Long-term performance of ceramic in/-onlays vs. cast gold partial crowns - a retrospective clinical study.

OBJECTIVES: To assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality. MATERIAL AND METHODS: In a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan-Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed. RESULTS: The cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration. CONCLUSIONS: Both CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management. CLINICAL RELEVANCE: CIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

ESE position statement on root resorption.

This Position Statement on root resorption represents the consensus of an expert committee convened by the European Society of Endodontology (ESE). The statement is based on current clinical and scientific evidence as well as the expertise of the committee. The aim is to provide clinicians with authoritative information on the aetiology, histopathology, clinical presentation and recommendations for the management of root resorption. It is the intention of the committee to update this position statement at appropriate intervals as further evidence emerges.

Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline.

BACKGROUND: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease. AIM: To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. METHODS: This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. RESULTS: The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed. CONCLUSION: The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.

Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study.

OBJECTIVES: To assess the impact of the age of resin-based composite (RBC) restorations used for deep margin elevation (DME) on the marginal quality and fracture resistance of inlays. MATERIALS AND METHODS: Permanent human molars with direct RBC restorations, involving the mesial, occlusal, and distal surface (MOD), were allocated to four groups (each n = 12). Half of the teeth underwent thermomechanical loading including 240,000 occlusal load cycles and 534 thermal cycles (TML, 5 °C/55 °C; 49 N, 1.7 Hz). With RBC left in one proximal box as DME, all teeth received MOD inlays, made from lithium disilicate (LDS) or a polymer-infiltrated ceramic network material (PICN). The restored teeth underwent TML including 1.2 million occlusal cyclic loadings and 2673 thermal cycles. The marginal quality was assessed at baseline and after both runs of TML. Load-to-fracture tests were performed. The statistical analysis comprised multiple linear regressions (α = 0.05). RESULTS: Simulated aging of RBC restorations had no significant effect on the marginal quality at the interface between the RBC and the tooth and the RBC and the inlay (p ≥ 0.247). Across time points, higher percentages of non-continuous margin were observed between the inlay and the tooth than between the tooth and the RBC (p ≤ 0.039). The age of the DME did not significantly affect the fracture resistance (p ≥ 0.052). CONCLUSIONS: Artificial aging of RBC restorations used for DME had no detrimental effect on the marginal quality and fracture resistance of LDS and PICN inlays. CLINICAL RELEVANCE: This laboratory study suggests that-in select cases-intact, direct RBC restorations not placed immediately before the delivery of an indirect restoration may be used for DME.

Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures.

OBJECTIVES: This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures. METHODS: This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures. RESULTS: Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up. CONCLUSIONS: Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups.  CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.

Guided endodontics versus conventional access cavity preparation: an ex vivo comparative study of substance loss.

BACKGROUND: To compare the outcomes of conventional access cavity preparation (CONV) versus guided endodontics (GE) for access cavity preparation in anterior teeth with pulp canal calcification (PCC) regarding root canal detection, substance loss, procedural time, and need for additional radiographs. METHODS: Extracted, sound human teeth with PCC (n = 108) were matched in pairs, divided into two groups and used to produce 18 models. An independent endodontist and a general dentist performed access cavity preparation under simulated clinical conditions on nine models each (54 teeth). The endodontist used the conventional technique and the general dentist GE. Time needed to access the root canals and the number of additional radiographs were recorded. Pre- and postoperative cone-beam computed tomography scans were obtained to measure substance loss. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs) between the groups. RESULTS: All root canals were successfully accessed by both methods. There were no significant differences in substance loss (CI: CONV 15.9-29.6 mm3 vs. GE 17.6-27.5mm3) or procedural time (CI: CONV 163.3-248.5 s vs. GE 231.9-326.8 s). However, 31 additional radiographs were required for GE compared to none for CONV. CONCLUSIONS: For access cavity preparation in teeth with PCC, both CONV by a specialist and GE by a general dentist produce good results in terms of substance loss and time requirements.

Present status and future directions: Endodontic management of traumatic injuries to permanent teeth.

The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.

Present status and future directions - Guided endodontics.

Luxation injuries and other stimuli may lead to a pulp canal obliteration (PCO). Even though the apposition of tertiary dentine is a sign of a vital pulp, in some cases root canal treatment is indicated in the long term due to apical periodontitis or pulpitis. Depending on the extent of PCO, root canal treatment may be challenging even for experienced and well-equipped endodontic specialists. The 'guided endodontics' (GE) technique was introduced 6 years ago as an alternative to conventional access cavity preparation for teeth with PCO and apical pathosis or irreversible pulpitis. Using three-dimensional radiological imaging such as cone-beam computed tomography and a digital surface scan, an optimal access to the orifice of the calcified root canal can be planned virtually with appropriate software. GE is implemented either with the help of templates analogous to guided implantology (= static navigation) or by means of dynamic navigation based on a camera-marker system. GE has emerged as a field of research in the last 6 years with very promising laboratory-based results regarding the accuracy of guided endodontic access cavities for both static and dynamic navigation. Clinical implementation seems to provide favourable results, but the evidence is mainly based on numerous case reports and a few case series. This narrative review aims to provide an update on the present status of GE and to identify relevant research areas that could contribute to further improvements of this technique.

Present status and future directions: Surgical extrusion, intentional replantation and tooth autotransplantation.

Surgical extrusion, intentional replantation and tooth autotransplantation procedures are important treatment options that clinicians may consider performing in their day-to-day clinical practice. Despite compromised teeth are generally considered for extraction, clinicians must be aware that these cases could be suitable for management by these alternative predictable treatment options. Surgical extrusion, intentional replantation or tooth autotransplantation have similar treatment protocols which includes atraumatic tooth extraction, visualisation of the root portion and replantation. Surgical extrusion is defined as the 'procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally'. Intentional replantation is defined as the 'deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position'. Tooth autotransplantation is defined as the 'transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket'. The same team previously published a narrative review (International Endodontic Journal. 2020, 53, 1636) and European Society of Endodontology position statement (International Endodontic Journal. 2020, 54, 655) on this topic in International Endodontic Journal. The aim of the current updated review was to provide the reader a complete overview and background on these procedures, to established clear clinical protocols and step-by-step for technically perform these therapies in their clinical practice and to establish future directions on the topics. The clinicians must periodically update their knowledge about these three procedures to achieve success.

Students' perception of three-dimensionally printed teeth in endodontic training.

INTRODUCTION: In endodontic education, there is a need for thorough training prior to students embarking on clinical treatment. The aim of this study was to use three-dimensional printing technology to create a new model and to compare its suitability for training purposes with resin blocks and extracted teeth. MATERIALS AND METHODS: Multi-jet-modelling (MJM) produced the 3D model replicating a common difficulty in root-canal morphology. An evaluation study comprising 88 students was run in the sixth semester (summer 2018 and winter 2018/2019). A new questionnaire assessed students' perception of training models and educational environment. Welch's t-test analysed significant differences. RESULTS: The most pronounced differences between models were noted when rating material hardness, radiopacity, root-canal configuration and suitability for practising. Students estimated their learning outcome as greater with 3D-printed teeth compared to resin blocks. Three-dimensionally printed teeth received significantly lower ratings with regard to enthusiasm, the learning of fine motor skills and spatial awareness, when compared to human teeth (p ≤ .001). However, 3D-printed teeth were appreciated for additional benefits, such as their cleanliness, availability and standardisation of training opportunities with complex root-canal configurations. CONCLUSION: Students preferred extracted human teeth to 3D-printed teeth with respect to their physical characteristics and training experience. However, educational advantages may compensate for the shortcomings. The new questionnaire proved both adequate and accurate to assess the models and educational environment in endodontic training. The new 3D-printed teeth enhanced the learning opportunities.

Spectrophotometric insights: calcium hydroxide influences tooth discolorations induced by short-term application of antibiotic/corticosteroid pastes.

OBJECTIVES: This in vitro study aimed to assess the influence of a calcium hydroxide dressing regarding the relative color change (ΔE) of enamel-dentin specimens previously exposed to antibiotic/corticosteroid pastes. MATERIALS AND METHODS: Eighty bovine enamel-dentin specimens with a cylindrical central cavity were randomly allocated to four groups: NEG (empty), POS (blood), LED (Ledermix), and ODO (Odontopaste) (n = 20 each). The materials were applied and sealed with self-adhesive resin luting material. After 3 weeks, the materials were removed and a calcium hydroxide (Ca(OH)2) dressing was placed in all cavities. After a further 3-week storage period, the cavities were restored with resin-based composite. Spectrophotometric color measurements were taken over 6 months, and ΔE values were calculated. A Tukey's multiple comparison test was performed to assess significant differences within the treatment groups (p < 0.05). RESULTS: Tooth discolorations were present after 3 weeks in LED (ΔE 29.14 ± 6.55) and POS (ΔE 18.05 ± 7.03); NEG and ODO remained color stable (ΔE 3.2 ± 1.36 and ΔE 2.3 ± 1.16). The 3-week Ca(OH)2 dressing decreased discolorations of POS (ΔE 15.93 ± 6.63; p = 0.37), whereas LED showed a further significant increase (ΔE 39.55; p < 0.0001). Between the end of the Ca(OH)2 dressing and the final restoration no significant color changes were observed in any group (p > 0.9). CONCLUSIONS: Discolorations induced by LED progressed during the Ca(OH)2 dressing despite careful removal of all residues. CLINICAL RELEVANCE: Calcium hydroxide might negatively affect the discoloring potential of Ledermix. This highlights the need for direct intracanal application methods of Ledermix ensuring a material-free access cavity or alternative antibiotic/corticosteroid pastes such as Odontopaste should be used.

Long-term outcome of adhesive fragment reattachment in crown-root fractured teeth.

BACKGROUND/AIMS: Adhesive fragment reattachment (AFR) is one treatment option for crown-root fractured teeth. However, there are no studies investigating the long-term outcome of this approach. The aim of this retrospective study was to evaluate the long-term outcome of AFR and periodontal health in crown-root fractured teeth by assessing complications and periodontal status. MATERIALS AND METHODS: Data regarding 41 patients with 51 traumatized teeth (TT) were included. Periodontal health was assessed by recording the pocket probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), gingival index (GI), and plaque index (PI) in the TT and in one unaffected control tooth (CT). Complications were classified as "restorative," "endodontic," and "additional root fracture." Based on these complications, the outcome was graded as "success," "partial success," "survival," and "failure." Statistics was performed by t test, chi-square test and logistic regression models. RESULTS: After 8.5 ± 4.6 years, 76.5% (39/51) of the TT had functionally survived. Functional survival of the reattached fragments was 66.7% (26/39) after 9.5 ± 3.7 years. PPD (TT: 4.11 ± 2.03; CT: 2.08 ± 0.65), CAL (TT: 4.78 ± 2.19; CT: 2.42 ± 1.03), and BoP values (TT: 77.4%; CT: 22.6%) were higher in TT than in CT. GI scores > 0 were found in 83.3% of the TT and in 27.8% of the CT. PI scores did not differ between TT and CT. Of the complications, 56.8% were "restorative," 22.7% "endodontic," and 20.5% "additional root fractures." Eleven (27.5%) TT were without complications and rated as "success." CONCLUSIONS: AFR in crown-root fractured teeth showed a high survival rate and occasionally compromised periodontal health. However, due to the high complication rate, it should be considered as a long-term temporary treatment to postpone other invasive therapy options. AFR can be a valuable way to avoid early loss of crown-root fractured teeth, especially in young patients. Moisture control and additional root fractures significantly influenced the outcome.

Guided endodontics: a comparative in vitro study on the accuracy and effort of two different planning workflows.

AIM: To compare the accuracy and effort of digital workflow for guided endodontic access (GEA) procedures using two different software applications in 3D-printed teeth modeled to simulate pulp canal obliteration (PCO) in vitro. MATERIALS AND METHODS: 32 3D-printed incisors with simulated PCO were fabricated and mounted, four each on maxillary and mandibular study arches. Cone beam computed tomography (CBCT) and 3D surface scans were matched and used to virtually plan and prepare GEA by one operator using two different methods: 1) CoDiagnostiX (CDX; Dental Wings) with 3D-printed templates, and 2) Sicat Endo (SE; Sicat) with subtractive CAD/CAM-manufactured templates. Postoperative CBCT and virtual planning data were superimposed for analysis. Accuracy was assessed by measuring the discrepancies between planned and prepared cavities at the tip of the bur (three spatial dimensions, 3D vector, angle). Virtual planning effort was defined as the time and number of computer clicks. A 95% confidence interval (CI) was computed for each sample. RESULTS: SE successfully located root canals for GEA in 16/16 cases (100%) and CDX in 15/16 cases (94%). SE resulted in less mean deviation at the tip of the bur with regard to distance in the labial-oral direction (0.12 mm), 3D vector (0.35 mm), and angle (0.68 degrees) compared with CDX (0.54 mm, 0.74 mm, 1.57 degrees, respectively; P < 0.001). CDX required less mean planning time and effort for each four-tooth arch (10 min 50 s, 107 clicks) than SE (20 min 28 s, 341 clicks; P < 0.05). CONCLUSIONS: Both methods enabled rapid drill path planning, a predictable GEA procedure, and the reliable location of root canals in teeth with PCO without perforation.

Long-term retention of avulsed maxillary permanent incisors replanted after prolonged non-physiological storage.

Ankylosis and external replacement resorption (ERR) are two typical biological responses to delayed replantation of avulsed teeth in cases where adequate root canal treatment is performed. The patient's growth stage affects the progression of root resorption and the long-term outcome of the affected teeth. This case report describes the long-term outcome of an 18.5-year-old patient following an accident in which both of his maxillary central incisors were avulsed and replanted after four hours of non-physiological storage. ERR and ankylosis of teeth 11 and 21 were detected clinically and radiographically during the second year of follow-up. Sixteen years after replantation, replacement resorption was progressing very slowly, enabling functional tooth retention with favorable esthetics. Young adults, with delayed replantation of avulsed teeth, may benefit from tooth retention with slow ERR.

Outcome of non-surgical root canal treatment related to periodontitis and chronic disease medication among adults in age group of 60 years or more.

OBJECTIVE: To assess the impact of non-endodontic factors like periodontitis and chronic disease medication (CDM) mostly affecting elderly people's health on the outcome of non-surgical root canal treatment (NSRCT). BACKGROUND: An increasing number of elderly people with high prevalence of marginal periodontitis and CDM benefit from adequate endodontic therapy, if irreversible pulpitis or apical periodontitis occurs. Only few data exist about the relevance of those non-endodontic factors on healing of endodontic lesions in a population 60 years or more. MATERIAL AND METHODS: Of 177 patients aged 60 years or more with 212 NSRCTs performed between the year of 2010 and 2013, complete documentation was available for 112 teeth in 93 participants. Mean time between baseline and last follow-up was 38.93 months. The primary endodontic factors studied were the periapical index (PAI) of periapical health, quality of the root canal filling and of coronal restoration, periodontal probing depth (PPD, mm) and tooth mobility (TM, 0-3). Secondary non-endodontic factors included the presence of marginal periodontitis and CDM, in particular antidiabetics, antihypertensives and anticoagulants. Statistical analyses were performed using Chi-square test statistics and logistic regression analysis. RESULTS: Periodontitis and CDM had no effect on endodontic outcome. Chronic intake of anticoagulants showed a significant association with endodontic outcome. Root-filled teeth with preoperative periapical lesions had a significantly higher rate of endodontic failure than those without preoperative lesion. The overall success rate of NSRCT was 87.1% with 81 healed teeth. CONCLUSION: Periodontitis and CDM have no impact on the endodontic outcome of NSRCT in a population 60 years or more.

Postendodontic Restoration: Endodontic Post-and-Core or No Post At All?

PURPOSE: The objective of this systematic review was to assess the impact of endodontic post insertion on the clinical performance of endodontically treated teeth (ETT). MATERIALS AND METHODS: A specific PICO question was developed and a Medline search was performed in January 2017 using relevant terms in order to identify studies comparing the success/survival of dental restorations using endodontic posts or no posts. Additionally, the electronic databases "Opengrey", "BBO", "LILAC" and "IBECS" were assessed and a hand search of cross references from original articles and reviews was performed. The methodological quality of the included studies was assessed independently by three referees using (1) the critical appraisal skills program (CASP) and (2) Cochrane checklist (version 5.1.0). RESULTS: A total of 14 studies were included, among them 11 randomized controlled trials (RCT), two prospective clinical trials, and one retrospective clinical trial. The overall quality of the studies was good according to the CASP. However, the Cochrane rating showed that in seven studies, the risk of bias was high in > 40% of the items, indicating a relevant level of methodological flaws. Three studies showed a low risk of bias in > 80% of the items. The majority (10 out of 14) of the clinical studies included failed to show a positive effect of post placement. A post effect is possible when no cavity wall is present. CONCLUSION: There is no unequivocal clinical evidence to support or reject the use of posts even for no-wall cavities, either for direct or indirect restorations.

Treatment of an Adolescent Patient with Dentinogenesis Imperfecta Using Indirect Composite Restorations - A Case Report and Literature Review.

PURPOSE: To demonstrate the field of application and prospects of individually modeled indirect composite restorations for the treatment of children and adolescents based on a case of dentinogenesis imperfecta. Dental malformations can affect single or multiple teeth. In most cases, direct composite fillings can be placed. However, in severe cases, these restorations may be more challenging and error-prone, especially when occlusal adjustments are necessary. Since composite materials do not require a specific lamination strength and are easy to repair, they can be applied using the indirect technique, enabling conservation of more sound hard tissue than is possible when conventional restorations are used. PATIENT AND METHODS: A young patient with dentinogenesis imperfecta type II underwent interdisciplinary full-mouth rehabilitation due to massive tooth wear and loss of vertical occlusion. First, a check bite was taken, and vertical occlusion was increased using overdentures. Six months later, a construction bite was taken over the existing overdentures (focusing on the sagittal dimension) to move the mandibular position more towards the anterior, correcting the skeletal Class II malocclusion. This resulted in a Class I intercuspidation with harmonization of the facial proportions. After a further six months, all teeth were restored using individually modeled indirect composite restorations, which preserved most of the sound hard tissue and restored esthetics and function. CONCLUSION: Indirect composite restorations can be a valuable tool for improving occlusion, esthetics and function in the treatment of children and adolescents.

Surgical extrusion with an atraumatic extraction system: A clinical study.

STATEMENT OF PROBLEM: Clinical studies evaluating the feasibility of a novel technique for the surgical extrusion of nonrestorable teeth with subgingival caries are lacking. PURPOSE: The purpose of this clinical study was to investigate the success rate and incidence of biological and technical complications after tooth extrusion with an atraumatic extraction system (AES). MATERIAL AND METHODS: Participants were recruited from 61 consecutive patients initially referred to a specialist oral surgery practice. Fifty-one participants who underwent surgical extrusion with an AES followed by endodontic treatment and coronal restoration could be re-evaluated clinically and radiographically. RESULTS: The mean observation period was 3.1 years (range: 0.8 to 6.5 years). The participants varied in age between 24.8 and 86.3 years. The amount of extrusion was between 2.5 and 5.0 mm (mean 3.2 mm). At recall, 92.2% (47 of 51) of the extruded teeth were considered successful. All extruded teeth were asymptomatic, without clinical signs of inflammation. Percussion appeared normal and did not differ from that of the adjacent teeth, indicating absence of ankylosis. Transient resorption with a slightly altered root contour was detected in 5 of the 51 teeth. Minor reduction of the bone level (less than 10%) was detected in 8 of the 51. In a further 2 teeth, bone loss amounted to 25% and 30%. Periapical periodontitis at recall was seen in 4 of the 51 teeth, and a preexisting periapical lesion healed in 10 of 13. Root perforation was identified in 3 of the 51, and a further 3 of 11 were not available for recall. Thus, the technical complication rate was 9.7% (6 of 62). CONCLUSIONS: The AES may be successfully used for surgical extrusion to save apparently nonrestorable teeth, irrespective of patient age.

Evaluation of a Fluorescence-aided Identification Technique (FIT) for removal of composite bonded trauma splints.

BACKGROUND/AIM: Accurate removal of composite bonded titanium trauma splints (TTS) can be challenging. The aim of this study was to evaluate a Fluorescence-aided Identification Technique (FIT) compared with a conventional light source (CT) for removal of trauma splints regarding loss of tooth substance, residual composite, and time taken. MATERIALS AND METHODS: Twenty maxillary models with six bovine teeth (13 - 23) were fabricated. An optical three-dimensional impression was taken and a TTS was applied from 12 to 22 with two bonding sites on every tooth under standardized conditions using an etch-and-rinse adhesive and resin composite. Two operators removed 10 splints each (5x FIT and 5x CT). For FIT, a 405 nm light-emitting headlamp was used. Time was recorded. A post-operative scan was superimposed on the pre-operative scan using OraCheck software. A qualitative and quantitative analysis of tooth defects and composite remnants was performed by two operators and statistically analyzed. RESULTS: Compared with the CT, FIT led to significantly fewer and smaller enamel defects (mean volume: -0.04 mm3 vs -0.33 mm3 ) (P < 0.001), significantly less composite remained (mean volume: 0.02 mm3 vs 0.28 mm3 ) (P < 0.001), and the removal procedure with FIT was significantly quicker (mean: 162 seconds vs 268 seconds) (P < 0.001), CONCLUSIONS: FIT facilitated the removal of composite used to bond trauma splints leading to less time-consuming as well as less invasive treatment. It left fewer composite residues on enamel surfaces.

Influence of Cavity Margin Design and Restorative Material on Marginal Quality and Seal of Extended Class II Resin Composite Restorations In Vitro.

PURPOSE: To investigate the influence of three cavity designs on the marginal seal of large Class II cavities restored with low-shrinkage resin composite limited to the enamel. MATERIALS AND METHODS: One hundred twenty (120) intact human molars were randomly divided into 12 groups, with three different cavity designs: 1. undermined enamel, 2. box-shaped, and 3. proximal bevel. The teeth were restored with 1. an extra-low shrinkage (ELS) composite free of diluent monomers, 2. microhybrid composite (Herculite XRV), 3. nanohybrid composite (Filtek Supreme XTE), and 4. silorane-based composite (Filtek Silorane). After artificial aging by thermocycling and storage in physiological saline, epoxy resin replicas were prepared. To determine the integrity of the restorations' approximal margins, two methods were sequentially employed: 1. replicas were made of the 120 specimens and examined using SEM, and 2. the same 120 specimens were immersed in AgNO3 solution, and the dye penetration depth was observed with a light microscope. Statistical analysis was performed using the Kruskal-Wallis and the Dunn-Bonferroni tests. RESULTS: After bevel preparation, SEM observations showed that restorations did not exhibit a higher percentage of continuous margin (SEM-analysis; p>0.05), but more leakage was found than with the other cavity designs (p<0.05). The lowest percentage of continuous margin was observed in ELS restorations (p<0.05). More fractured margins were observed in the undermined enamel cavity design groups (p<0.05). CONCLUSION: Bevel preparation failed to improve margin quality in large Class II composite restorations and is no longer recommended. However, undermined enamel should be removed to prevent enamel fractures.