Transitioning from injectable resin composite restorations to resin composite CAD/CAM veneers: A clinical report.

OBJECTIVE: To describe a shift from injectable resin composite technique to composite resin computer-aided design and computer-aided manufacturing (CAD/CAM) veneers in addressing esthetic concerns associated with diastemas between anterior lower teeth in a clinical case. CLINICAL CONSIDERATIONS: Among several techniques proposed for direct resin composite restoration, the "Injectable resin composite technique" has gained popularity for its time-efficiency, reduced technique sensitivity, and diminished reliance on clinician skills. However, challenges such as staining and the need for frequent polishing follow-ups may prompt the consideration of more stable alternatives such as indirect veneer restorations. While ceramic veneers offer superior mechanical and optical properties, resin ceramic veneers, especially those milled from CAD/CAM resin ceramic blocks, offer advantages such as rapid, cost-effective production, simplified intra-oral repairs, less susceptibility to fracture, superior stress absorption, and requires minimal tooth preparation, making them an appealing option for many patients. Moreover, a fully-digital approach not only streamlines the process but also saves time and labor while ensuring the delivery of high-quality restorations to patients. CONCLUSION: In addressing a patient's dissatisfaction with constant polishing of direct resin composite restorations, a shift to resin composite CAD/CAM veneers was implemented. Utilizing a fully-digital approach with CAD/CAM resin ceramic restorations successfully restored both esthetics and function. CLINICAL SIGNIFICANCE: While the injectable resin composite technique achieves immediate esthetic results, its low color stability necessitates frequent polishing sessions. The replacement of direct resin composite restorations with CAD/CAM resin composite veneers becomes a viable option for patients seeking more stable restorations that require fewer follow-ups. This transition addresses both esthetic concerns and the need for enduring solutions in restorative dentistry.

Quo vadis, esthetic dentistry? Part II: Composite resin overtreatment and social media appeal.

OBJECTIVES: This article presents case reports highlighting over-treatments with resin composites, often misconceived as minimally invasive procedures. CLINICAL CONSIDERATIONS: Tooth-colored restorative materials, such as ceramics and composites, have found widespread application to correct problems related to tooth color, shape, and alignment. When composite resin is used, these procedures can be done in a very conservative, cost-effective, and timely fashion. However, it is noteworthy that contemporary dental esthetic expectations are based on standards propagated by social media and other marketing and communications platforms. The abuse of and addiction to social media impacts can lead to unrealistic esthetic expectations and standards for both patients and dentists. CONCLUSIONS: After a critical discussion on ceramic veneers published in part I of this 2-part series, this article directs attention towards what has become a trendy fashion, i.e., the use of direct composite resins as "non-prep" veneers in clinical situations that arguably required no restorative intervention at all. We further explore how social media influences the decision-making processes of both professionals and patients.

Ultrathin lithium disilicate and translucent zirconia crowns for posterior teeth: Survival and failure modes.

PURPOSE: To evaluate the reliability and failure modes of ultrathin (0.5 mm) lithium disilicate, translucent and ultra-translucent zirconia crowns for posterior teeth restorations. MATERIALS AND METHODS: Fifty-four mandibular first molar crowns of three ceramic materials: (1) Lithium disilicate (e.max CAD, Ivoclar Vivadent), (2) 3Y-TZP (Zirconn Translucent, Vipi), and (3) 5Y-PSZ (Cercon XT, Dentsply Sirona), with 0.5 mm of thickness were milled and cemented onto composite resin abutments. Eighteen samples of each group were tested under mouth-motion step-stress accelerated life testing in a humid environment using mild, moderate, and aggressive profiles. Data was subjected to Weibull statistics. Use level curves were plotted and reliability was calculated for a given mission of 100,000 cycles at 100, 200, and 300 N. Fractographic analyses of representative samples were performed in scanning electron microscope. RESULTS: Beta (ß) values suggest that failures were dictated by material's strength for lithium disilicate and by fatigue damage accumulation for both zirconias. No significant differences were detected in Weibull modulus and characteristic strength among groups. At a given mission of 100,000 cycles at 100 N, lithium disilicate presented higher reliability (98% CB: 95-99) regarding 3Y-TZP and 5Y-PSZ groups (84% CB: 65%-93% and 79% CB: 37&-94%, respectively). At 200 N, lithium disilicate reliability (82% CB: 66%-91%) was higher than 5Y-PSZ (20% CB: 4%-44%) and not significantly different from 3Y-TZP (54% CB: 32%-72%). Furthermore, at 300 N no significant differences in reliability were detected among groups, with a notable reduction in the reliability of all materials. Fractographic analyses showed that crack initiated at the interface between the composite core and the ceramic crowns due to tensile stress generated at the intaglio surface. CONCLUSIONS: Ultrathin lithium disilicate crowns demonstrated higher reliability relative to zirconia crowns at functional loads. Lithium disilicate and zirconia crown's reliability decreased significantly for missions at higher loads and similar failure modes were observed regardless of crown material. The indication of 0.5 mm thickness crowns in high-load bearing regions must be carefully evaluated. CLINICAL SIGNIFICANCE: Ultraconservative lithium disilicate and zirconia crowns of 0.5 mm thickness may be indicated in anterior restorations and pre-molars. Their clinical indication in high-load requirement regions must be carefully evaluated.

Opalescence and color stability of composite resins: an in vitro longitudinal study.

OBJECTIVES: This study aims to evaluate the opalescence (OP) and color stability of composite resins over a period of 180 days and to compare composite resins' OP with enamel's OP. MATERIALS AND METHODS: Twenty human enamel specimens (5.0 × 0.3 mm) and 9 specimens (10.0 × 1.0 mm) of 10 colors of 4 different composite resins (3 M ESPE, FGM, Ivoclar-Vivadent, Miscerium) and one brand of adhesive (3 M ESPE) were made. The results were obtained by measuring the reflectance and transmittance spectra in the visible region. After baseline measurement, composites and adhesive were analyzed after 2, 7, 30, 60, 120, and 180 days. The Lab color coordinates were used in the calculations of the OP parameter and color differences in the CIELab and CIEDE2000 methods. The data were analyzed statistically. RESULTS: The materials tested showed variation and an increase in OP over time. The OP found for enamel was 18.06 ± 2.99, and some resins showed higher results. There was a strong correlation between the coordinate b*T and the OP over time. Enamel Plus was the only one material that presented no color changes during all periods in both color analyses. Filtek Z350 XT, AT, and BT did not show differences in any time when analyzed by CIELAB. CONCLUSIONS: The OP of most composite resins changed during the period of 180 days and was different from the OP of tooth enamel. In general, composites demonstrated small color changes over the period tested, being this characteristic material dependent. CLINICAL RELEVANCE: Natural teeth present different optical properties. Composite resins restorations should present properties similar to natural teeth and it is important that characteristics like color and opalescence remain stable over time.

Quo vadis, esthetic dentistry? Ceramic veneers and overtreatment-A cautionary tale.

The increased emphasis on orofacial esthetics, experienced both by dental professionals and the lay public, results in an environment where overtreatment can easily occur. Patients on the one hand feel pressure from esthetic norms that are often unrealistic, while dental professionals are compelled to deliver immediate results many times without considering what is best for the ill-informed patient. This article is an illustrated cautionary tale against overtreatment disguised as esthetic dentistry. Representative clinical examples illustrate how porcelain veneers are used without following sound operatory principles, as well as how these cases have been resolved.

A comparison of ceramic crown color difference between different shade selection methods: Visual, digital camera, and smartphone.

STATEMENT OF PROBLEM: The light source stability of digital cameras and smartphones is important in shade matching in restorative and prosthetic dentistry to communicate objectively with the dental laboratory. Techniques that standardize the light source of such devices are lacking, and this limitation can lead to color mismatches, difficulties in color communication, and treatment documentation. PURPOSE: The purpose of this clinical study was to compare the magnitude of color difference (ΔE) among 3 shade selection methods during the fabrication of ceramic crowns: visual shade selection with a shade guide, digital shade selection with a digital camera and cross-polarizing filter, and digital shade selection with a smartphone and a light-correcting device. MATERIAL AND METHODS: Forty-five patients in need of ceramic crowns were enrolled, and shade selection was evaluated according to different protocols: visual shade selection (A-D shade guide and IPS Natural Die Material Shade Guide, sent to the dental laboratory technician via a laboratory prescription); digital shade selection with a digital camera (D7000; Nikon Corp) with an 85-mm lens and wireless close-up flash, with and without a cross-polarizing filter (Polar eyes); and digital shade selection with a smartphone and a light-correcting device (iPhone XS attached to Smile Lite MDP, with and without its cross-polarizing filter accessory). Information from the smartphone was imported to an app (IPS e.max Shade Navigation App; Ivoclar AG) that converted the reading to a shade and level of translucency for the ceramic restoration. For all photographs, a gray reference card with known color values was positioned by the mandibular teeth and was used for white balancing of the digital photographs with a software program. All photographs were edited and sent to the dental laboratory: white-balanced with the shade guide; white-balanced with the substrate shade guide; black and white; saturated; and cross-polarized. Ceramic crowns were made with the same lithium disilicate material (IPS e.max CAD; Ivoclar AG) and cemented with the same resin cement (RelyX Ultimate Clicker, A3 shade; 3M). The ΔE values between the crown and the adjacent tooth were determined. The data were analyzed by using a 1-way analysis of variance (ANOVA) and Tukey post hoc tests (α=.05). RESULTS: The mean ΔE between a cemented ceramic crown and the adjacent tooth in the visual shade selection group was 5.32, significantly different than both digital camera (ΔE=2.75; P=.002) and smartphone (ΔE=2.34; P=.001), which were not different from each other (P=.857). CONCLUSIONS: The digital shade selection with photographs acquired with both a digital camera and a smartphone with a light-correcting device showed a threshold within the acceptable values (ΔE<3.7), whereas the visual shade selection showed an average ΔE above the threshold for acceptable values (ΔE>3.7). The use of a gray reference card helped standardize the white balance from the digital images.

Full-mouth adhesive rehabilitation of a severe case of erosion treated with v-shaped veneers.

OBJECTIVE: To demonstrate a minimally invasive approach of a full-mouth rehabilitation of a severe case of erosion treated with v-shaped veneers, tabletops, overlays, veneerlays, laminate veneers, and a full contour veneer. CLINICAL CONSIDERATIONS: The present case report successfully rehabilitated a full-mouth case of severely eroded teeth with minimal healthy structure removal, maintaining viability of all teeth that were vital before the treatment started, and promoting long-lasting esthetic and functional results after 3 years of use. CONCLUSIONS: A deep knowledge of etiology, etiopathogenesis, and classifications of dental erosion will guide the clinician in the right direction for solving this issue correctly, according to modern prosthetic and conservative principles. CLINICAL SIGNIFICANCE: Dental erosion represents today a relatively widespread phenomenon among the global population and a significant challenge in each of its clinical stages for the clinicians who must treat it. In advanced stages, a careful evaluation phase of the case, a great patient motivation and a wise use of materials and clinical protocols are the success key of the case. Moreover, an advanced knowledge of adhesive dentistry is strictly required to successfully manage a severe erosion case with a modern and minimally invasive approach.

The injectable resin composite restorative technique: A case report.

OBJECTIVE: To describe the use of the injectable resin composite restorative technique with a flowable resin material, in a clinical case with esthetic problems associated with irregular tooth anatomies, allied with a finishing, and polishing protocol due to staining after 1 year of use. CLINICAL CONSIDERATIONS: The presented case report helped to achieve an immediate highly esthetic restoration with appropriate width proportions based on a previous wax-up. After 1 year of use, restorations presented staining; therefore, finishing and polishing procedures were required to re-achieve acceptable esthetic results and thus increase restoration's survival. CONCLUSIONS: The use of the presented technique allowed to obtain a simple and predictable workflow; however, care must be taken on the follow up of the restorations due to intrinsic characteristics of the flowable resin material. CLINICAL SIGNIFICANCE: The use of the presented injectable technique helped on obtaining a precise anatomy replicating a diagnostic wax-up, thus improving marginal precision and achieving a highly esthetic and functional immediate outcome, with an easy workflow when appropriately planned and executed. However, it also presented low color stability after 1 year of use only, thus, requiring attention from clinicians in regard to its maintenance over time.

Microcomputed tomography evaluation of cement film thickness of veneers and crowns made with conventional and 3D printed provisional materials.

OBJECTIVE: To evaluate, through microcomputed tomography (µCT), the cement film thickness of veneers and crowns made with different provisional materials. MATERIAL AND METHODS: A veneer and a crown preparation were performed on a central incisor and a second molar of a dental model, respectively, scanned with an intraoral scanner, and the .stl files were exported to an LCD-based SLA three-dimensional (3D)-Printer. Twenty-four preparations were 3D-printed for each veneer and crown and divided into four groups (n = 6/group): (a) Acrylic resin (Acrílico Marche); (b) Bisacrylic resin (Protemp 4); (c) PMMA computer-aided design and computer-aided manufacturing (CAD-CAM) (Vipiblock); and (d) 3D-printed resin for provisional restorations (Raydent C&B for temporary crown and bridge). Veneers and crowns restorations were performed and cemented with a flowable composite. Each specimen was scanned with a µCT apparatus, files were imported for data analysis, and cement film thickness was quantitatively measured. Data were analyzed by 2-way ANOVA and Tukey post-hoc tests (α = .05). RESULTS: Crowns presented a thicker cementation film than veneers (P < .05).The bisacrylic resin showed the smallest veneer film thickness, similar to the acrylic resin (P = .151), which was not significantly different than the PMMA CAD/CAM material (P = .153). The 3D printed provisional material showed the thicker film, different than all other materials (P < .05). The bisacrylic resin showed a cement film thickness with a high number of voids in its surface. For crowns cementation, the 3D printed provisional material showed the thicker cementation film, different than all other materials (P < .05). CONCLUSIONS: Different provisional materials present different film thicknesses. The 3D printed provisional material showed the highest veneer and crown film thicknesses. Veneers film thicknesses were smaller than crowns for all provisional materials. CLINICAL SIGNIFICANCE: The 3D printed provisional material studied can be satisfactorily used, presenting appropriate adaptation with the tooth preparation, however, it shows the highest cement film thickness for both veneers and crowns cementations when compared with other provisional materials. A better internal fit, or smaller cement film thickness is obtained by CAD/CAM materials, acrylic and bisacrylic resins. Veneer cementation showed a smaller cement film thickness compared with crown cementation for all provisional materials.

Effect of argon plasma on repair bond strength using nanofilled and microhybrid composites.

OBJECTIVES: To evaluate the effect of atmospheric pressure plasma (PLA), sandblasting (SAN), silanization (SIL) and hydrophobic bonding resin (HBR) on the micro-shear bond strength (MSBS) of fresh nanofilled (NF) or microhybrid (MH) composites to water-aged nanofilled composite. MATERIALS AND METHODS: NF plates were fabricated and stored in distilled water for 4 months. The aged plates were assigned to the groups (n = 6): 1- untreated; 2- SAN + SIL + HBR; 3- HBR; 4- PLA + HBR; 5- SAN + HBR; 6- SAN + PLA + HBR; and 7- PLA. Two fresh composite cylinders were constructed on each plate with NF or MH composites and tested after 24 h or 1 year of water-storage, using the MSBS testing. Data were analyzed by three-way ANOVA and Tukey test (α = 0.05). RESULTS: NF yielded better outcomes than MH at 24 h, which was not observed at 1 year. HBR showed the highest MSBS results, while untreated and PLA groups yielded the lowest one. MSBS reduced for all groups after 1 year. CONCLUSIONS: Only HBR can obtain good MSBS results, while PLA alone was not beneficial. After 1 year, a reduction in repair MSBS was observed and the type of composite did not influence the results. CLINICAL RELEVANCE: The repair technique can be simplified with the use of only an adhesive and macromechanical retentions in the old composite, regardless the type of fresh composite.

Analysis of the color matching of universal resin composites in anterior restorations.

OBJECTIVE: To evaluate color matching of universal composite restorations performed in anterior teeth using two evaluation methods. MATERIALS AND METHODS: Sixty class III preparations were made on denture central incisors with different shades (A1-A3) and restored with multishade (Tetric Evoceram, Filtek Universal, and TPH Spectra Universal) and single-shade (Omnichroma) universal composites (n = 5). For photographic analysis, a digital photograph of each specimen was taken under standardized set-up. Color measurements were taken in the center of the restoration, and in the tooth surface 1.0 mm adjacent from the tooth/restoration margin. CIELab coordinates were recorded and color difference analysis (ΔE) was made using the CIEDE-2000 formula. For visual analysis, calibrated observers performed visual scoring of color matching and differences were graded as 0:excellent match; 1:very good match; 2:not so good match; 3:obvious mismatch; 4:huge mismatch. All data were statistically analyzed using a linear mixed model analysis with a confidence interval of 95%. RESULTS: For photographic analysis, Omnichroma showed the highest ΔE compared to the other composites for all shades (P < .05), without difference among experimental groups regarding tooth shade. For visual analysis, Omnichroma showed the highest scores (P < .05) for all teeth shades, without differences between the other groups. Furthermore, there were no differences between visual scores for different shades of a same resin composite group. CONCLUSIONS: Multishade universal composites presented higher color matching than the single shade universal composite. There were no differences of color matching for different tooth shades for all composites. CLINICAL SIGNIFICANCE: Universal composites with increased color matching may be helpful to simplify anterior restorations, minimizing clinical errors.

Heating and preheating of dental restorative materials-a systematic review.

OBJECTIVES: To perform a review on the influence of preheating and/or heating of resinous and ionomeric materials on their physical and mechanical properties and to discuss the benefits and methods of preheating/heating that have been used. MATERIAL AND METHODS: A search was performed in the Pubmed, Scopus, Scielo, and gray literature databases. In vitro studies published from 1980 until now were searched using the descriptors "composite resins OR glass ionomer cements OR resin cements OR adhesives AND heating OR preheating." Data extraction and quality of work evaluation were performed by two independent evaluators. RESULTS: At the end of reading the search titles and abstracts, 74 articles were selected. Preheating of composite resins reduces viscosity, facilitates adaptation to cavity preparation walls, increases the degree of conversion, and decreases the polymerization shrinkage. Preheating of resin cements improves strength, adhesion, and degree of conversion. Dental adhesives showed good results such as higher bond strength to dentin. However, unlike resinous materials, ionomeric materials have an increase in viscosity upon heating. CONCLUSIONS: Preheating improves the mechanical and physical properties. However, there is a lack of clinical studies to confirm the advantages of preheating technique. CLINICAL RELEVANCE: Preheating of dental restorative materials is a simple, safe, and successful technique. In order to achieve good results, agility and training are necessary so the material would not lose heat until the restorative procedure. Also, care is necessary to avoid bubbles and formation of gaps, which compromises the best restoration performance.

Moist vs over-dried etched dentin: FE-SEM/TEM and bond strength evaluation of resin-dentin interfaces produced by universal adhesives.

OBJECTIVE: To evaluate the influence of the degree of dentin moisture on interfacial ultramorphology and bond strength (µTBS) of universal adhesives. MATERIALS AND METHODS: Futurabond U (FBU), Scotchbond Universal (SBU), Adhese Universal (ADU), and Prime&Bond active (PBA) were used. After acid-etching, moist or over-dried dentin surfaces were tested. Teeth were restored for scanning and transmission electron microscopy (n = 3) and µTBS evaluation (n = 5). µTBS results were analyzed by two-way ANOVA and Tukey. RESULTS: For moist dentin, a well-formed hybrid layer (HL) was observed. However, when applied to over-dried dentin, remarkable differences were observed. Defects, gaps, and reduced HL thickness were observed mainly for ADU and FBU. When applied to wet dentin, µTBS values were similar for all adhesives, except for FBU, which was significantly lower. When applied to over-dried dentin, PBA presented the highest µTBS values, followed by SBU, ADU, and FBU. ADU presented significantly lower µTBS when applied to over-dried dentin. CONCLUSION: PBA, SBU, and FBU µTBS values were not sensitive to the degree of moisture. Even though application to over-dried dentin revealed defects, gaps and reduced HL thickness for SBU, ADU, and FBU, µTBS analysis only revealed a significant reduction for ADU. CLINICAL SIGNIFICANCE: Universal adhesives can be applied in either self-etching or etch-and-rinse mode. However, clinicians are not aware which universal adhesives should be strictly applied on a moist dentin for bonding in the etch-and-rinse mode.

Copy milling to duplicate the emergence profile for implant-supported restorations.

This technique article describes the duplication of a definitive implant-supported computer-aided design and computer-aided manufacture (CAD-CAM) crown with soft-tissue modification on a misplaced implant. Gingival contours were ideally shaped in the stone die, and a custom healing abutment was designed. After scanning the modified surface, images were correlated with the initial intraoral digital scan, and the definitive restoration was designed, milled, and delivered with an ideal soft-tissue emergence profile.

Variability of color matching with different digital photography techniques and a gray reference card.

STATEMENT OF PROBLEM: Color matching in restorative and prosthetic dentistry is important for the success of dental treatments, although communication with the dental laboratory remains subjective, and studies of the performance of objective communication methods are lacking. PURPOSE: The purpose of this study was to evaluate color differences (ΔE) and compare color luminosity (L*) values among different types of digital photography equipment used to document tooth color, with and without a gray reference card, and to determine whether the gray card could be used to standardize color assessment in dental photography. MATERIAL AND METHODS: Sixty photographs were made (n=10) using different equipment: a D7000 digital camera (Nikon Corp) with an 85-mm lens and wireless close-up flash (DC+WCF); close-up flash surrounded by 80 grams per square meter (gsm; specification of paper thickness) white printing paper (DC+WPP); ring flash (DC+RF); close-up flash attached to a dual-point rigid flash bracket (DC+DPRF); cross-polarizing filter attached to a close-up flash (DC+CPF); and iPhone 7 (I7). For all photographs, a gray reference card with known color values was positioned at the patients' mandibular teeth, acting as a parameter for the analysis of white-balanced digital photographs. Each photograph underwent white balance with the reference card and software. ΔE were obtained from each piece of equipment by comparing images with and without white balance (original photo) with software and the smallest ΔE achieved was used as the gold standard for comparisons of luminosity. Values of luminosity were subsequently obtained for the different equipment with and without white balancing the photographs; these values were compared using a general estimating equation with Huber-White standard error (α=.05). RESULTS: The use of a cross-polarizing filter was used as the gold standard for luminosity evaluation, as the smallest ΔE (3.4) among photographs were observed when those with and without white balance were compared. Luminosity results from the cross-polarizing filter method (DC+CPF) were not significantly different from those of the DC+DPRF (P=.73), DC+WPP (P=.106), and DC+WCF (P=.551) groups but were statistically different from DC+RF (P=.028) and I7 groups (P<.001). Use of a gray card was significant when a ring flash (P=.008) or the iPhone (P=.023) were used but not statistically significant for the other groups (P>.05). CONCLUSIONS: The use of a cross-polarizing filter results in more color-standardized photographs, while the ring flash system and the iPhone 7 result in less standardized photographs. The gray reference card had a significant effect when a ring flash system or iPhone 7 was used.

Fatigue Failure of External Hexagon Connections on Cemented Implant-Supported Crowns.

PURPOSE: To evaluate the probability of survival and failure modes of different external hexagon connection systems restored with anterior cement-retained single-unit crowns. The postulated null hypothesis was that there would be no differences under accelerated life testing. MATERIALS AND METHODS: Fifty-four external hexagon dental implants (∼4 mm diameter) were used for single cement-retained crown replacement and divided into 3 groups: (3i) Full OSSEOTITE, Biomet 3i (n = 18); (OL) OEX P4, Osseolife Implants (n = 18); and (IL) Unihex, Intra-Lock International (n = 18). Abutments were torqued to the implants, and maxillary central incisor crowns were cemented and subjected to step-stress-accelerated life testing in water. Use-level probability Weibull curves and probability of survival for a mission of 100,000 cycles at 200 N (95% 2-sided confidence intervals) were calculated. Stereo and scanning electron microscopes were used for failure inspection. RESULTS: The beta values for 3i, OL, and IL (1.60, 1.69, and 1.23, respectively) indicated that fatigue accelerated the failure of the 3 groups. Reliability for the 3i and OL (41% and 68%, respectively) was not different between each other, but both were significantly lower than IL group (98%). Abutment screw fracture was the failure mode consistently observed in all groups. CONCLUSION: Because the reliability was significantly different between the 3 groups, our postulated null hypothesis was rejected.

Diastema closures: A novel technique to ensure dental proportion.

OBJECTIVE: To describe a novel technique that helps the clinician on promoting a midline diastema closure with appropriate width proportions based on previous wax up, avoiding excesses of the resin material on the gingival area, which could lead to possible inflammation. MATERIALS AND METHODS: Two different silicone indexes were made over a wax up to perform a diastema closure. RESULTS: The use of a silicone index made with putty polyvinyl siloxane (PVS) material and another index made with putty and light PVS materials performed over a modified wax up, helped on achieving esthetically pleasant diastema closure with appropriate proportional widths, respecting the gingival tissue. CONCLUSIONS: The use of a novel silicone index technique allowed for ensuring the same width for both upper central incisors in a midline diastema closure, improving gingival tissue's health. CLINICAL SIGNIFICANCE: The main difficulties regarding diastema closure are related to reaching an appropriate width proportion of the central incisors and avoiding a ledge at the gingival aspect of the contact area, which could become a plaque and food trap. This article describes, step-by-step, how to avoid such diastema closure issues, ensuring the width proportions of the upper central incisors.

Thickness evaluation of articulating papers and foils.

Articulation and occlusion test materials are tools used in daily prosthodontic and restorative procedures that aid the clinicians in the evaluation of adjacent and opposing natural and/or artificial tooth contacts. A precision micrometer (Series 293, Mitutoyo, Japan) with a resolution of 0.001 mm was used to measure the thickness of five articulating papers and six articulation foils. Four of the articulating foils tested presented thicknesses inferior or equal to 21 µm, confirming their adequacy for the evaluation of natural dentitions. Clinicians and researchers should be aware that some labeled and actual papers/foils thicknesses are not in accordance. CLINICAL SIGNIFICANCE: The thickness of articulating papers and foils reported by some manufacturers is not accurate. The information provided in this article may aid clinicians and researchers to better select the most appropriate materials for the evaluation of static and dynamic occlusion.

Adhesive/silane application effects on bond strength durability to a lithium disilicate ceramic.

OBJECTIVE: To test the effects of different adhesive protocols and silane application on the adhesive durability to a Lithium Disilicate reinforced glass ceramic. METHODS: Forty disks of 13 mm diameter (E.max Press) were used. After etching with 9.5% HF for 20 seconds, disks were randomly assigned into 4 groups according to the adhesive/silane protocol: silane application only (SIL); silane application followed by adhesive (SILXP-XP Bond); silane-containing adhesive (SBU-ScotchBond Universal); silane application followed by silane-containing adhesive (SILSBU). Four resin composite cylinders of 1-mm diameter and 3-mm height were made on each ceramic disk and tested in shear. Specimens were stored in water for 24 hours or 12 months prior to testing. Results were statistically analyzed by two-way ANOVA and Tukey test. RESULTS: After 24 hours, the highest SBS values were observed for SILXP and SILSBU. However, after 12 months, SILXP and SILSBU presented a significant reduction in SBS, while the highest SBS were observed for SIL. For SBU, no significant reduction in SBS was observed, however, it showed the lowest SBS after 12 months. CONCLUSIONS: Regardless of the presence of silane in the composition of SBU, previous silane application is still recommended prior to cementation of Lithium Disilicate. CLINICAL SIGNIFICANCE: The application of silane as a separate step is recommended prior to cementation of Lithium Disilicate reinforced glass-ceramic, independent of the presence of silane within the universal adhesive solution.

Void and gap evaluation using microcomputed tomography of different fiber post cementation techniques.

STATEMENT OF PROBLEM: Few studies have investigated the voids and gaps produced during the cementation of fiber posts using different techniques. PURPOSE: The purpose of this study was to evaluate and quantify void and gap area formations of different fiber post cementation techniques using microcomputed tomography (µCT). MATERIAL AND METHODS: Standardized endodontically treated acrylic resin roots (N=24) were divided into 4 groups (n=6) according to different fiber posts cemented with the resin cement (FB); fiber posts relined with composite resin followed by cementation (FBR); fiber posts cemented using an ultrasonic device (FBU); and fiber posts relined with composite resin and cemented using an ultrasonic device (FBRU). Each specimen was scanned twice using micro-computed tomography (µCT; empty root, followed by after fiber post cementation). Digital imaging and communications in medicine (DICOM) files were transferred into 3-dimensional (3D) reconstruction software for analysis. Void volume in the cementation system and gap area formation were evaluated; quantitative and qualitative analyses were performed. The data were analyzed using 2-way ANOVA and the Tukey honest significant difference post hoc test (α=.05). RESULTS: FBR showed a lower percentage of voids than obtained for FB (P<.05). Groups FB, FBU, and FBRU did not show significant difference in void formation (P>.05). No significant differences were found in gap area formations among the experimental groups (P>.05). CONCLUSIONS: The use of a composite resin to reline the fiber post significantly decreased the void formation in the cementation procedure when no ultrasonic device was used. The use of an ultrasonic device did not decrease the percentage of void or gap formation for any technique evaluated.