Minimally invasive vertical preparation design for ceramic veneers: a multicenter retrospective follow-up clinical study of 265 lithium disilicate veneers.

The esthetic treatment of the anterior teeth has always presented a challenge in clinical practice. With the improvement of dental materials, many restorative options such as resin composites, all-ceramic crowns, and ceramic veneers have become available. The current challenge in reconstructive dentistry is how to obtain excellent esthetic results while preserving the biological structures involved as much as possible. Thanks to the introduction of high-strength etchable dental ceramics, clinicians and technicians now have materials and procedures at their disposal that allow for the restoration of esthetics and function through a minimally invasive approach. New-generation, all-ceramic restorations and adhesive systems allow greater preservation of residual hard tooth structures, especially with regard to single elements. PURPOSE: To evaluate the clinical performance of lithium disilicate (LiDiSi) veneers with a feather-edge finish line margin. MATERIALS AND METHODS: A total of 265 LiDiSi veneers were cemented with resin cement after fluoridric acid and silane surface treatment and observed by different clinicians. These veneers were placed in 53 (32 female, 21 male) patients between October 2009 and April 2015, with a mean observation period of 54.4 months. Of these, 211 veneers were placed in the maxilla (77 central incisors, 65 lateral incisors, 49 canines, 12 first bicuspids, 5 second bicuspids, 2 first molars, 1 second molar), and 54 in the mandible (16 central incisors, 14 lateral incisors, 13 canines, 6 first bicuspids, 1 second bicuspid, 2 first molars, 2 second molars). The clinical evaluation used the modified California Dental Association (CDA) and Ryge criteria after recalling all patients between January and March 2017. The clinical parameters evaluated were color matching, quality of the ceramic surface, the presence of marginal discoloration, and marginal integrity. The data were analyzed through descriptive statistical analysis. RESULTS: The clinical survival of the 265 veneers over the follow-up period was 99.63%. One restoration showed adhesive failure due to a traumatic event after 3 years of clinical service. The color matching parameter was classified as Alfa in 93.9% (248/265) and Bravo in 6.4% (17/265) of the restorations, with no Charlie or Delta ratings recorded. The ceramic surface was rated as Alfa in 97.7% (259/265) and Bravo in 2.2% (6/265), marginal discoloration as Alfa in 97.3% (257/265) and Bravo in 3% (8/265), and marginal integrity as Alfa in 96.9% (256/265) and Bravo in 3.4% (9/265) of the restorations. CONCLUSION: In this retrospective analysis, LiDiSi veneers with a vertical finish line showed good clinical performance in terms of color matching, ceramic surface, marginal discoloration, and marginal integrity. Despite the present results, further clinical studies are needed in order to investigate the long-term performance of this type of restoration.

Trueness and precision of 5 intraoral scanners in the impressions of single and multiple implants: a comparative in vitro study.

BACKGROUND: Until now, a few studies have addressed the accuracy of intraoral scanners (IOSs) in implantology. Hence, the aim of this in vitro study was to assess the accuracy of 5 different IOSs in the impressions of single and multiple implants, and to compare them. METHODS: Plaster models were prepared, representative of a partially edentulous maxilla (PEM) to be restored with a single crown (SC) and a partial prosthesis (PP), and a totally edentulous maxilla (TEM) to be restored with a full-arch (FA). These models were scanned with a desktop scanner, to capture reference models (RMs), and with 5 IOSs (CS 3600®, Trios3®, Omnicam®, DWIO®, Emerald®); 10 scans were taken for each model, using each IOS. All IOS datasets were loaded into a reverse-engineering software where they were superimposed on the corresponding RMs, to evaluate trueness, and superimposed on each other within groups, to determine precision. A statistical analysis was performed. RESULTS: In the SC, CS 3600® had the best trueness (15.2 ± 0.8 µm), followed by Trios3® (22.3 ± 0.5 µm), DWIO® (27.8 ± 3.2 µm), Omnicam® (28.4 ± 4.5 µm), Emerald® (43.1 ± 11.5 µm). In the PP, CS 3600® had the best trueness (23 ± 1.1 µm), followed by Trios3® (28.5 ± 0.5 µm), Omnicam® (38.1 ± 8.8 µm), Emerald® (49.3 ± 5.5 µm), DWIO® (49.8 ± 5 µm). In the FA, CS 3600® had the best trueness (44.9 ± 8.9 µm), followed by Trios3® (46.3 ± 4.9 µm), Emerald® (66.3 ± 5.6 µm), Omnicam® (70.4 ± 11.9 µm), DWIO® (92.1 ± 24.1 µm). Significant differences were found between the IOSs; a significant difference in trueness was found between the contexts (SC vs. PP vs. FA). In the SC, CS 3600® had the best precision (11.3 ± 1.1 µm), followed by Trios3® (15.2 ± 0.8 µm), DWIO® (27.1 ± 10.7 µm), Omnicam® (30.6 ± 3.3 µm), Emerald® (32.8 ± 10.7 µm). In the PP, CS 3600® had the best precision (17 ± 2.3 µm), followed by Trios3® (21 ± 1.9 µm), Emerald® (29.9 ± 8.9 µm), DWIO® (34.8 ± 10.8 µm), Omnicam® (43.2 ± 9.4 µm). In the FA, Trios3® had the best precision (35.6 ± 3.4 µm), followed by CS 3600® (35.7 ± 4.3 µm), Emerald® (61.5 ± 18.1 µm), Omnicam® (89.3 ± 14 µm), DWIO® (111 ± 24.8 µm). Significant differences were found between the IOSs; a significant difference in precision was found between the contexts (SC vs. PP vs. FA). CONCLUSIONS: The IOSs showed significant differences between them, both in trueness and in precision. The mathematical error increased in the transition from SC to PP up to FA, both in trueness than in precision.

Accuracy of four intraoral scanners in oral implantology: a comparative in vitro study.

BACKGROUND: Until now, only a few studies have compared the ability of different intraoral scanners (IOS) to capture high-quality impressions in patients with dental implants. Hence, the aim of this study was to compare the trueness and precision of four IOS in a partially edentulous model (PEM) with three implants and in a fully edentulous model (FEM) with six implants. METHODS: Two gypsum models were prepared with respectively three and six implant analogues, and polyether-ether-ketone cylinders screwed on. These models were scanned with a reference scanner (ScanRider®), and with four IOS (CS3600®, Trios3®, Omnicam®, TrueDefinition®); five scans were taken for each model, using each IOS. All IOS datasets were loaded into reverse-engineering software, where they were superimposed on the reference model, to evaluate trueness, and superimposed on each other within groups, to determine precision. A detailed statistical analysis was carried out. RESULTS: In the PEM, CS3600® had the best trueness (45.8 ± 1.6µm), followed by Trios3® (50.2 ± 2.5µm), Omnicam® (58.8 ± 1.6µm) and TrueDefinition® (61.4 ± 3.0µm). Significant differences were found between CS3600® and Trios3®, CS3600® and Omnicam®, CS3600® and TrueDefinition®, Trios3® and Omnicam®, Trios3® and TrueDefinition®. In the FEM, CS3600® had the best trueness (60.6 ± 11.7µm), followed by Omnicam® (66.4 ± 3.9µm), Trios3® (67.2 ± 6.9µm) and TrueDefinition® (106.4 ± 23.1µm). Significant differences were found between CS3600® and TrueDefinition®, Trios3® and TrueDefinition®, Omnicam® and TrueDefinition®. For all scanners, the trueness values obtained in the PEM were significantly better than those obtained in the FEM. In the PEM, TrueDefinition® had the best precision (19.5 ± 3.1µm), followed by Trios3® (24.5 ± 3.7µm), CS3600® (24.8 ± 4.6µm) and Omnicam® (26.3 ± 1.5µm); no statistically significant differences were found among different IOS. In the FEM, Trios3® had the best precision (31.5 ± 9.8µm), followed by Omnicam® (57.2 ± 9.1µm), CS3600® (65.5 ± 16.7µm) and TrueDefinition® (75.3 ± 43.8µm); no statistically significant differences were found among different IOS. For CS3600®, For CS3600®, Omnicam® and TrueDefinition®, the values obtained in the PEM were significantly better than those obtained in the FEM; no significant differences were found for Trios3®. CONCLUSIONS: Significant differences in trueness were found among different IOS; for each scanner, the trueness was higher in the PEM than in the FEM. Conversely, the IOS did not significantly differ in precision; for CS3600®, Omnicam® and TrueDefinition®, the precision was higher in the PEM than in the FEM. These findings may have important clinical implications.

Minimally invasive vertical preparation design for ceramic veneers.

The esthetic treatment of anterior teeth has always presented a challenge in clinical practice. With the improvement of dental materials, many restorative options such as composite resins, all-ceramic crowns, and ceramic veneers have become available. The current challenge in reconstructive dentistry is to obtain excellent esthetic results while preserving the biological structures involved as much as possible. Thanks to the introduction of high-strength etchable dental ceramics, clinicians and technicians have materials and procedures at their disposal that allow them to restore esthetics and function through a minimally invasive approach. New-generation all-ceramic restorations and adhesive systems allow a greater preservation of residual hard tooth structures, especially with regard to single elements. This article describes a vertical preparation technique for ceramic veneers.

Long-Term Retrospective Clinical and Radiographic Follow-up of 205 Brånemark System Mk III TiUnite Implants Submitted to Either Immediate or Delayed Loading.

BACKGROUND: Studies are needed to evaluate long-term performance of immediately loaded implants with moderately rough surface. This retrospective study evaluated long-term survival and periimplant soft and hard tissue conditions in patients treated with TiUnite implants. MATERIALS AND METHODS: Forty-one consecutive patients (mean age, 52.6 years) received 205 Brånemark System Mk III TiUnite implants (145 maxillary, 60 mandibular). The indication was single tooth (n = 7 implants), partial (n = 94), or full arches (n = 104). One hundred thirteen implants were immediately loaded. Cumulative survival rate (CSR) of implants was assessed. Long-term marginal bone remodeling, probing pocket depth (PPD), and periimplant mucosa conditions were assessed. RESULTS: Follow-up averaged 8.8 years (range, 6.6-10.6 years). Eight implants in 5 patients failed. CSR was 96.1% (implant basis) and 87.8% (patient basis) up to 10 years. At the longest follow-up, bone loss averaged 0.43 ± 1.15 mm (n = 173), PPD averaged 3.64 ± 0.74 mm, and periimplant mucosa was healthy in 74.6% of cases. Furthermore, 50.3% and 35.5% of implants scored negative for plaque and bleeding, respectively. No significant difference in CSR and hard and soft tissue conditions was found in the long term between immediately and delayed loaded implants. CONCLUSION: Implants with TiUnite surface demonstrated excellent long-term survival, marginal bone response, and soft tissue conditions, despite a nonoptimal level of oral hygiene.

Patient and team communication in the iPad era - a practical appraisal.

Communication with the patient and within the team is a critical factor that can influence the treatment outcome, especially in complex and multidisciplinary dental treatments. Indeed, effective communication, not focused on marketing but on proper information of the patient's intraoral situation, can encourage greater acceptance of treatment and also greater treatment satisfaction. Better communication within the dental team is also a very important factor to improve the final result and reduce the time needed to reach it. Thanks to new technological devices widely available, such as tablets, we can use visual communication and interaction with the clinical images of the patient in order to improve communication with the patient, and especially within the dental team. The use of this method allows us to obtain a facial, dentolabial and dental esthetic analysis of the patient that can be used in various clinical steps, improving the predictability of the esthetic outcome and at the same time reducing the number of clinical sessions usually required.

Immediate loading of implants placed simultaneously with sinus membrane elevation in the posterior atrophic maxilla: a two-year follow-up study on 10 patients.

BACKGROUND: Clinical studies on immediate loading of implants in the posterior atrophic maxilla are rare. PURPOSE: The study aims to evaluate immediate loading of implants placed with sinus membrane elevation without additional grafting material for bone augmentation of the maxillary sinus floor. MATERIALS AND METHODS: The study group comprised of 10 patients in whom a total of 10 maxillary sinus floor augmentations were performed. A total of 21 dental implants (1 to 4) were inserted through the residual bone to protrude into the maxillary sinus under the elevated sinus membrane. The implant site was underprepared to improve primary stability. All the implants were inserted with a torque insertion no less than 20 Ncm. Implants were loaded immediately after surgery with a screw-retained temporary acrylic restoration. Intraoral X-rays were taken at implant insertion, after 6 months loading, and after 1st and 2nd year of loading. Resonance frequency analysis (RFA) was performed at the time of initial placement and after 6 months of functional loading. RESULTS: RFA after implant insertion gave an implant stability quotient (ISQ) level with a range from 62 to 72. All implants remained clinically stable during the follow-up period of 2 years. Radiography demonstrated on average 5.7 ± 3.4 mm of intrasinus new bone formation after 6 months of implant loading. RFA measurements showed ISQ mean values of 67 (range: 62-72) and 68 (range: 62-71) at placement and after 6 months of loading, respectively. CONCLUSION: Within the limits of this case series report, it is concluded that maxillary sinus membrane elevation with simultaneous placement and immediate loading of implants without the use of any additional grafting material shows predictable results after 2 years of functional loading. Moreover, evidence of intrasinus bone formation around the implants was found in all patients. Further studies are needed to study the influence of immediate loading on the mineralization of bone forming at dental implant sites.

The effects of antimicrobial sprays and mouthrinses on supragingival plaque regrowth: a comparative study.

BACKGROUND: Due to the side effects of chlorhexidine digluconate (CHX) mouthrinsing, a spray has been proposed as an alternative method of CHX delivery to the oral cavity. The aim of this study was to investigate the plaque inhibitory effects of CHX, cetylpyridinium chloride (CPC), and triclosan (TRN) delivered by sprays and mouthrinses. METHODS: The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 15 healthy volunteers in a 4-day plaque regrowth model. Products being tested (0.2% CHX, 0.12% CHX, 0.05% CPC, and 0.03% TRN) were used both as sprays and mouthrinses. A saline solution served as a negative control. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced using their allocated products. On day 5, subjects were scored for disclosed plaque. RESULTS: CHX sprays (P<0.01) were the most effective sprays in preventing plaque regrowth, without significant differences between the two concentrations tested (P>0.05). TRN spray showed a significant inhibition of plaque regrowth in comparison to the negative control (P<0.05). CPC spray did not differ from saline spray (P>0.05). A similar trend of efficacy was detected for rinses. Although the effect on plaque regrowth observed with CHX rinses was superior to that of CHX sprays (P<0.0003), the latter did not cause side effects (P>0.2). CONCLUSIONS: These findings, together with those from clinical trials, suggest that the CHX-containing sprays may represent an effective alternative to CHX rinses when mechanical oral hygiene has to be avoided in restricted areas. On the contrary, the TRN and CPC sprays showed little or no plaque inhibitory effects.