International Journal of Esthetic Dentistry最新文献

Aim: The objective of the present study was to evaluate the survival rate and clinical performance of three CAD/CAM materials used for the fabrication of monolithic single crowns: lithium disilicate glass-ceramic (LiSi); feldspathic ceramic (FC); and polymer-infiltrated ceramic network (PICN).

Materials and methods: Fifty patients requiring a maxillary or mandibular posterior single crown were included in the present prospective randomized controlled clinical trial. Patients were randomly assigned to one of three study groups (LiSi, FC, PICN). The primary outcome was survival; the secondary outcomes were biologic and technical parameters as well as modified-USPHS (mUSPHS, United States Public Health Service) criteria. Outcomes were assessed after crown insertion at baseline (BL) and at a 1- and 3-year follow-up (1y-FU, 3y-FU). Statistical analysis included descriptive statistics and Kaplan-Meier curves, with the log-rank test for survival and the Kruskal-Wallis test for the comparison of biologic and technical parameters.

Results: At the 3y-FU, the survival rate was 100% for both LiSi and PICN crowns, while FC crowns exhibited a significantly lower survival of 76.9% (P = 0.039). The failures in the FC group were attributed to three complete crown fractures. Regarding the secondary outcomes, PICN crowns showed significantly more plaque accumulation than FC and LiSi crowns after 1 and 3 years.

Conclusions: Monolithic single crowns fabricated using CAD/CAM techniques, specifically in LiSi and PICN, demonstrated high survival rates at the 3y-FU. However, crowns made of FC showed a higher rate of both minor and catastrophic fractures. Therefore, the use of FC may not be recommended for single posterior crowns, especially when restoring teeth with reduced tooth substance.

Clinical implications: The present study highlights the clinical superiority of LiSi and PICN over FC for single crowns in the posterior region, with LiSi and PICN showing significantly higher 3-year survival rates.

Objective: Maxillary anterior gingival recessions (GRs) are esthetically demanding. The aim of this study was to evaluate clinical and esthetic outcomes and tissue stability of mucogingival procedures performed by means of a coronally advanced flap (CAF) or tunnel (TUN) technique in combination with a subepithelial connective tissue graft (SCTG) at 2 to 14 years follow-up and to identify patients' esthetic perception.

Materials and methods: Individuals presenting with RT1 or RT2 GRs in the maxillary anterior sextant were recalled to evaluate clinical outcomes and patient satisfaction 2 to 14 years postoperatively. Visual analog scale (VAS) and recession esthetic score (RES) assessment was used for evaluation.

Results: Thirty-four consecutive individuals, 20 CAF and 14 TUN, participated in this study. Complete root coverage (CRC) was 90% and 92.8% for CAF (18/20) and TUN (13/14) individuals, respectively (P > 0.05). Mean root coverage was 98.5% ± 3.5 and 99.2% ± 2.7 for the CAF/TUN groups, respectively (P > 0.05). Mean recession depth (RD) at baseline was 4.9 ± 1.1 (range: 4 to 9 mm) and 4.4 ± 0.6 (range: 4 to 6 mm) for the CAF and TUN groups, respectively, and 0.05 ± 0.15 and 0.03 ± 0.13, respectively, at follow-up. Mean baseline RD difference (0.5 ± 0.3 mm) was not statistically significant (P > 0.05; confidence interval [CI]: 0.17 to 1.21). Keratinized tissue width (KTW) was significantly greater (0.7 ± 0.2) in TUN individuals at follow-up (4.9 ± 0.8 vs 4.2 ± 0.5; P = 0.007; CI: 0.22 to 1.21). Mean follow-up was 42.0 ± 32.9 and 44.2 ± 25.6 months (range: 24 to 168 months) for CAF/TUN groups, respectively. Patients' perception (VAS) of satisfactory esthetics was high for both CAF and TUN, but not statistically significantly higher than the professional RES assessment (P > 0.05). Mean VAS scores of CAF vs TUN were not statistically significant (P > 0.05). The lowest RES score attained was for RT2 defects, with a mean 9.5 points for both CAF and TUN, and was not statistically significantly different from the VAS score (P > 0.05).

Conclusions: Both CAF and TUN provided satisfactory long-term esthetics and tissue stability. Patients' esthetic perception of CAF and TUN was equally high and similar to the professional RES evaluation.

Clinical relevance: Greater keratinized tissue can be achieved with the TUN approach. Residual recessions of ≤ 0.5 mm after 2 years were absent for RT1 and unlikely for RT2 defects and did not significantly influence the overall VAS or RES esthetic scores.

Restorative correction of a moderate to severe malocclusion puts both the dentist and patient at a higher subjective risk regarding biologic and occlusal parameters. Without the use of orthodontics or orthognathic surgery, the prosthodontic demands on misaligned abutments can be significant. However, the use of logical force management concepts can deliver a biomechanically stable result. Some of these include accurately recording a repeatable condyle position, distributing non-axial occlusal forces evenly, adding length and buccal volume in a 1:1 ratio, and testing the new occlusal scheme for a considerable time before finalization. The present case report describes an alternative treatment route to rehabilitate a patient who declined orthodontic therapy after several specialist consultations. In summary, our expedition involved orthopedic repositioning of the condyles into an airway centric relation, increase in the vertical dimension of occlusion, autorotation of the mandible, buccalization of the maxillary arch, lingualization of the mandibular arch, dentoalveolar decompensation, diastemata closure, and prosthetic soft tissue camouflage.

Objective: Immediate implant placement and immediate provisional (IIPIP) are widely accepted by patients because they minimize overall treatment time. The aim of the present article is to describe all the zones that could influence esthetic outcomes and provide biologic plausibility of their relevance.

Clinical considerations: Six zones are identified in the alveolar postextraction socket: anchorage zone (Zone A), bone compartment (Zone B), clot compartment (Zone C), dermal compartment (Zone D), esthetic zone (Zone E), and fixed restoration (Zone F). Three zones are intra-alveolar (Zones A, B, and C), and three are extra-alveolar (Zones D, E, and F). Zone F (fixed restoration) is further subdivided into F1, F2, and F3. In the present article, the authors explain the effect on the esthetic outcome of these six different immediate implant zones (related to the alveolus and fixed restoration), aiming to elucidate the reasons why immediate implant therapy is effective in transitioning a tooth-gingival complex into a peri-implant complex.

Conclusions: Immediate implants in the esthetic region must be addressed from the perspective of the integration of planning, surgical intervention, and prosthetic restoration. The approach adopted to each area of the tooth to be extracted and its periodontium plays a significant role in the final healing of the peri-implant tissue.

Clinical significance: The topic of IIPIP is highly relevant in the current dentistry scenario due to the growing demand for time-efficient and esthetically pleasing dental treatments. The 'zones' concept provides a detailed analysis of the specific areas that influence esthetic outcomes, offering insights that can refine clinical practice.

Endoperiodontal lesions (EPLs) are defined as an acute or chronic condition in which both the pulp and periodontal tissue are infected, resulting in deep periodontal pockets that may be a very challenging scenario for clinicians. No clear protocol has been established to date for the complete resolution of these cases. The aim of the present article is to present a new interdisciplinary treatment protocol that reduces the time interval between the nonsurgical periodontal and endodontic treatment and the periodontal regeneration surgery. Two clinical reports of EPLs are described. During Step I periodontal therapy, endodontic treatment was also performed. Six weeks later, Step II periodontal therapy by means of periodontal regeneration surgery was achieved. After 12 and 42 months, periodontal pocket depth reduction, clinical attachment level gain, and radiographic bone fill of the areas involving the EPLs were observed. Reducing the time interval between the nonsurgical periodontal and endodontic treatment and the periodontal regeneration surgery may be beneficial in these complex scenarios.