Journal of Esthetic and Restorative Dentistry最新文献

Objective: Gingival excess, also referred to as excessive gingival display (EGD), represents a multifactorial esthetic concern influenced by skeletal, dental, and soft tissue factors. Conventional orthodontic or orthognathic interventions, while effective, may present increased morbidity. This prospective case series evaluates a minimally invasive, interdisciplinary approach integrating periodontal and cosmetic techniques for managing multifactorial gingival excess.

Clinical considerations: Twelve systemically healthy adult patients (mean gingival display: 5.3 mm) diagnosed with both altered passive eruption and hyperactive upper lip were treated in a private practice using a combined single-session protocol. The "combo technique" involved esthetic crown lengthening, botulinum toxin-A (Botox) injections, and hyaluronic acid-based lip augmentation. Diagnosis and treatment planning were based on comprehensive clinical and radiographic assessments. Outcome measures included gingival display reduction, patient satisfaction, and postoperative discomfort, evaluated at 6 and 18 months.

Conclusions: The integrated "combo technique" offers a minimally invasive and highly effective alternative for correcting EGD. It enables individualized treatment planning, reduces the amount of Botox needed, and results in stable esthetic outcomes with high patient satisfaction and minimal postoperative discomfort. This interdisciplinary approach provides a predictable and long-lasting solution for complex GS cases in patients unwilling or unsuitable for orthognathic surgery.

Purpose: This study aimed to evaluate how the transmucosal contour of posterior single-tooth implant crowns, fabricated with CAD-CAM abutments, influences peri-implant soft tissue dimensions using the profile angle and crown ratio concepts.

Materials and methods: Digital scans of 58 posterior single-tooth implant crowns were analyzed to measure peri-implant soft tissue height, width, crown ratio, and profile angles. Pearson's correlation analysis and independent t tests were performed to assess relationships between morphological parameters and soft tissue dimensions, as well as differences by arch and implant position (p < 0.05).

Results: Significant negative correlations were found between both profile angle and crown ratio and the soft tissue height and width, particularly within the 1-2 mm region above the implant platform (r = -0.873 to -0.719, p < 0.05). Buccal tissue width was greater in the maxilla than in the mandible, while soft tissue height showed no arch-dependent differences. Similar patterns were observed on the lingual aspect.

Conclusion: The profile angle and crown ratio significantly associated with peri-implant soft tissue dimensions in posterior implant restorations. Larger profile angles and crown ratio, especially within the 1-2 mm coronal region, were closely associated with reductions in both soft tissue height and width. These findings demonstrate region-specific associations between crown contour morphology and peri-implant soft tissue dimensions.

Objectives: To evaluate the effect of violet LED light (VL) and hydrogen peroxide (HP) in-office bleaching gels supplemented with calcium polyphosphate (CaPP) or calcium gluconate (GU): MATERIALS AND METHODS: Bovine enamel blocks (n = 10) were randomly assigned: commercial HP gel, commercial HP gel with GU, or experimental 35% HP with or without CaPP (0.5 or 1.5 wt%), and their VL-irradiated versions. Bleaching efficacy was assessed by color analyses (CIE L*a*b*, ΔE_ab, ΔE₀₀, ΔWID) at baseline (T₀) and after treatment (T₁). Knoop microhardness (KHN), percentage surface microhardness loss (%SHL), and roughness variation (ΔRa) were measured at T₀, T₁, and 14 days post-treatment (T₂). Surface morphology was assessed by scanning electron microscopy (SEM). Data were analyzed using generalized linear models, Kruskal-Wallis and Dunn tests (α = 0.05).

Results: The group irradiated only with VL exhibited lower color change (p < 0.0001). CaPP addition significantly increased ΔE₀₀ in VL-irradiated groups (p < 0.05). For roughness and SEM, no significant differences were observed among groups. Only CaPP- and GU-containing gels restored initial KHN values at T₂ (p < 0.05). CaPP groups showed lower %SHL than control groups (p < 0.05).

Conclusions: Bleaching gels containing CaPP maintained bleaching efficacy and mediated enamel microhardness recovery. VL further enhanced the bleaching effect in CaPP gels.

Clinical significance: CaPP represents a promising alternative for bleaching gel formulations, promoting enamel remineralization and enhancing bleaching efficacy when combined with VL.

Objectives: To investigate the effect of the touch-cure mechanism of Scotchbond Universal Plus adhesive system and different light-curing delay periods on the polymerization kinetics of RelyX Universal dual-cure resin cement (URC).

Methods: The resin cement, alone or combined with the adhesive system, was light cured after 0, 1, 3, 5, 10, 15, or 20 min of delay, or left without light (control). Degree of conversion (DC; n = 3) and maximum polymerization rate (Rp_max; n = 3) were measured and analyzed by two-way ANOVA and Tukey's test (α = 0.05).

Results: With adhesive, DC significantly increased at 10- and 15-min delays, and also in the control, while without adhesive, no difference was observed among delays. The lowest DC occurred in the control of both conditions. Rp_max was significantly reduced at dark cure and at 20 min delay (without adhesive), at dark cure, and at 15- and 20-min delays (with adhesive). The adhesive further reduced Rp_max at 10- and 15-min delays.

Conclusion: Ten and 15-min light-curing delays enhanced DC and Rp_max of URC, particularly with Scotchbond Universal Plus. Even without light, the adhesive-cement interaction promoted effective polymerization.

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.