A novel test for hyposalivation using a sugar cube.

BACKGROUND: Hyposalivation is a highly prevalent condition in old persons. OBJECTIVES: The aim of this study was to assess a novel tool for the diagnosis of hyposalivation using a sugar cube and to compare its reliability to other validated test methods. METHODS: Five tests were performed: unstimulated salivary flow test by draining method (USFT), oral moisture device Mucus® (MCS), sugar cube test (SCT), stimulated salivary flow test by chewing gum (CG) and Saxon test (SX). The sugar cube test consisted in measuring the time needed to disintegrate a standard-sized sugar cube N°4 (5.6 g) placed beneath the tongue. Bivariate correlation analyses were performed. ROC curve analysis and the Youden Index were used to determine the cut-off value. Sensitivity and specificity were calculated according to the determined cut-off point. RESULTS: A total of 121 participants were recruited, with an average age of 49.8 ± 18.2 years. The USFT was best correlated with the SCT. No correlation was found between SCT and the stimulated saliva tests (CG, SX) as well as the MCS test. According to the Youden index, 140 s is appropriate to diagnose hyposalivation. Sensitivity of .64 and specificity of .91 were found for SCT using USFT as gold standard. The mean subjective evaluation score of the SCT was 3.1 ± 1, significantly higher than USFT 2.6 ± 1.1 (p < .05). CONCLUSIONS: The sugar cube test proved to be a useful method for assessing unstimulated salivation, reducing test execution time and causing less participant discomfort than the gold standard unstimulated salivary flow test.

Volumetric Analysis of Peri-implant Tissue Change Over Time: Validating an Innovative 3D Method.

PURPOSE: To validate an innovative 3D volumetric method of evaluating tissue changes proposed by Lee et al in 2020 by comparing the results of this method-in which the scanned peri-implant surfaces were transformed, visualized, and analyzed as 3D objects-to the results reported by an existing method based on calculation of the mean distance between measured surfaces. The null hypothesis was that there was no statistically significant difference between the two methods. Additionally, the present study evaluated peri-implant tissue changes 5 years after single implant placement in the esthetic zone. MATERIALS AND METHODS: Both methods were applied to 11 oral implant site casts (6 maxillary central incisor sites, 5 maxillary lateral incisor sites) taken from 11 patients at crown placement and at follow-up examinations 5 years later. The methods are based on digital workflows in which the reference and 5-year casts are scanned and the resulting STL files are superimposed and analyzed for three regions of interest (mesial papilla, central area, and distal papilla). The volumetric changes reported by the Lee et al method and the mean distance method were calculated and compared using the Spearman rank correlation coefficient (P < .01) and the Wilcoxon signed-rank test (P < .05). RESULTS: The correlation between the two sets of measurements was very high (Spearman rank correlation coefficient = 0.885). The new volumetric method indicated a mean volume loss of 2.82 mm3 (SD: 5.06), while the method based on the measurement of mean distance showed a mean volume loss of 2.92 mm3 (SD: 4.43; Wilcoxon signed-rank test result: P = .77). No statistically significant difference was found. The two methods gave equivalent results, and the null hypothesis was accepted. CONCLUSIONS: The new volumetric method was validated and can be considered a trustworthy tool.

Immediately versus early placed bone-level-tapered implants supporting all-ceramic crowns on titanium base abutments: 1-year radiographic and pink esthetic outcomes of a multicenter pilot RCT.

OBJECTIVES: Aim of this study was to assess survival rates, radiographic, and pink esthetic outcomes of a bone-level-tapered (BLT) implant following immediate or early implant placement. MATERIALS AND METHODS: Patients in need of tooth extraction and one implant in the anterior or premolar area were recruited in five centers. Patients were randomly assigned to the immediate or early placement protocol. Implants were restored with all-ceramic crowns cemented to titanium-base-abutments. Radiographic bone levels, implant stability quotient (ISQ), and pink esthetic outcomes were assessed. Data were analyzed descriptively. Level of significance was set at 0.05. Differences between groups were tested using Wilcoxon-signed-rank and Mann-Whitney-U test as nonparametric tests. RESULTS: A total of 60 patients received 60 BLT implants (Institut Straumann). At 12-months, 59 implants (98.3%) were osseointegrated. The mean distance from implant shoulder to first bone-to-implant contact was 0.15 ± 0.59 mm without significant differences between the groups. Median ISQ values increased from 75.5 to 78.5. A mean buccal recession of 0.1 ± 0.70 mm occurred with no difference between groups. The mean papilla height gain in both groups was 0.5 ± 1.47 mm mesially and 0.4 ± 1.36 mm distally. CONCLUSIONS: After 1 year, immediately and early placed BLT implants exhibit similar bone level changes, ISQ values, and pink esthetic outcomes. CLINICAL SIGNIFICANCE: The present research contributes to the knowledge on clinical outcomes of immediately and early placed BLT implants restored with buccally microveneered ceramic single crowns out of two different ceramic materials. The research shows that similar esthetic and radiographic outcomes can be reached by means of immediate implant placement compared to the conventional early placement protocol. The improvement of esthetic soft-tissue parameters over time was shown for both implant placement protocols.

Extended porcelain veneers in the maxillary anterior region. A retrospective study with an up to 27-year follow-up

AIM: The aim of the present retrospective study was to evaluate the long-term results, including technical and biologic outcomes, of maxillary extended porcelain veneers with an incisal edge thickness above 2 mm. MATERIALS AND METHODS: Patients treated with extended porcelain veneers performed by a single clinician at University of Geneva between 1990 and 2003 were identified and invited to an examination. Of the 37 identified patients, 10 patients with 50 veneers agreed to be examined and were included. A clinical examination was performed to assess survival rates as well as technical and biologic outcomes (modified United States Public Health Services criteria). Patient records were also reviewed to retrieve patient and reconstruction data and every complication event. Patient-reported outcome measures (PROMs) were evaluated using a visual analog scale to measure esthetic satisfaction, functional and phonetic comfort, masticatory improvement, tooth sensitivity, and acceptance of restoration replacement in case of failure. Data were descriptively analyzed, and Kaplan-Meier survival estimators were computed for survival rates and complication events. RESULTS: The survival rate of the veneers was 96% after a mean follow-up of 20.7 ± 3.7 years in function. The technical complication rate amounted to 30%, including two failures, nine repairable fractures, three cracks, and one displacement due to trauma. No cavitated caries lesions or endodontic complications were registered. PROMs were very high for esthetic satisfaction and phonetic comfort. CONCLUSIONS: Within the limitations of the present retrospective study, extended porcelain veneers appear to be a successful long-term treatment option in terms of clinical outcomes and patient satisfaction.

Influence of sterilization on the retention forces of lithium disilicate and polymer-infiltrated ceramic-network crowns bonded to titanium base abutments: An in-vitro study.

OBJECTIVES: The aim of this study was to evaluate the effect of sterilization on the retention forces of lithium disilicate (LD) and polymer-infiltrated ceramic network (PICN) crowns bonded to titanium base (Ti-base) abutments. MATERIALS AND METHODS: Forty LD and 40 PICN crowns were milled and then bonded to 80 Ti-bases with two resin composite cements: Multilink Hybrid Abutment (mh) and Panavia V5 (pv) for a total of 8 groups (n = 10). Half of the specimens (test) underwent an autoclaving protocol (pressure 1.1 bar, 121°C, 20.5 min) and the other half not (control). Restorations were screw-retained to implants, and retention forces (N) were measured with a pull-off testing machine. The surfaces of the Ti-bases and the crowns were inspected for the analysis of the integrity of the marginal bonding interface and failure mode. Student's t-test, chi-square test, and univariate linear regression model were performed to analyze the data (α = 0.05). RESULTS: The mean pull-off retention forces ranged from 487.7 ± 73.4 N to 742.2 ± 150.3 N. Sterilized groups showed statistically significant overall higher maximum retention forces (p < .05), except for one combination (LD + mh). Sterilization led to an increased presence of marginal gaps and deformities compared to no-sterilization (p < .001), while no statistically significant relationship was found between failure mode and sterilization (p > .05). CONCLUSIONS: Sterilization may have a beneficial effect on the retention forces of LD and PICN crowns bonded to titanium base abutments, although it may negatively influence the integrity of the marginal bonding interface.

Laser induced temperature changes on the outer surface of titanium dental implants-an in vitro study.

PURPOSE: to measure the surface temperature distribution after CO2-laser heating of titanium dental implants using different power settings, application intervals and irradiation times. MATERIALS AND METHODS: 10 tissue-level-type titanium implants (Camlog Screw-line Promote Plus 4.3mm x 11mm) were embedded (Epofix, Struers ApS, Copenhagen, Denmark) and irradiated with a carbon-dioxide-laser (Denta II, Lutronic Corporation, Fremont, USA) with a wavelength of 10.6µm and at power levels of 4watts (group 1), 6watts (group 2), 8watts (group 3) and 10watts (group 4). A continuous beam mode (setting I) and non-continuous beam modes with 5second (setting II) and 10second (setting III) pause intervals were used. For each setting, a total irradiation time of 50seconds was used and repeated 10 times. The temperature was measured using external thermocouples (Testo SE & Co. KGaA, Lenzkirch, Germany) in contact with the implant surface at implant shoulder, middle and apex. A linear regression model was used to analyse the data (p = 0.05). RESULTS: Setting I demonstrated the most rapid increase in implant surface temperature in all three test sites as well as the greatest total temperature at 50 seconds of irradiation time. The greater the pause interval (settings II and III) during the 50 seconds of irradiation, the lower the rate of temperature increase as well as the total temperature in all three test sites and with all power levels. The average temperature difference between the apex and shoulder site was significant for test setting III for all groups, but not for any groups in settings I and II. CONCLUSION: Heating the internal aspect of a dental implant with a CO2-laser produces different temperature distribution profiles depending on the laser power level and the application interval. Laser-beam irradiation leads to a temperature gradient which is greatest at the implant apex and smallest at the implant shoulder.

Three tests to determine a preferred chewing side in partially edentulous patients: A pilot study.

STATEMENT OF PROBLEM: Determining the preferred chewing side may be an important factor in prosthetic treatment planning, especially where additional support for a removable dental prosthesis can be provided by implants. PURPOSE: The purpose of this clinical study was to investigate the validity and reproducibility of 3 different tests to determine the preferred chewing side. MATERIAL AND METHODS: A total of 82 partial denture wearers, with an average age of 70 years, were enrolled in this study. The first test (CG) evaluated the left or right position of a piece of chewing gum after spontaneous mouth opening during mastication. A second test (ASI) videotaped 30 seconds of mastication and analyzed the distribution of masticatory cycles by means of an asymmetry index. For the third test (VAS), participants were asked to mark their subjective perception of their preferred chewing side on a visual analog scale representing the right and left sides. All the tests were performed and repeated in a randomized sequence. The reproducibility of the tests was first evaluated. The mean values of the ASI and VAS tests were calculated, and the results were compared with the second series of the CG test. The Pearson correlation test was used to associate ASI and VAS, and the Cohen kappa agreement was used for the inter-reliability of CG (α=.01). RESULTS: The results indicated fair to almost perfect reproducibility for the 3 tests. Kappa values were.37 (P<.01) for the CG,.47 (P<.01) for the ASI and.91 (P<.01) for the VAS. Correlation coefficients resulted in rho=.86 (P<.01) for the ASI and rho=.97 (P<.01) for the VAS. The correlation between ASI and VAS was excellent, with rho=.85 (P<.010). CG and ASI (test kappa=.36, P<.010) and CG and VAS (test kappa=.39, P<.010) showed fair agreement. CONCLUSIONS: ASI and VAS seem more reliable than CG to determine a patient's preferred chewing side and might be helpful within the context of prosthetic treatment planning, where additional support may improve denture function.

Masticatory performance in oral function assessment: Alternative methods.

BACKGROUND: Masticatory function declines with age or disease, implicating a poor chewing efficiency and an often-unconscious change for a less healthy, yet easy to chew diet. Timely screening of masticatory function may foster an early-onset diagnosis and potential treatment. The aim of this study was to compare alternative diagnostic tools for masticatory function to a Jelly-scan test. MATERIALS AND METHODS: Patients aged 70 years and older who were hospitalised for rehabilitation were recruited for this study. A total of four different tests for masticatory function were administered. The Japanese Society of Gerodontology glucose extraction test (Jelly-scan) was used as reference to compare a colour-changing gum test (Gum1-colour) as well as a mixing ability test with a visual (Gum2-visual) and opto-electronical (Gum2-digital) analyses. Receiver operating characteristic (ROC) curves were used to establish the discriminative value, kappa-values were used to estimate individual agreements and correlations were verified using Spearman's tests. RESULTS: Sixty-one patients (Men n = 23, Women n = 38) aged 82.4 ± 6.8 years participated in the experiments. The average number of natural teeth was 16.5 ± 10.5, 34.4% of the participants wore removable dentures. For all tests, the sum of sensitivity and specificity was >150%. All test correlated with Jelly-scan (absolute Rho >0.5). With Jelly-scan 51 participants (83.6%) were diagnosed with "masticatory hypofunction". After reducing the cut-off value of the test from 100 mg/dL to 65 mg/dL, only 33 participants (54%) fulfilled the diagnosis. This post-hoc analysis increased the sensitivity of the Gum2-tests and the agreement to kappa >0.5 for all three tests. CONCLUSION: All three tests can be considered useful screening alternatives. In its original version, Jelly-scan may tend to over-diagnose masticatory hypofunction, hence a novel cut-off with better agreement between tests is suggested.

Retention and Marginal Integrity of CAD/CAM Fabricated Crowns Adhesively Cemented to Titanium Base Abutments-Influence of Bonding System and Restorative Material.

PURPOSE: To assess the influence of the bonding system and restorative material on the marginal integrity and pull-off forces of monolithic all-ceramic crowns bonded to titanium base (ti-base) abutments. MATERIALS AND METHODS: A total of 108 ti-bases were sandblasted and divided into nine experimental groups (n = 12) according to the combination of crown material (polymer-infiltrated ceramic-network [PI], lithium-disilicate [LD], and zirconia [ZI]) and bonding system (Multilink Hybrid-Abutment [MH], Panavia V5 [PV], RelyX Ul5mate [RU]) with the respective primers. After bonding the crowns to the ti-base abutments, the restorations were screw-retained on implants and thermomechanically aged (1,200,000 cycles, 49 N, 1.67 Hz, 5 to 55°C). Marginal integrity and bonding failures were evaluated under a light microscope, and pull-off forces (N) were calculated. Chi-square tests for marginal integrity as well as one-way and two-way ANOVA statistical tests for pull-off forces were applied (a = .05). RESULTS: PI presented higher marginal integrity than LD (P = .023). Bonding system PV revealed higher marginal integrity than MH (P =.005) and RU (P =.029). Differences in pull-off forces were found between restorative material and resin cements (P < .001), with the highest values for ZI + RU (598 ± 192 N), PI + PV (545 ± 114 N), LD + MH (532 ± 116 N), and PI + RU (528 ± 81 N). Specimens with marginal integrity revealed higher pull-off forces than those with alteration (P = .006). Specimens presenting bonding failures (micromovements) showed lower pull-off forces than those without bonding failures (P < .001). CONCLUSIONS: The tested CAD/CAM materials show favorable bonding performances with different bonding systems, nevertheless for each restorative material a specific bonding system has to be recommended. Int J Prosthodont 2023;36:e88-e102.

A multicenter randomized controlled clinical pilot study of buccally micro-veneered lithium-disilicate and zirconia crowns supported by titanium base abutments: 1-year outcomes.

OBJECTIVES: To investigate survival rates, technical and biologic outcomes of buccally micro-veneered all-ceramic single implant crowns. MATERIAL AND METHODS: Sixty subjects randomly received immediately or early placed implants. Crowns out of lithium-disilicate (n = 30) and zirconia-ceramic (n = 30) were bonded to titanium-base-abutments. Restorations were inspected at baseline (BL) and during follow-up visits (6, 12 months). Technical and biologic parameters were recorded. Data were analysed descriptively. Differences between groups were tested with Student's t-test. Paired T-test was used when comparing data from the same implant or tooth over time. Linear model repeated measures were used to test differences between materials over time. Differences in counts were evaluated using Pearson Chi-square test. The level of significance was at p < .05. RESULTS: After a mean observation time of 13.2 ± 2.4 months, 54 restorations were re-examined. The implant survival rate was 98.3%, and the restoration survival rate was 100%. One early implant failure occurred. Two minor chippings occurred in lithium-disilicate restorations. No chippings or fractures occurred in any zirconia restorations at 1 year (0%). The technical complication rate was 3.7%, with 7.7% complications among the lithium-disilicate restorations and no differences between the two materials (p = .558). At 1-year follow-up, mean Bleeding on Probing (BOP) was higher at implants (0.27 ± 0.3) than adjacent teeth (0.17 ± 0.18) (p = .046) with no differences between materials (p = .36). Differences in pocket probing depth (PPD) between implants and adjacent teeth were significant (p < .01). Jemt Index improved significantly from BL to 1-y-follow-up (p < .001). CONCLUSIONS: Preliminary results were good, suggesting that the ceramic type does not impact technical and biologic parameters.

Single and partial tooth replacement with fixed dental prostheses supported by dental implants: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years.

AIM: To evaluate outcome measures, methods of assessment, and analysis in clinical studies on fixed single- and multiple-unit implant restorations. MATERIALS AND METHODS: Three independent electronic database searches (MEDLINE, EMBASE, and Cochrane) were done to identify prospective and retrospective clinical studies published from January 2011 up to June 2021 with ≥20 patients and minimum 1-year follow-up period on technical and clinical outcomes of implant-supported single crowns (SCs) and partial fixed dental prostheses (P-FDPs). An entire data extraction was performed to identify primarily the most reported outcome measures and later to define the choice of assessment methods of those outcome measures. The outcomes were analysed descriptively, and the strength of association was evaluated using the Pearson chi-square test (p ≤ .05). RESULTS: In a total 531 studies, 368 on SCs (69.3%), 70 on P-FDPs (13.1%), and 93 on both restoration types (17.5%) were included; 56.3% of all studies did not clearly define a primary outcome. The most frequent primary outcome was marginal bone level (MBL) (55.2%) followed by implant survival (5.3%), professional aesthetic evaluation (3.4%), and technical complications (2.1%). Peri-implant indices were the most reported secondary outcome (55.1%), followed by implant survival (39.9%), MBL (36%), and implant success (26.4%). Prosthetic failure (seven studies [3.9%]) was one of the least reported outcome measures. CONCLUSIONS: Outcome measures and their assessment methods showed high heterogeneity among studies. Primary outcomes were not often defined clearly, and the most frequently selected primary outcome was marginal bone loss. Prosthetic outcomes, implant survival, and patient-related outcomes were only infrequently reported.

Single and partial tooth replacement with fixed dental prostheses supported by dental implants: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years.

AIM: To evaluate outcome measures, methods of assessment, and analysis in clinical studies on fixed single- and multiple-unit implant restorations. MATERIALS AND METHODS: Three independent electronic database searches (MEDLINE, EMBASE, and Cochrane) were done to identify prospective and retrospective clinical studies published from January 2011 up to June 2021 with ≥20 patients and minimum 1-year follow-up period on technical and clinical outcomes of implant-supported single crowns (SCs) and partial fixed dental prostheses (P-FDPs). An entire data extraction was performed to identify primarily the most reported outcome measures and later to define the choice of assessment methods of those outcome measures. The outcomes were analysed descriptively, and the strength of association was evaluated using the Pearson chi-square test (p ≤ .05). RESULTS: In a total 531 studies, 368 on SCs (69.3%), 70 on P-FDPs (13.1%), and 93 on both restoration types (17.5%) were included; 56.3% of all studies did not clearly define a primary outcome. The most frequent primary outcome was marginal bone level (MBL) (55.2%) followed by implant survival (5.3%), professional aesthetic evaluation (3.4%), and technical complications (2.1%). Peri-implant indices were the most reported secondary outcome (55.1%), followed by implant survival (39.9%), MBL (36%), and implant success (26.4%). Prosthetic failure (seven studies [3.9%]) was one of the least reported outcome measures. CONCLUSIONS: Outcome measures and their assessment methods showed high heterogeneity among studies. Primary outcomes were not often defined clearly, and the most frequently selected primary outcome was marginal bone loss. Prosthetic outcomes, implant survival, and patient-related outcomes were only infrequently reported.

Mechanical Properties of Additively Manufactured and Milled Interim 3-Unit Fixed Dental Prostheses.

PURPOSE: To investigate the survival and mechanical properties of 3-unit interim fixed dental prostheses (FDPs) made with additive manufacturing (AM) technology compared to milled and conventional manual fabrication. MATERIALS AND METHODS: Sixty 3-unit interim FDPs replacing the first left mandibular molar were divided in 6 groups (n = 10): manual (Man) (Protemp 4), milled (Mil) (Telio-CAD Multi), and 4 additive manufacturing (AM) groups were subdivided into 4 AM technology subgroups: direct light positioning (DLP) (Rapidshape P30 [RS]), and stereolitography (SLA) (Formlabs 2 [FL]) and the type of printed interim polymer (P Pro C&B [St] and SHERAprint-cb [Sh]) (RS-St, RS-Sh, FL-St, and FL-Sh). Survival and complications were assessed after thermomechanical aging. The surviving samples were tested for fracture resistance. Kaplan-Meier test followed by log-rank test to show differences between groups was used to calculate the survival and complication rates. For fracture strength, one-way ANOVA and Tukey-b post hoc test were used to compare groups. Descriptive statistics was used for failure modes and Pearson chi-square to compare groups (α = 0.05). RESULTS: Survival rates among groups varied from 100% (Man, Mil and FL-Sh), 70% (FL-St), 50% (RS-Sh), and 20% (RS-Sh) (p < 0.001), respectively. Additional events were observed in 50% to 80% in FL-St, RS-St, and RS-Sh groups (p < 0.001). Man, FL-St, and RS-S showed lower mean static load resistance (p < 0.001). Fracture through the connector between tooth 35 and the pontic was the most prevalent type of failure. CONCLUSION: The manufacturing method, type of resin, and the printing mode had a significant influence on the mechanical properties of AM interim 3-unit FDPs.

Influence of the Titanium Base Abutment Design on Monolithic Zirconia Multiple-Unit Implant Fixed Dental Prostheses: A Laboratory Study.

PURPOSE: This in vitro study evaluated technical outcomes of monolithic zirconia implant-supported fixed dental prostheses (iFDPs) supported by different designs of titanium base abutments after aging and static load testing. MATERIALS AND METHODS: Sixty three-unit monolithic zirconia (yttrium oxide partially stabilized tetragonal zirconia polycrystals; Y-TZP)iFDPs were produced and divided into four groups: group A-conical titanium base abutments for the prosthesis; group B-cylindrical titanium base abutments for the crown; group C-conical titanium base abutment for the prosthesis and cylindrical titanium base abutment for the crown; group D-cylindrical titanium base abutments for the prosthesis. The samples were subjected to an aging protocol and to continuous static loading until failure and analyzed visually and with specific software. The technical outcomes comprised the occurrence of debonding, screw loosening, deformation and fracture, abutment deformation and fracture, implant deformation and fracture, zirconia chipping and fracture, and bending moments. The Pearson chi-squared test (χ2) and Fischer exact test were used to compare the outcomes. The Kolmogorov-Smirnov test was used to evaluate data distribution of the bending moments. Analysis of variance (ANOVA) was used for the analysis of parametric data distribution, and the Kruskal-Wallis test was used for nonparametric data distribution. RESULTS: After aging, a higher percentage of debonding (P = .042) and micromovement (P = .034) was recorded in group C (P = .042). The conical titanium base abutments had a higher debonding (P = .049) and a higher macromovement rate (P = .05). The static load test showed higher bending moments in group D (P = .001) and lower bending moments in group A (P = .001). Debonding was highest in group C (P = .001) and lowest in group A (P = .002). Complete loss of retention rate was highest in group C (P = .001). The conical titanium base abutment had the highest debonding rate (P = .001) and complete loss of retention (P = .001). The micromovement rate was the highest for cylindrical titanium base abutments for the crown (P = .001). The lowest screw loosening, zirconia chipping, and fracture rate (P = .001) and the highest screw deformation (P = .004) were recorded in group A. The screw deformation rate was lowest in the cylindrical titanium base abutments for the crown (P = .008). CONCLUSION: The mixed titanium base abutment design comprising one conical and one cylindrical abutment in Y-TZP iFDPs led to the highest debonding rate. The cylindrical titanium base abutment for the prosthesis provided a lower percentage of debonding and the highest load resistance.

Biological outcomes and patient-reported outcome measures (PROMs) of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions by means of the "3-step technique": part 2 of the 6-year outcomes of a retrospective clinical study.

PURPOSE: To evaluate biologic and esthetic outcomes, as well as the patient-reported outcome measures (PROMs), of full-mouth rehabilitations in patients suffering from generalized erosive and/or abrasive tooth wear following the 3-step technique. MATERIALS AND METHODS: Patients who received a minimally invasive full-mouth rehabilitation according to the 3-step technique and who were treated at the University of Geneva and/or in a private practice were considered for inclusion. The minimum service time of the restorations was 12 months. The biologic outcomes were analyzed by assessing pocket probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP). Furthermore, secondary caries, tooth vitality, and sensitivity to temperature were evaluated using the modified United States Public Health Service (USPHS) criteria. The esthetic outcomes were rated with the White Esthetic Score (WES). Finally, PROMs were evaluated using visual analog scales (VAS). RESULTS: A total of 19 patients with 406 restorations (149 direct composite resins, 110 indirect composite resin/ceramic onlays, and 147 composite resin/ceramic veneers) were examined after a mean follow-up of 71.8 ± 28.6 months. Periodontal parameters were good (mPPD = 2.9 ± 0.4; mPI = 0.1 ± 0.2; and mBOP = 0.05 ± 0.1). No secondary caries were found, and no abutment tooth had lost vitality. A total of 36 abutment teeth had moderate sensitivity, but none presented pronounced sensitivity. The rehabilitations exhibited good esthetic outcomes (mWES = 8.4 ± 1.9). Patients reported satisfying esthetic results of their rehabilitations (mean VAS = 9.2 ± 1.6) and considered their treatment as comfortable (mean VAS = 8.2 ± 2.1), while the least favorably rated parameter was the cost of treatment (mean VAS = 4.1 ± 3.2). CONCLUSION: Minimally invasive full-mouth rehabilitations of patients with generalized tooth wear by means of the 3-step technique exhibit very good clinical medium-term results with respect to biologic and objective/subjective esthetic outcomes. The patient satisfaction with this treatment was high.

Effects of overnight storage conditions on conventional complete removable prostheses.

PURPOSE: To evaluate the effects of overnight storage conditions on the dimensional stability and retention of prostheses, as well as the participant's subjective perception of these interventions. MATERIALS AND METHODS: Subjects with maxillary complete prostheses (CRPs) were randomly assigned to receive two interventions in a crossover design: storing the CRPs overnight in a dry or wet environment with a cleansing tablet. The denture intaglio surface was scanned, and outcome measures were collected before each intervention (BLN), post ntervention (PIS), and after immersion in water for 15 minutes after the intervention (WOC). Dimensional changes were analyzed for the total surface, anterior flange, palate, and tuberosities. Retention force was measured using a dynamometer, and the participants' subjective assessment of comfort, fit, and retention of their CRPs were collected. After verifying normal distribution, paired t and Wilcoxon signed-rank tests were used to check for any statistical significance (α = .05). RESULTS: Ten participants (mean age: 76.5 ± 5.9 y) were recruited in this study. Between BLN and PIS, the dimensional changes after dry intervention were significantly less than when stored wet for total surface (P = .009), anterior flange (P = .028), and the palate (P = .005). No difference was found between the effects of storage or washout interventions on objectively measured CRP retention. However, after WOC following dry storage, participants perceived a lower retention (P = .021), and a more comfortable palate after WOC following the wet intervention (P = .018). CONCLUSION: For dimensional stability, dry overnight storage of removable prostheses can safely be recommended when indicated. Immersion in water for 15 minutes does not seem to add advantages.

Digital wear analysis of different CAD/CAM fabricated monolithic ceramic implant-supported single crowns using two optical scanners.

PURPOSE: To digitally evaluate the volumetric wear of four different implant-crown materials and their antagonists after artificial aging using an intraoral scanner (IOS) device and a laboratory desktop scanner. MATERIALS AND METHODS: A total of 48 implants were restored with monolithic crowns divided according to restorative material: lithium disilicate (LDS), zirconia (ZR), polymerinfiltrated ceramic network (PICN), and porcelain fused to metal (PFM). Each specimen was scanned using a desktop scanner (LAB; iScan D104, IMETRIC 3D) and an IOS (TRIOS 3, 3Shape) before and after chewing simulation (1,200,000 cycles, 49 N, steatite antagonist, 5°C to 50°C). The obtained STL files were superimposed, and the volumetric loss of substance of the crowns and their antagonists was quantified (Materialise 3-matic). Kruskal-Wallis, Spearman rho, and paired t tests were used to analyze the data (α = .05). RESULTS: The means of volume loss for each restorative material varied between 0.05 ± 0.06 mm3 (ZR with IOS) and 3.42 ± 1.65 mm3 (LDS with LAB). The wear of the antagonists was significantly lower (P < .05) for ZR than the other groups. Increased wear of the crowns was highly correlated with increased wear of their antagonists (rs = 0.859). When comparing the wear measurement using the two scanning devices, no difference in mean volume loss was found (IOS: 1.81 ± 1.81 mm3; LAB: 1.82 ± 1.78 mm3) (P = .596). CONCLUSION: Polished ZR was the most wear-resistant material and the least abrasive to the respective antagonist among the tested ceramics. For the quantification of wear, this IOS device can be used as an alternative to desktop scanners.

Retrospective clinical study of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions following the "3-step technique". Part 1: 6-year survival rates and technical outcomes of the restorations.

PURPOSE: To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition. MATERIALS AND METHODS: For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross-tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P < .05. RESULTS: A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials and locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003). CONCLUSION: Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended.

Oral function and nutritional status in non-acute hospitalised elders.

INTRODUCTION: Malnutrition and risk of malnutrition continues to be a common finding in elders, yet its association with oral function in hospitalised patients remains unclear. MATERIAL AND METHODS: Patients aged 70 years or over who had been hospitalised for non-acute rehabilitation were recruited. Nutritional risk was screened using the Mini-Nutritional Assessment Short Form (MNA-SF) and Nutritional Risk Screening (NRS) scores. Malnutrition was assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. All participants underwent the oral hypofunction test battery, evaluating oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory and swallowing function. Statistical analyses comprised Mann-Whitney or Kruskal-Wallis tests. Bivariate associations between categorical variables were tested using the Pearson chi-square test; for continuous variables, the Spearman correlation was calculated. A P-value < .05 was considered statistically significant. RESULTS: Sixty patients aged a mean 82.5 ± 7.0 years participated. Some 88.3% were diagnosed with oral hypofunction, and this was more common in older patients (P = .020). Analysing the 7 oral hypofunction tests as an interval variable (NiOF) revealed additional correlations with number of teeth (ρ = 0.477) as well as the nutritional risk, evaluated by the MNA-SF (ρ = -0.284) and NRS (ρ = 0.317) scores. NiOF scores were higher among denture wearers (P = .003). GLIM did not confirm the correlation with NiOF. Biomarkers such as serum albumin and CRP were not associated with the NiOF score. CONCLUSION: In this sample, the association between oral function and nutritional state is more obvious in nutritional risk scores than in the malnutrition diagnosis by GLIM.

Accuracy of Additively Manufactured and Milled Interim 3-Unit Fixed Dental Prostheses.

PURPOSE: To investigate the accuracy of additive manufacturing (AM) by means of internal fit of fixed dental prostheses (FDPs) fabricated with two AM technologies using different resins and printing modes (validated vs nonvalidated) compared to milling and direct manual methods. MATERIAL AND METHODS: Sixty 3-unit interim FDPs replacing the first mandibular molar were divided into 6 groups (n = 10): manual (Protemp 4), milled (Telio-CAD), and AM groups were subdivided based on AM technology (direct light processing (Rapidshape P30 [RS]) and stereolithography (FormLabs 2 [FL])) and the polymer type (P-Pro-C&B [St] and SHERAprint-cb [Sh]) (RS-St, RS-Sh, FL-St, FL-Sh). Validated (RS-Sh and RS-St) or nonvalidated (FL-St and FL-Sh) modes were adopted for AM. The specimens were scanned to 3D align (GOM inspect) according to the triple scan method. The internal space between the FDPs and preparation surfaces in four sites (marginal, axial, occlusal, and total) was measured using equidistant surface points (GOM Inspect). Statistical analysis was done using Kruskal Wallis and Dunn post-hoc tests. (α = 0.05). RESULTS: One AM group (FL-Sh) and milling exhibited better adaptation compared to manual and RS-St at molar site (p < 0.05). FDPs with St resin (FL-St and RS-St) displayed bigger marginal space than milled, FL-Sh, and RS-Sh. The nonvalidated printing mode showed better mean space results (p < 0.05) with higher predictability and repeatability (p < 0.001). CONCLUSIONS: The AM interim FDPs tested provided valid alternatives to the milled ones in regard to their accuracy results. The printing mode, resin, and the AM technology used significantly influenced the manufacturing accuracy of interim FDPs, particularly at the marginal area. The nonvalidated printing mode with lower-cost 3D printers is a promising solution for clinical applications.