissue changes at pontic sites over more than 10 years. It investigates whether tissue contour changes with and without soft tissue grafting before the insertion of FDPs. Remodeling of the soft tissue contour at pontic sites was observed over 15 years, with more pronounced changes when soft tissues were augmented with SCTGs before FDP insertion. The volume loss at the augmented site must be considered in relation to the overall tissue changes over long periods. Connective tissue grafts reliably improve shape and esthetics around the pontic unit. Further long-term studies with more patients are needed to evaluate the initial gains and long-term performance of these augmentations.

Aim: Several treatment modalities have been used to restore crown fractures in case of uncomplicated crown fractures. Although many treatment modalities have been reported, there is no consensus on which one has the best results in terms of success and durability. This systematic review of treatment modalities in uncomplicated crown fractures aims to provide the most common and successful treatment modality for each patient's unique needs, balancing conservation, aesthetics, and long-term durability.

Materials and methods: Three electronic databases (PubMed, Scopus, and Google Scholar) were searched for articles regarding treatment modalities in uncomplicated crown fractures in anterior maxillary teeth.

Results: Following the application of the inclusion and exclusion criteria, 10 case reports, four case series, and two retrospective studies were selected for the review. These studies reported on fragment reattachment, direct composite resin, and veneers for the management of uncomplicated crown fractures. Fragment reattachment was the most preferred treatment modality, with milk, water, or sterile saline used as storage mediums. Direct composite restoration was preferred for missing or bad-shaped fragments or longevity. Veneers were given for aesthetic consideration and fracture resistance when the crown structure was majorly affected by the fracture. Fragment reattachment was favored in 63% of the articles included in the review followed by direct composite restoration in 26% of the articles. Venners were used in about 11% of the articles. Composites depicted a higher survival rate and a better outcome than fragment reattachment. Follow-up periods ranged from 1 week to 4 years, and all articles successfully re-established function and aesthetics, except for one tooth that required root canal treatment.

Conclusion: Fragment reattachment, direct composite restoration, and veneers are successful treatment modalities in uncomplicated crown fractures of anterior teeth. The choice of treatment depends on various factors like availability of fragments, age, and financial condition of the patient.

Trial registration: PROSPERO Registration ID: CRD42020153091.