Classified diagnosis and treatment scheme of oral cosmetic restoration based on aesthetic analysis (part â ): basic concept, decision tree and clinical pathway.

At present, the commonly used clinical protocols of oral comestic restoration are mostly based on the aesthetic indicators proposed by Western developed countries (referred to as Western aesthetics). Mechanically copying the Western aesthetic scheme, ignoring the difference between it and the Chinese oral aesthetic indicators (referred to as Chinese aesthetics), is unable to effectively support personalized cosmetic restoration diagnosis and treatment. In addition, new technologies and new solutions for cosmetic restoration, which are developing rapidly in recent years, are emerging one after another, but many popular concepts are confusing and lack of proper hierarchical diagnosis and treatment norms, and there is indeed an urgent need for discussion and clarity. From the perspective of serving clinical application, this paper discusses the deficiencies of the Chinese translation of the word "aesthetics", the diffe-rence and connection between aesthetics and cosmetology, and the relationship between cosmetic restoration and fixed restoration. It also discusses the difference between anterior teeth, esthetic zone and exposed zone, the diagnostic and therapeutic value of oral aesthetic analysis, as well as the application methods of desensitization, suggestion, and other therapies in difficult oral cosmetic restoration cases. We further introduce the decision tree and the clinical pathway for restoration and reconstruction of teeth in exposed zone guided by aesthetic analysis, and introduce the clinical process of aesthetic analysis and evaluation, the clinical triclassification of oral cosmetic restoration, and the corresponding clinical classification diagnosis and treatment points.

Vitamin C mesotherapy versus diode laser for the esthetic management of physiologic gingival hyperpigmentation: a randomized clinical trial.

BACKGROUND: Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation. METHODS: Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction. RESULTS: Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients. CONCLUSIONS: Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022).

Evaluation of the color stability of attachments made with different resin composites.

INTRODUCTION: Coloring solutions-such as coffee and cola, frequently consumed daily-cause coloration of attachments made with resin composites. This may reduce the motivation for clear aligner treatment, often preferred by patients with esthetic concerns. This study aimed to compare color changes of orthodontic attachments made with 3 different composite resins. METHODS: A total of 90 premolar teeth (n = 10) extracted for orthodontic reasons were used. All teeth were embedded in plaster models to imitate the arch shape and scanned with an intraoral scanner. Horizontal rectangular attachments were placed on each tooth by printing the attachment template obtained using digital models. Three composite resins: Omnichroma, GC Aligner Connect, and Tetric PowerFlow were used to prepare the attachments. The models prepared in arc-shaped in each composite group were divided into subgroups and kept in 3 different solutions (coffee, cola, and distilled water) in the incubator at 37 ± 1°C. The models were photographed at baseline and 28 days later with the Smile-Lite MDP device. L, a, and b values were obtained with Digital Color Meter (version 5.22; Apple, Cupertino, Calif). CIEDE2000 formula (ΔE00) was used to evaluate color changes. In addition, models were scanned for color determination at baseline and 28 days later with the 3Shape intraoral scanner. RESULTS: There were significant color differences between solutions (P <0.05). CONCLUSIONS: Attachments can be colored easily. Patients should be warned against coloring solutions at the beginning of the treatment, and their eating and drinking habits should be regulated.

Extended Superolateral Cheek Lift With a Short Preauricular Scar: A Local Anesthesia-based Practicable Technique for the Correction of Moderate-degree Facial Aging Signs.

An ideal technique applicable to middle-aged individuals with a moderate degree of facial aging signs has not yet been established. This study aimed to evaluate the utility of an extended superolateral cheek lift with a short preauricular scar technique for the correction of facial aging signs. A total of 200 female patients (mean age: 43 y, range 27-56 y) who underwent a local anesthesia-based extended superolateral cheek lift for the correction of facial aging signs confined to the malar and nasolabial area, lower eyelid, jawline, and neck were included. Data on the Global Aesthetic Improvement Scale, patient-reported outcomes, and complications were recorded at 1, 6, 12, and 24 months postoperatively. The Global Aesthetic Improvement Scale scores revealed exceptional improvement in 90% of patients along with no complications at month 24. None of the patients developed a depressed scar, skin necrosis, breaking of the superficial musculoaponeurotic system plication sutures, asymmetry, or facial nerve problems. At postoperative month 24, the appearance was reported to be very much improved by 90% of patients, and 94% of patients reported that they were very satisfied with the treatment and that they would recommend this treatment to friends and acquaintances. Our findings revealed the potential utility of an extended superolateral cheek lift with a short preauricular scar as a local anesthesia-based practicable technique for the correction of facial aging signs in middle-aged patients, offering a favorable postoperative outcome, lack of complications and high patient satisfaction in addition to invisible scars and a short-term postoperative recovery.

Tranexamic Acid in Facial Feminization Surgery: Quantifying a High-risk Setting With Exogenous Estrogen Supplementation.

Tranexamic acid (TXA) has been increasingly utilized in orthognathic surgery, aesthetic surgery, and craniofacial surgery. However, the risk of increasing venous thromboembolic events (VTE) must be carefully considered as TXA is a prothrombotic agent. Our study aimed to investigate the safety of TXA in the setting of facial feminization surgery. These patients are at an elevated risk for VTE at baseline given their uniform history of exogenous estrogen supplementation. A retrospective review of all patients that underwent facial feminization surgery at our medical center between December 2015 and September of 2022 was performed. Demographic information, procedure type, Caprini scores, hematoma rate, VTE rate, estimated blood loss, and operative time were all studied. Unpaired t tests were used to compare patients that received TXA and those who did not. In total, there were 79 surgeries performed during our study period. There were 33 surgeries (41.77%) that used TXA intraoperatively. Ten patients (12.65%) received anticoagulation postoperatively, 5 of whom received TXA intraoperatively. Of the 33 patients who received TXA, 30 patients remained on estrogen therapy. There was no statistically significant difference in VTE rates in patients who received TXA (n=33, 41.77%) and those who did not (n=46, 58.23%). Bleeding events, Caprini scores, estimated blood loss, and operative time were also not found to be significantly different between the 2 cohorts. The authors found no significant increase in VTE in facial feminization patients undergoing estrogen supplementation when intraoperative TXA was utilized. This is the first known report investigating the safety of TXA in this higher risk patient population.

Relevant domains, core outcome sets and measurements for implant dentistry clinical trials: The Implant Dentistry Core Outcome Set and Measurement (ID-COSM) international consensus report.

AIM: Lack of consistently reported outcomes limits progress in evidence-based implant dentistry and quality of care. The objective of this initiative was to develop a core outcome set (COS) and measurements for implant dentistry clinical trials (ID-COSM). MATERIALS AND METHODS: This Core Outcome Measures in Effectiveness Trials (COMET)-registered international initiative comprised six steps over 24 months: (i) systematic reviews of outcomes reported in the last 10 years; (ii) international patient focus groups; (iii) a Delphi project with a broad range of stakeholders (care providers, clinical researchers, methodologists, patients and industry representatives); (iv) expert group discussions organizing the outcomes in domains using a theoretical framework and identifying the COSs; (v) identification of valid measurement systems to capture the different domains and (vi) final consensus and formal approval involving experts and patients. The methods were modified from the best practice approach following the Outcome Measures in Rheumatoid Arthritis Clinical Trial and COMET manuals. RESULTS: The systematic reviews and patient focus groups identified 754 (665 + 89, respectively) relevant outcome measures. After elimination of redundancies and duplicates, 111 were formally assessed in the Delphi project. By applying pre-specified filters, the Delphi process identified 22 essential outcomes. These were reduced to 13 after aggregating alternative assessments of the same features. The expert committee organized them into four core outcome areas: (i) pathophysiology, (ii) implant/prosthesis lifespan, (iii) life impact and (iv) access to care. In each area, core outcomes were identified to capture both the benefits and harms of therapy. Mandatory outcome domains included assessment of surgical morbidity and complications, peri-implant tissue health status, intervention-related adverse events, complication-free survival and overall patient satisfaction and comfort. Outcomes deemed mandatory in specific circumstances comprised function (mastication, speech, aesthetics and denture retention), quality of life, effort for treatment and maintenance and cost effectiveness. Specialized COSs were identified for bone and soft-tissue augmentation procedures. The validity of measurement instruments ranged from international consensus (peri-implant tissue health status) to early identification of important outcomes (patient-reported outcomes identified by the focus groups). CONCLUSIONS: The ID-COSM initiative reached a consensus on a core set of mandatory outcomes for clinical trials in implant dentistry and/or soft tissue/bone augmentation. Adoption in future protocols and reporting on the respective domain areas by currently ongoing trials will contribute to improving evidence-informed implant dentistry and quality of care.

Colour stability of 3D-Printed orthodontic brackets using filled resins.

OBJECTIVE: To determine the effect of common beverages and accelerated aging on the colour stability of filled resins, which could potentially be used for fabrication of 3D-printed orthodontic brackets. MATERIALS AND METHODS: GR-17.1 (shades A1, A2, and A3), and GR-10 Guide resins (pro3dure medical, Eden Prairie, MN) were printed on an Asiga MAX UV printer into discs 2 mm thick, with a diameter of 10 mm, and then post-print processed as per manufacturer's instructions. Discs were immersed in 5 mL of coffee, tea, red wine, or distilled water for 7 days. Another group was subjected to accelerated aging in accordance with ISO Standard 4892-2. Ten samples were produced per resin, per treatment condition. Colour measurements were taken on the discs before and after treatment using a spectrophotometer against white and black reference tiles to assess colour and translucency differences with the CIEDE2000 colour difference formula. RESULTS: While initial colour of the printed resin discs was acceptable, all resin groups underwent significant colour change during the experiment. Red wine and coffee produced the greatest colour and translucency change, followed by tea, with accelerated aging producing the least change in colour and translucency. CONCLUSION: The 3D-printed resins tested underwent significant changes in colour and translucency following exposure to endogenous and exogenous sources of staining, which may affect their acceptability for fabrication of aesthetic orthodontic brackets.

Effect of aging on color, gloss and surface roughness of CAD/CAM composite materials.

OBJECTIVES: To assess the effect of aging procedures on color, gloss and surface roughness of CAD/CAM composite materials. METHODS: 6 CAD/CAM composite materials (Brilliant CRIOS, Cerasmart, Lava Ultimate, Tetric CAD, Shofu Block HC, Grandio Blocs) were tested. 10 CAD/CAM fabricated specimens of each material polished according to manufacturers' recommendations, were subjected to one of the following aging procedures; immersion in coffee (30 days, 37οC), water thermocycling (5000 cycles, 5-55 °C) and photoaging (150,000 kJ/m2). Color, gloss and surface roughness measurements were performed before and after aging and the respective changes were calculated. Kruskal-Wallis tests, paired t-tests, one-way ANOVA and Bonferroni post-hoc tests were used for statistical analysis (a = 0.05). RESULTS: Color changes ranged from 3.03 to 4.13 after coffee immersion, from 1.33 to 2.55 after thermocycling and from 1.02 to 2.75 after photoaging. No statistically significant differences for ΔE*ab were found among materials after coffee immersion and thermocycling (p>0.05). Gloss changes ranged from -5.7 to -1.6 GU after coffee immersion, from -2.3 to 0.1 GU after thermocycling and from -4.4 to 0.5 GU after photoaging. No significant differences in gloss changes were found among materials after aging (p>0.05). Tetric CAD demonstrated the significantly lower gloss and the higher surface roughness after polishing. Except for gloss after thermocycling, aging procedures caused significant alteration of gloss and surface roughness parameters from baseline levels. CONCLUSIONS: Aging procedures caused perceptible but acceptable color changes and small but visible gloss changes, while surface roughness parameters of the tested CAD/CAM composite materials were significantly affected by aging. CLINICAL SIGNIFICANCE: Aging procedures affected CAD/CAM composite materials indicating that these materials may be prone to color and surface alterations in the oral environment that could compromise the esthetics and the performance of the restorations. Clinical studies are needed to investigate the long-term behavior of the newly introduced CAD/CAM materials.

In vitro evaluation of dental color stability using various aesthetic restorative materials after immersion in different drinks.

BACKGROUND: Currently, the demands for restorations have increased considerably; thus, improvements and modifications have been made in dental composite technologies especially using materials that have been claimed to improve color stability. OBJECTIVE: This study aimed to determine the effect of various solutions on the color stability of different restorative materials in vitro study. METHODS: This study used three types of esthetic restorative materials. The samples comprised 45 discs, including 15 micro-hybrids, 15 nano-hybrids, and 15 glass ionomers). These discs were immersed in various beverages an hour a day for one month at room temperature. The color stability was measured using a spectrophotometer before/after immersion (days 7 and 30). RESULTS: We realized a significant difference in color change with Coca-Cola and tea-milk solution after seven days and 30 days (p < 0.05). However, no significant difference was found in the samples immersed in DM after seven days and 30 days (p > 0.05). The highest value of lightness (∆L) and stainability (∆a) was seen in micro-hybrid after 30 days of immersion in tea-milk solution (- 12.16 ± 1.74 and 11.4 ± 3.82, respectively), while most samples had a positive ∆b value. CONCLUSION: After one month, the tea-milk solution affected the color stability of all used restorative materials. In addition, micro-hybrid had higher color stability than nano-hybrid and glass ionomer.

Single-retainer all-ceramic resin-bonded fixed dental prostheses: Long-term outcomes in the esthetic zone.

OBJECTIVES: To present an update on the concept of cantilevered single-retainer all-ceramic resin-bonded fixed dental prostheses (RBFDPs) first presented 25 years ago in the Journal of Esthetic Dentistry. OVERVIEW: The initially presented case of the concept was followed clinically over 26 years and is presented along with two additional clinical long-term cases using varying methods to obtain an esthetic and hygienic ovate pontic design. Veneered alumina and zirconia ceramic (3 mol% yttria-tetragonal zirconia polycrystalline ceramic; 3Y-TZP) was used and bonded with a phosphate monomer containing luting resin after 50 µm alumina particle air-abrasion at 0.25 MPa pressure. The restorations replacing incisors did not debond and soft tissues in the pontic area were maintained over 26 years. CONCLUSIONS: Cantilevered single-retainer all-ceramic RBFDPs today made from veneered 3Y-TZP zirconia ceramic can be considered a standard of care for the replacement of single incisors and provide an excellent esthetic outcome with a long-term preservation of soft tissues in the pontic area. CLINICAL SIGNIFICANCE: Bonding nonretentive oxides ceramics such as alumina and zirconia ceramic with phosphate monomer containing luting resins after alumina particle air-abrasion is durable over decades. This proves that bonding to zirconia ceramic is not of any problem when adequate methods are used. Single-retainer zirconia ceramic RBFDPs maintain soft tissues in the edentulous area of single missing incisors and often deem implants unessential for this indication.

An In Vitro Comparative Evaluation of Conventional and Novel Thymus vulgaris Derived Herbal Disinfectant Solutions against Pathogenic Biofilm on Maxillofacial Silicones and Its Impact on Color Stability.

AIM: This study aims to assess the antimicrobial efficacy and impact on color stability of Thymus (T.) vulgaris solution compared to conventional disinfectants on maxillofacial silicones. MATERIALS AND METHODS: Various solutions were evaluated, including T. vulgaris solutions at 5 and 10%, saline (control), chlorhexidine (4%), and soap water. The substrates were MDX4-4210 silicone elastomers, and the microorganisms tested were Candida (C.) albicans and Staphylococcus (S.) aureus. The viability of microorganisms was determined through an 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) reduction assay, and color stability was measured using a spectrophotometer with X-Rite Europe software. Statistical analysis was performed using the Kruskal-Wallis test, Mann-Whitney U post hoc test, and Wilcoxon Signed Rank test. RESULTS: Soap water demonstrated superior disinfectant action against both microorganisms, while T. vulgaris solutions at 5 and 10% exhibited comparable antimicrobial efficacy. Chlorhexidine and 10% T. vulgaris solution showed minimal color changes in the silicone material. In contrast, soap water and the 5% T. vulgaris solution resulted in clinically unacceptable color alterations. CONCLUSION: This study underscores the potential of T. vulgaris as an herbal disinfectant for combating microbial biofilms on maxillofacial silicones, particularly at concentrations of 5 and 10%. The importance of maintaining color stability is emphasized, with Chlorhexidine and the 10% T. vulgaris solution demonstrating effective preservation of esthetics. These findings suggest the viability of considering T. vulgaris as an alternative disinfectant in clinical settings for maxillofacial silicone prostheses. CLINICAL SIGNIFICANCE: Maxillofacial silicones are vital in restoring aesthetic features for individuals with facial trauma, congenital deformities, or post-surgical interventions. Yet, biofilm-related infections jeopardize their durability and visual integrity. Clinically, T. vulgaris signifies a potential advance in prosthodontic care, offering valuable insights for improving antimicrobial performance and aesthetic durability in maxillofacial prostheses. How to cite this article: Peter M, Kanathila H, Bembalagi M, et al. An In Vitro Comparative Evaluation of Conventional and Novel Thymus vulgaris Derived Herbal Disinfectant Solutions against Pathogenic Biofilm on Maxillofacial Silicones and Its Impact on Color Stability. J Contemp Dent Pract 2023;24(12):967-973.

Effect of cigarette smoke on aesthetic brackets: an in vitro study.

OBJECTIVE: The objective of this study was to evaluate the effect of cigarette smoke (CS) on physical and mechanical properties of ceramic, polycarbonate and alumina ceramic brackets. The null hypothesis tested was that aesthetic brackets would not be influenced by CS. METHODS: Ninety aesthetic brackets were allocated to three groups (n = 30): ceramic (GCE), polycarbonate (GCO) and alumina ceramic (GPS). Ten samples of each group were assigned to color and surface roughness analysis, performed before (T0) and after (T1) exposure to CS; and twenty samples were allocated into control and experimental groups (n = 10) (not exposed and exposed to CS, respectively) for shear bond strength test (SBS). Exposure to CS followed an adaptation of the method described by Le Mesurier. Colorimetric reading, surface morphology and roughness, SBS and adhesive remnant index (ARI) were assessed. Statistical analysis comprised independent and paired t-tests, ANOVA/Tukey and Fisher's exact tests (α = 0.05). RESULTS: Changes were observed in brackets' color (NBS: GCE = 2.4; GCO = 1.9; GPS = 2.1), surface roughness (ΔRa: GCE = 1.1 ± 0.8 µm; GCO = 1.9 ± 1.5µm; GPS = -0.3 ± 0.1 µm / ΔRz: GCE = 1.4 ± 1.0 nm; GPS = -0.5 ± 0.1 nm); and SBS (GPS - experimental = 221.8 ± 48.6 N) after exposure to CS (p< 0.05). CONCLUSIONS: Exposure, in vitro, of aesthetic brackets to CS resulted in changes of color to darker and more opaque shades, surface roughness alterations, and higher SBS values. ARI scores were not associated with exposure to CS.

Combining Clear Aligner Treatment With Bone Grafting for Comprehensive Care of Missing Teeth.

In cases of missing or damaged teeth, patients who elect a fixed restorative option often choose a bridge, which typically offers convenience, affordability, and fewer appointments than dental implants. Often, such patients may have mild to moderate malocclusion that requires some movement of abutment teeth to ensure an optimal esthetic result. Additionally, socket preservation is crucial to the success of restorative efforts. By offering patients clear aligner therapy combined with bone grafting using a unique collagen plug filled with non-ceramic bone graft crystals, the author demonstrates in two case presentations the ability to produce enhanced esthetic results when providing tooth replacement.

Mechanical characterization of aesthetic orthodontic brackets by the dynamic indentation method.

The objective of this study is to investigate the mechanical properties, such as the dynamic hardness and indentation elastic modulus, of commercially available aesthetic orthodontic brackets, such as ceramic and plastic brackets, by the dynamic micro-indentation method. Five ceramic brackets, which were made of alumina (both monocrystalline and polycrystalline forms) or zirconia, and two plastic brackets, which were made of glass fiber-reinforced polycarbonate or polyamide, were tested. There were significant differences in the mechanical properties of the monocrystalline and polycrystalline alumina brackets. The mechanical properties of the glass fiber-reinforced plastic bracket were significantly superior to these of the non-glass-fiber-reinforced plastic bracket. The differences in the crystal structures of the ceramic brackets surface affected the dynamic hardness and indentation elastic modulus. Furthermore, the short glass fibers contained in the plastic bracket might contribute to the improvement of the mechanical properties.

Quality-of-life improvement, psychosocial benefits, and patient satisfaction of patients undergoing orthognathic surgery: a summary of systematic reviews.

BACKGROUND: Function, aesthetics, and social and psychological well-being are all important aspects for patients undergoing orthognathic surgery. OBJECTIVE: To evaluate the impact of orthognathic surgery on patient perception and quality of life before, during and after treatment. SEARCH METHODS: All relevant systematic reviews published up to 31st July 2020 have been searched via MEDLINE via OVID, Scopus, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, PsycINFO, AMED (Allied and Complementary Medicine Database), and PubMed.Ongoing systematic reviews and grey literature were eliminated. A manual search was also undertaken, and no restrictions were applied to language or publication date. SELECTION CRITERIA: Systematic reviews involving dentofacial deformities related to systemic disorders, cleft lip and palate, facial trauma, and syndromes affecting cranial and dentofacial structures were excluded. DATA COLLECTION AND ANALYSIS: Identification, screening, eligibility, and quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)] were performed by two authors independently. Data were synthesized qualitatively using thematic analysis. RESULTS: A total of 662 eligible studies were obtained of which 24 studies were selected for full-text evaluation, resulting in 12 eligible systematic reviews. LIMITATIONS: Due to heterogeneity of data, quantitative analysis was not possible. CONCLUSIONS AND IMPLICATIONS: Aesthetics and function are the main motives for seeking orthognathic surgery. Patient assessment before, during, and after orthognathic surgery is necessary for a thorough evaluation of self-perception and satisfaction throughout treatment. While psychological and social domains improved after orthognathic surgery treatment, the quality of life can deteriorate transiently during the pre-surgical orthodontic phase of treatment. A standardized assessment tool needs to be developed to assess quality-of-life changes consistently and provide comparable results. REGISTRATION: CRD42020199091.

Color stability of resin composites for orthodontic attachments: an in vitro study.

OBJECTIVE: The aim of the present study was to evaluate the color stability of Filtek Z350 XT, Filtek Z250 XT, Z100 resin composites and Transbond XT orthodontic resin, all used in orthodontic attachments, when immersed in popular beverages. METHODS: Thirty disk-shaped specimens of each resin composite (2 x 5mm) were manufactured and randomly divided into six groups according to immersion solutions: coffee, red wine, white wine, regular beer, dark beer and deionized water (control). The specimens were fully immersed in each of the solutions for six days at 37°C, representing approximately six months of consumption. The color measurements were evaluated by a reflection spectrophotometer, at baseline (before immersion) and after staining. L*a*b* coordinates were measured and the color change (ΔE00) was calculated using the CIEDE2000 formula. The data were analyzed by ANOVA/Tukey tests at a significance level of 0.05. RESULTS: The resin composites immersed in white wine and regular beer showed either imperceptible or clinically acceptable ΔE00, and no difference from the control group (p= 0.4449 and p= 0.467 respectively). Immersion in coffee and red wine were considered clinically unacceptable and were significantly different from the control group (p= 0.0028 and p= 0.0475 respectively). CONCLUSION: Based on the results of the present study, the consumption of coffee and red wine may cause color change of the resin composite attachments above the visual acceptability threshold, and impair aesthetics during treatment.

A Novel Concept of Combined High-Level-Laser Treatment and Transcutaneous Photobiomodulation Therapy Utilisation in Orthodontic Periodontal Interface Management.

This case report is aimed to demonstrate the synergetic effects of λ940 nm laser photobiomodulation (PBM) therapy in augmenting the advantages of high-level-laser treatment (HLLT)-mediated reaction orthodontic periodontal interface management. Materials and Methods: A 32-year-old female who presented with a persistent gummy smile of upper incisors and low upper midline frenum attachment post-orthodontic treatment, was seeking a better smile appearance. She had a history of delayed wound healing without underlying medical conditions; otherwise, she was fit and healthy. She underwent laser ablation of the upper midline frenum and gingivoplasty of the upper incisors region with λ940 nm and λ2780, respectively, as well as transcutaneous PBM therapy (λ940 nm) to accelerate wound healing. The laser protocols were as follows: λ2780 nm: power output-2 W, pulse width-60 µs, free running pulse (FRP), spot area-0.0016 cm2, pulse repetition rate-25 pulses per second (s), 80 mJ/pulse, 90 s, λ940 nm: 1.2 W, continuous wave (CW) emission mode, 300 µm, 60 s; whereas the adjunctive λ940 nm induced-PBM parameters were as follows: power output-1.4 W, CW-120 s, single application, spot area-2.8 cm2. An acceleration of the wound healing was observed on the 4th day of treatment with no immediate or post-operative complications. The results showed no functional or aesthetic relapses at a long-term follow-up of 6 months. The authors concluded that λ940 nm laser-PBM can provide a synergetic effect to HLLT in accelerating wound healing and offering a precision smile with minimal to none post-operative complications. It is safe and justifiable to utilise dual therapy over the conventional methods, which serves our patients' needs in our daily practice and in various clinical indications. The concept and laser protocols of this clinical case report can pave the roadmap for future extensive studies.

Do you know your ceramics? Part 4: alumina.

Alumina is a well-known dental ceramic material that has made waves within the dental industry for its good aesthetics and strength when compared to older materials for fixed prostheses, such as crown and bridgework. To be able to confidently use this material, a clinician should understand the physical and optical properties so as to know why and how this material might work in various clinical settings. This part of the ceramic series aims to explore the various alumina-based ceramic systems available on the market and discuss their properties, applications and indications. We also intend to briefly describe the preparation design requirements and cementation protocol for this type of ceramic.

Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial.

OBJECTIVES: To investigate effects of root conditioning with 24% ethylenediaminetetraacetic acid (EDTA) on the 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG). MATERIALS AND METHODS: Twenty patients with 142 GR were treated (72 test sites: SCTG + EDTA and 70 control sites: SCTG). Average and complete root coverage (ARC, CRC), gain in keratinized tissue width (KTW), gain in gingival thickness (GT), root esthetic coverage score (RES), and patient-reported outcome measures (PROMs) were evaluated at 12 months post-operatively. RESULTS: Differences between pre- and post-operative values were statistically significant only within but not between treatment modalities. At 12 months, ARC was 86.0% for SCTG + EDTA-treated and 84.6 for SCTG-treated defects (p = 0.6636). CRC was observed in 90.2% (tests) and 91.4% (controls) of all cases (p = 0.9903). Professional assessment of esthetic outcomes using RES showed highly positive results reaching the value of 8.9 in case of test sites and 8.7 for control sites (p = 0.3358). Severity of pain and swelling did not differ between sites, regardless of whether EDTA was used. CONCLUSIONS: Test and control sites presented similarly positive outcomes related to root coverage, periodontal and esthetic parameters, and patient satisfaction and self-reported morbidity with no statistical differences between them 12 months after surgery. No significant differences in evaluated variables were observed between sites treated with and without 24% EDTA. Clinical relevance Considering the limitations of the present study, the use of 24% EDTA for root conditioning did not improve 12-month outcomes after treatment of multiple RT1 and RT2 gingival recessions with MCAT and SCTG. Trial registration ClinicalTrials.gov identifier: NCT03354104.

Endodontic and Periodontal Treatment of Complete Buccal Root and Apex Exposition: A Challenging Case Report With 17 Months Follow-Up.

INTRODUCTION: This case report demonstrated a challenging clinical case addressed within a multidisciplinary approach to achieve its maintenance, even though had a poor prognosis. It was associated with the endodontic treatment with mucogingival techniques, including periodontal microsurgery and connective tissue graft. CASE PRESENTATION: A patient presented a deep gingival recession with the apex-exposed non-vital tooth with interproximal bone loss (RT2) and without mobility. The treatment involved an initial endodontic approach and periodontal therapy (scaling and root planing), microsurgical techniques with coronally advanced flap, root preparation with PrefGel (24% EDTA), enamel matrix derivatives (Emdogain), and connective tissue graft. As a clinical result, it was verified an increase of keratinized tissue width and gingival thickness, and root coverage (RC), reaching good esthetics and a stable result after 17 months. CONCLUSION: The correct diagnosis and technique selection may affect directly the outcome, especially in challenging cases. Even though there was a poor prognosis, an adequate treatment plan, patient cooperation, and technique mastery help to achieve a high level of RC, esthetic recovering, and successful outcome.