Impact of SARS-CoV-2 on dentistry: a review of literature.

OBJECTIVE: SARS-CoV-2 is a new Coronavirus identified as the cause of Coronavirus disease in 2019 (COVID-19). The epidemic spread in China and beyond its borders, involving 114 countries with more than 5 million dead. On March 11, the WHO declared the spread of SARS-CoV-2 to be a pandemic and encouraged nations to adopt harsh restrictive measures. Therefore, patients more and more often turn to dental offices only for emergencies. Healthcare professionals, including dentists, are at high infectious risk. In fact, the closeness to the oral cavity and nasopharynx and the use of drills or ultrasonic devices that cause aerosol release, make dental professions at high risk of bacterial and viral infections. The way patients are treated has changed. In fact, it should be mandatory to carry out a pre-treatment telephone triage and the use of mouthwashes to reduce bacterial load. In the current pandemic, it is necessary to adopt specific safety protocols that can protect dental operators as well as limit the spread of the virus. The purpose of this review is to present an overview on ways to reduce the risk of SARS-CoV-2 contagion in dentistry by focusing on the immediate situation as well as by looking towards the future. MATERIALS AND METHODS: To reach the review purpose, we selected a series of studies using keywords "COVID-19" OR "SARS-CoV-2" in association with "dentistry" AND "safety protocols" AND "healthcare procedures" AND "individual protection dispositive" AND "air transmission" AND "droplet". We selected papers exclusively in English language, up to 1st January 2022. RESULTS: During future phases of the pandemic, everywhere in the World, it is necessary to impose all dentistry team both a serological screening and the vaccination, as already established for all health staff in Italy. CONCLUSIONS: For own safety, it is an important for the whole dentistry category constantly update the devices and the protocols adopted, as well as monitoring the real infectious threats, which may occur.

Posterior partial crowns out of lithium disilicate (LS2) with or without posts: A randomized controlled prospective clinical trial with a 3-year follow up.

OBJECTIVES: The objective of this randomized controlled trial was to assess the influence of use of posts as well as the type of posterior tooth (premolars vs molars) for the treatment with lithium disilicate (LS2) partial crowns. MATERIALS AND METHODS: A total of 60 patients were treated with posterior LS2 partial crowns. Two groups (n = 60) were made based on the type of restored tooth: Group 1, premolars and Group 2, molars. The samples of each group were divided into 2 subgroups (n = 30): Subgroup A restored with fiber posts and Subgroup B without them. Clinical and intraoral radiographic examinations were assessed during each recall (6 months and, 1, 2, and 3 years). Kaplan-Meier log-rank test and Cox regression analysis (Pp < 0.05) were applied. RESULTS: Three subgroups showed 100% of survival while group 2 A exhibited the lowest performance (93.3%). The Cox regression analysis showed that the presence of the post was not a significant factor for survival time (Hazard Ratio HR = 0388; CI95% Confidence Interval for H R = 0,1- to 1,5; pp = 017). Tooth type had an influence on survival time that was at the limit of statistical significance (Hazard Ratio HR = 0123; CI95% Confidence Interval for HR = 0 0015- to 0997; p = 005). Particularly, failure risk was greater for premolars. 'Post by tooth type' interactions were not statistically significant (p = 0126). CONCLUSIONS: over a 3-year observation period, the clinical performance of endodontically treated teeth restored with lithium disilicate partial crowns was not significantly affected by the use of a fiber post and by the type of tooth (premolars or molars).

Aging resistance, mechanical properties and translucency of different yttria-stabilized zirconia ceramics for monolithic dental crown applications.

OBJECTIVES: The dental market moves towards high-translucency monolithic zirconia dental crowns, which are usually placed either with - or without - a thin glaze layer. The microstructural features and the mechanical performances of these materials are still controversial, as well as their susceptibility to aging. This paper aims at studying these aspects in the current generation of zirconia dental crowns showing different degrees of translucency. METHODS: Four different commercial zirconia materials were investigated, including one standard 'full-strength' 3Y-TZP and three grades with improved translucency. The microstructural features (phase composition and assemblage, grain size) were carefully studied, as well as mechanical properties (biaxial bending strength and indentation toughness), translucency and aging behavior (in autoclave at 134°C). Aging was conducted on crowns with and without glaze to better represent clinical uses. RESULTS: Important differences are found in terms of microstructures among the materials in terms of cubic phase content and yttria in the tetragonal phase, leading to different optical, mechanical and aging resistance properties. We show that higher cubic phase content leads to better translucency and stability in water steam, but at the expense of strength and toughness. A compromise is always inevitable between translucency and aging resistance on one side and mechanical properties on the other side.

Influence of finish line on the marginal seal of nanohybrid composite crowns after periodontal scaling: a microleakage study.

AIM: The aim of the present microleakage study was to assess the sealing ability of nanohybrid composite crowns with different finish lines exposed to simulated mechanical periodontal treatment (SMPT). METHODS: After sample size calculation (α=0.05; ß=0.20; δ=1.0; σ=0.8), sixty extracted mandibular molars were divided into four groups (N.=15): G1, 90° shoulder; G2, beveled 90° shoulder; G3, 90° shoulder and SMPT; G4, beveled 90° shoulder and SMPT. Tooth preparations were carried out by means of diamond burs and Arkansas stones. The buildup of crowns was performed with a nanohybrid composite on master casts obtained after polyether impressions and crowns were cemented with self-adhesive cement. Groups G3 and G4 were subjected to the equivalent of five years of semestral mechanical periodontal scaling with Gracey curettes (2-mm long strokes, 5 N). Samples were immersed into a methylene blue supersaturated solution for 10 minutes. Microleakage was measured by stereomicroscopic observation of multiple sections of the samples and leakage data underwent statistical analysis with non-parametric tests. RESULTS: Marginal microleakage was 1.53±1.27% and 17.60±12.72% of the length of the adhesive interface in G1 and G2, respectively. SMPT reduced dye penetration (P<0.001) with G3 not leaking at all and G4 leaking along the 5.58±1.84% of the adhesive interface. The bevel preparation significantly worsened the marginal seal both in control and treated crowns (P<0.001). CONCLUSION: Microleakage of nanohybrid composite crowns increased by adding a bevel to a 90° shoulder preparation and diminished after SMPT.

Zirconia abutments and restorations: from laboratory to clinical investigations.

In last years the use of zirconia in dentistry has become very popular. Unfortunately, the clinical indications for a dental use of zirconia are not completely clear yet, neither are their limitations. The objective of this review was to evaluate the basic science knowledge on zirconia and to discuss some aspects of the clinical behavior of zirconia-based restorations. In particular, one of the goals was highlighting the possible correlation between in vitro and in vivo studies. The definition of concepts like success, survival and failure was still debated and the correlation between in vitro results and predictability of clinical behavior was investigated.

Fibre-reinforced composite crowns luted to implant abutments via electroformed primary copings: an in vitro retention study.

AIM: The aim of this study was to investigate the retention values and mode of failure of metal crowns and fibre-reinforced composite crowns. METHODS: Seventy-five implants and the corresponding abutments were used. After the galvanic copings were fabricated, the specimens were distributed into three groups: in group A traditional metal crowns were realized, whereas in groups B and C fibre-reinforced composite crowns were made. In group B the same resin based cement used in group A was employed for luting the fibre-reinforced composite crowns to the galvanic copings, while in group C a dedicated self-adhesive composite cement was used. All galvanic coping/crown assemblies were cemented onto abutments with Panavia 21 cement. Specimens were subjected to a pull-out test; median retentive values and standard deviations were calculated. RESULTS: All samples in the group A showed separation at the abutment-galvanic cap interface. All samples in the group B showed decementation at galvanic cap-crown interface. In 13 samples of the group C the decementation occurred at the abutment-galvanic cap interface and in 12 samples of this group the decementation occurred at the galvanic cap-crown interface. The mean retention value was 659.1 N±162.9 for group A, 304.7 N±101.4 for B and 635.4 N±155.9 for C. Differences between groups A/B and B/C are statistically significant (t-student test, P<0.01), while is not statistically different between groups A/C. CONCLUSION: When a self-adhesive composite cement is used, fibre-reinforced composite single crowns and conventional metal crowns show similar retentive performance.

The effects of scaling and root planing on the marginal gap and microleakage of indirect composite crowns prepared with different finish lines: an in vitro study.

The present in vitro study aimed to assess the effects of root surface mechanical instrumentation on the marginal integrity and adaptation of resin composite crowns. The following null hypotheses were tested: no differences exist between finish line and 1) marginal gap or 2) marginal microleakage before and after manual mechanical periodontal maintenance. A total of 56 intact human mandibular molars were randomly distributed into four groups and subjected to standardized tooth preparations for indirect composite crowns with different marginal finish lines (90° shoulder, beveled 90° shoulder, feather edge, chamfer). One-half of the specimens was used as a control and remained untreated, and the remaining half was subjected to root surface procedures simulating five years of semestral mechanical supportive periodontal treatment. The marginal gap and microleakage were evaluated and statistically analyzed. The specimens used as controls showed lower mean marginal gaps than those subjected to the simulated periodontal treatment, whereas the latter showed lower microleakage than the control crowns. Statistically significant differences were recorded for both the experimental variables. The root surface procedures resulted in altered surfaces of the composite crowns. The marginal gap increased after the treatment, whereas the marginal microleakage was reduced. The 90° shoulder and the chamfer preparation could be considered a viable option to fabricate composite crowns, but the beveled 90° shoulder and the feather edge should not be recommended.

Characterization of the interface between prefabricated gold copings and cast dental alloy in implant restorations.

The objective of this study was to analyse the characteristics of the metal interface between the casting of a dental noble alloy and prefabricated gold copings (OCTA-ITI Implant System) after the fabrication procedures of a prosthetic implant-retained superstructure. The microscopical investigation, performed by optical microscopy (OM) and scanning electron microscopy (SEM), of the region around the cylinder after the casting process and the subsequent porcelain firing procedures showed the presence of an ideal interface, including: i) maintenance of coping and casting alloy microstructures up to the interface, and ii) absence of interfacial reaction products. A low content of porosity (less than 3% by volume in average) was observed in the casting alloy bulk as well as at interface. The investigation by energy-dispersive spectroscopy (EDS) of the alloy composition close to the interface showed the presence of a minimal elemental interdiffusion, suggesting that an adequate compatibility between alloy and coping characterized the materials used. A small decrease of the prefabricated coping hardness was also observed after the casting and porcelain firing procedures.

A finite-element model study of occlusal schemes in full-arch implant restoration.

A three-dimensional finite-element model of a human mandible is presented, and the stresses and deformations computed for loading states induced by two different gnathologic reconstructions using six and four implants are discussed. Occlusal canine guidance and posterior and anterior group functions on cantilevered and distally supported prostheses have been simulated. The stress distributions generated by the different loading conditions on either the osseointegrated prosthesis or the bone tissue surrounding the implants are described. The analysis of the stress distribution on the working side reveals that the posterior group function undergoes a reduction in stress intensity on the cortical bone surrounding the implants (especially for the distal implant) compared with the anterior group function and canine guidance in both gnathologic reconstructions.

[Occlusal planning according to classical gnathology]. / La programmazione occlusale secondo la gnatologia classica.

The importance of perfect knowledge of the anatomy and physiology of the stomatognathic complex for any understanding of the aetiopathogenic mechanisms behind temporomandibular joint pain dysfunction syndrome is emphasised and the fundamental concepts underlying the use of the bite plane as a valuable aid in the diagnosis and initial treatment of articular dysfunction are described.