Do onlays and crowns offer similar outcomes to posterior teeth with mesial-occlusal-distal preparations? A systematic review.

OBJECTIVE: Teeth prepared for mesial-occlusal-distal (MOD) restorations have a significant risk of cusp fracture. Crowns and onlays can provide cusp coverage to reinforce posterior teeth at risk. Onlays are often more conservative of tooth structure which may be an advantage for teeth with large MOD preparations. It remains uncertain how onlays and crowns compare for posterior teeth with MOD tooth structure loss. The purpose of this systematic review was to compare the resistance to fracture, success rate, survival rate, and failure rate of teeth with MOD preparations restored with onlays or crowns. MATERIALS AND METHODS: An electronic search queried Medline (PubMed), Embase (Ovid), Scopus, the Cochrane Library, and grey literature (OpenGrey) from database inception through April 29, 2023. RESULTS: After eliminating duplicates and irrelevant records, 32 manuscripts were assessed. Only three publications met the criteria for inclusion. Most exclusions were due to poor reporting of restorative design and the amount of tooth structure remaining, or due to combining various restorative designs. Due to the limited sample size and high heterogeneity, no meta-analysis was conducted. One study observed a better outcome for onlays and two observed no difference. All three studies reported the mode of failure for crowns as more catastrophic whereas teeth with onlays could be salvaged. CONCLUSIONS: Onlays may be an advantageous alternative to crowns for teeth with MOD preparations, but the level of evidence is insufficient to draw meaningful conclusions. CLINICAL SIGNIFICANCE: Current evidence is insufficient to determine whether onlays or crowns are providing a different outcome when used to restore posterior teeth with MOD tooth structure loss. However, the fracture of teeth with MOD tooth structure loss restored with onlays appears to be less catastrophic than when restored with crowns.

Comparison of the torque transferred to the implant-bone interface when tightening abutment screws and when torque testing implants: An in vitro study.

STATEMENT OF PROBLEM: Before dental implants are restored, osseointegration is often verified by torque testing the implant. For this test, it might be appropriate to select the torque subsequently used to tighten the abutment screw during prosthetic delivery. However, whether the full torque applied to the abutment screw is transferred to the implant-bone interface remains unknown. PURPOSE: The purpose of this in vitro study was to assess whether the same torque is transferred to the implant-bone interface when tightening abutment screws and when torque testing implants and to investigate whether the implant system used affects the torque transfer. MATERIAL AND METHODS: A digital torque gauge was used to register the torque directed to a simulated implant-bone interface. Twenty implants from 4 different manufacturers were successively secured to the digital torque gauge. An implant driver was used to torque test the implant. An implant abutment screw was then tightened to attach a universal base (TiBase) abutment to the implant. During both tests, a mechanical torque limiting device was used to apply the same manufacturer-specific torque. For both experiments, the peak torque transferred to the simulated implant-bone interface was recorded. To allow pooling data from different torque targets, the data were converted into absolute difference. A t test was used to evaluate whether the same magnitude of torque was transferred to the implant-bone interface when tightening abutment screws and when torque testing implants. An ANOVA was used to test whether the percentage of torque transferred to the implant-bone interface was impacted by the implant system used (α=.05). RESULTS: No significant difference was found between the torque transmitted when tightening an abutment screw and that transmitted when torque testing the implant (P=.600). Also, no difference was found in the percentage of torque transferred to the simulated implant-bone interface of different implant systems (P=.996). CONCLUSIONS: Regardless of the implant system used, when tightening abutment screws and when torque testing implants, the same amount of torque is transferred to the implant-bone interface.

A technique to guide implant placement with the long axis parallel to the path of insertion of removable partial dentures.

This article describes a novel technique that allows the planning and placing of dental implants with their long axis parallel to a path of insertion chosen for a prospective removable partial denture. The technique is straightforward, uses digital technologies efficiently, and enables prosthetically driven implant placement. It also optimizes the outcome when dental implants are used in association with removable partial dentures.

Management of atypical occlusal discrepancy after condylar resection: A clinical report.

This clinical report describes the prosthetic management of occlusion for a patient who had received condylar resection as part of cancer treatment. Previous reports have identified that patients with unrepaired segmental resection of the mandible experienced a frontal plane rotation of the mandible toward the nonsurgical side. In contrast, because of preservation of temporomandibular muscles and their attachments, the mandible rotated toward the surgical side, and occlusal contacts were limited to a pair of molars on that side. Manual manipulation and instructions for muscular stretching and massages were provided to reduce muscular tension. A mandibular guidance prosthesis was fabricated and gradually adjusted to guide the mandible progressively toward a normal position. These treatments helped improve general comfort, mastication, occlusion, and the gradual rotation of the mandible toward a normal position.

Resistance to fracture of extracted teeth used for pre-clinical endodontic procedures: Influence of storage conditions.

OBJECTIVES: The purpose of this in vitro study was to determine whether different storage conditions used during endodontic procedures affect the fracture resistance of extracted teeth used for pre-clinical dental education. METHODS: Freshly extracted mandibular incisors and canines were sterilised in an autoclave for 40 minutes at 24°F under a pressure of 20 psi and then stored in distilled water at 4°C until use. Specimens were randomly assigned to two groups based on the storage method used whilst undergoing endodontic procedures. Between endodontic sessions, teeth in the Wet Group (n = 16 incisors; n = 4 canines) were stored in distilled water and teeth in the Dry Group (n = 16 incisors; n = 4 canines) were stored in a dry container. All specimens were kept at room temperature and away from sunlight. Endodontic treatments were performed in 3 sessions over a 3-week period. The specimens were then brought to fracture under compressive forces along the long axis of the tooth in an Instron universal testing machine. The data were analysed using t tests (α = 0.05). RESULTS: None of the teeth fractured during endodontic procedures. However, the compressive load required to fracture teeth stored under wet conditions was significantly higher than the load needed for teeth stored dry (P < .05). CONCLUSIONS: Fracture resistance is affected by storage conditions; teeth stored in water have a higher resistance to fracture than teeth that are stored dry. Fracture resistance was, however, not reduced enough to lead to tooth fracture during pre-clinical endodontic procedures.

Use of a dental surveyor to ensure optimal seating of implant overdenture attachments.

Many implant overdenture attachments accommodate divergent abutments. However, there can be instances where the denture base resin surrounding the abutment may impede seating by binding on the axial surface(s) of the abutment. This article describes the use of a dental surveyor to aid clinicians in determining where the resin denture base might be preventing the seating of overdenture attachments. The surveyor can be used for judicious adjustment to allow optimal seating of the attachments.

Effect of universal adhesive etching modes on bond strength to dual-polymerizing composite resins.

STATEMENT OF PROBLEM: Information is lacking as to the effect on bond strength of the etching modes of universal adhesives when they are used to bond dual-polymerizing composite resins to dentin. PURPOSE: The purpose of this in vitro study was to investigate the bonding of dual-polymerizing foundation composite resins to dentin when universal bonding agents are used in self-etch or etch-and-rinse modes. MATERIAL AND METHODS: Sixty caries-free, extracted third molar teeth were sectioned transversely in the apical third of the crown and allocated to 12 groups (n=5). Three different bonding agents (Scotchbond Universal, OptiBond XTR, All-Bond Universal) were used to bond 2 different dual-polymerizing composite resins (CompCore AF or CoreFlo DC) to dentin, using 2 different etching approaches (etch-and-rinse or self-etch). The specimens were sectioned into sticks (1×1×8 mm) with a precision saw. The bond strength of the specimens was tested under microtensile force at a crosshead speed of 0.5 mm/min. The data were analyzed using a 3-way ANOVA, a Games-Howell post hoc comparisons model, and Student t tests with Bonferroni corrections (α=.05). RESULTS: In the overall model, the composite resin used had no effect on bond strength (P=.830). The etching protocol by itself also did not have a significant effect (P=.059), although a trend was present. The bonding agent, however, did have an effect (P<.001) on bond strength. Also, a significant interaction effect was found for the bonding agent and etching protocol on bond strength (P<.001). The etching protocol influenced the bond strength when Scotchbond Universal (P<.008) and All-Bond Universal (P<.004) were used but not when OptiBond XTR was used (P=1.00). A self-etch protocol provided significantly higher bond strength when Scotchbond Universal was used, whereas with All-Bond Universal, an etch-and-rinse protocol, provided higher bond strength. CONCLUSIONS: When universal bonding agents were used to secure dual-polymerizing composite resins to dentin, no single etching protocol is better than another. Depending on which bonding agent is being used, one etching mode may perform better.

Digital scanning to aid guiding plane and rest seat preparations for removable partial dentures.

This article describes the use of a digital intraoral scanner to aid clinicians making rest seat and guiding plane preparations, simplifying the procedure and reducing the time needed to analyze the abutment modifications. No additional equipment is required other than a diagnostic cast and a digital scanner with preparation comparison software.

Compatibility between dental adhesive systems and dual-polymerizing composite resins.

STATEMENT OF PROBLEM: Information is lacking about incompatibilities between certain types of adhesive systems and dual-polymerizing composite resins, and universal adhesives have yet to be tested with these resins. PURPOSE: The purpose of this in vitro study was to investigate the bonding outcome of dual-polymerizing foundation composite resins by using different categories of adhesive solutions and to determine whether incompatibilities were present. MATERIAL AND METHODS: One hundred and eighty caries-free, extracted third molar teeth were allocated to 9 groups (n=20), in which 3 different bonding agents (Single Bond Plus [SB]), Scotchbond Multi-purpose [MP], and Scotchbond Universal [SU]) were used to bond 3 different composite resins (CompCore AF [CC], Core Paste XP [CP], and Filtek Supreme Ultra [FS]). After restorations had been fabricated using an Ultradent device, the specimens were stored in water at 37°C for 24 hours. The specimens were tested under shear force at a rate of 0.5 mm/min. The data were analyzed with Kruskal-Wallis tests and post hoc pairwise comparisons (α=.05). RESULTS: All 3 composite resins produced comparable shear bond strengths when used with MP (P=.076). However, when either SB or SU was used, the light-polymerized composite resin (FS) and 1 dual-polymerized foundation composite resin (CC) bonded significantly better than the other dual-polymerized foundation composite resin (CP) (P<.005). Both FS and CC performed best with SU but had acceptable results with all of the bonding agents. CP only performed acceptably with MP (P=.023) and had poor results with both other agents. CONCLUSIONS: Dual-polymerizing composite resins can obtain equally good bond strengths as light-polymerizing alternatives. However, not all dual-polymerizing composite resins perform well with all bonding systems; some incompatibilities exist between different products.

Hereditary gingival fibromatosis with extreme ridge thickness and insufficient interarch distance: A clinical report of surgical and prosthetic management.

Hereditary gingival fibromatosis is a rare genetic disorder resulting in gingival overgrowth that can be found in both dental arches. As a result of the gingival overgrowth and associated dental displacement, affected patients occasionally present with increased occlusal vertical dimension and/or inadequate lip closure. Depending on the disorder's severity, these patients can be challenging to treat. This clinical report describes a comprehensive surgical and prosthetic approach to the rehabilitation of a middle-aged patient with severe manifestations of hereditary gingival fibromatosis and severe generalized chronic periodontitis.

Implant-assisted complete prostheses.

The current review was undertaken to obtain a better understanding of the knowledge base of implant-assisted complete dental prostheses (fixed and removable) in the treatment of the completely edentulous maxilla or mandible. Indications, advantages and disadvantages, complications and maintenance issues, as well as the cost-effectiveness of both treatments, are discussed to help clinicians in their therapeutic decision-making. In summary, when indicated and depending on the patients' needs, both removable and fixed implant-assisted prostheses are highly safe, reliable and satisfactory treatment modalities for the rehabilitation of edentulous jaws. Careful and precise treatment planning is highly recommended to assist the clinician in preventing potential prosthetic failures. The review also reveals that there is still a need for data, generated using robust research methods, on some patient-based and clinical outcomes.

Three-Dimensional Printing Methods for Bioceramic-Based Scaffold Fabrication for Craniomaxillofacial Bone Tissue Engineering.

Three-dimensional printing (3DP) technology has revolutionized the field of the use of bioceramics for maxillofacial and periodontal applications, offering unprecedented control over the shape, size, and structure of bioceramic implants. In addition, bioceramics have become attractive materials for these applications due to their biocompatibility, biostability, and favorable mechanical properties. However, despite their advantages, bioceramic implants are still associated with inferior biological performance issues after implantation, such as slow osseointegration, inadequate tissue response, and an increased risk of implant failure. To address these challenges, researchers have been developing strategies to improve the biological performance of 3D-printed bioceramic implants. The purpose of this review is to provide an overview of 3DP techniques and strategies for bioceramic materials designed for bone regeneration. The review also addresses the use and incorporation of active biomolecules in 3D-printed bioceramic constructs to stimulate bone regeneration. By controlling the surface roughness and chemical composition of the implant, the construct can be tailored to promote osseointegration and reduce the risk of adverse tissue reactions. Additionally, growth factors, such as bone morphogenic proteins (rhBMP-2) and pharmacologic agent (dipyridamole), can be incorporated to promote the growth of new bone tissue. Incorporating porosity into bioceramic constructs can improve bone tissue formation and the overall biological response of the implant. As such, employing surface modification, combining with other materials, and incorporating the 3DP workflow can lead to better patient healing outcomes.

Effects of remeshing algorithms on trueness of fit when used to compress .stl files for dental models: A narrative review.

OBJECTIVES: In recent years, there has been a transition toward using and storing digitized dental models instead of physical casts. The size of .stl files is directly correlated with a need for higher computer processing power, longer operation time and a need for more storage space. Several studies explored the impact of decreasing the mesh resolution to decrease file size while maintaining trueness of fit between the original and modified files. Multiple authors suggested to compress .stl files by removing a fixed percentage of triangular faces. However, certain variables which are not yet fully investigated may impact the outcome of remeshing and compressing .stl files. METHODS: This narrative review explores concepts that may have a significant impact on the outcome of remeshing and compressing .stl file. RESULTS: When restructuring digital meshes to compress .stl files, variables such as initial mesh density, adaptive resolution, scanning technology, rendition and remeshing algorithms, as well as the clinical situation, can affect the outcome. CONCLUSION: Prior to applying subjective compression to .stl files by a static percentage, multiple variables must be considered to ensure trueness of fit is preserved. The results obtained for specific situations may not extrapolate to others. CLINICAL SIGNIFICANCE: Remeshing algorithms used to reduce .stl file size, or to optimize the files prior to manufacturing, may cause the loss of important data. Further research is needed to guide clinicians safely altering digital meshes.

Virtual Oral Health across Canada: A Critical Comparative Analysis of Clinical Practice Guidances during the COVID-19 Pandemic.

During the COVID-19 pandemic, teledentistry was suggested as a cost-effective and promising approach to improve access to oral health care. In response, Canadian provincial and territorial dental regulatory authorities (DRAs) published teledentistry-related clinical practice guidances (TCPGs). However, an in-depth comparison between them is needed to understand their gaps and commonalities so as to inform research, practice, and policy. This review aimed to provide a comprehensive analysis of TCPGs published by Canadian DRAs during the pandemic. A critical comparative analysis of these TCPGs published between March 2020 and September 2022 was conducted. Two members of the review team screened the official websites of dental regulatory authorities (DRAs) to identify TCPGs and performed data extraction. Among Canada's 13 provinces and territories, only four TCPGs were published during the relevant time period. There were some similarities and differences in these TCPGs, and we identified gaps pertaining to communication tools and platforms, and measures to safeguard patients' privacy and confidentiality. The insights from this critical comparative analysis and the unified workflow on teledentistry can aid DRAs in their development of new or an improvement to existing TCPGs or the development of nationwide TCP guidelines on teledentistry.

A Prolonged Time to Diagnosis Due to Misdiagnoses: A Case Report of an Atypical Presentation of Eagle Syndrome.

BACKGROUND Eagle syndrome is an unusual condition in which the styloid process (SP) becomes elongated and causes different clinical symptoms due to pressure on adjacent anatomical structures. The symptoms are non-specific and include severe throat, facial, and ear pain, or headaches. They are usually exacerbated by head rotation, swallowing, yawning, or chewing, but atypical presentations exist. It is a difficult pathology to diagnose and it can take several years before a proper diagnosis is made. CASE REPORT This report describes the case of a dental student presenting with an atypical presentation of Eagle syndrome. His styloid processes were 75 mm long and he was affected with severe pain to his throat, the anterior part of his ears, his submandibular area, and his molar teeth. The pain was exacerbated during maximal mouth opening, yawning, mandibular protrusion, and during downward head tilt, but not during the classically described movements of head rotation, swallowing, yawning, or chewing. Due to the absence of the classic symptoms, even with knowledge of the condition and unusual direct access to several oral and maxillofacial specialists, it took 4 years and multiple misdiagnoses to reach the final diagnosis. Following bilateral styloidectomy, all pain subsided. CONCLUSIONS The clinical presentation of Eagle syndrome varies, and the symptoms are non-specific. This greatly increases the complexity of diagnosing the condition and raises the time to diagnosis and the chances of misdiagnoses. It is, therefore, crucial to recognize the diagnostic tools, applicable imaging, and definitive treatment alternatives to successfully identify and treat patients affected.