Journal of Esthetic and Restorative Dentistry最新文献

Background: Esthetically pleasing, bright teeth and a symmetrical dental arch are of great importance. There are only a few scientific studies that compare the evaluation of anterior restorations by experts and patients. Additionally, there are hardly any studies that deal with the weighting of esthetic parameters.

Objective: The current study was performed to test the hypothesis that patients and experts evaluate anterior restorations differently and place their emphasis differently. Therefore, aim of this prospective study was to compare the evaluation of the red and white esthetics of anterior restorations by patients and an expert and to find out which parameters play an important role in the evaluation of the esthetic appearance of anterior restorations.

Material and methods: Anterior restorations of 21 patients were analyzed. All patients evaluated their own restorations using a questionnaire of ten defined parameters (pink esthetic score, PES and the white esthetic score, WES). Additionally, the questionnaire was used to determine how important the individual parameters are for them in relation to the assessment of the esthetic result. An expert also gave her assessment and weighting for all 21 patients.

Results: The statistical analysis of the questionnaires shows that the expert assigned lower values, particularly in the evaluation of the PES. The expert weighted individual parameters of the PES to be more important than the patients. The type of abutment of the restoration (tooth or implant) had no influence on the evaluation of the restorations.

Discussion/conclusion: The study shows that patients and experts have different assessments of the esthetics and the weighting of the various parameters. Nevertheless, patients are sensitive to esthetic deviations and patient preferences should be taken into account in anterior restorations.

Statement of problem: Esthetic dental features, especially the maxillary anterior teeth, significantly influence perceived attractiveness. Gingival recessions can negatively affect smile esthetics, particularly when asymmetrical.

Purpose: This study aimed to investigate the perception of dentists and non-professionals regarding subtle variations in the apically displaced soft tissue surrounding a lateral or central incisor.

Materials and methods: Based on an ideal image of the esthetic zone, asymmetrical modifications of either a central or lateral incisor in the maxillary anterior were created and used in a digital survey asking participants to assess the overall appearance of the smile, using a visual analog scale (VAS). The dental expertise, age, and gender of the participants were recorded. For each image, the question was posed to identify if any of the teeth caused a visible irritation. The mean results of each tooth alteration and the correlation between dental expertise were statistically analyzed.

Results: A total of 114 participants were polled. There was a significant difference in the esthetic perception between the central and lateral incisors (p < 0.001). The perception threshold for a noticeable asymmetrical recession was 1.2 mm for the central and 2.0 mm for the lateral incisor. Gender and age showed no significant difference in the esthetic evaluation, and dental expertise was only significantly different for larger recessions (p < 0.05).

Conclusion: The asymmetric changes were more noticeable for the central incisor than the lateral incisor. A unilateral recession change of 0.8 mm did not appear to influence the assessment of the overall smile. The dental expertise, age, or gender of the participants did not significantly correlate with a stricter esthetic perception.

Clinical implications: The present study highlights that the perception of unilateral recession changes in the anterior maxilla varies between central and lateral incisors, with lateral incisor recessions being less impactful on the overall appearance of the smile. These findings suggest that small gingival changes can be acceptable for the overall esthetic outcome, underscoring the importance of discussing patient expectations and treatment options before restoration or orthodontic treatment and prioritizing the gingival margin of the central incisor which appeared more noticeable.

Objective: This study aimed to compare dental plaque scores measured using clinical examination and different imaging methods.

Materials and methods: Twenty-eight volunteers were included in the study and divided into two groups according to DMFT (D: Decayed, M: Missing, F: Filling, T: Teeth) scores (under 3 and over 10). Dental plaque on anterior labial surfaces' was scored using clinical visual examination with/without staining and different imaging systems (Digital photography, intraoral digital scanning, FluoreCam). Turesky Modified Quigley Hein Plaque Index was used for dental plaque scoring. The comparison between clinical examination and imaging dental plaque scores was analyzed using Linear Models and Bonferroni Correction (p < 0.050).

Results: In low DMFT group, the scores in clinical examination scores with staining were similar to the scores obtained with digital camera (p = 1.000) and intraoral digital scanning plaque scores (p = 0.997). The lowest plaque score was obtained in clinical visual examination without staining (p < 0.05) while the highest score was recorded by FluoreCam in low DMFT group (p < 0.05). In both groups, the FluoreCam scores were quantitatively higher among all imaging methods.

Conclusions: Plaque staining in low DMFT group may increase the efficiency of all imaging methods. Plaque staining-guided digital imaging can be used as an alternative method to visual evaluation methods for monitoring dental plaque clinically.

Clinical significance: Dental plaque diagnosis is important in preventing caries and periodontal diseases. This study investigates the comparison of various imaging systems with clinical visual examination plaque scoring in patients with different oral hygiene status. The use of intraoral scanners might be a new option for the evaluation of oral hygiene levels and used as an alternative technique to clinical visual examinations in dental practice.

Objective: To assess the effect of chairside adjustment and polishing on the clinical performance of zirconia endocrowns and digitally calculate the opposing enamel wear.

Materials and methods: A total of 20 participants received zirconia endocrowns on their endodontically treated lower first molars. All endocrowns were fabricated using CAD/CAM technology. According to the occlusal adjustments needed for the restorations, patients were divided into two groups: Group ZG with 10 glazed monolithic zirconia endocrowns and Group ZP with 10 adjusted and polished zirconia endocrowns. Bonded endocrowns were evaluated clinically and radiographically for 24 months following modified FDI criteria. Wear of the antagonistic enamel was calculated at 6, 12, 18, and 24 months using an intraoral scanner and Geomagic software.

Results: The overall survival rate of the 20 endocrowns was 100%, according to the Kaplan-Meier survival method. None of the endocrowns were replaced during the follow-up. After 2 years, polished zirconia caused enamel wear (0.422 ± 0.130 mm³), while glazed zirconia caused enamel wear (0.491 ± 0.105 mm³), with no statistically significant difference (p = 0.108).

Conclusion: Both glazed and polished monolithic zirconia endocrowns showed comparable enamel wear after a 2-year clinical follow-up, with no significant difference.

Clinical significance: Glazing or intra-oral polishing could be applied to monolithic zirconia endocrowns with minimal antagonist enamel wear.

Objectives: To evaluate the complementary mechanical properties of dental ceramics using edge chipping resistance (Rea) and flexural strength before and after thermomechanical aging.

Material and methods: Computer-aided design and computer-aided manufacturing of ceramic materials, including zirconia (ZR), lithium disilicate (LS2), and resin nanoceramics (RNC), were evaluated. Specimens for flexural strength testing were fabricated with dimensions of 3 × 4 × 25 mm, with 30 specimens per group. For the edge chipping test (ECT), specimens were fabricated with dimensions of 3 × 4 × 12 mm, with 48 specimens per group. Half of the specimens for both tests were subjected to thermomechanical aging for 200,000 cycles at 50 N. A Weibull analysis was performed to determine flexural strength. Fractographic analysis was performed before and after thermomechanical aging during the ECT. X-ray diffractometry (XRD) was performed on the ZR specimens before and after thermomechanical aging. Flexural strength was analyzed using a two-way repeated analysis of variance (ANOVA) with a t-test, and Rea was analyzed using Pearson correlation and a two-way repeated ANOVA.

Results: The flexural strength and Rea differed according to the material (p = 0.001), whereas they were similar before and after thermomechanical aging (p > 0.05). The Weibull modulus of the flexural strength decreased after thermomechanical aging. In the fractographic analysis of the ECT, more than two fracture origins were identified after thermomechanical aging. The XRD analysis of ZR showed an increased monoclinic phase after thermomechanical aging.

Conclusion: All the materials met the ISO 6872 standards for bending test. However, LS2 and RNC show low edge chipping resistance within the range of the occlusal force. The thermomechanical aging did not significantly alter the mechanical properties of the materials. However, the Weibull coefficients of the flexural strength decreased, and an additional origin of fracture appeared after thermomechanical aging.

Significance: Flexural strength and Rea differed depending on the material used. The probability of the material fracture increased after thermomechanical aging. To understand ceramic fractures, two mechanical tests and thermomechanical aging must be performed together.

Objective: This clinical case describes a multidisciplinary retreatment of a patient with anterior fixed dental prostheses (FDPs) using minimally invasive restorations and a biologically oriented preparation technique (BOPT).

Clinical considerations: A 56-year-old female patient, treated 30 years ago with a metal-ceramic FDP due to dental agenesis, presented a misfit prosthesis at the gingival margin, black spaces, and food retention at the pontics. Notably, tooth number 2.6 was absent, and she exhibited a left crossbite. Her chief complaint was the compromised esthetics of her restorations. Given her coagulation disorder, von Willebrand disease, she declined mucogingival surgery. A diagnostic wax-up and mock-up was performed to establish treatment goals. The initial phase involved periodontal, orthodontic, and implant treatment. The orthodontic treatment with aligners to correct the crossbite. Subsequently, bleaching and a second mock-up were conducted to guide prosthetic treatment. In the prosthodontic treatment, the abutment teeth were prepared using a vertical BOPT to remodel the gingival tissues, achieving the esthetic goal of repositioning the gingival margin without surgery. The provisional phase was critical for soft tissue remodeling and ensured clinical success. After stabilization of the soft tissues, a monolithic zirconia FDP was delivered, with a follow-up of 2 years.

Conclusions: A multidisciplinary treatment plan, utilizing a digital workflow, resulted in stable clinical and esthetic outcomes at the two-year follow-up, effectively retreating an anterior bridge using BOPT in a patient with a coagulation disorder that contraindicated complex surgical interventions.

Objective: In the young and growing patient, tooth ankylosis impedes alveolar growth and presents a serious dilemma regarding the best treatment approach. Two common treatment approaches, extraction of the ankylosed tooth or a "wait and see" will result in a compromised alveolar ridge that can affect future prosthetic rehabilitation. The purpose of this article is to discuss five treatment strategies that can be utilized in the management of tooth ankylosis in the growing patient: (1) extraction, (2) decoronation or root submergence, (3) socket shield (partial extraction), (4) segmental osteotomy and (5) replacement with tooth autotransplantation.

Overview: It is important to understand the biologic sequelae of ankylosis and the value of the tooth for alveolar ridge management. Strategies will be discussed with an emphasis on alveolar ridge management using a natural tooth and root. With an interdisciplinary team, treatment options can then be developed, to achieve more favorable long-term outcomes.

Conclusions: An understanding of each of these procedures and the proper time for implementation will help the clinician achieve the most optimal long-term outcomes for these growing patients.

Clinical significance: There are several treatment options for traumatized ankylosed incisors in growing patients. This article will describe the details of these treatment strategies, emphasize the value of the tooth for ridge management and present guidelines about selecting the most optimal strategy based on age, rate of growth, condition of the traumatized tooth, and the definitive prosthetic plan.

Objective: To investigate the nature and availability of evidence on the clinical performance of posterior partial coverage restorations (PCR) fabricated from different ceramic materials, outcome definitions, measurement methods, study drop-outs and follow ups.

Overview: A systematic literature search (inception-February 2024) was performed through MEDLINE, Scopus, CENTRAL, ClinicalTrials.gov, and the International Clinical Trials Registry Platform to identify clinical studies with a focus on posterior PCRs (onlays, occlusal veneers and partial crowns) with a minimum follow-up of 1 year. Thirteen of 31 included studies were randomized controlled trials (RCT) and 18 non-randomized studies of intervention (NRS). Six RCTs compared two different ceramic materials and might be suitable for meta-analysis. Differences in study design, definition of survival, evaluation methods, and statistical models for survival analysis were identified as reasons for expected heterogeneity among studies. The most common reasons for restoration failures were ceramic fractures and retention loss.

Conclusion: The evidence informing the effect of PCRs varied in definitions of survival and failure, complication classifications, and workflow approaches. RCTs addressing clinical performance of PCRs comparing different ceramic materials are available for conducting systematic reviews and meta-analyses.

Objective: Gingival recession is a complication that can occur after orthodontic treatment, and its cause is still very controversial in the literature. The objective of this study was to report a clinical case of orthodontic retreatment conducted with in-office aligners and root coverage using free gingival graft, connective tissue graft, and Emdogaim for a patient with severe gingival recession.

Clinical considerations: This report presents a potential solution to correct a gingival recession with in-office clear aligner. A mandibular left lateral incisor whose root was positioned buccally to the bone plate, likely due to improper bonding of a fractured orthodontic retainer. The treatment consisted of 10 in-office aligners, which effectively repositioned the root within the alveolus. After the orthodontic retreatment, the patient underwent gingival grafting surgery, which was successful due to the accurate positioning of the root in the socket, influencing bone deposition in the area. Subsequent 4-year follow-up showed treatment stability, mainly in the soft tissue area.

Conclusion: Within the limitations of this case report, the in-office aligners facilitated individualized and precise movements, allowing for torque adjustments when necessary. Besides that, the improved root positioning facilitated successful surgical procedures for covering the gingival recession, including the free gingival graft (FGG) and connective tissue graft with Emdogain (CTG + Emdogain).

Clinical significance: This case report presents an orthodontic treatment alternative for the multidisciplinary correction of a gingival recession, meeting the esthetic and functional demands of an adult patient.

Objective: To report and compare the survival of minimally invasive direct and indirect restorations of different materials for restoring the worn dentition.

Material and methods: A systematic search was conducted in six databases: MEDLINE, Web of Science, Scopus, CENTRAL, VHL, and EMBASE. The eligibility criteria of this systematic review used the PICO framework to address the following research question: "In dentate patients with a worn dentition (P), does rehabilitating their lost tooth structure with indirect restorations (I) or direct (C) effect the survival and success of treatment (O)?". Study characteristics, survival rates of the restorations were extracted from each article. No language restrictions were applied. Survival and prevalence estimates were calculated using random-effect models.

Results: The electronic search yielded 5009 entries, resulting in 14 publications selected for full-text analysis. These included 2 RCTs, 7 prospective, and 5 retrospective studies, with a varying level of methodological quality. This included 52% direct and 48% indirect restorations, using varying materials and follow-up periods. The survival of direct composite resin restorations versus indirect manually processed composite resin restorations showed no significant difference (n = 2; OR, 1.79 [95% CI, 0.64-5.05]; p = 0.270). For the prospective articles, the pooled prevalence estimates of the survival restorations were; direct (n = 3; 99% [95% CI, 0.97-1.00]) and; indirect (n = 5; 100% [95% CI, 0.99-1.00]). Lithium disilicate recorded the least amount of failures at 1.8%.

Conclusions: Although the survival estimates of indirect manually processed and direct composite resins were not significantly different, indirect restorations-especially those made of lithium disilicate ceramic-may offer better survival rates, compared to direct resin restorations in patients with worn dentition.

Clinical significance: Despite the limited evidence, indirect ceramic restorations appear to be well-suited for long-term treatment of worn dentition, whilst direct composite resin restorations are more suited as an medium-term solution.