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OBJECTIVE: This article puts forward consensus recommendations from PROSEC North America regarding single indirect restorations made from ceramic and nonmetallic biomaterials in posterior teeth. OVERVIEW: The consensus process involved a multidisciplinary panel and three consensus workshops. A systematic literature review was conducted across five databases to gather evidence. The recommendations, informed by findings from systematic reviews and formulated based on a two-phase e-Delphi survey, emphasize a comprehensive treatment strategy that includes noninvasive measures alongside restorative interventions for managing dental caries and tooth wear. The recommendations advocate for selecting between direct and indirect restorations on a case-by-case basis, favoring inlays and onlays over crowns to align with minimally invasive dentistry principles. The recommendations highlight the critical role of selecting restorative biomaterials based on clinical performance, esthetic properties, and adherence to manufacturer guidelines. They emphasize the importance of precision in restorative procedures, including tooth preparation, impression taking, contamination control, and luting. Regular follow-up and maintenance tailored to individual patient needs are crucial for the longevity of ceramic and nonmetallic restorations. CONCLUSIONS: These PROSEC recommendations provide a framework for dental practitioners to deliver high-quality restorative care, advocating for personalized treatment planning and minimally invasive approaches to optimize oral health outcomes. CLINICAL SIGNIFICANCE: The PROSEC North America recommendations highlight the importance of minimally invasive techniques in posterior tooth restorations using ceramic and non-metallic biomaterials. These principles prioritize tooth structure conservation and personalized treatment planning, essential for enhancing clinical outcomes and long-term oral health.
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Purpose: To evaluate the preferences of dental practitioners for tooth-supported crowns dental ceramics by means of an online survey and to assess the influence of age, gender, years of experience, and dental specialty on those preferences. Materials and Methods: An anonymous questionnaire was delivered online through Google Surveys, targeting 796 dentists. It contained 17 dichotomous, closed questions with two sections. The first section dealt with general characteristics, including age, gender, years of experience, training in prosthodontics, and hours worked per week. The second section included questions regarding preferences of different materials for crowns, and the use of digital workflows. Analyses were carried out with Stata 14.0 software (StataCorp, TX, USA). A significance level of p=0.05 was adopted. Results: 248 surveys were answered. Practitioners in Chile preferred lithium disilicate for the anterior region (55.2%) but also for the posterior area (40.7%), regardless of their age, gender, years since graduation, hours worked per week or any training in prosthodontics. Chilean dentists over 50 years old considered zirconia almost 4 times more than those under 30 years old for anterior crowns (51.85%). 59.68% of dentists take digital impressions, and 37.10% have access to chairside CAD/CAM technology. In this group, 54.4% preferred feldspathic ceramic for anterior and 23.9% for posterior crowns. Conclusions: While there is a wide range of dental ceramic materials, these results provide a snapshot of the current trends in Chile where lithium disilicate is the most preferred ceramic material for tooth-supported crowns, and metal-ceramic is the least preferred material.
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Adhesive dentistry is an essential component in the delivery of direct and indirect restorations. Ongoing discussions among scientists and clinicians have focused on whether or not current self-etch and universal adhesives adequately prepare enamel surfaces to achieve optimal bond strengths. To address these concerns, a selective enamel etch technique has been recommended. The definition of a selective enamel etch technique is as its name suggests. The clinician selectively etches the enamel of a cavity preparation by applying phosphoric acid etchant to the enamel surfaces of the preparation while refraining from applying the etchant to the dentin. This article explores the current research to help guide clinicians to achieve ideal outcomes when using dental adhesives. With few exceptions, the current scientific evidence recommends a selective enamel etch technique in conjunction with the clinician's adhesive system of choice.
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Condicionamento Ácido do Dente , Colagem Dentária , Esmalte Dentário , Humanos , Esmalte Dentário/efeitos dos fármacos , Condicionamento Ácido do Dente/métodos , Colagem Dentária/métodos , Ácidos Fosfóricos/química , Preparo da Cavidade Dentária/métodosRESUMO
OBJECTIVE: The present clinical report describes a long-term temporary restorative approach using injectable composite to reshape a canine into a central incisor, within the context of an ongoing orthodontic treatment. This treatment protocol describes a fully-digital workflow, incorporating digital designed and 3D printed diagnostic wax up, reduction guides and resin-injection index. CLINICAL CONSIDERATIONS: Effective planning is important when aiming to deliver a comprehensive and multidisciplinary workflow, and digital tools serve as invaluable aids. CONCLUSION: The use of a fully digital workflow in a comprehensive dental treatment resulted in a predictable and successful outcome for a restoration of a canine that was transformed into a central incisor. CLINICAL SIGNIFICANCE: This approach highlights the efficacy of digital technology in achieving precise and successful dental restorations, emphasizing its significance in modern dental practice.
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AIM: The aim of the present retrospective case series was to longitudinally assess soft tissue volume changes on the vestibular aspect of implants in relation to keratinized mucosa thickness (KMT) and width (KMW) after the application of the microsurgical envelope technique combined with a connective tissue graft (CTG). MATERIALS AND METHODS: A total of 12 healthy patients received 12 dental implants placed either in the posterior maxilla or mandible. The study involved the harvesting of 12 CTGs with a minimally invasive single-incision technique, grafted to the vestibular peri-implant soft tissue utilizing the envelope technique, followed by the insertion of 12 screw-retained IPS e.max crowns. RESULTS: The healing process was uneventful across all areas, and all patients were followed up for a period of 5 years. The evaluation of KMT showed the highest decrease in the first 6 weeks after surgery (5.5 ± 0.79 to 4.59 ± 0.62 mm), then dropped slightly to 4 ± 0.85 mm, after which it maintained at 4 ± 0.36 mm until the 2-year time point. Between the second and third years after surgery, a further decrease of 3.59 ± 0.42 mm was recorded for KMT, which then remained constant until the end of the 5-year research period. The observations regarding KMW were slightly different, with the measurements demonstrating the greatest decrease in first 6 weeks (from 2.5 ± 0.42 to 1.5 ± 0.42 mm), which was maintained until the 1-year time point. Between the first and second years after surgery, the KMW increased to 2 ± 0.60 mm and remained level for the next 3 years, at 2 ± 0.85 mm. CONCLUSIONS: The current research demonstrated the advantages of using a combination of a minimally invasively harvested CTG and the microsurgical envelope technique for a duration of 5 years.
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Tecido Conjuntivo , Microcirurgia , Humanos , Estudos Retrospectivos , Tecido Conjuntivo/transplante , Masculino , Microcirurgia/métodos , Feminino , Adulto , Pessoa de Meia-Idade , Implantação Dentária Endóssea/métodos , Implantes Dentários , Maxila/cirurgia , Mandíbula/cirurgia , Gengiva/transplanteRESUMO
Post and core systems have long been used in dentistry for the purposes of replacing missing coronal tooth structure, retaining the core, and providing sufficient retention and resistance form to the final restoration to re-establish original form and function. While Part 1 of this two-part article provided a history of post and core systems and materials and discussed empirical data regarding fiber-reinforced post systems, this second part of the article focuses on an alternative approach for developing a fiber-reinforced post and core system using a monoblock system via the injectable resin technique and a recently developed fiber-optic post. The present article explains the concept of a ferrule effect and demonstrates the novel restorative procedure.
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Técnica para Retentor Intrarradicular , Fraturas dos Dentes , Dente não Vital , Humanos , Resinas Compostas/uso terapêutico , Resinas Compostas/química , Análise do Estresse DentárioRESUMO
The popular immediate dentin sealing (IDS) technique is used to improve the bond strength of indirect restorations. This systematic review assessed whether bond strength is affected by the type of aging conditions, bonding agents, flowable resin composites, impression materials, temporary materials, and/or resin cement used within the IDS procedure. A comprehensive database search of PubMed, Embase, Scopus, Ovid Medline, Web of Sciences, Cochrane Library, Dentistry & Oral Sciences Source, and ProQuest was carried out up to 30 January 2024 without publication year or language limitations. Only in vitro full-texts regarding the effect of IDS on bond strength were included, and the quality of their methods was assessed via a Risk of Bias (RoB) test. In total, 1023 pertinent studies were initially found, and 60 articles were selected for review after screening for the title, abstract, and full texts. IDS application improves the bond strength of indirect restorations to dentin and reduces the negative effects of temporary materials on the bond durability of final indirect restorations. Filled dentin bonding agents or combinations with flowable resin composite are preferred to protect the IDS layer from conditioning procedures.
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Post systems have long been used in the roots of teeth to retain dental restorations. The primary objectives of current post and core systems are to replace missing coronal tooth structure, retain the core, and provide sufficient retention and resistance form to the final restoration to restore original form and function. Many varieties of user-friendly post and core systems are available today for different endodontic, restorative, and esthetic requirements. The present article provides a history of post and core usage in dentistry, describes various systems and materials for this purpose, and discusses empirical data regarding fiber-reinforced post systems.
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Técnica para Retentor Intrarradicular , Dente não Vital , Humanos , Resinas Compostas/química , Estética DentáriaRESUMO
The clinical success of indirect restorations is directly correlated with their specific anatomic shape and design as well as marginal accuracy and overall precision of fit. These factors require a precise impression of the preparation and, to the extent necessary and possible, other teeth and supporting hard and soft tissues.
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Planejamento de Prótese Dentária , Dente , Adaptação Marginal Dentária , Desenho Assistido por Computador , Técnica de Moldagem Odontológica , Materiais para Moldagem OdontológicaRESUMO
Besides meticulous application of proper bonding protocols and clinical technique, the clinical success of direct resin-based restorations is dependent on the selection of the appropriate restorative material, curing light, and, whenever certain contours of the tooth need to be rebuilt, matrix band system. All of these aspects have seen significant developments and improvements over the years, all geared toward increased clinical success and longevity. Highlighting some of these key developments, this article provides an update on resin-based composites, curing lights, and matrix bands.
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Assistência Odontológica , Materiais Dentários , HumanosRESUMO
STATEMENT OF PROBLEM: Intraoral digital scan techniques have been widely used and sufficient evidence supports this technique in partially edentulous patients. However, the evidence supporting the use of intraoral scanners (IOSs) for edentulous patients is limited. PURPOSE: The purpose of this in vitro study was to measure and compare the accuracy of complete arch conventional pick-up implant impressions with open and closed trays, complete arch digital implant scans with IOSs, and 3-dimensional (3D) printed casts from complete arch digital implant scans. MATERIAL AND METHODS: Six implants were placed in a mandibular model. Scannable pick-up impression copings were inserted in the implants, scanned with a reference scanner, and exported in standard tessellation language (STL) format (Group Control). Splinted open-tray pick-up impressions (Group OT, n=5) and closed-tray pick-up impressions (Group CT, n=5) were made, and stone casts were fabricated. Digital scans (Group DS, n=5) were made with an IOS, and the STL files were exported to fabricate 3D printed casts (Group STL, n=5). Scannable pick-up impression copings were inserted in the dental implant analogs in Groups OT, CT, and STL and scanned with the reference scanner. Using a 3D inspection software program, the recording techniques were compared with the control. Root mean square (RMS) values were calculated from the control, and superimposed digitized casts from different recording techniques. Analysis of variance was used to determine differences in RMS values, and theTukey post hoc test was used to determine difference between different groups. RESULTS: Group CT had the lowest mean dimensional difference when superimposed with Group Control, followed by Groups DS, OT, and STL. Significant differences were found in RMS values between Control and digitized casts fabricated with different techniques (P<.05). The post hoc Tukey test revealed that Group DS (P<.05) was significantly different from the other groups, while no significant difference was found among Groups CT, OT, and STL (P>.05). CONCLUSIONS: Based on the findings of the present study, 3D printed casts from digital scans have the same accuracy as stone casts from conventional impressions in complete arch implant cases. Intraoral scans had the highest accuracy. Complete arch pick-up impression techniques using dual-functioning scannable pick-up impression copings are as accurate as splinted complete arch pick-up impressions.
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Implantes Dentários , Boca Edêntula , Humanos , Capacidades de Enfrentamento , Mandíbula , Projetos de PesquisaRESUMO
OBJECTIVE: Obtaining strong resin bonds to computer-aided design and computer-aided manufacturing (CAD-CAM) resin-based composites with dispersed fillers (CCRBCs) poses a challenge. Therefore, this study aimed to assess the effect of three universal adhesives and a two-component silane coupling agent on the shear bond strength to three (CCRBCs). MATERIALS AND METHODS: Eight hundred and sixty-four specimens of Brilliant Crios, Lava Ultimate, and Tetric CAD were polished or grit blasted, bonded with Adhese Universal DC, One Coat 7 Universal (OC7), and Scotchbond Universal Plus Adhesive (SBU) with or without a silane primer. Shear bond strength was measured after 24 h and 10,000 thermocycles. Linear regressions were performed (α = 0.05). RESULTS: After thermocycling, bond strengths were similar for the universal adhesives on polished Brilliant Crios and Lava Ultimate (p ≥ 0.408). Grit blasted Tetric CAD showed no significant differences (p ≥ 0.096). The silane primer had minimal impact on grit blasted Tetric CAD (p ≥ 0.384). The silane primer increased the bond strength of OC7 to Brilliant Crios (p = 0.001) but decreased the adhesion of SBU to Brilliant Crios and Lava Ultimate (p ≤ 0.018). CONCLUSIONS: Bond strength of universal adhesives varied with CCRBC type. The two-component silane coupling agent showed mixed effects on adhesive performance. CLINICAL SIGNIFICANCE: Selecting universal adhesives from the same CCRBC product line does not always guarantee superior bond strength. The efficacy of silane coupling agents differs based on the bonding substrate.
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Colagem Dentária , Silanos , Silanos/química , Cimentos Dentários , Propriedades de Superfície , Materiais Dentários , Cimentos de Resina/química , Desenho Assistido por Computador , Teste de MateriaisRESUMO
The clinical quality and longevity of increasingly popular resin-bonded CAD/CAM ceramic restorations depends greatly on the strength and durability of the resin-ceramic bond. With a diverse array of ceramic materials available, the choice of ceramic bonding protocol is highly influenced by the specific ceramic's type and composition. Typically, this protocol encompasses a surface pretreatment step followed by the application of a priming agent. This article provides a comprehensive update on current resin-bonding protocols for the most commonly used CAD/CAM ceramics.
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Colagem Dentária , Cimentos de Resina/química , Propriedades de Superfície , Teste de Materiais , Cerâmica/química , Desenho Assistido por Computador , Resistência ao Cisalhamento , Porcelana Dentária/químicaRESUMO
Technical advances in such fields as optical magnification (eg, loupes, microscopes), microsurgical instruments, bone and soft-tissue grafting materials, and digital dentistry have paved the way for dentists to be able to provide all the necessary specialties for a state-of-art single-tooth replacement treatment under one roof in their clinics, without having to involve a technical laboratory. This case report demonstrates a routine complete chairside digital workflow using minimally invasive and microscopic techniques in every stage of treatment, from tooth extraction and socket preservation, to implant insertion and soft-tissue management, to delivery of the final chairside digital zirconia full-anatomic supraconstruction. In addition to describing the intent of minimally invasive tooth extraction and socket preservation, this article illustrates how to perform a vestibular split rolling flap procedure and discusses its benefits. The goal of this digitally driven single-implant treatment was to achieve restoration as close as possible to the original condition.
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Implantes Dentários para Um Único Dente , Implantes Dentários , Humanos , Alvéolo Dental/cirurgia , Fluxo de Trabalho , Extração Dentária/métodos , Estética DentáriaRESUMO
Unsplinted attachment systems for implant overdentures offer various benefits for edentulous patients, including cost-effectiveness, enhanced cleansability, and less need for manual dexterity. This article describes a facially driven digital workflow for fabricating a maxillary implant overdenture retained by conometric-style attachments (Atlantis® Conus) with a palateless design opposing an implant overdenture retained by standard attachments (LOCATOR®). This procedure provides a predictable and accurate technique to digitally scan the master casts with wax rims for articulation and to guide the digital teeth design set-up for a predictable esthetic outcome. The removable prosthesis workflow involves virtual teeth set-up, a 3D-printed trial denture, a milled definitive prosthesis, and intraoral pick-up for both unsplinted attachment systems. The clinical and laboratory steps are described.
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Implantes Dentários , Revestimento de Dentadura , Humanos , Fluxo de Trabalho , Prótese Dentária Fixada por Implante/métodos , Retenção de Dentadura , Estética Dentária , MandíbulaRESUMO
Surgical crown lengthening (SCL) is the treatment of choice to ensure healthy tissues when subgingival tooth defects encroach on the biologic width.1 However, restorative techniques employing adhesive dentistry may provide viable alternatives to or complement SCL in select cases without the repercussions of surgical bone removal and open interproximal spaces. One such clinical technique, deep margin elevation (DME), employs a direct restoration to relocate the cervical margin of small subgingival defects of posterior teeth supragingivally. The "elevated" margin simplifies impression-making and bonding of indirect restorations, especially inlays and onlays. Recent scientific systematic literature reviews indicate favorable clinical outcomes and suggest that DME restorations made with scrupulous care have high success rates and are compatible with periodontal health. Optimal working field isolation, meticulous placement of matrices, proper bonding and buildup procedure, as well as regular maintenance and follow-up are essential for success. This article provides an overview of this approach.
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Aumento da Coroa Clínica , Restauração Dentária Permanente , Restauração Dentária Permanente/métodos , Aumento da Coroa Clínica/métodos , Cimentos Dentários , Restaurações Intracoronárias , CoroasRESUMO
Purpose: To evaluate the performance of one- and two-piece ceramic implants regarding implant survival and success and patient satisfaction. Materials and Methods: This review followed the PRISMA 2020 guidelines using PICO format and analyzed clinical studies of partially or completely edentulous patients. The electronic search was conducted in PubMed/MEDLINE using Medical Subject Headings (MeSH) keywords related to dental zirconia ceramic implants, and 1,029 records were received for detailed screening. The data obtained from the literature were analyzed by single-arm, weighted meta-analyses using a random-effects model. Forest plots were used to synthesize pooled means and 95% CI for the change in marginal bone level (MBL) for short-term (1 year), mid-term (2 to 5 years), and long-term (over 5 years) follow-up time intervals. Results: Among the 155 included studies, the case reports, review articles, and preclinical studies were analyzed for background information. A meta-analysis was performed for 11 studies for one-piece implants. The results indicated that the MBL change after 1 year was 0.94 ± 0.11 mm, with a lower bound of 0.72 and an upper bound of 1.16. For the mid term, the MBL was 1.2 ± 0.14 mm with a lower bound of 0.92 and an upper bound of 1.48. For the long term, the MBL change was 1.24 ± 0.16 mm with a lower bound of 0.92 and an upper bound of 1.56. Conclusion: Based on this literature review, one-piece ceramic implants achieve osseointegration similar to titanium implants, with a stable MBL or a slight bone gain after an individual initial design depending on crestal remodeling. The risk of implant fracture is low for current commercially available implants. Immediate loading or temporization of the implants does not interfere with the course of osseointegration. Scientific evidence for two-piece implants is rare.
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Implantes Dentários , Boca Edêntula , Humanos , Cerâmica , Restauração Dentária Temporária , OsseointegraçãoRESUMO
Current diagnostic and treatment planning tools support a complete digital workflow that takes the guesswork out of implant dentistry and facilitates asynchronous collaboration between all involved specialties, from the restorative dentist to the surgeon to the dental laboratory. Long gone are the days of freehanded implant placement as guided as well as navigated surgery and now even robots provide unprecedented precision and predictability in implant placement based on the individual medical, morphologic, and anatomic situation of each patient.
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Implantes Dentários , Humanos , Fluxo de Trabalho , Desenho Assistido por Computador , Implantação Dentária Endóssea , Prótese Dentária Fixada por ImplanteRESUMO
Immediate implant placement in the anterior maxilla remains a complex procedure, particularly when the cortical bone plate of the socket is not intact and a gingival recession is present. The reconstruction of both hard and soft tissues increases the complexity of these clinical scenarios. This case report describes a novel, minimally invasive technique to reconstruct class III sockets with simultaneous implant placement. Four incisions are made with a scalpel blade to create, or "draw," a square outline instead of raising a flap at the tuberosity to harvest a hard- and soft-tissue block. In addition, a tunneling approach is described to graft the site while preserving the recipient area's vascularity. Harvesting a hard- and soft-tissue block from the tuberosity in a minimally invasive manner preserves the donor site and helps to reconstruct a class III alveolus in one single appointment, thereby reducing morbidity, costs, and treatment time.
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Implantes Dentários para Um Único Dente , Implantes Dentários , Retração Gengival , Carga Imediata em Implante Dentário , Humanos , Implantação Dentária Endóssea/métodos , Retalhos Cirúrgicos/cirurgia , Alvéolo Dental/cirurgia , Retração Gengival/cirurgia , Carga Imediata em Implante Dentário/métodos , Maxila/cirurgia , Estética Dentária , Extração Dentária/métodosRESUMO
Xenogeneic-derived biomaterials are among the most routinely employed bone substitutes for immediate grafting of extraction sites as a modality of alveolar ridge preservation (ARP). The deproteinized bovine bone material is widely used and documented around the world. The present pilot clinical trial evaluated and compared the clinical and morphologic alterations of extraction sites after ARP using two commercially available yet differently processed bovine bone grafts. A total of 20 adjacent extraction sites in 10 patients were included. All sites received the exact same ARP therapy except for the type of bovine bone graft, which was randomly assigned between two adjacent extraction sockets in 10 patients (Group A received Bio-Oss particles and Group B received Cerabone particles). At all sites, healing was monitored at the time of surgery and at 1, 2, 3, and 4 months postoperative. All of the augmented extraction sites achieved successful implant therapy regardless of the bone graft material used for ARP. Six weeks after implant placement, second-stage/uncovering procedures were performed without complications. Intergroup comparisons of the crestal gingival healing process (CGHP), mean transversal crestal ridge resorption (MTRR), and mean implant primary stability (MIPS) were in favor of Group A sites (treatment with Bio-Oss particles).