Journal of Esthetic and Restorative Dentistry最新文献

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.

Objective: Patients who exhibit severe loss of tooth structure are challenging to rehabilitate. Conventional treatment of these patients may require adjunctive procedures of surgical crown lengthening, elective endodontic therapy and placement of posts and cores to retain full coverage crowns as part of a full mouth rehabilitation. Minimally invasive approaches to treatment of these patients provides opportunity to conserve tooth structure and to reduce adjunctive procedures by using an advanced adhesive approach to retain all ceramic partial coverage restorations as part of a full mouth rehabilitation.

Clinical considerations: The use of an advanced adhesive approach to perform a full mouth reconstruction restoring occlusal vertical dimension (OVD) is described. This approach emphasizes preserving healthy tooth structure, maximizing restoration adhesion to enamel and dentin, maintaining pulpal vitality and minimizing adjunctive dental procedures. The preparation design focuses on being defect-oriented to remove only diseased or undermined tooth structure. The all ceramic restorations are additive, where indicated, to further aid in preserving tooth structure. An advanced adhesive approach using an immediate dentin seal and resin coating over exposed dentin and composite resin cement under rubber dam isolation is used to lute the restorations. The restorations are fabricated using micro-layered lithium disilicate ceramic to maximize the esthetic appearance of the rehabilitation where needed.

Conclusion: An advanced adhesive approach to full mouth rehabilitation should be considered as a treatment option for patients exhibiting tooth surface loss as an alternative to conventional full coverage restorations when clinical parameters allow.

Objectives: These two clinical case reports show the use of the Triple Layer Graft procedure along with the Decoronation procedure to help restore normal contour and height of tissue The procedure was highly effective at restoring the esthetics that the patients needed on their implants. Short and long term results along with the step by step technique are shown.

Clinical considerations: Two patients of 33 and 25 years of age both had significant reduction in the height over their implants in the #7 and #10 locations. The first patient had the implants placed 15 years ago and the second patient had them done 5 years before our treatment. Current techniques to remedy esthetic issues created by malpositioned implants consist of soft and/or hard tissue grafting but tend to be utilized independently of each other in discrete procedures as opposed to being combined in one surgical protocol. The Triple Layer Graft (TLG) surgical protocol is novel in that it incorporates all three layers of grafting to address both soft and hard tissue deficits in one procedure done at one time after doing a decoronation technique. The TLG surgical and prosthetic protocol has been previously published by these authors, but this article will discuss the rationale along with the technique and indications and contraindications, illustrated via case reports. The authors will also report on the long-term results of this technique.

Conclusions: The Triple Layer Graft TLG) in combination with the Decoronation technique is an effective method in managing mild as well as severe esthetic defects over the facial of previously placed implants.

Clinical significance: The Triple Layer Graft will allow implants that were previously removed in order to place a new implant along with ridge augmentation may be able to be saved. This is a wonderful procedure for the patient since the implant does not have to be removed and replaced.

Objectives: To analyze survival and complication rates for anterior and premolar laminate-veneers out of different ceramic materials (feldspathic, leucite-reinforced glass-ceramic [LRGC], lithium-disilicate [LDS] and zirconia).

Material and methods: A systematic literature search was conducted across multiple databases for clinical studies on ceramic laminate-veneers with a minimum-follow-up of ≥ 1 year. The date of last search was on February 19, 2024. Survival, technical, esthetic and biological events were assessed for different laminate-veneer materials at three observation periods (short- [1-3 years], mid- [4-6 years] and long-term [≥ 7 years]).

Results: Twenty-nine studies were included. Meta-analysis revealed a pooled survival-rate of 96.13% for feldspathic, 93.70% for LRGC and 96.81% for LDS at 10.4 years. No difference was found between materials. Complication rates (technical/esthetic/biological) were as follows: Feldspathic: 41.48%/19.64%/6.51%; LRGC: 29.87%/17.89%/4.4%; LDS: 6.1%/1.9%/0.45% at 10.4 years. Zirconia showed a 100% survival-rate with no complications at 2.6 years. No long-term data was available for zirconia.

Conclusions: Feldspathic, LRGC and LDS laminate-veneers showed high survival-rates at long-term observation. LDS slightly outperforms feldspathic and LRGC laminate-veneers with lower long-term complication rates. More studies providing long-term data on zirconia laminate-veneers are needed.

Clinical significance: Ceramic laminate-veneers are a reliable treatment option. LDS may be preferred as a restorative material for long-term success.

Objective: The aim of the study was to compare medium to long-term clinical and patient-reported outcomes between implants placed with computer-assisted implant surgery (CAIS) and freehand protocols.

Materials and methods: Thirty dental implants in the anterior maxillary region with an average of 4 years after loading were assessed by means of Pink Esthetic Scores (PESs), marginal bone level (MBL), and clinical and patient-reported outcomes.

Results: CAIS significantly outperformed freehand placement with regard to PES scores (p = 0.011). Likewise, implants placed with CAIS showed significantly higher MBLs (p < 0.001). Bleeding on probing, probing depth, and prevalence of mucositis did not differ between the groups, while no peri-implantitis was diagnosed.

Conclusions: The use of CAIS leads to superior outcomes in terms of esthetics and MBLs for implants placed in the esthetic zone as observed in medium to long-term follow-up. No difference was however observed with regard to peri-implant mucosa inflammation.

Clinical significance: This article highlights the outcome of computer-assisted implant surgery in achieving higher esthetic, MBL, and esthetic satisfaction compared to freehand implant placement.

Thai clinical trial registry: TCTR20240422015.

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.