Therapeutic solutions for discoloration of calcified teeth based on CBCT diagnosis.

Single tooth orange discoloration secondary to root canal calcification occurs as a consequence of dental trauma, orthodontic treatment, or for unknown rea- sons. A correct case history must be compiled and a CBCT study carried out in order to establish the diag- nosis and define the best treatment plan in each case. The aim of the present study was to offer a therapeutic protocol involving a clinical decision-making tree dia- gram based on the presence or absence of apical dis- ease and the degree of canal calcification. Dental bleaching and the use of ceramic veneers allow es- thetic restoration in such cases.

Do 3D-printed and milled tooth-supported complete monolithic zirconia crowns differ in accuracy and fit? A systematic review and meta-analysis of in vitro studies.

STATEMENT OF PROBLEM: Additive (3-dimensional printing) and subtractive (milling) methods are digital approaches to fabricating zirconia restorations. Comparisons of their resultant fabrication accuracy and restoration fit are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the accuracy and fit of monolithic zirconia crowns fabricated by 3-dimensional printing and milling. MATERIAL AND METHODS: The PubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar databases were searched up to August 2023. Eligible records were included, and the standardized mean difference (SMD) analyzed 4 outcomes: marginal fit, intaglio fit, trueness, and precision. Publication bias was analyzed with Trim-and-fill, the Egger regression test, and Begg funnel plot. Methodological quality was rated using the QUIN tool. RESULTS: A total of 15 publications were found eligible out of the initial 6539 records. The 3-dimensional printing group demonstrated a lower marginal fit (SMD=1.46, 95% CI=[0.67, 2.26], P<.001; I2=83%, P<.001) and trueness (SMD=0.69, 95% CI=[0.20, 1.18], P=.006; I2=88%, P<.001) and a significantly higher precision (SMD=-2.19, 95% CI=[-2.90, -1.48], P<.001; I2=56%, P=.045). The intaglio fit did not differ significantly across the study groups (SMD=0.77, 95% CI=[-0.22, 1.77], P=.127; I2=87%, P<.001). CONCLUSIONS: Given the high degree of heterogeneity, it can be cautiously concluded that while 3-dimensional printing led to greater precision, the outcomes of the 2 accuracy and adaptation parameters most crucial to the longevity of the restorations-trueness and marginal fit-showed the superiority of the milling technique.

Bond strength of selected composite resin-cements to zirconium-oxide ceramic.

OBJECTIVES: The aim of this study was to evaluate bond strengths of zirconium-oxide (zirconia) ceramic and a selection of different composite resin cements. STUDY DESIGN: 130 Lava TM cylinders were fabricated. The cylinders were sandblasted with 80 µm aluminium oxide or silica coated with CoJet Sand. Silane, and bonding agent and/or Clearfil Ceramic Primer were applied. One hundred thirty composite cement cylinders, comprising two dual-polymerizing (Variolink II and Panavia F) and two autopolymerizing (Rely X and Multilink) resins were bonded to the ceramic samples. A shear test was conducted, followed by an optical microscopy study to identify the location and type of failure, an electron microscopy study (SEM and TEM) and statistical analysis using the Kruskal-Wallis test for more than two independent samples and Mann-Whitney for two independent samples. Given the large number of combinations, Bonferroni correction was applied (α=0.001). RESULTS: Dual-polymerizing cements provided better adhesion values (11.7 MPa) than the autopolymerizing (7.47 MPa) (p-value M-W<0.001). The worst techniques were Lava TM + sandblasting + Silane + Rely X; Lava TM + sandblasting + Silane + Multilink and Lava TM + CoJet + silane + Multilink. Adhesive failure (separation of cement and ceramic) was produced at a lesser force than cohesive failure (fracture of cement) (p-value M-W<0.001). Electron microscopy confirmed that the surface treatments modified the zirconium-oxide ceramic, creating a more rough and retentive surface, thus providing an improved micromechanical interlocking between the cement and the ceramic. CONCLUSIONS: Best results were provided by dual-polymerizing cements associated with sandblasting or silica coating and a bonding agent containing MDP.