Perception of Dental and Smile Esthetics by Orthodontists and Prosthodontists: A Pilot Study.

PURPOSE: To examine if there are differences in smile esthetic evaluation scores by orthodontists and prosthodontists and if there are changes in those scores when two evaluations are performed, when the time of observation is increased, and when the lips are present or absent from the images. MATERIALS AND METHODS: In total, 12 individuals participated in this pilot study. Two digital images were taken from each individual. The first digital image was a smile view, and the second image was an intraoral view. Two presentation files were prepared, with two images for each individual. The smile and dental attractiveness ratings were obtained from 10 specialists. RESULTS: Repeated measures ANOVA was applied including all four within-subject factors, the evaluator (E), the repetition (R), the time of observation (T), and the presence or not of lips (L). Factors E, T, and L each had a statistically significant main effect. E and R had a statistically significant combined effect. In particular, the esthetic score for the view with smile was overall higher than for the intraoral view. The same results were obtained when the analysis was repeated with the 10 evaluators grouped to prosthodontists and orthodontists, and the prosthodontists tended to score higher than the orthodontists. CONCLUSIONS: The evaluator and the presence of lips have a statistically significant effect. The present pilot study has found that three (E, L, R) out of four factors (T) are important for the evaluation of dental esthetics.

Tooth preservation vs. extraction and implant placement in periodontally compromised patients: A systematic review and analysis of studies.

PURPOSE: The aim of this systematic review was to identify studies with a minimum of 5-years follow-up, reporting on the management of periodontally compromised teeth with either extraction and subsequent implant placement or teeth preservation with conventional periodontal treatment and application of regenerative procedures. The outcomes of these two approaches, based on clinical and radiographic data and the incidence of tooth- and implant-loss, were also investigated. MATERIAL AND METHODS: A systematic search for studies reporting on clinical and radiographic outcomes of periodontal treatment or replacement of periodontally compromised teeth with implants was conducted in 3 electronic databases, followed by a hand-search in 8 journals. Only randomized controlled trials (RCTs), cohort studies, and case series with prospective design were included. RESULTS: The initial search resulted in 1080 papers. After the first two screenings, 24 publications were selected for inclusion in this systematic review. The treatment protocols for the teeth preservation group contained nonsurgical and/or surgical periodontal treatment with or without regeneration procedures. The implant studies included extraction of periodontally involved teeth and implant placement with or without bone and soft tissue augmentation, followed by restoration with fixed dental prostheses (FDPs). Survival rates ranged between 81.8% and 100% in the tooth retention group, and between 94.8% and 100% in the implant group. In the extraction group, no complications were reported for 76.09% of the implants. Similarly, no complications were reported for 86.83% of the tooth retention group. The lack of standardized comparable studies prohibited conduction of a metaanalysis. CONCLUSION: Both treatment approaches, treatment of periodontally compromised teeth, or tooth extraction followed by implant placement, present high survival rates. The application of bone regeneration techniques improves the long-term prognosis of periodontally involved teeth. Hence, treatment of periodontally involved teeth with subsequent application of a rigorous maintenance protocol can be a viable alternative for a number of years, before proceeding to extraction and replacement with dental implants. More well-designed randomized controlled trials are needed in order to draw definite conclusions on the subject.

Assessment of cytotoxicity and antibacterial effects of silver nanoparticle-doped titanium alloy surfaces.

OBJECTIVES: This study aimed to develop silver nanoparticle (AgNP)-doped Ti6Al4V alloy surfaces and investigate their antibacterial properties against representative periopathogens and potential cytotoxicity on osteoblastic cells. METHODS: AgNPs of different size distributions (5 and 30nm) were incorporated onto the Ti6Al4V surfaces by electrochemical deposition, using colloid silver dispersions with increasing AgNP concentrations (100, 200 and 300ppm). The time-course silver release from the specimen surfaces to cell culture media was assessed by Atomic Absorption Spectroscopy (AAS). Cell attachment, viability and proliferation were investigated by SEM, live/dead staining MTT and BrdU assays. The antibacterial effects were assessed against P. gingivalis and P. intermedia by serial dilution spotting assays. RESULTS: A time- and concentration-dependent silver release from the experimental surfaces was observed. Overall, cell viability and attachment on the AgNP-doped surfaces, suggested adequate cytocompatibility at all concentrations. A transient cytotoxic effect was detected at 24h for the 5nm-sized groups that fully recovered at later time-points, while no cytotoxicity was observed for the 30nm-sized groups. A statistically significant, concentration-dependent decrease in cell proliferation rates was induced at 48h in all AgNP groups, followed by recovery at 72h in the groups coated with 5nm-sized AgNPs. A statistically significant, concentration-dependent antibacterial effect up to 30% was confirmed against both periopathogens. SIGNIFICANCE: This study sheds light to the optimal size-related concentrations of AgNP-doped Ti6Al4V surfaces to achieve antibacterial effects, without subsequent cytotoxicity. These results significantly contribute to the development of antibacterial surfaces for application in oral implantology.

In Vitro Assessment of Retention and Resistance Failure Loads of Teeth Restored with a Complete Coverage Restoration and Different Core Materials.

PURPOSE: To investigate in vitro the retention and the resistance form, as well as the failure modes of maxillary premolars restored with cast metal crowns and different core materials. MATERIALS AND METHODS: Sixty human extracted maxillary premolars were selected according to their size and were embedded in PMMA resin blocks. After removing a part of their clinical crowns, the teeth were randomly divided into 3 groups of 20 teeth and were either left unrestored, or they were restored with amalgam or composite resin. All teeth were prepared for a cast metal complete coverage restoration. The restorations were cemented on the prepared teeth with a resin-modified glass ionomer luting agent (GC Fuji Plus). All specimens were subjected to static loading at 1 mm/min by a universal testing machine, until failure. Half the specimens of each group were subjected to tensile loading along the long axis of the teeth. The other half were subjected to compressive loading at a 30° angle. Failure loads and failure modes for each tooth were recorded. The statistical analysis included descriptive statistics, one-way ANOVA, and Tukey's HSD test. RESULTS: One-way ANOVA revealed statistically significant differences among the 3 tested groups (p < 0.05) for both tests. The group of teeth with no core material presented the highest failure loads for both the tensile and the compressive loading tests, with mean loads of 381.02 Ν and 741.21 Ν, respectively. Mean tensile and compressive failure loads for the amalgam group were 277.34 Ν and 584.75 Ν, while the composite resin group presented the lowest tensile and compressive failure values, which were 250.77 Ν and 465.78 Ν, respectively. The compression loading test resulted in the same failure mode for all specimens, which included unfavorable fracture of the teeth in combination with detachment of the cast metal complete coverage restorations. The tensile loading test resulted in different failure modes between the groups that used a core material and the group with no core material. CONCLUSIONS: Teeth that lost more than half of their coronal structure presented better retention and resistance form if no core material was used, provided that a minimum of 2-mm axial wall height was present at the missing part. Teeth that have lost more than half of their coronal structure and were restored with amalgam core presented better retention and resistance form than those restored with composite resin. Catastrophic fractures, extending to the root, were associated with compression forces but not with tensile forces.

Treatment options for congenitally missing lateral incisors.

AIM: The aim of this systematic review was to identify studies that examined maxillary lateral incisor agenesis treatment, by either orthodontic space closure by canine mesial repositioning and reshaping, or by a prosthodontic intervention, in order to compare the biological, functional and aesthetic outcomes of these two approaches. MATERIALS AND METHODS: An electronic MEDLINE search was conducted by two independent reviewers in order to isolate English language articles, published in scientific journals between January 1975 and March 2015, reporting on treatment of agenesis of maxillary lateral incisors, accomplished either by canine orthodontic repositioning or prosthodontic intervention. The search terms were categorised into the four groups comprising the PICO (problem, intervention, comparison and outcome) question. Supplementary manual searches of published reviews and other full-text articles were also performed. RESULTS: The initial database search produced 8,453 titles. After careful examination and discussion, 12 articles were selected for inclusion, where 5 of them compared the two therapeutic options directly. No randomised controlled trials were identified. CONCLUSIONS: Definitive conclusions cannot be drawn, since randomised controlled trials and more prospective and retrospective studies directly comparing the two therapeutic options are required. According to this systematic review, both therapeutic options are effective. However, it seems that the orthodontic space closure, whenever this is possible, is advantageous over the prosthodontic rehabilitation.

New Ti-Alloys and Surface Modifications to Improve the Mechanical Properties and the Biological Response to Orthopedic and Dental Implants: A Review.

Titanium implants are widely used in the orthopedic and dentistry fields for many decades, for joint arthroplasties, spinal and maxillofacial reconstructions, and dental prostheses. However, despite the quite satisfactory survival rates failures still exist. New Ti-alloys and surface treatments have been developed, in an attempt to overcome those failures. This review provides information about new Ti-alloys that provide better mechanical properties to the implants, such as superelasticity, mechanical strength, and corrosion resistance. Furthermore, in vitro and in vivo studies, which investigate the biocompatibility and cytotoxicity of these new biomaterials, are introduced. In addition, data regarding the bioactivity of new surface treatments and surface topographies on Ti-implants is provided. The aim of this paper is to discuss the current trends, advantages, and disadvantages of new titanium-based biomaterials, fabricated to enhance the quality of life of many patients around the world.