Journal of Esthetic and Restorative Dentistry最新文献

Objective: This article describes a clinical protocol utilizing soft tissue augmentation alone or in combination with guided bone regeneration (GBR), introducing simultaneous application of the one abutment one time concept for three-dimensional reconstruction of the deficient ridge.

Clinical considerations: Soft and hard tissue quality and dimensions are fundamental elements for long lasting results in implant dentistry. Different techniques have been described for soft and hard tissue augmentation at time of implant placement presenting favorable results. However, multiple abutment disconnections during the prosthetic phase of treatment can compromise the results achieved during surgery. The purpose of this article is to present a surgical protocol that allows three-dimensional ridge reconstruction involving soft tissue augmentation alone, or in combination with hard tissue augmentation in one single step with the use of an one-time intermediate abutment as an anchorage device for the regenerative materials. Two clinical cases utilizing the proposed protocol are also presented, demonstrating favorable results.

Conclusions: The application of the proposed protocol simplifies the surgical phase of treatment, protects the achieved result and enables a favorable outcome in decreased time.

Clinical significance: Utilising an intermediate abutment as an anchorage device at time of surgery can be proven an easy to apply and biologically favorable alternative way to other methods of soft tissue graft stabilization proposed in the past.

Objective: To evaluate the effect of staining, glazing, and polishing of stabilized zirconia with 5 mol% of yttrium oxide (5Y-TZP) on the wear behavior of opposing tooth enamel.

Materials and methods: The plane specimens of 5Y-TZP were divided into 6 groups (n = 10), according to surface treatment: as sintered, staining, glazing, polishing, staining followed by glazing, and staining followed by polishing, and positioned against tooth enamel during the two-body wear test (20 N, 2 Hz, until completing 300,000 cycles). The wear rates of tooth enamel were evaluated using a profile projector and a digital pachymeter as a measure of vertical height loss. The data were analyzed by one-way ANOVA and a Tukey post hoc test (α = 0.05).

Results: Polishing reduced the vertical height loss (p < 0.001) while there was no difference among other groups.

Conclusion: Polishing is recommended as a finishing procedure to reduce the wear rates of tooth enamel, and finishing procedures (glazing or polishing) performed after staining did not affect the vertical height loss of tooth enamel.

Clinical significance: Polishing is the recommended finishing procedure for preshaded 5Y-TZP to reduce the wear rates of opposing tooth enamel. Staining is applied to the occlusal surface to reproduce the pigmented groove appearance, and glazing or polishing performed after staining did not affect the wear rates of opposing tooth enamel.

Objective: This study proposes an updated method for the film thickness of 21 resin composites used as cements.

Materials and methods: A load of 30 N was subjected to two glass plates stacked on a heated base to simulate clinically relevant pressure and temperature during the seating of inlays/onlays/veneers. The axial position of the actuator was recorded before and after placing 22.15 mm³ of resin composite between the glass slides. The difference between the two measurements was calculated for each specimen. A total of 18 condensable restoratives, 1 injectable restorative, and 2 resin cements were tested, 5 specimens each (n = 5, N = 105). One-way ANOVA was performed for both variables and Games-Howell post hoc test was used for pairwise comparisons.

Results: The film thickness range was 6-200 μm, with the lowest values for restorative composites (AP-X, Z250, and Herculite XRV Incisal LT with 6-8 μm), followed by Gradia Direct (25 μm) and flowable/injectable composite resins, including designated cements (15-27 μm). Inspiro, Ultradent Transcend Universal, and ENA Hri dentin stood below 50 μm (range 28-49 μm). The other materials (range 81-200 μm) cannot be recommended for thermo-modified cementation.

Conclusions: The initial viscosity of restorative composites is not an indication of the film thickness when used for thermo-modified cementation. There is a wide choice of appropriate materials available on the market.

Clinical significance: Some restorative composites are able to generate very thin films and can be used as cement with numerous advantages when compared to designated flowable or dual-cure cements.

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.