Comparative Evaluation of Biofilm Formation on Temporization Crown Materials Used in the Rehabilitation of Primary Dentition With Different Polishing Materials: An In Vitro Study.

Introduction Advancements in dental materials have enhanced aesthetic treatments for managing dental caries and injuries in primary dentition. Bis-acryl composite-based temporization materials are now preferred for restoring primary crowns due to their superior properties. However, prolonged exposure to dietary and hygienic factors can lead to discoloration and roughness, making efficient polishing essential to prevent plaque buildup. Objective This study aims to evaluate Streptococcus mutans biofilm formation on temporization material polished with different polishing systems. Methods This study tested bis-acryl methacrylate temporization material. Thirty disk-shaped specimens were prepared and divided into three groups according to the polishing system used (n = 10 per group): Shofu Super Snap mini kit (Shofu, San Marcos, CA), aluminum oxide polishing paste, and propol polishing paste. Each group's specimens were polished according to the manufacturer's instructions. Surface roughness (SR), scanning electron microscopy (SEM) morphological analysis, and Streptococcus mutans biofilm formation were assessed for each group. Results The results showed significant differences in roughness average (Ra) values among the polishing materials, with the Shofu Super Snap mini kit having the highest roughness (Ra = 2.04), followed by propol polishing paste (Ra = 1.30) and aluminum oxide paste (Ra = 0.75). Additionally, polishing methods significantly affected mean colony-forming unit (CFU) levels, with the first group having the highest mean CFU value (0.24), with SEM images showing substantial biofilm formation by Streptococcus mutans. Conclusion Bacterial biofilm formation on the aluminum oxide paste group's surface differed from that on the propol polishing paste and aluminum oxide disc groups. The polishing techniques that we tested significantly influenced surface properties and biofilm formation. These findings suggest that selecting an appropriate polishing system can reduce the risk of gingival inflammation associated with temporization materials.

Recent Advances in Intraoral Scanners.

Intraoral scanners (IOSs) have emerged as a cornerstone technology in digital dentistry. This article examines the recent advancements and multifaceted applications of IOSs, highlighting their benefits in patient care and addressing their current limitations. The IOS market has seen a competitive surge. Modern IOSs, featuring continuous image capture and advanced software for seamless image stitching, have made the scanning process more efficient. Patient comfort with IOS procedures is favorable, mitigating the discomfort associated with conventional impression taking. There has been a shift toward open data interfaces, notably enhancing interoperability. However, the integration of IOSs into large dental institutions is slow, facing challenges such as compatibility with existing health record systems and extensive data storage management. IOSs now extend beyond their use in computer-aided design and manufacturing, with software solutions transforming them into platforms for diagnostics, patient communication, and treatment planning. Several IOSs are equipped with tools for caries detection, employing fluorescence technologies or near-infrared imaging to identify carious lesions. IOSs facilitate quantitative monitoring of tooth wear and soft-tissue dimensions. For precise tooth segmentation in intraoral scans, essential for orthodontic applications, developers are leveraging innovative deep neural network-based approaches. The clinical performance of restorations fabricated based on intraoral scans has proven to be comparable to those obtained using conventional impressions, substantiating the reliability of IOSs in restorative dentistry. In oral and maxillofacial surgery, IOSs enhance airway safety during impression taking and aid in treating conditions such as cleft lip and palate, among other congenital craniofacial disorders, across diverse age groups. While IOSs have improved various aspects of dental care, ongoing enhancements in usability, diagnostic accuracy, and image segmentation are crucial to exploit the potential of this technology in optimizing patient care.

Synergistic effects of bacteria, enzymes, and cyclic mechanical stresses on the bond strength of composite restorations.

Predicting how tooth and dental material bonds perform in the mouth requires a deep understanding of degrading factors. Yet, this understanding is incomplete, leading to significant uncertainties in designing and evaluating new dental adhesives. The durability of dental bonding interfaces in the oral microenvironment is compromised by bacterial acids, salivary enzymes, and masticatory fatigue. These factors degrade the bond between dental resins and tooth surfaces, making the strength of these bonds difficult to predict. Traditionally studied separately, a combined kinetic analysis of these interactions could enhance our understanding and improvement of dental adhesive durability. To address this issue, we developed and validated an original model to evaluate the bond strength of dental restorations using realistic environments that consider the different mechanical, chemical, and biological degradative challenges working simultaneously: bacteria, salivary esterases, and cyclic loading. We herein describe a comprehensive investigation on dissociating the factors that degrade the bond strength of dental restorations. Our results showed that cariogenic bacteria are the number one factor contributing to the degradation of the bonded interface, followed by cyclic loading and salivary esterases. When tested in combinatorial mode, negative and positive synergies towards the degradation of the interface were observed. Masticatory loads (i.e., cycling loading) enhanced the lactic acid bacterial production and the area occupied by the biofilm at the bonding interface, resulting in more damage at the interface and a reduction of 73 % in bond strength compared to no-degraded samples. Salivary enzymes also produced bond degradation caused by changes in the chemical composition of the resin/adhesive. However, the degradation rates are slowed compared to the bacteria and cyclic loading. These results demonstrate that our synergetic model could guide the design of new dental adhesives for biological applications without laborious trial-and-error experimentation.

Impact of dental operative microscopes on precision in minimally invasive dental restoration procedures.

OBJECTIVE: To evaluate the effect of dental operative microscopes on precision in minimally invasive dental restoration procedures. METHODS: This retrospective analysis included patients who underwent minimally invasive dental restoration procedure at Nanjing Stomatological Hospital from March 2018 to December 2019. Patients were categorized into two groups, an observation group treated with microscope-guided provisional restorations, and a control group treated using conventional methods. Clinical indices, including implant survival rates over five years, were compared between the groups. Multivariate analysis was employed to identify independent risk factors for implant failure. RESULTS: After treatment the observation group exhibited significantly lower labial vertical marginal discrepancies and absolute marginal discrepancies, as well as improved labial gingival indices and periodontal probing depths compared to the control group (all P<0.001). Additionally, the observation group scored significantly higher in efficiency, accuracy, and overall quality of tooth preparation (all P<0.001). Clinicians using microscopes demonstrated significantly lower mean Rapid Upper Limb Assessment scores, indicating reduced ergonomic strain (P<0.001). Higher age, worn tooth defects, poor oral hygiene, and non-use of a microscope were identified as independent risk factors for implant failure at the five-year mark. CONCLUSION: Dental operative microscopes significantly enhance the precision, efficiency, and ergonomic comfort in minimally invasive dental restorations for both clinicians and patients. Widespread adoption of this technology is strongly recommended.

Comparison of Bulk Polymeric Resin Composite and Hybrid Glass Ionomer Cement in Adhesive Class I Dental Restorations: A 3D Finite Element Analysis.

This study aimed to investigate the mechanical behavior of resin composites and hybrid glass ionomer cement in class I adhesive dental restorations under loading and shrinkage conditions. Three CAD models of a mandibular first molar with class I cavities were created and restored with different techniques: a bi-layer of Equia Forte HT with Filtek One Bulk Fill Restorative composite (model A), a single layer of adhesive and Filtek One Bulk Fill Restorative (model B), and a single layer of Equia forte HT (model C). Each model was exported to computer-aided engineering software, and 3D finite element models were created. Models A and B exhibited a similar pattern of stress distribution along the enamel-restoration interface, with stress peaks of 12.5 MPa and 14 MPa observed in the enamel tissue. The sound tooth, B, and C models showed a similar trend along the interface between dentine and restoration. A stress peak of about 0.5 MPa was detected in the enamel of both the sound tooth and B models. Model C showed a reduced stress peak of about 1.2 MPa. A significant stress reduction in 4 mm deep class I cavities in lower molars was observed in models where non-shrinking dental filling materials, like the hybrid glass ionomer cement used in model C, were applied. Stress reduction was also achieved in model A, which employed a bi-layer technique with a shrinking polymeric filling material (bulk resin composite). Model C's performance closely resembled that of a sound tooth.

Longevity and risk factors of CAD-CAM manufactured implant-supported all-ceramic crowns - A prospective, multi-center, practice-based cohort study.

OBJECTIVES: The aim of this prospective, multi-center, practice-based cohort study was to analyze factors associated with the success of implant supported all-ceramic single-unit crowns, made by computer-aided-design/computer-aided-manufacturing (CAD-CAM). METHODS: All-ceramic crowns placed in a private practice-based research network (Ceramic Success Analysis, AG Keramik) were analyzed. Data from 567patients with CAD-CAM implant supported all-ceramic crowns placed between 2008-2023 by 54dentists were evaluated. Firstly, all crowns with at least one follow-up control were included (n = 907). Secondly, all crowns being followed up for ≥ 5years and all failures were included (n = 151). At the latest follow-up visit, crowns were considered as successful (not failed) if they were still in function without the need for additional therapy. Multi-level Cox proportional hazards models were used to evaluate the association between a range of predictors and time of success. RESULTS: Within a mean follow-up period (SD) of 2.5 (2)years (first scenario) and 6.2 (1.2)years (second scenario) [maximum:12years], 27crowns failed (annual failure rate [AFR]:0.74 %). The main failure types were decementation, (n = 11), fracture of the ceramic (n = 4) or Ti-Base (n = 4). In 5-year-scenario, crowns fabricated in the laboratory had 26times lower failure rate than those fabricated chairside (95 %CI:0.0-0.7;p = 0.038). Furthermore, the use of a silane (HR:0.051;95 %CI:0.0-0.5;p = 0.014) and etching of the ceramic (HR:0.053;95 %CI:0.0-0.8;p = 0.035) resulted in a significantly higher risk for failure than their non-use. SIGNIFICANCE: For CAD-CAM manufactured implant supported all-ceramic crowns, high success rates were found in up to 12-year evaluation. Furthermore, after 5years, no patient-or implant-level factors, but operative-level factor (i.e.fabrication method, use of silane/etching) were significantly associated with failure. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00020271).

Alkasite restorative material for endodontically treated teeth: a randomized controlled pilot study.

Objectives: This study aimed to evaluate the clinical performance of an alkasite restorative material in molars that had undergone root canal treatment. Materials and Methods: The research was registered in Brazilian Registry of Clinical Trials. The randomized clinical trial involved 33 patients, each with at least 1 mandibular molar requiring restoration after receiving endodontic treatment. Patients were randomly assigned to receive either bulk-fill resin composite (Tetric N Ceram Bulk Fill, Ivoclar Vivadent) or the alkasite restorative material (Cention N, Ivoclar Vivadent). Upon completion of the restorations, 3 calibrated professionals utilized the United States Public Health Service criteria to assess various factors, including retention, secondary caries, marginal adaptation, restoration color, marginal pigmentation, and anatomical form. Evaluations were conducted at intervals of 7 days, 6 months, and 17 months. Additionally, the assessment encompassed the presence of radiolucent lines adjacent to the restoration, material deficiencies or excess, contact points, and caries recurrence. The data underwent analysis using the Friedman and Mann-Whitney tests (α = 0.05). Results: After 17 months, the results revealed that the alkasite restorative material exhibited greater wear of anatomical shape compared to the bulk-fill resin composite (p = 0.0189). Furthermore, the alkasite restorative material significantly differed from the natural tooth color in most cases (p = 0.0000). However, no other criteria displayed significant differences between the materials or over time (p > 0.05). Conclusions: The alkasite restorative material (Cention N) emerges as a viable option for restoring endodontically treated teeth, displaying clinically acceptable alterations after a 17-month evaluation period. Trial Registration: Brazilian Registry of Clinical Trials (ReBEC) Identifier: RBR-97kx5jv.

Declining US dental amalgam restorations in US Food and Drug Administration-identified populations: 2017-2023.

BACKGROUND: In light of the Minamata Convention on Mercury and efforts to phase down dental amalgam use, tracking dental amalgam proportions across US Food and Drug Administration (FDA)-identified at-risk populations is of interest to optimize material selection aligned with patient needs. METHODS: A retrospective observational study of Epic's Cosmos electronic health records data set was conducted to calculate the rates of dental amalgam restorations from 2017 through 2023 and stratified using the social vulnerability index (quartile 4 indicates the highest social vulnerability and quartile 1 indicates the lowest) and payer type (Medicare, Medicaid, self-pay, miscellaneous or other). The authors included the following FDA-identified at-risk populations: pregnant people, children younger than 6 years, people with preexisting neurologic conditions, and people with impaired kidney function (n = 1,897,976). RESULTS: The overall rate of dental amalgam restoration placements in the general population declined from 21.8% in 2017 to 4.1% in 2023. Dental amalgam restoration trends, according to social vulnerability index quartile and payer type, decreased consistently across all 4 evaluated populations. Of all the social vulnerability index quartiles, quartile 4, representing the most socially vulnerable group, had the smallest decrease in dental amalgam placement rates among the FDA-identified populations examined. CONCLUSIONS: The study results showed a decreasing trend in dental amalgam restorations from 2017 through 2023 among FDA-identified populations, consistent with the Minamata Convention on Mercury directive for a phasedown in dental amalgam use. Notwithstanding improvements, lingering disparities persist among the most vulnerable population. PRACTICAL IMPLICATIONS: Even within the groups identified as most vulnerable to harm, more targeted interventions and strategies are required to improve treatment among the most socially vulnerable.

Designing and additive manufacturing of biomimetic interpenetrating phase zirconia-resin composite dental restorations with TPMS structure.

Zirconia and resin are the most commonly utilized materials in dental restorations. However, zirconia presents significant wear on opposing teeth, whereas resin materials have low wear resistance and mechanical performances. A zirconia-resin interpenetrating phase composite (IPC) dental restoration was designed and fabricated using 3D printing and vacuum infiltration processes, incorporating zirconia scaffolds with triply periodic minimal surfaces (TPMS) structures. The mechanical and tribological performances of the IPCs were investigated through compressive and tribological experiments and finite element analysis, elucidating the influence of zirconia volumetric fraction. Results showed that IPCs exhibit excellent mechanical and tribological compatibilities, which can reduce the damage and wear of the antagonistic teeth. This designing and manufacturing strategy enables the IPC restorations with promising applications in dentistry.

Clinical behavior and survival of endodontically treated teeth with or without post placement: a systematic review and meta-analysis.

PURPOSE: Non-vital teeth usually exhibit substantial loss of coronal and radicular tooth structure, and use of posts after root canal treatment is controversial. This review examined whether placement of posts influences clinical behavior and survival probability of endodontically treated teeth (ETT). METHODS: An electronic search, without time restrictions, for publications written in English was undertaken in PubMed, Scopus, and Web of Science. Terms related to four main components (endodontically treated teeth, fixed prosthesis, post restoration, and survival rate) were used for the database search strategies. RESULTS: 57 studies met the inclusion criteria and were included in the qualitative analysis. Of the publications chosen for qualitative analysis, 17 clinical studies (11 prospective and 6 retrospective studies) were found to be suitable for quantitative analysis. These studies included 7,278 patients (7,330 ETT), with a mean age ± standard deviation (SD) of 45.46 ± 12.1 years. There was a statistically significant difference in survival rate between ETT with or without posts (P < 0.001). CONCLUSION: As compared with teeth with no posts, post placement on ETT may improve clinical performance and survival probability of endodontically treated teeth.

Survival, technical and biological outcome of fixed tooth- and implant-supported restorations: A retrospective analysis of a patient cohort treated in an undergraduate dental education program.

OBJECTIVES: There is a paucity of data on the outcome of fixed tooth- and implant-supported porcelain-fused-to-metal (PFM) and ceramic-based (CB) restorations fabricated during undergraduate dental education. Therefore, this retrospective study examined the outcome of fixed restorations placed in patients participating in an undergraduate program. METHODS: Patient records were searched for data on fixed PFM and CB restorations. For these restorations, the functional period in situ and technical and biological complications, namely restoration fracture, decementation, screw loosening, secondary caries, and loss of vitality, were recorded. Periodontal parameters were also documented. Kaplan-Meier survival and complication estimates after 1 and 5 years were calculated for restoration types, materials, designs (veneered/non-veneered), cementation/retention modes and localizations with group sizes ≥ 15. Regression models were used to analyze the influence of demographic data and abovementioned restoration characteristics on restoration survival, technical and biological outcome. RESULTS: 1196 restorations with a mean observation time of 5 years were included in the analysis. The different restoration types exhibited survival rates of > 90.8% after 5 years, accompanied by a favorable biological outcome. However, monolithic resin-matrix or feldspathic ceramic restorations were found to have a higher fracture rate than lithium disilicate or zirconium dioxide ceramic restorations resulting in lower survival rates for these restorations. Additionally, resin-matrix ceramic restorations showed a higher decementation rate than lithium disilicate restorations. CONCLUSIONS: Fixed tooth- and implant-supported CB restorations fabricated from lithium disilicate and zirconium dioxide ceramics demonstrated better survival and lower complication rates than restorations fabricated from resin-matrix or feldspathic ceramics in an undergraduate dental education program. CLINICAL SIGNIFICANCE: Due to the more favorable outcome of CB restorations fabricated from lithium disilicate or zirconium dioxide ceramics, undergraduate dental education should focus on the application of these ceramics to increase restoration survival by reducing technical complications.

A Conservative Approach to Ceramic Laminates in the Anterior Region: A Clinical Report.

This clinical report presents a conservative approach to restoring aesthetic function in anterior maxillary teeth using digital dental technologies. A 40-year-old female patient sought treatment to enhance the aesthetics of her anterior maxillary teeth. The clinical examination revealed wear on the incisal surfaces and gingival asymmetry. Utilizing a digital workflow, intraoral and extraoral data were acquired through clinical photographs and an intraoral scanner. The patient's restorative needs were assessed using the 3Shape Smile Design system (3Shape, Copenhagen, Denmark). Minimal-thickness ceramic restorations were designed and fabricated using Computer-Aided Design-Computer-Aided Manufacturing (CAD-CAM) technologies. Lithium disilicate was selected for its strong mechanical properties and adhesive capabilities. The restorations were then placed using an adhesive cementation protocol under magnification. Digital technologies facilitated precise diagnosis, planning, and execution of the treatment. The ceramic restorations provided excellent aesthetic outcomes, aligning with the patient's expectations. The minimal thickness of the restorations ensured the preservation of natural tooth structure while maintaining structural integrity and adhesion performance. This case underscores the advantages of a digital workflow in achieving optimal restorative outcomes. The digital dental workflow demonstrated in this case report provides a reliable, efficient, and patient-centric approach to minimal thickness restorations, highlighting the potential for future advancements in restorative dentistry.

Five-year survival of class II restorations with and without base bulk-fill composite: a retrospective cohort study.

OBJECTIVE: This study aimed to determine the survival of class II composite restorations in premolars and molars with and without base bulk-fill composite in general dental practice. MATERIALS AND METHODS: We collected data from the electronic patient files of the Public Dental Services in the City of Oulu, Finland. The timespan of data collection was from August 15th, 2002, to August 9th, 2018. The data consisted of class II composite restorations both with and without base bulk-fill composite. We compared the survival of these restorations using Kaplan-Meier survival curves, the log-rank test, survival rates, and the Wilcoxon signed ranks test. RESULTS: We observed 297 restorations in 96 patients. The five-year survival rates for restorations with and without base bulk-fill composite were comparable in premolars (77.5% and 77.4%, respectively) but different in molars (69.9% and 57.8%, respectively, p = 0.069). In molars, the restorations with base bulk-fill composite exhibited a higher survival rate in 14 patients, whereas in 11 patients the restorations without base bulk-fill composites exhibited a higher survival rate. In 24 patients the survival rates were similar for restorations with and without the base bulk-fill composite (p = 0.246). CONCLUSIONS: The restorations with and without base bulk-fill composite had similar longevity. CLINICAL RELEVANCE: Base bulk-fill composites are safe to use in general practice due to their similar survival rates compared to conventional composites.

Determining the Failure Rate of Direct Restorations-Chart Review versus Electronic Health Record Reports.

Amalgam and composite restorations are used to treat minor dental issues. University of Michigan, School of Dentistry Electronic Health Record (EHR) reports show a 2.31% failure rate for amalgam and 1.14% for composite. Our study aims to determine the true failure rates through manual EHR chart reviews. Patient data from the University of Michigan School of Dentistry were utilized-216 amalgam restorations from 2020 to 2022 and 350 composite restorations in 2021 were searched. We defined failure and retreatment as replacing a restoration with the same material and failure and alternate treatment as replacing restoration with an alternative treatment within one year. The failure rate refers to a combination of replacement with the same and alternative treatment material within one year. For Amalgam: 1.85% failed and were retreated; 7.87% failed and were received an alternate treatment. Composite: 9.71% failed and retreated; 2.86% failed and received alternate treatment. In total anterior composite: 10.5% retreated, 2.6% failed; posterior composite: 9.1% retreated, 3.0% failed. Our study revealed higher restoration failure rates than the reports extracted in the EHR. This highlights the need to foster a culture of precise documentation to align EHR reports with hand-search findings.

Influence of viscosity and fiber reinforcement of resin composite on fracture strength and failure mode of restored molars.

OBJECTIVE: To evaluate the fracture behavior of human molars with extensive MOD restorations using short-fiber-reinforced resin composite of varying viscosities. MATERIALS AND METHODS: Human molars were randomly divided into seven groups (n = 12): intact teeth (control); restoration using conventional high-viscosity resin composite without (Filtek Z350XT, 3M) or with fibers (everX Posterior, GC); conventional low-viscosity resin composite without (Filtek Supreme Flowable, 3M) or with fibers (everX Flow Dentin Shade, GC); bulk-fill low-viscosity resin composite (Filtek Bulk Fill Flow, 3M) or with fibers (everX Flow Bulk Shade, GC). Restorations were performed on extensive MOD preparations, following the manufacturers' recommendations for each material. Specimens underwent fracture strength testing (N) and fracture pattern (%) categorized as repairable, possibly repairable, or non-repairable. Results were analyzed using a generalized linear model (N) and Fisher's exact test (%), with α = 0.05. RESULTS: Restorations performed with high-viscosity materials showed fracture strength values similar to the control and higher than those of restorations using low-viscosity resin composites (p < 0.0001), except for the bulk-fill low-viscosity resin composite with fibers (p > 0.05). Teeth restored using low-viscosity resin composite with fibers showed a higher % of repairable and possibly repairable fractures than the control (p = 0.0091). CONCLUSIONS: The viscosity of materials mediated the fracture strength, with restorations using high-viscosity resin composites promoting values similar to the intact tooth; however, the presence of fibers influenced the fracture pattern. CLINICAL SIGNIFICANCE: Teeth with MOD cavities restored with high-viscosity resin composites showed similar fracture strength to intact teeth. Fiber-reinforced low-viscosity resin composite for the base of restoration resulted in a more repairable/possibly repairable fracture pattern.

Color Stability of Single-Shade Resin Composites in Direct Restorations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The objective was to compare the color match and color stability behavior of single- and multi-shade resin-based composites (RBCs) used for direct restorations. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized clinical trials evaluating the shade performance of single-shade RBCs in direct restorations were included. A search of the scientific literature was performed in five databases (April 2024). The meta-analysis was performed using RevMan 5.4, calculating the risk difference (RD) and 95% confidence interval (CI) of the dichotomous outcome using a random effects model. Bias was assessed using the RoB 2.0 tool, and certainty of evidence was assessed using the GRADEpro tool. Four studies were selected, with 263 restorations analyzed. The results showed comparable performance between single-shade RBCs and multi-shade RBCs in terms of color match and color stability over 12 months. Three studies had a low risk of bias with all expected results, and one study had some concerns. The certainty of evidence for color stability was considered low for all follow-up periods due to the small number of events and sample size. According to the United States Public Health Service Evaluation (USPHS) and the World Dental Federation (FDI), there is comparable clinical color performance between single-shade and multi-shade RBCs over 12 months.

Exceptional bone remodeling over composite restoration in the management of external root resorption: A case report.

A 65-year-old Caucasian male was referred to an endodontic specialist practice in a private clinic in December 2019 for the management of an asymptomatic, radiolucent lesion located at the cervical level of the distal root of his right lower first molar, noticed during a routine periapical radiograph. After an accurate evaluation with cone-beam computed tomography (CBCT), the subgingival lesion was diagnosed as a supracrestal external cervical resorption (ECR), with a circumferential spread ⩽90°, confined to dentine without pulp involvement. The lesion was treated with the following sequence: (1) a full flap accessed the ECR, (2) the granulomatous tissue was removed from the root area, (3) the cavity was refreshed and filled with a well-refined and polished resin composite, (4) the flap was sutured at the cemento-enamel junction. A mandibular CBCT scan was performed before treatment, right after treatment, and 3 years postoperatively. Compared to the 3-year posttreatment CBCT scan, the immediate posttreatment one, revealed the absence of bone loss and an unexpected coronal bone remodeling with new bone formation over the treated lesion.

Spot-etch technique and other adhesive strategies for provisional veneers.

AIM: The objective of the present study was to evaluate the influence of different adhesive strategies regarding shear bond strength (SBS) of provisional resin--based materials bonded to the enamel surface as well as on the enamel surface roughness. MATERIALS AND METHODS: Bovine incisors were randomly divided into six groups (n = 10) according to the adhesive strategy used: BRControl (bis-acrylic resin); Spot-etch+BR (spot-etch + bis-acrylic resin); Spot--etchSB2+BR (spot-etch + adhesive + bis-acrylic resin); Spot-etchZ350Flow+BR (spot-etch + flowable composite resin + bis-acrylic resin); SBU+BR (universal adhesive + bis-acrylic resin); Spot-etchSBMP+Z350 (spot-etch + adhesive + composite resin). The enamel surface roughness was determined by a surface profil-ometer. An SBS test was performed in a universal testing machine, and failure modes were classified under magnification. The SBS data were analyzed by one-way analysis of variance (ANOVA). A paired t test was used for enamel surface roughness intragroup comparisons, and the Friedman one-way repeated meas-ures analysis of variance by ranks was used for differences in enamel surface roughness between groups, with the Tukey post hoc test (a = 0.05). RESULTS: BRControl had the lowest SBS values (MPa), with a significant difference (P ≤ 0.001) from the other groups. Spot-etch+BR had the highest SBS values but with no significant differences from the other groups in which the spot-etch technique was also used. Adhesive failure mode was predominant for all groups. BRControl had the lowest surface roughness difference, significantly different (P = 0.001) from all the other groups. CONCLUSIONS: Spot-etch and other adhesive strategies could be applied to increase the SBS values of provisional restorations to enamel compared with no surface pretreatment. However, the adhesive strategy may change the enamel surface roughness, revealing the importance of cleaning the tooth surface.

Restauração em resina composta semidireta em dente posterior: relato de caso / Semi-direct composite restoration in posterior toth: a case report

A escolha da técnica restauradora desempenha papel fundamental na eficácia e duração de um tratamento reabilitador. O objetivo deste relato de caso foi descrever a utilização da técnica semidireta para a confecção de uma restauração em resina composta em um primeiro molar inferior. A paciente apresentava uma restauração insatisfatória no dente 36, que necessitava ser substituída devido à infiltração por cárie. Optou-se pela técnica semidireta devido à amplitude da cavidade, que envolvia estruturas de suporte, e pela combinação das vantagens das abordagens direta e indireta. O procedimento envolveu a remoção de tecido cariado, a aplicação de hidróxido de cálcio pasta, seguida da aplicação de uma fina camada de ionômero de vidro e, posteriormente, resina fluída para realizar o selamento dentinário. O preparo foi realizado seguindo os princípios necessários. O elemento em questão foi moldado com silicone de adição e o arco antagonista, com alginato. Ambos modelos foram vertidos com silicone para modelos semirrígidos e montados em oclusor de peças de brinquedo. A restauração semidireta foi confeccionada em resina composta Filtek Z350 XT, respeitando a anatomia do dente 36. Pigmentos foram utilizados para aprimorar detalhes estéticos. Após acabamento e polimento, a peça foi condicionada e cimentada com cimento dual Relyx Ultimate. Pode-se concluir que a abordagem restauradora por meio da técnica semidireta construída em modelo semirrígido é uma opção terapêutica conservadora e vantajosa para dentes com extensa destruição coronária. Essa técnica possibilita a restauração de forma eficaz, garantindo tanto a estética quanto a função adequada do dente afetado(AU)

The choice of restorative technique plays a fundamental role in the effectiveness and duration of rehabilitation treatment. The objective of this case report was to describe the use of the semi-direct technique to create a composite resin restoration in a lower first molar. The patient had an unsatisfactory restoration on tooth 36, which needed to be replaced due to cavity infiltration. The semi-direct technique was chosen due to the amplitude of the cavity, which involved support structures, and the combination of advantages of the direct and indirect approaches. The procedure involved the removal of carious tissue, and the application of calcium hydroxide paste, followed by the application of a thin layer of glass ionomer and, subsequently, fluid resin to seal the dentin. The preparation was carried out following the necessary principles. The element in question was molded with addition silicone and the antagonist arch was molded with alginate. Both models were poured with silicone for semi-rigid models and mounted on toy parts occluders. The semi-direct restoration was made in Filtek Z350 XT composite resin, respecting the anatomy of tooth 36. Pigments were used to improve aesthetic details. After finishing and polishing, the piece was conditioned and cemented with Relyx Ultimate dual cement. It can be concluded that the restorative approach using the semi-direct technique built on a semi-rigid model is a conservative and advantageous therapeutic option for teeth with extensive coronal destruction. This technique allows for effective restoration, ensuring both the aesthetics and adequate function of the affected tooth(AU)

Esthetically driven immediate provisionalization in the anterior zone: 5-year results from a prospective study evaluating 3.0-mm-diameter tapered implants.

OBJECTIVES: Evaluate the 5-year safety and efficacy of a narrow-diameter (3.0 mm) implant that was immediately provisionalized with a single crown in the maxillary lateral incisor or mandibular central or lateral incisor area. MATERIALS AND METHODS: An open, prospective, single-cohort, multicenter study was conducted, in which narrow-diameter implants were placed in fresh, healed extraction, or congenitally missing sites. All patients were required to meet strict criteria for immediate loading. The primary endpoints were marginal bone levels (MBL) and MBL changes (MBLC) from implant placement to 5-year follow-up. Secondary endpoints included cumulative 5-year survival and success rates, soft tissue health, and esthetic parameters. RESULTS: A total of 91 implants were placed in 77 patients. The mean MBL remained stable from the 1-year (- 0.79 ± 0.73 mm, n = 75) to 5-year (- 0.74 ± 0.87 mm, n = 65) follow-up. A marginal bone gain of 0.11 ± 0.83 mm was observed from the 1-year to 5-year follow-up. The cumulative 5-year survival rate was 96.5%, and the cumulative 5-year success rate was 93%. The clinical parameters, including the modified plaque index, modified sulcus bleeding index, Jemt's papilla index, and pink esthetic score improved throughout the 5-year study. CONCLUSIONS: The study demonstrated that narrow-diameter implants represent a safe and predictable treatment option for subjects suitable for immediate loading and with limited bone volume or limited inter-dental space. CLINICAL RELEVANCE: Narrow-diameter implants with immediate provisionalization can be considered for use to restore missing or damaged teeth with predictable functional and esthetic outcomes. This trial was registered with ClinicalTrials.gov (NCT02184845).