PURPOSE To evaluate translucency, fluorescence and opalescence stabilities of direct and indirect composite resins after aging. MATERIALS AND METHODS One direct (16 shades) and two indirect composite resins (16 and 26 shades) were investigated. Resins were filled in a mold (1 mm thick) and light cured; post-curings were performed for indirect resins. Color was measured before and after 5,000 cycles of thermocycling on a reflection spectrophotometer in reflectance and transmittance modes to calculate parameters for translucency (TP), fluorescence (FL) and opalescence (OP). Differences in the changes of TP, FL and OP after aging by the type of resin were determined by t test, and those were also determined by one-way ANOVA with the factor of the brand or the shade group (P < 0.05). RESULTS Changes in TP, FL and OP were -1.2 to 0.7, -0.2 to 0.4 and -0.6 to 1.3, respectively, for direct resins; and were -2.0 to 1.8, -0.9 to 0.4 and -2.9 to 3.7, respectively, for indirect resins. Changes in TP were not significantly different by the type of resin, but those in FL and OP were different (P = 0.05). Changes in optical parameters were influenced by the brand or the shade group of the resins (P < 0.05). CONCLUSION Stabilities in optical properties of resins varied depending on type, brand or shade group. Aging significantly affected fluorescence and opalescence, but not translucency, of indirect resins compared to those of direct resins.
Purpose The purpose of this study was to evaluate the esthetic result of monophasic zirconium dental implants, placed in the highly esthetic areas of the jaws. Material and methods In this case series the results of 12 monophasic zirconium dental implants placed in highly esthetic areas of 8 patients (6 male and 2 female). For each implant the Pink Esthetic Score (PES) and the White Esthetic Score (WES) were evaluated. All implants were inserted in fresh postextraction sites. Results The esthetic parameters PES/ WES has given a total average value of 15.5 ± 1.5. Analyzing the two indices individually, the PES has given a value equal to 7.5 ± 1 and the WES has given a value equal to 8 ± 1.13. Both values obtained indicate the achievement of an absolutely satisfactory esthetic result. Conclusion Within the limits of this study, the zirconium dental implants seems to give excellent results with regard to the esthetic result and for the maintenance of peri-implant soft tissues.
Nowadays, materials and process engineering, especially digital-based techniques, are becoming more and more important for esthetic dentistry. Digital communication is also increasing, which is accompanied by a change from a personal contact to a more technocratic and less emotional and empathic communication. Sometimes our personal experiences and perceptions, based on dental, empirical knowledge, collide with this development. It also happens very often, that the patients - with their perceptions, concerns and not least their esthetic preferences - feel neglected by the treatment team. Patient's wishes often cannot be described adequately. The patient-supported esthetic protocol (PEP) described in this article is a simple tool with which the patients are involved in the esthetic concerns of their treatment. The patient feels to be more perceived, respected, and their wishes implemented, without affecting the medical therapy. At the same time, PEP is used for communication within the health care team, such as the dentist and the dental technician. Because of the clear record it is easy to recognize the changes the patient desires, and the suggestions a teammate developed with the patient, without having been present at the session. Furthermore, the protocol can be attached to the patient's medical history and, therefore, could be a tool for quality management.
Composite resins are the most commonly used materials in restorative dentistry. When first introduced in dental practice, they began to change the esthetic approach to anterior teeth treatments. At first they simply represented a 'white' alternative to unesthetic materials. Today, the clinician can select different materials depending on the characteristics required, such as opalescence, fluorescence, translucency, transparency, viscosity, elasticity, and, obviously, shade. It is no longer a mere matter of selecting the right single syringe. The thicknesses of one or several materials may drastically change the final outcome. A three-dimensional way of planning restorations has overcome the old monochromatic bi-dimensional one. Sound tooth preservation, affordable treatments, and reparability are only a few of the advantages of using composite resins. Clinicians generally consider non-vital anterior teeth a big challenge from an esthetic point of view and they very often prefer to treat them with full or partial indirect ceramic restorations. In the present article, through the analysis of several step-by-step clinical cases, the authors point out that direct restorations could lead to successful esthetic outcomes if correct techniques are applied in order to make up for the differences between vital and non-vital teeth.
PURPOSE: To evaluate translucency, fluorescence and opalescence stabilities of direct and indirect composite resins after aging. MATERIALS AND METHODS: One direct (16 shades) and two indirect composite resins (16 and 26 shades) were investigated. Resins were filled in a mold (1 mm thick) and light cured; post-curings were performed for indirect resins. Color was measured before and after 5,000 cycles of thermocycling on a reflection spectrophotometer in reflectance and transmittance modes to calculate parameters for translucency (TP), fluorescence (FL) and opalescence (OP). Differences in the changes of TP, FL and OP after aging by the type of resin were determined by t test, and those were also determined by one-way ANOVA with the factor of the brand or the shade group (P < 0.05). RESULTS: Changes in TP, FL and OP were -1.2 to 0.7, -0.2 to 0.4 and -0.6 to 1.3, respectively, for direct resins; and were -2.0 to 1.8, -0.9 to 0.4 and -2.9 to 3.7, respectively, for indirect resins. Changes in TP were not significantly different by the type of resin, but those in FL and OP were different (P = 0.05). Changes in optical parameters were influenced by the brand or the shade group of the resins (P < 0.05). CONCLUSION: Stabilities in optical properties of resins varied depending on type, brand or shade group. Aging significantly affected fluorescence and opalescence, but not translucency, of indirect resins compared to those of direct resins.
Bone remodeling and, consequently, soft tissue levels around osseointegrated implants may be influenced by many variables that are considered of prosthetic or biomechanical nature: implant-abutment connection type and geometry (external vs internal), timing of abutment connection (at uncovering vs delayed), abutment material (titanium vs gold vs ceramic), abutment shape and dimensions (convex versus concave, flush with the implant’s collar versus narrower), abutment surface topography (smooth vs microgrooved), number of abutment removals and reconnections (single vs multiple), type of prostheses retention (screw vs cement), loading modality (axial vs off axis, dynamic vs static), parafunctional habits (none vs clencher/bruxer). Many of these variables have been addressed in a previous EAED Closed Meeting by Happe and Körner.1 Therefore, this review will be focused only on the consequences of abutment or reconstruction micromovement on bone and soft tissue stability. Micromovements may occur whenever the abutment screw loosens, or when a prosthetic protocol that contemplates repeated connections and disconnections is selected. These situations may create mechanical irritation of the tissues and pumping of the fluids with bacterial toxins contained in the implant cavities. Thus, they may have negative repercussions on the stability of the peri-implant hard and soft tissues. The topics that will be investigated are: Implant-abutment connection geometry and its influence on screw stability. Abutment insertion protocol.
Enamel white spot lesions are frequent and can impact patients' quality of life. The most conservative treatment in such cases is microabrasion, a technique that presents some drawbacks. The proposed strategy is not based on the elimination of dysplastic enamel, but on masking the lesion by infiltrating the porous subsurface enamel with a hydrophobic resin that has a refraction index closer to that of sound enamel, after permeating the non-porous surface enamel through hydrochloric acid erosion. Erosion-infiltration approaches have been proposed to treat initial caries, but this report suggests extending it to two novel indications: fluorosis and traumatic hypo-mineralization lesions. Four cases were treated by erosion infiltration following the original protocol. They were followed up clinically at several intervals during a period of 19 months of clinical service. The clinical results, although not perfect, satisfied the patients entirely. Erosion infiltration could be a promising alternative for minimally invasive treatment in similar situations.
Coronal rehabilitation of endodontically treated posterior teeth is still a controversial issue. Although the classical crown supported by radicular metal posts remains widely spread in dentistry, its invasiveness has been largely criticized. New materials and therapeutic options based entirely on adhesion are nowadays available. They allow performing a more conservative, faster and less expensive dental treatment. All clinical cases presented in this paper are solved by using these modern techniques, from direct composite restorations to indirect endocrowns.
This study aimed to evaluate the efficacy of chemical agents to increase the bleaching effectiveness of 10% carbamide peroxide. Two hundred and ninety enamel-dentin discs were prepared from bovine incisors. The color measurement was performed by a spectrophotometer using the CIE L*a*b*system. The groups were divided according to the bleaching treatment: negative control group (NC): without bleaching; positive control group (PC): bleached with 10% carbamide peroxide gel without any chemical activator; Manganese gluconate (MG); Manganese chloride (MC); Ferrous gluconate (FG); Ferric chloride (FC); and Ferrous sulphate (FS). Three different concentrations (MG, MC, FG, FC: 0.01, 0.02 and 0.03% w/w; FS: 0.001, 0.002 and 0.003% w/w) for each agent were tested. The bleaching gel was applied on the specimens for 8 h, after which they were immersed in artificial saliva for 16 h, during 14 days. Color assessments were made after 7 and 14 days. The data were analyzed by repeated measures analysis of variance and Tukey's test (5%). Generally, the test groups were unable to increase the bleaching effect (ΔE) significantly compared to the PC group. Only for ΔL, significant higher values compared to the PC group could be seen after 7 days in groups MG (0.02%), and FS (0.002 and 0.003%). The NC group showed significantly lower values than all tested groups. It was concluded that for home bleaching procedures, the addition of chemical activators did not produce a bleaching result significantly higher than the use of 10% carbamide peroxide without activation, and that the concentration of chemical activators used did not significantly influence the effectiveness of treatment.
A full-mouth adhesive rehabilitation in case of severe dental erosion may present a challenge for both the clinician and the laboratory technician, not only for the multiple teeth to be restored, but also for their time schedule, difficult to be included in a busy agenda of a private practice. Thanks to the simplicity of the 3-step technique, full-mouth rehabilitations become easier to handle. In this article the treatment of a very compromised case of dental erosion (ACE class V) is illustrated, implementing only adhesive techniques. The very pleasing clinical outcome was the result of the esthetic, mechanic and most of all biological success achieved, confirming that minimally invasive dentistry should always be the driving motor of any rehabilitation, especially in patients who have already suffered from conspicuous tooth destruction.
Specialist literature shows that the repeated disconnection of the transmucosal components can generate tissue recession due to the alteration of the delicate environment created between the abutment and surrounding soft tissue. This article will analyze two different techniques of creating the final abutment in the pre-surgery phase, evaluating 2 failing central incisors considered suitable for the immediate tooth replacement technique.
In restorative dentistry, the non-vital tooth and its restoration have been extensively studied from both its structural and esthetic aspects. The restoration of endodontically treated teeth has much in common with modern implantology: both must include multifaceted biological, biomechanical and esthetic considerations with a profound understanding of materials and techniques; both are technique sensitive and both require a multidisciplinary approach. And for both, two fundamental principles from team sports apply well: firstly, the weakest link determines the limits, and secondly, it is a very long way to the top, but a very short way to failure. Nevertheless, there is one major difference: if the tooth fails, there is the option of the implant, but if the implant fails, there is only another implant or nothing. The aim of this essay is to try to answer some clinically relevant conceptual questions and to give some clinical guidelines regarding the reconstructive aspects, based on scientific evidence and clinical expertise.
UNLABELLED:In case of severe dental erosion, the maxillary anterior teeth are often particularly affected. Restoring such teeth conventionally (ie, crowns) would frequently involve elective endodontic therapy and major additional loss of tooth structure. A novel, minimally invasive approach to restore eroded teeth has been developed and is currently being tested in the form of a prospective clinical trial, termed The Geneva Erosion Study. To avoid crowns, two separate veneers with different paths of insertion have been used to restore the affected anterior maxillary teeth, regardless of clinical crown length and amount of remaining enamel. This treatment is called The Sandwich Approach.OBJECTIVES:The purpose of this case series study was to analyze the mid-term clinical outcome of maxillary anterior teeth affected by severe dental erosion that were restored following the Sandwich Approach.MATERIALS AND METHODS:Twelve consecutively consulting patients (mean age: 39.4 years) suffering from advanced dental erosion have been enrolled in the study and were subsequently treated. Due to the late interception of the disease, all patients needed a full-mouth rehabilitation, which was performed without any conventional crowns. At the level of the maxillary anterior teeth, a total of 70 palatal indirect composite restorations and 64 facial feldspathic ceramic veneers were delivered. Both types of veneers were adhesively luted with a hybrid composite. Clinical reevaluations were performed 6 months after insertion of the veneers, and then annually, using modified United States Public Health Service (USPHS) criteria. Marginal adaptation, marginal integrity (seal, absence of infiltration), status of pulp vitality, postoperative sensitivity, esthetics, and restoration success/failure, were the principal clinical parameters analyzed.RESULTS:After an up to 6-year observation time (mean observation time 50.3 months for the palatal veneers and 49.6 months for the facial veneers), no complete or major failure of the restorations was encountered. On the basis of the criteria used, most of the veneers rated Alpha for marginal adaptation and marginal seal. Secondary caries or endodontic complications were not detected. Using visual analogue scale analysis, the patient-centered satisfaction revealed a high esthetic and functional acceptance of 94.6%.CONCLUSIONS:Compared to conventional crown preparation, restoring compromised maxillary anterior teeth by means of 2 veneers prevents excessive tooth structure removal and loss of tooth vitality. Questions on the longevity of this new treatment arise, due to the nonfavorable initial status of the teeth to be restored (eg, lack of enamel, sclerotic dentin substrate and short clinical crowns). The clinical performance of the teeth treated following the Sandwich Approach seems promising, since none of the treated teeth lost their vitality, no failure of any of the restorations was detected, and the patients' overall satisfaction was high. Even though further investigation is needed to determine the clinical long-term performance of the described treatment modality, the encouraging mid-term results (biological, esthetic, and mechanical success) clearly question if conventional crowns in the anterior maxillary segments can still continue to be considered the best and only option to treat this particular population of patients.
Aims and objectives The aim of this study was to assess the efficacy of 18% hydrochloric acid and 37% phosphoric acid by an in vivo comparison. Methods Sixty fluorotic permanent maxillary central incisors from 30 patients were divided into 3 categories. The teeth received 5 seconds (mild fluorosis), 20 seconds (moderate fluorosis) and 30 seconds (severe fluorosis) application of 18% hydrochloric acid on 11 and 37% phosphoric acid on 21. Standardized intraoral photographies were taken immediately before, after, and one month after treatment. Vinyl polysiloxane impression of the patient were made before and after the treatment. A scanning electron microscopic (SEM) evaluation was carried out on the models to judge the surface alterations. Wilcoxon and Mann-Whitney tests were used to verify the hypothesis. Results A statistically significant result was obtained in the reduction of white spot opacities, intensity of stains and the total area occupied by the stains in mild and moderate fluorosis teeth. Results of severe fluorosis had an unpredictable outcome. An SEM evaluation revealed good improvement in the surface texture of mild and moderate fluorosis teeth. Teeth with severe fluorosis showed only a slight improvement. Conclusion A microabrasion procedure is effective for treating mild and moderate fluorosis cases.
This study aimed to evaluate whether preheated resin-based flowable restoratives would show increased hardness and softening susceptibility after an early cariogenic challenge. Fluroshield- Yellowed, Bioseal, Wave, Master Flow, Fluroshield-White, Conseal F, Filtek Z350 Flow, and Opallis Flow were tested. Preheating was performed using a microwave device. Five specimens of each preheated or room temperature material (n = 5) were fabricated. Hardness was assessed before and after a cariogenic challenge. The analysis was done by two-way analysis of variance (ANOVA) with repeated measures (cariogenic challenge) and Tukey's test for multiple comparisons (
Compliance and adherence are multidimensional challenges. The terms adherence and compliance are, in fact, not synonymous. Compliance implies obedience to a directive, rather than a mutually agreedupon course of action.2 Conversely, adherence implies a more participatory process. The World Health Organization (WHO) defines adherence as the extent to which a person’s behaviour—taking medications, following a diet, and/or executing lifestyle changes—corresponds with recommendations from a health-care provider.3 The WHO describes five interacting factors that affect adherence: social and economic, health-care teamand systemrelated, condition-related, therapy-related, and patient-related. Other considerations within these dimensions include: • knowledge of disease and its precursors; • previous levels of adherence; • ability to follow recommended behaviours; • perception of health/benefits of therapy; • availability of social support; and • complexity of treatment regimen.4
BACKGROUND The need for proper framework support for the veneer porcelain in fixed partial dentures (FPDs) has been well documented. The aim of this study was to compare the variations of the support provided by frameworks designed directly on the computer, or indirectly through scanning a wax pattern. MATERIALS AND METHODS For each of the six upper anterior FPDs that were involved in the study, prior to milling one framework was designed conventionally in wax and scanned and another one was directly digitally designed. The restorations consisted of full coverage retainers and pontics on natural abutment teeth and implant abutments at random. The produced frameworks were evaluated regarding the incisal support they would provide to the veneer material, as this was revealed by a silicon key representing the outer labial contour of the provisional restoration. The distances between the distal and mesial incisaledges and the corresponding negative incisal contour of the key were measured with a digital caliper. Statistical analysis was performed by linear regression with the design method, abutment type and pontic type as independent parameters (a = 0.05). RESULTS The values recorded were: means ± SD: 3.3 ± (direct CAD), 2.6 ± mm (indirect CAD) 2.7 ± mm (for retainers on natural teeth) 2.7 (on implant abutments), and 3.3 mm (for pontics). Linear regression analysis showed that the indirect technique provided more intimate incisal support for the ceramic veneer on a statistically significant level and even more so in the pontic areas.
OBJECTIVES To our knowledge, there is no study regarding the effects of facial type (short face or long face) on the esthetic perception of smiles as related to the amount of tooth and gingival display. MATERIALS AND METHODS Four photographs from two long- and two shortfaced females with posed smiles were prepared and, with altering the amount of tooth display, 5 photos for each of them were produced. These photos were given to 62 dentists and 69 laypersons to rate the images. RESULTS There were significant differences between short and long-face patterns in low and high smile lines; also there were significant differences between dentists and laypersons about some images. Smile lines consistent with gingival margin were the best for both short and long-face patterns; also 1.5 mm incisor coverage in short-face and 1.5 mm gingival display in long-face received as high scores. CONCLUSION In short-face patterns, lower smile lines, and in long-face patterns, higher smile lines are more acceptable by both dentists and laypersons, which can help in designing orthodontic treatment goals.
As the demand for an esthetically satisfactory smile has increased, interest in less invasive procedures, such as composite restoration and tooth bleaching, has also increased. Composite resins exhibit several optical properties, including fluorescence, which are intended to mimic the natural dentition. The aim of this study was to evaluate the effect of hydrogen peroxide (HP) bleaching protocols for home and in-office applications on the fluorescence of composite resins. Sixty composite resin specimens (shade A2) were divided into 2 groups of 30 each according to the material type (groups R1 and R2 were made up of 4 Seasons and Opallis specimens, respectively). Each group was subdivided into 3 subgroups (n = 10) according to the bleaching protocol administered: home application (HP 7.5%); in-office application (HP 35%); and control (Co), immersion in deionised water. The fluorescence intensities were measured before and after the bleaching treatments using a Cary Eclipse fluorescence spectrophotometer and statistically analysed by paired t test, Student's t test, analysis of variance (ANOVA), and Tukey's multiple comparison test (P < 0.05). Significant differences between groups R1 and R2 after the different treatments were noted. The fluorescence intensities differed across the subgroups after 30 days of treatment. The HP 7.5% protocol induced the greatest change in the fluorescence intensities among the specimens in the R1 group.
