Comparison of surface micro-roughness and adaptation of titanium and cobalt chrome implant abutment fabricated by selective laser melting and conventional techniques.

PURPOSE: The objective of this study was to assess the surface micro-roughness and abutment adaptation of selective laser melting (SLM) implant abutments in comparison to cast and machined implant abutments. METHODS: Forty abutment specimens were divided equally into four groups according to the fabrication technique as follows (n = 10), Machined Ti alloy abutments (Control), Cast CoCr abutments, SLM-CoCr abutments, and SLM-Ti alloy abutments. Forty internal connection implants (Ø 4.0 ×10 mm, Superline™, Dentium Co., Seoul, Korea) were mounted in clear acrylic resin. Fabricated abutments were assessed for surface micro-roughness using a 3D optical noncontact surface microscope. Vertical and horizontal adaptation of the abutment with implant interface was assessed by using Bruker micro-CT. Data was assessed using analysis of variance and Tukey post hoc comparison tests for all the variables except vertical misfit was assessed using Kruskal-Wallis test. Pearson correlation was used to assess dependence between independent variable (surface roughness) and dependent variables (Horizontal misfit and vertical misfit). RESULTS: SLM-Ti abutments showed significantly rougher surface (p < 0.05) among the study groups. While SLM-CoCr abutments were smoother than Cast abutments with mean Ra of 1.30 ± 0.11 and 1.58 ± 0.17 µm, respectively (p < 0.05). For abutment adaptation, SLM-Ti abutments showed the highest horizontal misfit among the groups (p < 0.05). While, SLM-CoCr abutments (29.24 ± 11.11 µm) showed comparable (p > 0.05) horizontal misfit results with Cast (26.08 ± 3.93 µm) and machined (26.45 ± 7.33 µm) abutments. Comparable (p > 0.05) vertical misfit values between Cast CoCr (487.01 ± 40.34 µm), SLM-CoCr (358.38 ± 114.93 µm) and SLM-Ti (299.85 ± 172.88 µm) abutments were observed. A positive correlation was found between the surface roughness of the mating surfaces and abutment adaptation. CONCLUSION: SLM CoCr abutments exhibited low roughness and comparable abutment adaptation (vertically and horizontally) than cast (control) abutments. Therefore, SLM CoCr abutments should be clinically investigated as potential implant abutments for clinical use.

Digital technology implementation in prosthodontics postgraduate programs in Saudi Arabia: a multi-institutional survey of program directors.

OBJECTIVE: To assess the current status of digital technology (DT) implementation in prosthodontics post-graduate (PG) programs in Saudi Arabian dental institutions. METHODOLOGY: A 19-item survey was created using Google forms and the link was emailed to the 29 prosthodontics PG program directors (advanced clinical training and joint program) in Saudi Arabia. The questionnaire contained five Sect. 1) didactic training and DT usage in PG preclinical, clinical and laboratory training, 2) incorporation of DT in PG program, 3) utilization of DT and the types of cases treated by PG students during their course, 4) information on the faculties involved in prosthodontics PG education, and 5) potential challenges encountered and program directors' satisfaction of the PG program. Descriptive statistics was used to present the frequencies and proportions, and Chi square inferential test was used to compare the participants' response based on the type of PG programs (α = 0.05). RESULTS: Only 28 program directors responded to the survey, yielding a 95.5% response rate. Among the program directors, 24 (85.7%) and 4 (14.3%) directors supervised the advanced clinical training and joint programs, respectively. Among the DT, CAD/CAM was the most used technology (50-80%), followed by intra-oral scanning (28-96%). Digital technology implementation was largely limited by lack of resources or equipment (67%), cost (53%) and scarcity of PG teaching staff (46%). A significant difference was observed between the programs regarding the mandatory use of DT for their cases (p = 0.03). CONCLUSIONS: This multi-institutional survey of program directors revealed that DT is continuously implemented in the last few years. Saudi dental institutions must prioritize implementing and utilizing DT in PG training to graduate competent prosthodontists in this fast-paced digital era. While DT is pivotal in dental education, its implementation is limited in many institutions due to resources or equipment, cost, and lack of trained faculty.

Randomized Clinical Trial on Direct Composite and Indirect Ceramic Laminate Veneers in Multiple Diastema Closure Cases: Two-Year Follow-Up.

In recent years, laminate veneer restorations should be considered as a minimally invasive treatment option for several aesthetic reasons. This study compared direct composite veneers' and indirect ceramic laminate veneers' longevity in multiple diastema closures. A total of 28 patients with a mean age of 26 years received 60 direct resin composite (Estelite Asteria; n = 14) and 60 indirect ceramic veneers (IPS e.max Press; n = 14) on the maxillary anterior teeth with diastema closure. Veneers were evaluated at baseline and thereafter every 6 months for up to 2 years using USPHS criteria. Data were analyzed with Fisher's exact and chi-squared tests, while Kaplan-Meier curve was used to assess time to event. In total, three failures were observed in the form of debonding (n = 1) and fracture (n = 2) in the indirect ceramic veneers. No significant difference was observed between the survival rates of composite and ceramic veneers (Estelite Asteria: 93.4%, IPS e.max Press: 95%; p > 0.05). The overall survival rate was 94.2% (Kaplan-Meier). Staining (n = 11) and roughness (n = 14) were frequently observed for the resin composite veneers up to the final recall. Thereby, the preliminary results from this clinical trial comparing two veneer materials indicated that their survival rates were statistically similar. However, surface quality changes were more frequent in the composite veneer material.

Different Designs of Deep Marginal Elevation and Its Influence on Fracture Resistance of Teeth with Monolith Zirconia Full-Contour Crowns.

Background and objectives: Even with the demand for high esthetics, the strength of the material for esthetic applications continues to be important. In this study, monolith zirconia (MZi) crowns fabricated using CAD/CAM were tested for fracture resistance (FR) in teeth with class II cavity designs with varying proximal depths, restored through a deep marginal elevation technique (DME). Materials and Methods: Forty premolars were randomly divided into four groups of ten teeth. In Group A, tooth preparation was conducted and MZi crowns were fabricated. In Group B, mesio-occluso-distal (MOD) cavities were prepared and restored with microhybrid composites before tooth preparation and the fabrication of MZi crowns. In Groups C and D, MOD cavities were prepared, differentiated by the depth of the gingival seat, 2 mm and 4 mm below the cemento-enamel junction (CEJ). Microhybrid composite resin was used for DME on the CEJ and for the restoration of the MOD cavities; beforehand, tooth preparations were conducted and MZi crowns were and cemented using resin cement. The maximum load to fracture (in newtons (N)) and FR (in megapascals (MPa)) were measured using the universal testing machine. Results: The average scores indicate a gradual decrease in the load required to fracture the samples from Groups A to D, with mean values of 3415.61 N, 2494.11 N, 2108.25 N and 1891.95 N, respectively. ANOVA revealed highly significant differences between the groups. Multiple group comparisons using the Tukey HSD post hoc test revealed that Group D had greater DME depths and showed significant differences compared with Group B. Conclusions: FR in teeth decreased when more tooth structure was involved, even with MZi crowns. However, DME up to 2 mm below the CEJ did not negatively influence the FR. Strengthening the DME-treated teeth with MZi crowns could be a reasonable clinical option, as the force required to fracture the samples far exceeded the maximum recorded biting force for posterior teeth.

"No-Primer" Resin Cementation of Lithium Disilicate Ceramic: A Microtensile Bond Strength Evaluation.

OBJECTIVE: The objective of this study was to evaluate the resin-ceramic adhesion of a long-carbon-chain silane (LCSI)-containing resin cement. METHODS: Polished lithium disilicate ceramic discs were etched with hydrofluoric acid and randomly assigned into four groups; (PSAP), cemented using a silane-free resin cement with no prior priming; (PSAP-S), primed using a silane-containing primer before cementation using a silane-free resin cement; (PSAU), cemented using a LCSI-containing resin cement with no prior priming; (PSAU-S), primed as for the group (PSAP-S) and cemented using a LCSI-containing resin cement. The cemented blocks were sectioned into microbeams. The resin-ceramic microtensile bond strength (µTBS) was measured at 1 week and after thermocycling. The failure modes of the tested microbeams were evaluated. RESULTS: The µTBS of the LCSI-containing and silane-free resin cements, either with or without a prior priming step, did not significantly differ. The adhesion of the LCSI-containing resin cement to lithium disilicate ceramic, either with or without a prior priming step, did not significantly deteriorate after artificial aging. CONCLUSIONS: The long-carbon-chain silane (LCSI) monomer incorporated in the resin cement eliminated the need for a silane priming step of a hydrofluoric acid-etched lithium disilicate ceramic.

Influence of root debridement with adjunct photodynamic therapy on periodontal parameters and gingival crevicular fluid cortisol levels among patients with and without type-2 diabetes mellitus.

OBJECTIVE: The aim of the present study was to assess the influence of scaling and root planing (SRP) with adjunct antimicrobial photodynamic therapy (aPDT) on periodontal parameters and gingival crevicular fluid (GCF) cortisol levels in type-2 diabetic and non-diabetic patients with periodontitis. METHODS: One hundred and twenty-eight patients with periodontitis (64 with and 64 without type-2 diabetes mellitus, respectively) were included. In the test- and control-groups, patients underwent SRP with and without aPDT, respectivey. In both groups, plaque and gingival indices (PI and GI), probing depth (PD), clinical attachment loss (CAL), marginal bone loss (MBL) and GCF volume and cortisol levels were assessed at baseline and three and six-months after SRP with or without aPDT. The aPDT was performed at baseline using methylene blue and photobiomodulation. The Kruskall-Wallis test was used to assess data normality; and group-comparisons were done. P-values, which were below 0.01 indicated statistical significance. RESULTS: Sixty-four type-2 diabetic patients with and 64 non-diabetic patients with periodontitis were included. All individuals had Stage-III/Grade-C periodontitis. Among patients with type-2 diabetes mellitus (DM), there was no statistically significant difference in hemoblobin A1c, PI, GI, PD, CAL and MBL at baseline and at 3- and 6-months intervals. Amongst diabetic patietns, there was no difference in the GCF volume and cortisol levels in the test- and control-groups at all time intervals. In non-diabetic patients, there was a significqnt reductionin GCF volume and cortisol levels when SRP was done with aPDT than when SRP was carried out as the sole treatment strategy CONCLUSION: Among non-diabetic patients, SRP with aPDT helps reduce periodontal inflammation and GCF cortisol levels for up to 6-months; however poorly-controlled DM compromises the beneficial effects of this treatment strategy.

The effectiveness of photodynamic and antibiotic gel therapy as an adjunct to mechanical debridement in the treatment of peri-implantitis among diabetic patients.

AIM: The current clinical trial aimed to assess the effectiveness of adjunctive photodynamic therapy (aPDT) and adjunctive antibiotic gel therapy (aAGT) to treat peri-implantitis among patients with type 2 diabetes mellitus (T2DM). METHODS: Selected T2DM participants with peri-implantitis were distributed into 3 groups: Group-1: received a single session of adjunctive (aPDT); Group-2: received a single session of adjunctive (aAGT) (metronidazole 400 mg and amoxicillin 500 mg); and Group-3: received MD alone. Clinical (probing depth [PD], bleeding on probing [BOP], and plaque scores [PS]) and radiographic (crestal bone loss [CBL]) peri-implant variables were recorded. Levels of interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) were assessed after the collection of peri-implant sulcular fluid (PISF). All the evaluations were carried out at baseline, 3- and 6-months. The significance level was set to p < 0.05. RESULTS: At 3-and 6-months of follow-up, all the three groups showed significant alleviation in PS (p < 0.05), BOP (p < 0.05), and PD (p < 0.05) when compared with the baseline. At baseline, no significant variation was observed in all clinical and radiographic peri-implant parameters among all three research groups. At 3-months follow-up, a considerable alleviation of in PS, BOP, PD, and CBL was noticeable in group-1 patients when compared with the baseline. At 6-months follow-up, a comparable difference was observed in BOP, PD, and CBL between group-1 and group-2. At baseline, no significant variation was observed in the PISF levels of IL-6 and TNF-α among all three research groups. At 3- and 6-months follow-up, a considerable alleviation of TNF-α and IL-6 levels was observed in group-1 and group-2 patients, respectively, when compared with the baseline. CONCLUSION: The application of aPDT demonstrated improved clinical, radiographic, and immunological peri-implant parameters for the treatment of peri-implantitis among T2DM patients.

Comparison of self-rated oral symptoms and periodontal status among cigarette smokers and individuals using electronic nicotine delivery systems.

Objective: The aim was to compare the self-rated oral symptoms (OS) and clinical and radiographic periodontal status among cigarette smokers and electronic nicotine delivery systems (ENDS) users.Participants: Self-reported cigarette smokers and electronic cigarette and JUUL users were included.Methods: Self-rated OS and demographic data were recorded. Clinical attachment loss (AL), plaque index (PI), probing depth (PD), number of missing teeth, and bleeding on probing (BOP) were determined. p Values<.05 were deemed significant.Results: Bad breath (p<.001) and pain in gums (p<.001) were more often reported by cigarette-smokers than ENDS users. Compared with never-smokers, pain in teeth (p<.001), bad-breath (p<.001), and pain in gums (p<.001) were higher among cigarette smokers. There was no significant difference in pain in teeth, bleeding gums, bad breath, and pain in gums when JUUL users were compared with never-smokers and electronic cigarette users. PI (p<.05) and PD (p<.05) were increased in cigarette smokers than ENDS users and never-smokers.Conclusions: Pain in teeth and gums are more often perceived by cigarette smokers than electronic cigarette and JUUL users and never-smokers.

Effectiveness of scaling and root planing with and without adjunct probiotic therapy in the treatment of chronic periodontitis among shamma users and non-users: A randomized controlled trial.

BACKGROUND: Effectiveness of scaling and root planing (SRP) with/without adjunct probiotic (Lactobacillus reuteri) treatment towards the reduction in periodontal inflammatory parameters (clinical attachment loss [AL], marginal bone loss [MBL], plaque index [PI], and bleeding on probing [BOP] in shamma users and non-users [controls] with chronic periodontitis [CP]) remains uninvestigated. The aim of the present randomized controlled trial was to compare the efficacy of SRP with and without adjunct probiotic therapy (PT) in the treatment of CP among shamma users and controls (individuals not using tobacco in any form). METHODS: The study was conducted in accordance with the Consolidated Standards of Reporting Trials guidelines. Patient demographics were recorded using a questionnaire. Therapeutically, patients were allotted into four groups as follows: 1) group 1: Shamma chewers that underwent SRP alone; 2) group 2: Shamma-chewers that underwent SRP + PT; 3) group 3: Non-chewers that underwent SRP alone; and 4) group 4: Non-chewers that underwent SRP + PT. Periodontal parameters (PI, BOP, PD, clinical AL and mesial and distal MBL) were measured on all teeth except third molars at baseline and at 3- and 6-month follow-ups. Level of significance was set at P < 0.05. RESULTS: In total, 31, 32, 31, and 33 individuals were included in groups 1, 2, 3, and 4, respectively. Among shamma users, there was no significant difference in the scores of PI, BOP, PD, clinical AL and MBL when SRP was performed with/without adjunct PT. Amongst controls, SRP with adjunct PT was more effective in reducing PI (P < 0.05), BOP (P < 0.05) and PD (P < 0.05) at 3-month follow-up. There was no significant difference in periodontal parameters at 3- and 6-month follow-ups in patients that underwent SRP with and without adjunct PT. CONCLUSIONS: Habitual shamma use compromises the outcome of SRP in patients with CP. Among patients that do not use any form of ST product, SRP is an effective treatment modality for the treatment of CP, and this relationship is independent of use of adjunct PT.

Clinical and radiographic peri-implant outcomes of short dental implants placed in posterior jaws of patients with treated generalized aggressive periodontitis: A 3-year follow-up study.

BACKGROUND: Studies assessing clinical and radiographic peri-implant parameters around short dental implants (SDIs) in treated generalized aggressive periodontitis (GAgP) patients are scant. OBJECTIVES: This 3-year follow-up study aimed to compare the clinical peri-implant and radiographic bone status around SDIs placed in partially edentulous patients treated for GAgP and periodontally healthy patients and to assess the implant success rate between both the groups. MATERIALS AND METHODS: A total of seven patients clinically diagnosed with GAgP and seven periodontally healthy patients was included in the clinical study. Forty-eight (29 maxilla; 19 mandible) and 11 (8 maxilla; 3 mandible) SDIs were placed in the GAgP group and healthy group, respectively. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were recorded at six sites around all teeth and implants. Marginal bone loss (MBL) was studied incorporating in a specialized software and examined on a calibrated computer display screen with the help of an image analyzer. Patient satisfaction was recorded using a questionnaire sheet that contained questions regarding esthetics and function of the restorations. RESULTS: The implant survival rate after 3 years was 81.25%. BOP and CAL around SDIs of GAgP patients were significantly higher than in periodontally healthy subjects (P = .01) throughout the follow-up. CAL around the teeth of GAgP patients was significantly greater during the follow-up than around the teeth of periodontal healthy subjects (P = .02). The PI and BOP between the teeth and implants showed no statistical significant difference. The mean PD at teeth was 0.4 mm greater than at implants. Implants showed significantly increased attachment loss than teeth (P = .01). The overall mean satisfaction of visual analogue scale was 12.8 ± 1.45. CONCLUSION: This short-term follow-up study indicates SDIs remain functionally stable in the posterior jaws of treated GAgP patients.

Knowledge, behavior and attitudes of dental practitioners towards photodynamic therapy use in dental practice.

BACKGROUND: The aim of the present study was to assess knowledge, behavior and attitudes of dental practitioners (DPs) towards photodynamic therapy (PDT) in dental clinical practice. METHODS: A cross-sectional study was performed and a 13-item survey questionnaire was given to DPs practicing in 13 different teaching hospitals in Karachi, Pakistan. Questions were aimed at exploring the knowledge of DPs regarding PDT and their attitude towards PDT and perceptions that may influence clinical practices. Chi-square and spearman coefficient were conducted to compare subgroups and correlate factors with the knowledge score of DPs. RESULTS: A total of 509 questionnaires were completed (response rate=82%). Median age of participants was 34 years and 70% were females. Most DPs demonstrated good knowledge related to PDT, and nearly 77%, 69% and 62% were aware of the mechanism of action and the role of photosensitizers in PDT respectively. It was reported that 74% of the respondents expressed that they are comfortable to know about PDT in detail for their clinical practice. A cumulative 54% disagreed that discussing the option for PDT with their patients was peripheral to their role as clinicians. A striking 82% would like to attend seminars and workshops on PDT. Significant difference was found among senior lecturers and assistant professors for the knowledge items (p <0.05). No statistical correlation was found between the knowledge items score of DPs and their behavior (r=0.18; p=0.762), attitude (r=0.04; p=0.594) and self-rated knowledge (r=0.42; p=0.854). CONCLUSION: Dental practitioners showed adequate knowledge regarding PDT and its use in dentistry. However, expertise with regards to handling and training is warranted so that DPs could use PDT in their dental practice.