Journal of Esthetic and Restorative Dentistry最新文献

The cover image is based on the article Three dimensionally printed template with an interproximal isolation design guide consecutive closure of multiple diastema with injectable resin composite by Yusen Shui et al., https://doi.org/10.1111/jerd.13268.

Objective: The present paper aims to demonstrate the incorporation of the double monolithic protocol (DMP) into a chairside digital workflow to reproduce the fluorescence properties of natural teeth with chairside monolithic restorations when exposed to different light sources.

Clinical considerations: A female patient reporting dissatisfaction with her upper anterior teeth was rehabilitated using seven veneers and a three-element bridge. The DMP was applied to the bridge, which consisted of a primary lithium disilicate framework to which leucite-reinforced glass ceramic veneers were cemented. The fluorescence of the different substrates and ceramic restorations was evaluated throughout the rehabilitation process, under 365 and 405 nm light.

Conclusions: The DMP allows chairside procedures to be optimized by achieving predictable, mechanically resistant, and esthetic restorations.

Clinical significance: The DMP is a new chairside solution for developing ceramic restorations with optimal esthetics and combined mechanical properties, eliminating the need for sintering or glazing procedures.

Objective: This systematic review and meta-analysis compared the accuracy of intraoral scanners and spectrophotometers in determining tooth shade.

Materials and methods: An electronic search of five databases (PubMed, Scopus, Embase, Web of Science, CENTRAL) was conducted on October 19, 2023. A total of 163 studies were identified from the databases, of which 23 articles were eligible for inclusion. In vivo and in vitro quasi-experimental studies were included. After data extraction, a quantitative analysis was performed to determine the accuracy of the intraoral scanner in subgroups using four outcomes: trueness and precision with different measurement locations. A random-effects model was used to pool effect sizes. The pooled proportion with a 95% confidence interval (CI) was used for the effect size measure.

Results: Eleven articles were included in the meta-analysis. Trueness with the intraoral scanner was between 0.28 (CI: 0.09-0.60) and 0.38 (CI: 0.24-0.53). Repeatability was between 0.81 (CI: 0.64-0.91) and 0.85 (CI: 0.74-0.92). Trueness showed low, and precision had moderate certainty of evidence.

Conclusion: The trueness of shade matching with intraoral scanners is low compared to spectrophotometers, although the precision is considered high and is similar to spectrophotometers.

Clinical significance: Shade determination with intraoral scanners is not recommended.

Objective: This in vitro study aimed to evaluate the effectiveness of a printed surgical guide for root sectioning in the socket-shield technique.

Materials and methods: A typodont model of the maxilla with augmented filler was used for the upper right central incisor, and CBCT images were obtained. Two types of vertical root sectioning guides were tested: one with a buccal sleeve (Group A, n = 10) and another with a buccal orientation slit (Group B, n = 10). Control group (n = 10) performed freehand cuts on printed models. After crown cutting with diamond burs, root sectioning was conducted using an ultrasonic tip with the guides. Mean and standard deviation were calculated for the remaining root length, width, and volume. Data were analyzed using the Kruskal-Wallis test and Dunn's post hoc test.

Results: Statistical analysis showed significant differences in root width between the control group (2.0 mm) and both Groups A (2.655 mm; p < 0.0001) and B (2.460 mm; p < 0.0001). Group B (5.585 mm) also showed a significant difference in root remnant compared with the control (13.880 mm; p < 0.0043). Groups A and B did not differ significantly from each other.

Conclusions: The socket shield technique is safe and effective, this study aimed to add improvements through the introduction of surgical guides, facilitating the root section, which is the critical phase so that the parameters that are requisite for success are achieved in terms of width, length, and volume of the root remnant. Both guided techniques effectively facilitated root sectioning, maintaining satisfactory root thickness and length.

Clinical significance: Sectioning the root is challenging for the correct angulation to remove the palatal portion in the socket shield technique. Therefore, modifying this technique with the use of the presented guides, it is possible to prevent damage to the soft tissues and to plan the surgery with the help of cone beam computed tomography (CBCT) scans to remove the root apex and maintain the root remnant with a thickness greater than 1.5 mm, making the socket-shield technique more predictable.

Objective: The purpose of this in vitro study was to evaluate the effect of staining, glazing, and polishing on the survival probability of monolithic crowns manufactured with preshaded stabilized zirconia with 5 mol% of yttrium oxide (5Y-TZP).

Materials and methods: Monolithic crowns in the shape of an upper canine (1.5 mm of thickness) were manufactured by CAD/CAM, adhesively cemented on metallic foundation, and divided into 6 groups (n = 21): C (control), S (staining), G (glazing), P (polishing), SG (staining and glazing), and SP (staining and polishing). The survival probability was determined by step-stress accelerated life testing with a load applied to the palatine concavity of the crown. First, the specimens were subjected to a single-load to fracture test (SLF) and next to the fatigue test (5 Hz, thermocycling immersed in water varying 5-55°C), including the light (n = 9), moderate (n = 6), and aggressive (n = 3) loading profiles (load ranged between 20% and 60% of SLF). The survival probability was calculated considering the cycles for failure (CFF) and fatigue failure load (FFL) and illustrated using a Kaplan-Meier graph. The comparison among groups was performed using a Log-Rank test (α = 0.05).

Results: The mean value of SLF was 586.7 N. There was no difference among groups in survival probability, considering CFF and FFL.

Conclusion: Staining, glazing, and polishing can be performed safely without damaging the mechanical behavior of 5Y-TZP monolithic crowns.

Clinical significance: Staining is used to characterize and improve the esthetic of zirconia monolithic crowns. It can be used to reproduce the color gradient in the cervical region of the crown and pigmented grooves. This study showed that staining, glazing, and polishing did not affect the survival probability and the use of finishing procedures (glazing or polishing) after staining did not improve the survival probability of zirconia monolithic crowns.

Objective: New shade-matching devices are available for clinical use, but their accuracy and reliability have not been investigated. This in vitro study compared the accuracy and reliability of a shade-matching colorimeter (Optishade), a spectrophotometer (VITA Easyshade V), and visual shade matching in simulated clinical conditions.

Material and methods: Shade matching was conducted with two digital devices; (Optishade and Vita Easyshade) and the visual shade selection method, with a new 16-tab Vita Classical shade guide. Shade tabs were placed within a gingival matrix and measurements were taken from the central area of each shade tab enclosed in a black box to simulate the oral cavity. Visual assessments were conducted independently by two examiners. For the reliability assessment, each shade tab was measured 20 times by each examiner. Accuracy was calculated as a percentage of the matching readings with the actual shade per each tab. Data were analyzed with the one-way ANOVA test (α = 0.05) and Pairwise Comparison (Bonferroni Post hoc Test) to assess accuracy. The reliability evaluation was conducted by comparison between both examiners using mean and standard deviation; by a two-tailed t-test for the independent samples for all the three groups included in the study.

Result: The shade matching accuracy of Optishade was 97.50%, Vita Easyshade 89.38%, and visual method 62.19%. Statistically, high significant difference in accuracy (p < 0.001) was found when comparing both Optishade and VITA Easyshade with the visual method. Additionally, there was statistically significant difference in accuracy (p < 0.05) when Optishade was compared to Vita Easyshade. The reliability of the Optishade was 99.6% and Vita Easy shade was 99.38%. Statistically, showed no statistically significant difference in the reliability of shade match obtained within the same group when comparing the readings of Examiner 1 and Examiner 2 (p > 0.05).

Conclusion: The colorimeter demonstrated the highest accuracy, followed by the spectrophotometer, and the visual shade selection method. Both digital methods investigated in this study showed comparable reliability.

Clinical implication: The results of this study emphasize the clinical advantage of digital shade-matching devices over visual shade-matching. The colorimeter offers high accuracy for shade matching and should be considered to use for shade matching especially with restorations in the esthetic zone.

Objective: This scoping review aims to clarify the concept of vertical dimension of occlusion (VDO) in prosthetic dentistry, addressing prevalent myths, and controversies regarding its clinical management and impact on the stomatognathic system.

Methods: This paper critically examines common beliefs about VDO alteration and its effects on temporomandibular disorders (TMD) through an extensive literature review and an international survey. The survey included 862 general dentists and prosthodontists and explored their approaches to altering VDO and their perceptions of the clinical implications. The literature review provided a thorough analysis of existing research on VDO modification techniques, the adaptability of the stomatognathic system, and the relationship between VDO changes and TMD.

Results: The survey revealed insights into dentists' perspectives on VDO, showing that while many practitioners test a new VDO due to concerns about patient adaptation, a significant majority observed that patients typically adjust well to a new VDO regardless of the technique used. The survey highlighted differing beliefs about the need for a gradual process and trial phase for VDO alteration, as well as the stability of modified VDO. Literature review suggests the stability and adaptability of VDO changes due to muscle adaptability and indicates no direct causal or curative link between VDO changes and TMD. Traditional methods for determining VDO in complete dentures may not be suitable for worn dentition, underscoring the need for tailored approaches.

Conclusion: This paper suggests that the traditional belief in the need for a prolonged trial phase for VDO alterations may be reconsidered in light of evidence supporting the adaptability of the stomatognathic system. Moreover, it emphasizes the importance of distinguishing between methods suitable for complete dentures and those for managing cases of worn dentition. The purported link between VDO alterations and TMD is also found to lack scientific evidence, highlighting the need for individualized patient care based on current evidence and clinical judgment.

Objective: This article aims to demonstrate the clinical application of a comprehensive workflow that integrates digital tools for accurate color matching, and its immediate implementation in the restoration of anterior teeth.

Clinical considerations: Two patients demonstrating dissatisfaction regarding a maxillary central incisor had an old restoration replaced resorting to a digital workflow to enhance the predictability of the new direct restoration. OptiShade allowed the precise assessment of tooth color and the CompoShade application provided precise color and material selection, as well as the determination of a layering strategy. Precision and accuracy of the colorimeter and the composite layering application were demonstrated clinically in vivo.

Conclusions: Implementing a digital workflow with the integration of OptiShade measurements and the CompoShade layering recipe calculation, as well as the respective realistic try-in, enables the achievement of precise color matching for anterior composite restorations.

Clinical significance: The employment of a digital colorimeter and layering recipes simplify shade matching, and optimizes composite resin clinical use and success. The implementation of a realistic try-in, previous to the definitive restoration, allows the clinician to perform any adjustments if needed.

Objective: To analyze and compare the impact of acidic media on the surface characteristics of highly filled flowable resin-based composites.

Materials and methods: Two hundred fifty-six specimens were divided into four groups: GUF (G-aenial Universal Flo), GUI (G-aenial Universal Injectable), TEF (Tetric EvoFlow), and FSF (Filtek Supreme Flowable Restorative). Surface characteristics were analyzed before (T0) and after specimens immersion in different media, such as gastric juice (GJ), fizzy drink (FD), citric juice (CJ), or artificial saliva (AS), for 9 h (T1) and 18 h (T2). The analyses included surface roughness (SR) measurements, where average roughness (Ra) was obtained, scanning electron microscopy (SEM) analysis, and surface hardness (SH) evaluation, with Vickers numbers (HV) reported. The differences in values among groups/subgroups within the same stage were assessed using two-way ANOVA and Tukey's post hoc test, whereas repeated measures ANOVA with Bonferroni post hoc test was performed to compare the changes in values through the stages. Data were presented as mean ± standard deviation (SD).

Results: At T0, GUI and GUF revealed lower Ra values (p < 0.05), more evenness in SEM micrographs, and higher HV values (p < 0.05) than FSF and TEF. At T1 and T2, specimens of all groups/subgroups demonstrated an increase in Ra and a decrease in HV compared with T0 (p < 0.05), as well as the changes in surface morphology on SEM micrographs. The lowest Ra and highest HV values were observed in GUI group, in contrast to FSF group, and in specimens immersed in GJ.

Conclusions: GUI revealed lower SR and higher SH compared to GUF and FSF both before and after exposure to acidic media. The presence of acidic media, especially GJ, significantly increases SR and decreases SH of tested materials.

Clinical significance: Information on the changes in the surface characteristics of highly filled resin-based composites after exposure to acidic media may be essential for the longevity of restorations like composite veneers fabricated from these materials.