Operative dentistry最新文献

Background: Dental liners are used on caries-free dentin to attenuate postoperative sensitivity and caries-affected dentin to promote remineralization and for antibacterial effects. The shear bond strength of liners to caries-affected and caries-free dentin is a significant clinical property in the restoration of teeth with large caries lesions. Objective: The aim of this in vitro study was to compare the shear bond strengths (SBS) of different liners to caries-free and caries-affected dentin.

Methods and materials: SBS specimens were prepared according to ISO 29022:2013(E) (n=10/ group). Caries-free dentin specimens were ground to superficial dentin. For caries-affected dentin, grinding to proximity of carious dentin was performed, remaining caries-infected dentin was removed with a polymer bur, and sanding to 320 grit was conducted to achieve a flat surface. 150-micron thick tape was centered over caries-free or caries-affected dentin, and five different liners (new RMGI-based calcium silicate liner [RMGI/ CS], Biodentine, Lime-Lite Enhanced, TheraCal LC, Vitrebond Plus) were applied to dentin and leveled with the tape. Specimens were treated with adhesive, cured, and bonded with resin composite using the Ultradent fixture. Specimens were stored in 37°C water for 24 ± 2 hours and debonded at 1 mm/min. SBS was analyzed by two-way analysis of variance (ANOVA) and the Tukey post hoc test.

Results: There was a significant difference in SBS among materials for both caries-affected and caries-free dentin (p<0.01). Tukey post hoc analysis grouped materials into significantly different groups for caries-free dentin (Lime-Lite Enhanced, Biodentine < TheraCal LC < Vitrebond Plus, RMGI/CS) and caries-affected dentin (Lime-Lite Enhanced, Biodentine, TheraCal LC < Vitrebond Plus, RMGI/CS). There was no difference in SBS to caries-free and caries-affected dentin for Lime-Lite Enhanced (p=0.359), Biodentine (p=0.522), Vitrebond Plus (p=0.406), or RMGI/CS (p=0.165). SBS was significantly greater to caries-free dentin with TheraCal LC (p<0.01).

Conclusions: RMGI/CS and Vitrebond Plus produced higher SBS to caries-free and caries-affected dentin than the three other materials. There was a higher bond to caries-free dentin than caries-affected dentin for TheraCal LC, but not for any of the other liners tested. Clinicians should balance biologic advantages of liner materials with a decrease in bond strength.

Objective: To evaluate the bond strength of self-adhesive (no need for bonding procedures) and conventional (with total-etch or self-etch primers) cementation strategies and the qualitative variables that interfere with the adhesion of fiberglass posts through a systematic review and meta-analysis of in vitro studies.

Methods: This systematic review and meta-analysis was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and registered under the International Prospective Register of Systematic Reviews (PROSPERO). The research question was "What resin cement provides better bond strength between the fiberglass posts and the root dentin: conventional or self-adhesive?" The PubMed/MEDLINE, Web of Science, Scopus, and Cochrane databases were searched by two independent researchers.

Results: There were statistically significant differences between self-adhesive and conventional resin cements (p<0.00001), favoring conventional cements.

Conclusion: Conventional cements presented the best results regarding the bond strength of the fiberglass post cementation. However, variations in methodology and the risk of bias in analyzed studies may have decreased the reliability of the present study. More studies on this subject using a leveled methodology are recommended.

Objective: In this case report, we describe the use of a universal shade resin composite to restore a discolored tooth before nonvital tooth bleaching. The intent of this procedure is to maintain an acceptable color match, eliminating the need for subsequent replacement of the restoration after bleaching.

Methods: A substantial defective Class IV resin composite was removed from a discolored, endodontically treated tooth #8. The existing gutta percha was sealed with glass ionomer, and 35% Thanawat Ruaydee, DDS MSc, Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Nahon Pathom, Thailand hydrogen peroxide gel was applied in the access chamber. The access cavity was temporarily sealed with a flowable resin composite and the entire tooth was restored with a group-shade universal resin composite. After a two-week bleaching period, the bleaching gel and temporary filling in the access cavity were replaced with the same universal shade resin composite, without necessitating the complete replacement of the entire restoration.

Results: A favorable outcome was noted during a one-year follow-up period, with the bleached tooth maintaining a harmonious color and the resin composite restoration exhibiting a stable and satisfactory condition.

Conclusion: The clinical use of a universal shade resin composite before bleaching exhibited significant promise in facilitating an effective color match in a discolored tooth after bleaching. This method may substantially diminish the need for restoration replacement due to challenges associated with color discrepancies.

Objectives: To depict restorative treatment recommendations of US dentists for posterior proximal enamel caries lesions detected with bitewing radiographs in permanent teeth.

Methods: The Fact Box format was utilized to depict the probabilities of restorative treatment recommendations made by US dentists for posterior proximal enamel caries lesions detected with bitewing radiographs in permanent teeth. Four case scenarios were considered, including patients at low caries risk versus those at high caries risk for two proportions (10% versus 38%) of proximal enamel caries lesions with external surface cavitation.

Results: The Fact Box showed that the decision to restore posterior proximal enamel caries lesion was more likely to be an incorrect decision (61-91%) in the four case scenarios considered. Meanwhile, the decision to not provide restorative treatment for posterior proximal enamel caries lesion was less likely to be erroneous (9-37%) in the four case scenarios considered.

Conclusion: Using the Fact Box to depict restorative decision-making for posterior proximal enamel caries lesions in permanent teeth may improve communication of decisional probabilities and reduce restorative overtreatment.

Objective: The aim of this bibliometric analysis was to investigate the prevalence of bibliometric parameters related to clinical trials with bulk-fill resin composites according to financial assistance over time.

Methods: Five electronic databases were accessed (PubMed/MEDLINE, Embase, The Cochrane Library, Virtual Health Library, and Scopus) and seven bibliometric parameters related to geographic origin, year, impact factor, and publication details related to bulk-fill resin composite restorations and their clinical performance were considered. The prevalence ratio was applied using Poisson multiple regression analysis (α=0.05) to assess the association between funding and associated bibliometric parameters.

Results: In total, 59 clinical trials that analyzed the clinical performance of restorations with bulk-fill resin composites were published between 2014 and 2023 and were evaluated bibliometrically; 40.7% (n=24) of the studies reported financial assistance. Financing was associated with bibliometric parameters related to the consistency of the materials, specifically with studies involving sculptable and flowable composites funded more frequently (p<0.001) than studies evaluating only sculptable consistency. Studies that analyzed class I and II cavities showed greater financial assistance (p=0.028) compared to class I cavities, and financing increased as the journal's impact factor increased (p=0.013).

Conclusions: Financial assistance of clinical trials evaluating bulk-fill resin composite restorations was associated with material consistency, tooth cavity design, and journal impact factor bibliometric parameters.

Purpose: To evaluate the in vivo and in vitro performance of an intraoral camera (IC), visual examination using the Thylstrup and Fejerskov Index (TFI), and quantitative light-induced fluorescence (QLF) to detect and quantify enamel fluorosis (EF).

Methods and materials: Calibrated examiners performed IC-qualitative (ICQual), TFI, IC-quantitative (ICQuant), and QLF (Area, Fluorescence loss [ΔF], and ΔQ: Area×ΔF) on 150 extracted teeth in vitro and 150 children in vivo. Polarized light microscopy (PLM) was the gold standard for the in vitro phase. Cross tabulation, agreement, correlation, comparison of means from quantitative measures, sensitivity, and specificity were calculated for TFI, QLF, ICQual, and ICQuant. For the in vivo phase, TFI scores were cross tabulated with ICQuant and ICQual, and Kendall's Tau was used to measure correlation.

Results: Agreements of TFI and ICQual with PLM were 53.77% and 47.17%, respectively. Correlation coefficients for QLF (area, ΔF, ΔQ) and ICQuant with PLM scores were 0.47, 0.56, 0.51, 0.46, respectively. Sensitivity/specificity for TFI, ICQual, ICQuant, and ΔQ were 0.86/0.58, 0.86/0.62, 0.86/0.58, and 1.00/0.13, respectively. For the in vivo phase, correlations of ICQual and ICQuant with TFI were 0.55 and 0.52, respectively. Quantitative measurements of ICQuant by TFI scores showed consistent separation in means, while those for QLF were neither as clear nor as consistent.

Conclusion: All methods were able to detect and quantify enamel fluorosis. However, there were consistent and significant differences among them.

Purpose: This study compared four CAD/CAM lithium disilicate-reinforced glass ceramic systems (IPS e.max CAD, Rosetta SM CAD, T-lithium CAD, and IRIS CAD) regarding their crystalline and microstructural characteristics, thermal properties, mechanical strength, and bonding to a resin cement.

Methods and materials: The crystalline and morphological characteristics of the ceramic microstructure were investigated by X-ray diffraction (XRD) and scanning electron microscopy (SEM), thermal behavior was assessed via differential thermal analysis (DTA). Mechanical properties were evaluated using a biaxial flexural strength test, and bonding to a resin cement was measured with a microshear strength test at distinct storage times. Data were evaluated using analysis of variance and Tukey HSD tests (α = 0.05).

Results: High peak positions corresponding to standard lithium metasilicate and lithium disilicate with similar intensities were observed for all ceramics in the XRD analysis. SEM morphological analysis showed differences in crystal characteristics among the ceramics after HF etching. The DTA thermograms showed a crystallization process ranging from 812-872°C among the different ceramic systems. The IRIS system showed the lowest flexural strength values, while bond strengths to resin cement remained comparable among materials, regardless of storage time.

Conclusions: Most lithium disilicate ceramic systems demonstrated acceptable characteristics in the tests performed, except for IRIS, which showed shortcomings in crystal morphology and mechanical strength, along with inconsistent thermal behavior. These findings underscore the importance of careful material selection to ensure durable dental restorations.

Objective: To present a clinical case featuring a posterior cantilevered single-retainer all-ceramic resin-bonded fixed dental prosthesis (PC-RBFDP) with 12 years of follow-up. This FDP was used to restore a missing premolar using a single-retainer canine abutment. The aim was also to draw clinical recommendations based on current data and experience.

Methods: To address the present case, the missing premolar was replaced with a stratified 3Y-TZP zirconia PC-RBFDP fabricated from a conventional impression using CAD-CAM technology. The prosthesis was bonded using a resin luting cement containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP), and the patient was reevaluated semi-annually. Insights obtained from this case, along with advancements in scientific understanding based on current data, are further explored.

Results: This clinical case, which occurred 12 years ago, was successful. Building on the insights gained from this case and subsequent ones, modifications to the preparation geometry have been implemented, informed by the in vitro biomechanical findings presented herein. Furthermore, a step-by-step clinical procedure is suggested, drawing from experience with other cases and the current literature on PC-RBFDPs.

Conclusions: With a necessity of caution due to the limited evidence supporting this therapy, this clinical case shows promising results in the use of ceramic RBFDPs in the posterior region, providing an alternative to implants in contraindicated patients. The comprehensive approach shown in the step-by-step clinical case and the manuscript, including indication assessment, selection of bonding materials, ceramic choice, and preparation geometry, utilizes, to the best of our ability, the most current information and technology available. Continued research is needed to further validate this treatment modality.