Influence of gingival color on the color differences of dental laminate veneers.

STATEMENT OF PROBLEM: The effect of various gingival colors on the color differences of laminate veneers is unclear and comparative evaluations should be documented. PURPOSE: The purpose of this in vitro study was to investigate the influence of different gingival colors on the color differences of laminate veneers. MATERIAL AND METHODS: Five maxillary typodonts were used to obtain study models using 5 different gingival colors: light pink (LP), dark pink (DP), orange (Or), brown (Br), and violet (V). A total of 45 laminate veneers were milled using A1-shaded lithium disilicate ceramic and cemented on natural tooth-colored substrates. Color parameters were assessed using a spectroradiometer at 3 measurement areas (cervical third, mid-third, and incisal third) along the midline of laminate veneer with a focus measuring diameter of 1 mm. Color differences (∆E*ab and ∆E00) were calculated and compared with perceptibility (PT: ∆E*ab=1.22, ΔE00=0.81) and acceptability (AT: ∆E*ab=2.66, ΔE00=1.77) visual thresholds. Color variation data were statistically analyzed using 2-way ANOVA and Tukey HSD tests (α=.05). RESULTS: Two-way ANOVA results of the ∆E*ab values revealed significant interaction between the gingival color and the measurement area (P=.002). The ∆E*ab and ΔE00 values of laminate veneers were significantly higher in the LP-V group that presented values above AT (P<.001). Measurement area significantly influenced ∆E values of laminate veneers (P<.001). Greater ∆E values were registered at the measurement area of the cervical third in the groups of LP-DP, LP-Br, LP-V, and Or-V. Regardless of the measurement area, ∆E00 values below AT were obtained for the gingival color groups of LP-Or, DP-Or, DP-Br, and DP-V. CONCLUSIONS: Gingival color influenced the color differences of laminate veneers. When the gingival color was a darker gingival color, rather than light pink, the color difference increased, especially at the measurement area of the cervical third.

Masking ability of gingiva-colored resin-based composites over different tooth-colored substrates.

The purpose of the study was to investigate the influence of different tooth-colored substrates and restoration thicknesses on the final color of gingiva-colored resin-based composites (GCRBCs). Five different shades of GCRBCs [light pink (LP), dark pink (DP), orange (Or), brown (Br), and purple (P)] were used to prepare disc-shaped specimens with 2 different thicknesses: 1.0 mm, and 2.0 mm. GCRBC discs (n = 5) were placed over 3 different tooth-colored substrates (ND1, ND5, and ND9) and color parameters were assessed using a spectroradiometer. Color differences (∆E*ab and ∆E00) were calculated using CIELab and CIEDE2000 formulas and compared to 50:50% perceptibility (PT: ∆E*ab = 1.7, ΔE00 = 1.1) and acceptability (AT: ∆E*ab = 3.7, ΔE00 = 2.8) visual thresholds. Color variation data were statistically analyzed using two-way ANOVAs followed by Bonferroni's post hoc tests (a = 05). The ∆E*ab and ΔE00 values of GCRBCs placed over ND9 substrates were significantly higher in the LP-1.0 mm and Or-1.0 mm groups that presented values above AT (p< .001).Regardless of the substrate color and GCRBC thickness applied, ∆E*ab and ΔE00 values below AT were recorded in the gingival color groups of P. Substrate color significantly affected the color differences in the gingival color groups of LP, DP, and Or with a restoration thickness of 1.0 mm (p < .05). Gingival color, restoration thickness, and substrate color influenced the color differences of GCRBCs. When the gingival color was a lighter gingival color, rather than dark purple, the masking ability was decreased, especially with a restoration thickness of 1.0 mm.

Evaluation of occlusion types, pain severity, and onset of complaints in 127 patients with temporomandibular disorders: A retrospective study.

Objective: The aims of this study are to evaluate if occlusal types affect the type of temporomandibular disorders and if the onset of complaints are related to the type of internal derangements. Methods: One hundred thirty-four patients were evaluated. Occlusion types were grouped as Angle Class I, II, and III. The temporomandibular disorders were classified as masticatory muscle disorders, anterior disc dislocation with reduction, and anterior disc dislocation without reduction. Results: No significant relationships were found between the occlusion types, pain severity, the onset of the complaints, and the temporomandibular disorders. Premature contacts were found to be significantly higher in Class II and Class III patients, but no significant relations were found between premature contacts and temporomandibular disorders. Discussion: Occlusal features are not discriminant factors in the occurrence of temporomandibular disorders. Also, it cannot be concluded that the longer the patients have temporomandibular disorders, the higher their pain scores will be.

In vitro study of effects of aging and processing conditions on colour change in maxillofacial silicone elastomers.

BACKGROUND: The inherent colour change in maxillofacial silicone elastomers becomes perceptible 6-12 months after fabrication. Determining the factors that accelerate the degradation of the prosthesis can help the clinicians increase its life span. Therefore, the aim of the study was to investigate the effect of time passage, processing temperature, and molding-stone colour on the colour change of maxillofacial silicone elastomers after darkroom storage for 6000 h. METHODS: A total of ten study molds, each incorporating ten specimen gaps were fabricated using five different colors of dental stones. The gaps were filled with coloured Cosmesil M511 maxillofacial silicone elastomer. Five of the study molds, one of each stone color, were processed at room temperature (25 °C) for 24 h while the remainder were vulcanized at 100 °C for 1 h. Two stainless-steel molds were also fabricated to obtain a total of twenty control-group specimens of the same dimensions that were processed under the same conditions as the study molds. Colour measurements of the vulcanized silicone samples were performed using a Konica Minolta spectrophotometer. Initial measurements were obtained after the blocks were removed from the molds and the final measurements were recorded 6000 h after storage in the dark at 25 °C and 40% relative humidity. The CIEDE2000 colour-difference formula was used to measure the changes in the colour. One-way and two-way ANOVA, and an independent-sample t-test were used for statistical assessments. RESULTS: For every group, the colour change exceeded the perceptible thresholds. Thus, either the vulcanization temperature or the colour of the molding stone has a significant effect on the colour change over time. Those samples vulcanized in green and white molding stones at 100 °C exhibited a significantly higher ∆L*, ∆a*, and ∆b* values relative to the samples vulcanized at room temperature. CONCLUSION: The molding-stone colour and vulcanization temperature both affect the degree of colour change after storage in a dark environment. The L*, a*, and b* values for the maxillofacial silicone elastomers are influenced by the direction of the increase or decrease according to the selected colour. This effect varies as the temperature increases.

Effect of vulcanization temperature and dental stone colour on colour degradation of maxillofacial silicone elastomers.

BACKGROUND: Colour degradation is a major problem in maxillofacial silicone elastomers. Recent studies have focused on colour stability and the mechanical properties of the silicone elastomers. A colour match is also essential for the acceptance of the prosthesis by the patient. The aim of this study is to assess the colour degradation of the silicone elastomer after being moulded in different colours of dental stones at two different vulcanization temperatures. METHODS: Five different colours of dental stones were used to fabricate a total of 120 silicone blocks using a Cosmesil M511 maxillofacial silicone elastomer. Vulcanization was completed at two different temperatures (25 and 100° Celsius). Colour measurements were obtained with a Conica Minolta spectrophotometer. The CIEDE2000 formula was used to calculate the colour differences (∆E00). Two-way ANOVA, one-way ANOVA with Bonferroni corrected post-hoc p values and independent samples t-test were used for the statistical analyses. RESULTS: High temperature vulcanization causes lightening of the maxillofacial silicone elastomers without regard to the dental stone colour (p = 0.001). Specimens moulded in green stone lightened least at room temperature (p = 0.999). Compared to the control group, at high temperature, all specimens moulded in coloured dental stones darkened significantly (p < 0.001 for white, blue and yellow; p = 0.006 for green; p = 0.045 for reddish-brown). In the high temperature group, the shift to a green chroma was significant in the white, yellow and green dental stones groups (p = 0.001, p = 0.002, p < 0.001, respectively). The mean b* of the high temperature control group was higher than that of the room temperature control group (p < 0.001). The only ∆E00 score lower than the perceptibility threshold for dental materials (∆E00 = 1.30) was between the room temperature control group and the room temperature green dental stone group (∆E00 = 0.96). CONCLUSIONS: Green and blue dental stones cause less colour degradation in silicone elastomers. Reddish-brown dental stones cause the most colour degradation in silicone elastomers. At 100 °C, the colour of the silicone elastomer lightens and yellows even if the elastomer is vulcanized in a stainless steel mould. White, yellow and reddish-brown dental stones make the silicone elastomer appear more yellow even if the elastomer is vulcanized at room temperature.

Soft Tissue Response and Survival of Extraoral Implants: A Long-Term Follow-up.

Maxillofacial defects may be reconstructed by plastic surgery or treated by prosthetic mean rehabilitation. In case of large defects, prosthetic rehabilitation rather than surgical reconstruction is preferred due to the insufficient esthetic results of surgical interventions. However, retention of the craniofacial prosthesis is a great problem despite the satisfactory esthetic results. With the presentation of extraoral implants, the retention of maxillofacial prostheses was improved, and osseointegrated craniofacial implants have become indispensable for retention and stability. However, there are conflicting results regarding the success rates of osseointegrated implants used at the craniofacial region. A total of 24 patients with 64 implants (30 in auricular region of 13 patients, 24 in nasal region of 8 patients, and 10 in orbital region of 3 patients) ranging in age from 16 to 83 years (mean age = 45.45 years) were evaluated. One patient among 13 patients (1/13) has lost his implants in the auricular area, 1 patient among 8 patients (1/8) lost his implants, and 1 patient among 3 patients (1/3) has lost all of her implants. Peri-implant soft tissue response was evaluated for a 60-month period and a total of 654 visits/sites recorded. Grade 0 (no irritation) was present in 72.8% (476/654) of the visits/sites. Grade 1 (slight redness) was observed for 18.8% (123/654). Grade 2 (red and slightly moist tissue) was scored in 6.9% (45/654). Grade 3 (red and slightly moist tissue with granulation) was noted in 1.5% (10/654) and grade 4 (infection) could not be found. Ossseointegrated implants provide reasonable support and show successful results when used with maxillofacial prostheses.

Early results of low-level laser application for masticatory muscle pain: a double-blind randomized clinical study.

BACKGROUND: To evaluate the effect of Low Level Laser (LLL) application at the points of greatest pain in patients with chronic masticatory muscle pain. METHODS: A total number of 30 (21 women, 9 men, with a mean age of 39.2) were selected after the diagnosis of MPDS according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD). The patients were randomly divided into three groups; laser group I (n = 10); patients received the LLL at the point of greatest pain, laser group II (n = 10); patients received LLL at pre-established points in the effected muscles and placebo group (n = 10). LLL and placebo were applied three times per week, for a total of 12 sessions. Mandibular mobility was examined, masticator muscles tenderness were assessed and PPT values were obtained. Subjective pain levels were evaluated using VAS. The measurements performed before the treatment and after the completion of the therapy. Descriptive statistics (mean, standard deviation, and frequency) Student's t-test, Mann-Whitney U-test and paired-sample t-tests were used for analysis. RESULTS: In both laser groups, there was a statically significant reduction in PPT values of the muscles, number of muscles without any pain on palpation increased significantly, mandibular movements' ranges were improved. Laser group I demonstrated statistically better results than the Laser group II in all of the measured values. Plasebo group did not show any statistically difference in any of the measured values. CONCLUSIONS: LLLT can be accepted as an alternative treatment modality in the management of masticatory muscle pain and direct irradiation seems to effect better. TRIAL REGISTRATION: Current Controlled Trials ISRCTN31085 , Date of registration 28/08/20145.

Zygoma Implant-Supported Prosthetic Rehabilitation of a Patient After Bilateral Maxillectomy.

Maxillectomy defects may vary from localized to extensive soft and hard tissue loss. In addition to physical and psychologic damages, functional and aesthetic aspects must be restored. This clinical report describes the rehabilitation of a patient with a zygoma implant-supported obturator prosthesis caused by a subtotal bilateral maxillectomy due to a squamous oral cell carcinoma. Prosthetic rehabilitation of this patient was performed after zygoma implant surgery. A maxillary obturator prosthesis supported by 2 osseointegrated zygoma implants was fabricated. Despite limited mouth opening and anatomic deficiencies, the patient's aesthetic and functional demands were fulfilled.

A surface roughening technique for maxillofacial prostheses.

Giving a natural surface texture to the maxillofacial prostheses is one of the major goals for the maxillofacial prosthodontists. This article describes a technique for application of an antiskid epoxy resin to the surface of the definitive mold before pouring the maxillofacial silicone elastomer. This technique produces evenly distributed and same-size pores that are more similar to the natural appearance of human skin.

Comparative evaluation of the effects of implant position, impression material, and tray type on implant impression accuracy.

PURPOSE: To evaluate the effect of implant position, impression, and tray material on the accuracy of implant impressions of edentulous arches with multiple implants. MATERIALS AND METHODS: Four experimental groups were produced; medium-viscosity polyvinyl siloxane (PVS) was used in 3 groups and polyether was used in 1 group. In PVS groups, different tray types were used; metal stock trays, custom acrylic tray, and full-arch perforated plastic trays. In polyether group, custom acrylic trays were used. The discrepancies in 3 dimensions were measured. RESULTS: The casts obtained exhibited small deviations (7.50-9.71 µm) from the master cast. There was no statistically significant difference between the polyether and PVS groups. Similarly, different tray materials did not produce any statistically significant discrepancies within the PVS groups. There was no significant difference among the groups when the accuracy of anterior implants were compared, but within-the-group comparisons showed that except group 1 (GR1), the posterior implants demonstrated more accuracy than anterior ones. CONCLUSIONS: Polyether and PVS can safely be used for the impressions of the edentulous arches with multiple implants and different tray types produce similar accuracy results.

Shear bond strength of a new self-adhering flowable composite resin for lithium disilicate-reinforced CAD/CAM ceramic material.

PURPOSE: The purpose of this study was to evaluate and compare the effects of different surface pretreatment techniques on the surface roughness and shear bond strength of a new self-adhering flowable composite resin for use with lithium disilicate-reinforced CAD/CAM ceramic material. MATERIALS AND METHODS: A total of one hundred thirty lithium disilicate CAD/CAM ceramic plates with dimensions of 6 mm × 4 mm and 3 mm thick were prepared. Specimens were then assigned into five groups (n=26) as follows: untreated control, coating with 30 µm silica oxide particles (Cojet™ Sand), 9.6% hydrofluoric acid etching, Er:YAG laser irradiation, and grinding with a high-speed fine diamond bur. A self-adhering flowable composite resin (Vertise Flow) was applied onto the pre-treated ceramic plates using the Ultradent shear bond Teflon mold system. Surface roughness was measured by atomic force microscopy. Shear bond strength test were performed using a universal testing machine at a crosshead speed of 1 mm/min. Surface roughness data were analyzed by one-way ANOVA and the Tukey HSD tests. Shear bond strength test values were analyzed by Kruskal-Wallis and Mann-Whitney U tests at α=.05. RESULTS: Hydrofluoric acid etching and grinding with high-speed fine diamond bur produced significantly higher surface roughness than the other pretreatment groups (P<.05). Hydrofluoric acid etching and silica coating yielded the highest shear bond strength values (P<.001). CONCLUSION: Self-adhering flowable composite resin used as repair composite resin exhibited very low bond strength irrespective of the surface pretreatments used.

Influence of acrylic resin polymerization methods on residual monomer release.

AIM: The aim of this study was to quantify and compare the amount of methyl methacrylate (MMA) monomer released from three different denture base acrylic material processed by different polymerization methods and storage conditions. MATERIALS AND METHODS: Microwave-cured, conventional heat and injection-technique acrylic polymerized materials were stored in neutral (pH = 7) and acidic (pH = 4.5) artificial saliva for 24 hours at the room temperature, separately. The residual MMA content was determined by high performance liquid chromatography (HPLC). RESULTS: The MMA leaching from resins showed that microwave-cured material has lower residual MMA leach compared both conventional and injection-technique on neutral saliva storage conditions. CONCLUSION: The all data's exhibited higher MMA release into an acidic saliva environment than neutral artificial saliva and there were no significant differences between the materials groups on acidic saliva storage conditions. CLINICAL SIGNIFICANCE: Microwave polymerization method might has some advantages on reducing release of MMA concentration and may contributory effect upon polymerization reaction on neutral pH storage condition, therefore methods of polymerization should be considered as amount of monomer release.

Implant-supported oral rehabilitation of a patient with pemphigus vulgaris: a clinical report.

Pemphigus vulgaris (PV) is a rare mucocutaneous vesiculobullous disease characterized by the development of autoantibodies against the desmosomal proteins. Current treatment is largely based on systemic immunosuppression using systemic corticosteroids. Immunosuppressive drugs used in the treatment of the disease may increase the risk of infection and delayed healing, which are of concern in dental treatment procedures in this group of patients. The clinical outcomes of implants in PV have not been investigated. We present a case of PV rehabilitated with an implant-supported prosthesis with a 32-month follow-up and discuss the important points in the surgical and prosthodontic phases.