Journal of Esthetic and Restorative Dentistry最新文献

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.

Objective: This study aimed to evaluate, through a case report combined with in vitro study, whether a new diagnostic white tip for the transillumination technique during resin infiltration influences the procedure and degree of conversion (DC).

Materials and methods: A clinical case report demonstrated resin infiltration using the transillumination technique with a new white diagnostic tip (Radii Xpert LED diagnostic tip, SDI, Bayswater, VIC, AU) along with a light-curing device to enhance aesthetic results. An in vitro study assessed the DC of two diagnostic white tips (Radii Xpert LED diagnostic tip [SDI, Bayswater, VIC, AU] and Valo Grand White Light Lens [Ultradent Prod., South Jordan, UT, USA]) compared to that achieved using conventional tips of both light-curing devices. Statistical analysis was performed using two-way ANOVA and Tukey's test (α = 0.05).

Results: The clinical case achieved complete masking of the white spot lesion. In vitro, the diagnostic white tips exhibited significantly lower DC values compared to conventional tips (p = 0.001), regardless of the light-curing unit.

Conclusions: The diagnostic white tip used in the transillumination technique improves resin infiltration visibility without compromising the degree of conversion.

Clinical significance: The transillumination technique with the diagnostic white tip enables monitoring of resin infiltration while maintaining effective polymerization.

Objective: This clinical case describes a digital workflow using face scans and CAD/CAM technology for a full-mouth rehabilitation with increased vertical dimension of occlusion (VDO) with adhesive lithium disilicate restorations after 9 years.

Clinical considerations: A healthy, 46-year-old man displaying severe tooth wear, underwent an extensive full-mouth rehabilitation involving an increase of the VDO through laminate veneers and adhesive partial coverage lithium disilicate restorations. Anatomical landmarks of the face and reference planes were captured using a digital face scanning system. The anatomical position of the maxilla was registered with a transfer device. Digital data sets of the intraoral situation combined with a facial scan enabled precise virtual planning, guiding minimally invasive preparations. Long-term provisional restorations, milled from high-performance polycarbonate, were used to test the novel VDO before the final lithium disilicate restorations were fabricated. This approach provided a time- and cost-efficient treatment solution. No failures were observed at the 9-year follow-up.

Conclusions: Utilizing face scans and design software enable a virtual visualization and comprehensive quality control for patients with dental wear, resulting in significant time savings and increased predictability for the dental technician, dentist and patient.

Clinical significance: The described digital workflow optimizes the planning and implementation of a comprehensive adhesive full-arch rehabilitation with an increase of the VDO. The clinical long-term follow up result of CAD/CAM assisted minimally invasive lithium disilicate restorations after 9 years demonstrates to clinicians a reliable treatment concept for patients with dental wear.

Objective: To evaluate the safety and effectiveness of alveolar bone reconstruction simultaneous to implant removal due to peri-implantitis.

Material and methods: Partial or fully dentulous patients subjected to implant removal due to advanced peri-implantitis (≥ 50% of bone loss) lesions and seeking to have the failed implant replaced for esthetic or functional reasons were consecutively included. Guided bone regeneration was performed by means of a mixture of xenograft and autogenous bone and a ribose cross-linked barrier membrane. Re-entry for implant placement was performed at 4-month follow-up. Overall, six radiographic variables were assessed before (T0) and after (T1) alveolar bone reconstruction at four levels in ridge width (RW) and height (RH). Peri-implant conditions were evaluated at latest follow-up. Simple and multiple binary logistic regression models were calculated using generalized estimation equations to evaluate the effect of baseline upon reconstructive outcomes.

Results: In total, 20 patients (n_implant = 39) met the inclusion criteria. Alveolar RW and RH were augmented from T0 to T1 at all levels. All implants achieved primary stability. Only ~13% were subjected to ancillary bone regeneration simultaneous to implant placement. After a mean follow-up period after loading of ~2.2 years, ~70% implants demonstrated peri-implant health, while mucositis was diagnosed in the remaining implants.

Conclusion: The performance of alveolar bone reconstruction in residual partially contained defects simultaneous to implant removal due to peri-implantitis lesions demonstrates being safe and effective for implant site development.

Objective: This article aims to describe a new technique for predicting the results of resin infiltration procedure in molar incisor hypomineralization lesions, named Infiltration Monitoring by Transillumination. The technique involves the use of transillumination together with ethanol application during the steps of lesion body opening and resin penetration. It provides color contrast that enhances the removal of the less porous surface layer and controls the effectiveness of resin infiltration within the lesion.

Clinical considerations: The clinical procedure presented illustrates the steps involved in the resin infiltration procedure for color masking of molar incisor hypomineralization lesions in anterior teeth, highlighting the use of transillumination both for monitoring the lesion body opening step and the resin infiltration process.

Conclusions: The monitoring with transillumination during the ethanol test can assist the removal of the enamel external layer over the lesion, necessary to expose the inner porosity to be infiltrated, in a very precise and conservative way. In addition, it can effectively help to determine the moment when the infiltrant resin has fully penetrated the lesion.

Clinical significance: The Infiltration Monitoring by Transillumination technique offers the possibility to precisely control the infiltration procedure in molar incisor hypomineralization lesions, thereby improving the predictability of the esthetic outcome.

Objective: In extensive prosthetic rehabilitations and in those involving the anterior area, a correct 3D spatial position is of fundamental importance for effective communication between the clinician and the dental technician. The aim of this article is to analyze the different methods used to position in space and/or in an articulator the maxillary arch in analog workflows highlighting shortcomings and difficulties in order to understand how to overcome them when employing digital workflows.

Overview: Traditional mechanical devices, such as anatomical, kinematic, esthetic and postural facebows, have clear indications, but also limitations, especially in cases of skeletal asymmetries. Modern digital tools, including photography, CBCT, facial scanners and jaw recording devices, are here critically analyzed to illustrate the advantages of working in a virtual space.

Conclusions: The adoption of digital tools in the prosthetic workflow represents a significant improvement compared to traditional techniques, as it reduces errors and artifacts of registration and transfer of the position of the maxillary arch in the articulator space. This contributes to more predictable esthetic and functional results, with a positive impact for clinicians and technicians, improving clinical-laboratory communication, operational efficiency and overall quality of work.

Clinical significance: The integration of digital tools into prosthetic workflows represents an important advancement in clinical practice since they reduce human error and facilitate communication between the clinician and the laboratory. When carrying out rehabilitations involving changes in esthetics or occlusal plane orientation, the proper and accurate positioning of the upper arch in space is particularly relevant.

Objective: Immediate Tooth Replacement Therapy (ITRT) has become popular due to its ability to reduce treatment time and provide immediate esthetic results. However, long-term challenges, such as mid-facial recession and labial bone resorption, have been reported. Anatomic temporary cylinders (ATC), which allow for efficient fabrication of provisional transitional restorations in the esthetic zone, were designed to mimic the natural emergence profile and guide mucosal tissue healing. This study examines the effect of ATCs on the fabrication of provisional restorations compared to conventional non-anatomic temporary cylinders (CTCs) in terms of peri-implant mucosal preservation and stability in patients undergoing ITRT using the dual-zone grafting technique.

Materials and methods: Parameters evaluated were peri-implant mucosal tissue thickness (PIMTT), Pink Esthetic Score (PES), and radiographic outcomes, including labial plate dimension (LPD).

Results: The use of ATCs resulted in a statistically significant increase in PIMTT compared to CTCs, suggesting better preservation of peri-implant mucosal architecture. Additionally, the ATC group exhibited a positive change in LPD, although this difference was not clinically significant.

Conclusions: The findings indicate that ATCs may offer advantages in maintaining peri-implant mucosal stability, contributing to the esthetic and functional outcomes of implant-supported restorations. Further long-term studies are needed to validate these preliminary results.

Clinical significance: The use of anatomic temporary cylinders (ATC) in immediate tooth replacement therapy (ITRT) demonstrated improved peri-implant mucosal tissue thickness, suggesting enhanced maintenance of peri-implant mucosal architecture. This can contribute to healthier and more esthetic outcomes while potentially reducing the risk of complications such as mid-facial recession.

Objective: Data on the stability of soft tissues at pontic sites of resin-bonded fixed dental protheses (RBFDP) are lacking. The purpose of this study was to evaluate soft tissue changes at pontic sites of cantilever zirconia ceramic RBFDPs with and without surgical pretreatment after different follow-up periods in the esthetic zone.

Materials and methods: Impressions were taken after the insertion of the restorations and an intraoral scan was performed at follow-up examinations. Dental casts were digitalized and superimposed with the follow-up scan. Vertical and horizontal soft tissue changes were measured buccally and lingually at mucosal margin at the central cross-section of each pontic, and for horizontal change at 1 and 2 mm below. One-way ANOVA and Kruskal-Wallis test were performed to analyze the collected data.

Results: A total of 36 pontic sites with (n = 7) and without surgical pretreatment (n = 29) were evaluated at a follow-up period of either > 4, > 6, or > 10 years (n = 12). The follow-up period had no significant effect on the tissue change. Surgical pretreatment showed significantly higher tissue loss at 2 mm below the lingual mucosal margin than for sites without surgical pretreatment.

Conclusions: Soft tissues at pontic sites remained stable with a tissue gain at the mucosal margin up to 10 years.

Clinical significance: Based on the findings of this study, cantilever resin-bonded fixed dental protheses provide excellent functional and esthetic outcomes with preservation of soft tissues in the edentulous area of single missing incisors and a gingival sulcus-like tissue growth at the mucosal margin forming an emergence profile at pontic sites similar to that of a natural tooth.

Objective: To map the evidence regarding the clinical performance of posterior restorations with bulk-fill resin composites and identify research gaps.

Materials and methods: This mapping review was conducted following PRISMA-ScR guidelines for scoping reviews, and its protocol was registered on the Open Science Framework platform. Systematic searches were conducted, considering studies published between 2013 and February 2024 in the PubMed, Embase, and Cochrane databases. Clinical studies investigating the performance of bulk-fill resin composite restorations in class I and/or class II preparations with increments of 4 to 5 mm were included.

Results: A total of 147 articles were identified, and based on the eligibility criteria, 26 studies were selected for descriptive analysis. Of the reviewed studies, 73% (n = 19) investigated high-viscosity bulk-fill composites, while 30% (n = 8) focused on low-viscosity bulk-fill composites. Evaluation periods ranged from 1 week to 10 years. Reported annual failure rates varied from 0% to 3%, with survival rates between 78.9% and 100%.

Conclusions: Bulk-fill resin composites of high viscosity were the most analyzed in the published studies, with evaluation periods of up to 10 years. The review of available scientific evidence showed clinically acceptable performance for composite bulk-fill restorations, with high survival rates and minimal annual failure rates. There is a need for long-term clinical studies on bulk-fill resin composites.

Clinical significance: This review demonstrates that both high and low-viscosity bulk-fill resin composites exhibit satisfactory clinical performance, which can help clinicians optimize chairside time. However, it is important to highlight the need for further studies with longer follow-up periods.

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.