Dental and composite resin discoloration induced by different hydraulic calcium silicate-based cements: two-year in vitro assessment.

Few long-term studies assess the discoloration induced by hydraulic calcium silicate-based cement on dental structures. In addition, as far as we know, no long-term study has assessed the discoloration induced by these cement on composite resin. This in vitro study aimed to assess, during a period of two years, the discoloration potential of different hydraulic calcium silicate-based cements (hCSCs) on the enamel/dentin structure and composite resin restoration. A total of 40 enamel/dentin discs were obtained from bovine incisors, and 40 composite resin discs (10 mm in diameter × 2 mm thick) were fabricated. A 0.8 mm-deep cavity was made in the center of each disc and filled with the following hCSCs (n=10): Original MTA (Angelus); MTA Repair HP (Angelus); NeoMTA Plus (Avalon); and Biodentine (Septodont). An initial color measurement was performed (T0 - baseline). After 7, 15, 30, 45, 90, 300 days, and two years, new color measurements were performed to determine the color (ΔE00), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and whiteness index (WID). For enamel/dentin, the ΔE00 was significant among groups and periods (p<0.05). NeoMTA Plus had the greatest ΔE00. The NeoMTA Plus group had the greatest ΔE00 after two years for composite resin. Significant reduction in lightness was observed for all groups after two years (p<0.05). The most significant WID values were observed after 30 days for Biodentine (enamel/dentin) and MTA Repair HP groups (composite resin) (p<0.05). The hCSCs changed the colorimetric behavior of both substrates, leading to greater darkening over time. The Bi2O3 in the Original MTA seems relevant in the short periods of color change assessment.

Evaluation and comparison of the effect of incorporating zinc oxide and titanium dioxide nanoparticles on the bond strength and microleakage of two orthodontic fixed retainer adhesives.

BACKGROUND: An adhesive with both proper mechanical and antimicrobial properties seems to be beneficial. We aimed to investigate the effect of zinc oxide (ZnO) and titanium dioxide (TiO2) nanoparticles (NPs) on bond strength and microleakage of two different fixed retainer adhesives. METHODS: In this in vitro experimental study, 168 extracted human incisors were randomly divided into six groups of 28 (eight double-tooth specimens for the bond strength test and 12 specimens for the microleakage test). In three groups: Transbond XT (3M Unitek, Monrovia, CA) without NPs, with 1% ZnO NPs and with 1% TiO2 NPs were applied. The other three groups included Ortho Connect Flow (GC orthodontics, Tokyo, Japan) composite with the same order to bond a 0.175-inch multistrand wire to the lingual surfaces of the teeth. The bond strength was measured using the Universal Testing Machine, and the adhesive remnant index was reported using a stereomicroscope (Nikon, SMZ800, Tokyo, Japan). The dye-penetration method was used to determine the microleakage. RESULTS: For bond strength, there was no significant difference among groups. For microleakage, there was no significant difference between GC and Transbond XT groups. However, in subgroups of Transbond XT, the addition of TiO2 NPs increased the microleakage significantly in comparison with ZnO and control groups (P = 0.011). There was no significant statistical difference between the groups in terms of residual adhesives (P = 0.166). CONCLUSIONS: Through the incorporation of 1% TiO2 and ZnO NPs into the fixed retainer adhesive, the bond strength was maintained within the clinically acceptable range. The addition of TiO2 NPs to Transbond XT significantly increased the percentage of microleakage.

Resistencia a la fuerza de tracción de espigos de fibra de vidrio y anatomizados / Tensile bond strength of fiberglass and anatomized posts

Introducción: Es frecuente el desprendimiento de los espigos de fibra de vidrio por pérdida de adhesión cuando son sometidos a las fuerzas masticatorias. Objetivo: Comparar in vitro la resistencia a las fuerzas de tracción de espigos de fibra de vidrio y anatomizado con un mismo cemento. Métodos: Estudio in vitro, de tipo experimental. Se seleccionaron 20 premolares extraídos por motivos ortodónticos que fueron distribuidos aleatoriamente en dos grupos. Se les realizó el tratamiento de conductos por un especialista, la preparación fue manual y la técnica de obturación por condensación lateral. Los dientes fueron preparados para, en forma estándar, recibir el espigo de fibra de vidrio y anatomizados con resina. Para ambos grupos la cementación siguió el protocolo sugerido por el fabricante de Allcem Core® (cemento dual). Los especímenes fueron troquelados en acrílico de autocurado. Para luego ser sometido a fuerza de tracción vertical en la máquina de pruebas de materiales (Instrom©). Resultados: En el grupo de dientes con espigos anatomizados se obtuvo una media de 31 Kg/F, postes de fibra de vidrio 12,47 Kg/F. Según las pruebas de Shapiro-Wilk, las muestras presentaron distribución normal (p > 0,05). Se contrastó la hipótesis con la prueba de t de Student y se encontró diferencia estadística altamente significativas entre los grupos (p = 0,001) Conclusiones: Existe una mayor resistencia a la tracción vertical en los espigos anatomizados(AU)

Introduction: Fiberglass posts often fall off their position due to loss of adhesive capacity when they are subjected to masticatory force. Objective: Compare in vitro the tensile bond strength of fiberglass and anatomized posts cemented with the same adhesive material. Methods: An in vitro experimental study was conducted. A selection was made of 20 premolars extracted by orthodontic indication which were then randomly distributed into two groups. The premolars underwent root canal treatment by a specialist. The preparation was manual and sealing was performed by lateral condensation. The teeth were prepared in the standard manner to receive the fiberglass and resin-anatomized posts. In both groups' cementation followed the protocol suggested by the manufacturer of Allcem Core® (dual cement). The specimens were stamped in self-curing acrylic. Next, they were subjected to vertical tensile strength in an materials testing machine (Instrom©). Results: The mean values obtained were 31 kg/F for teeth with anatomized posts and 12.47 kg/F for fiberglass posts. According to Shapiro-Wilk tests, the samples exhibited a normal distribution (p > 0.05). The hypothesis was contrasted with Student's t test, obtaining a highly significant statistical difference between the groups (p = 0.001). Conclusions: Vertical tensile bond strength is greater in anatomized posts(AU)

Tooth Discoloration Induced by Different Calcium Silicate-Based Cements: A Two-Year Spectrophotometric and Photographic Evaluation in Vitro.

OBJECTIVE: Calcium silicate-based cements (CSCs) may lead to coronal staining in young permanent teeth over the time. The purpose of this study was to evaluate and compare the long-term tooth discoloration induced by different CSCs. STUDY DESIGN: Ninety freshly-extracted human molars were assigned randomly into 6 groups (n=15/group) according to the CSC used as a pulpotomy material: ProRoot MTA, MTA Angelus, NeoMTA, EndoSequence Putty, Biodentine and Negative control (No cement). The color was assessed at baseline, and thereafter at 3, 6, 12 and 24 months by using both a spectrophotometer and digital images taken with and without a cross-polarizing filter. The time-dependent changes in color (ΔE) were compared within and among groups using Analysis of Variance. RESULTS: Angelus MTA and ProRooT MTA showed severe coronal discoloration (p>0.05) starting at 3 months. ΔE values of NeoMTA, EndoSequence Bioceramic Putty and Biodentine were below the perceptibility threshold, with Biodentine showing greater ΔE values than NeoMTA and EndoSequence Putty in the absence of statistical significance (p>0.05). CONCLUSIONS: Discoloration elicited by CSCs may develop soon after placement, and continue to increase for up to two years. Angelus MTA and ProRooT MTA cannot be recommended for vital pulp therapies in the esthetic zone of young individuals.

Tooth discoloration induced by the different phases of a calcium aluminate cement: One-year assessment.

OBJECTIVES: To assess the discoloration of teeth treated with the different phases of calcium aluminate cement (CAC), in comparison with the conventional CAC and mineral trioxide aggregate (MTA). MATERIALS AND METHODS: Fifty bovine incisors were prepared and filled. Two millimeters of the filling was removed to fabricate a cervical plug with the following cements (n=10): CA(CaO.Al2 O3 ); CA2 (CaO.2Al2 O3 ); C12 A7 (12CaO.7Al2 O3 ); CAC and MTA. The initial color measurement was performed and after 7, 15, 30, 45, 90, 180, and 365 days new color measurements were performed to determine the color (ΔE00 ), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and the whiteness index (WID ). RESULTS: ΔE00 was significant for groups (p = 0.036) and periods (p < 0.05). The greater ΔE00 was observed after 365 days for CAC (12.8). C12 A7 (7.2) had the smallest ΔE00 . ΔL' and ΔC' were significant for groups and periods (p < 0.05). ΔH' was significant for periods (p < 0.05). After 365 days, significant reduction in lightness was observed for all groups. For CA, CA2 , CAC, and MTA groups, the WID values decreased over time (p < 0.05). CONCLUSIONS: The tested cements changed the color behavior of the samples, resulting in greater teeth darkening over time. CLINICAL SIGNIFICANCE: There is no long-term study assessing the discoloration induced by the different phases of CAC.

Secondary caries risk of different adhesive strategies and restorative materials in permanent teeth: Systematic review and network meta-analysis.

OBJECTIVES: Secondary caries is a major long-term complication of dental restorations. Different adhesive strategies and restorative materials may affect secondary caries risk. We aimed to systematically review and synthesize the secondary caries risk of different adhesive strategies and restorative materials. SOURCES: Medline via PubMed 01/2005-10/2019. STUDY SELECTION: Randomized controlled studies with minimum 2 years follow-up, comparing different adhesive strategies and/or restorative materials in permanent teeth were included. Our outcome was the occurrence of secondary caries. Bayesian pairwise and network-meta-analysis were conducted. DATA: We included 50 trials; 19 assessing secondary caries depending on different adhesive strategies, 31 on restorative materials. Studies were published between 2005 and 2017, largely of unclear risk of bias, and included a mean of 40 (range: 8-90) participants and 46 (range: 14-200) placed restorations. Mean follow-up was 43 (range: 24-180) months. Secondary caries was a rare event; the majority of studies did not find any lesions. Network meta-analysis found great uncertainty. 3-step etch-and-rinse adhesives showed the lowest risk of secondary caries, 2-step etch-and-rinse the highest. For restorative materials, resin-modified glass ionomer showed the lowest risk of secondary caries. Most resin composites showed similar risks. CONCLUSION: Data from randomized trials comparing different adhesive strategies or restorative materials are extremely scarce. The differences between materials were limited over the observational period of the included studies. The yielded rankings should be interpreted with caution. CLINICAL SIGNIFICANCE: Despite often claimed to be a major complication of restorations, there is surprisingly little data on secondary caries from randomized trials. Longer-term studies may be needed to identify differences in secondary caries risk between materials.

Progressive myeloneuropathy with symptomatic anaemia.

Hypocupremia is a rare and under-recognised cause of bone marrow dysplasia and myeloneuropathy. A 47-year-old Caucasian woman had progressive ascending peripheral neuropathy and gait ataxia over 3 months and fatigue, dyspnoea and unintentional weight loss over 8 months. She had profound macrocytic anaemia and neutropenia. Initial workup included normal serum vitamin B12 Bone marrow biopsy was suggestive of copper deficiency. Serum copper levels were later confirmed to be undetectable. The patient received oral copper repletion which resulted in complete normalisation of haematological abnormalities 16 weeks later. However, neurological deficits persisted. This case describes a delayed diagnosis of hypocupremia as initially suggested through invasive testing. Associating myeloneuropathy with cytopenia is imperative for accurate and prompt diagnosis of hypocupremia, which can be confirmed by serum analysis alone. Developing an accurate differential diagnosis can help prevent unnecessary procedures. Furthermore, initiating prompt copper repletion prevents further neurological impairment. Neurological deficits are often irreversible.

Peri-implant Mucosal Tissues and Inflammation: Clinical Implications.

PURPOSE: The purpose of this review was to explore the available literature and compile studies that discuss the relevance of the biofilm, onset and progression of disease, critical peri-implant pocket depth, frequency of supportive implant therapy, excess cement, and keratinized peri-implant tissues as related to peri-implant disease. MATERIALS AND METHODS: PubMed, Cochrane Oral Health Group Specialized Trial Register, and hand searches of related journals were performed in relationship to the focused question. Reports describing techniques, preclinical studies, and case reports were excluded. RESULTS: Due to the absence of controlled studies, a meta-analysis could not be performed. Summaries of relevant publications were completed for each topic area. Clinical recommendations were developed to provide guidance to the practitioner. CONCLUSION: The importance of proper diagnosis, planning, and clinical treatment cannot be overstated. Patient factors including systemic disease, periodontal status, and oral hygiene significantly impact peri-implant health. Clinician factors such as implant position, excess cement, and restorative design can contribute to development of peri-implant disease. Surveillance of implant status is essential and can be assisted by the assessment of risk factors, establishment of a proper recall program, and monitoring changes in bone and peri-implant pocket depths.

Comparison of clinical bond failure rates and bonding times between two adhesive precoated bracket systems.

OBJECTIVE: To compare the clinical bracket failure rate and bonding time differences between Adhesive Precoated Flash-Free (APCF) and Adhesive Precoated Plus (APCP) bracket systems. METHODS: Thirty-three patients (7 male and 26 female) with a mean age of 17.2 ± 3.6 years and permanent dentition were included in the study. Total of 660 brackets were bonded by 1 operator with the use of a split-mouth design, and bracket failure rates were observed over 6 months. Bracket bonding time of each group was also evaluated. Bracket failure rates were evaluated by means of chi-square test. One-way analysis of variance (ANOVA) and Tukey honestly significant difference tests were used to evaluate the bonding time differences between groups. RESULTS: The overall, APCF, and APCP bracket failure rates were 1.21%, 1.81%, and 1.51%, respectively. Chi-square test revealed significant differences (P <0.01) between groups in bracket failure rates. The upper left APCP group showed significantly (P <0.05) more failure than the other groups. One-way ANOVA test (P <0.001) showed statistically significant bonding time differences between groups. Bonding time of APCF brackets was significantly shorter than the bonding time of APCP brackets for the same quadrants. Chi-square test did not reveal significant differences (P >0.05) between groups according to adhesive remnant index scores. CONCLUSIONS: Compared with APCP brackets, APCF brackets can reduce the bonding time without increasing bracket failure rate.

Nonsurgical Management of Peri-implant Bone Loss Induced by Residual Cement: Retrospective Analysis of Six Cases.

This report presents six consecutive cases of peri-implantitis associated with residual methacrylate cement. The cases responded to cement removal and disinfection procedures. Six patients, each presenting one methacrylate cement-retained implant restoration and showing peri-implant inflammation and bone loss, were treated. All the cases were negative for bleeding on probing after 6 weeks, and this was maintained at 1 year of follow-up from nonsurgical therapy and crown refixation with alternative and resorbable cement. The treatment effectively solved the inflammation and led to complete restoration ad integrum, as evaluated clinically and radiographically, after 1 year.

Resin Cement: Correspondence with Try-In Paste and Influence on the Immediate Final Color of Veneers.

PURPOSE: To assess the correspondence of shades between try-in pastes and resin cements and their influence on the final color of veneers. MATERIALS AND METHODS: Bovine teeth (n = 140) were prepared and divided into 2 groups (a or b) according to ceramic veneer thickness (0.35 or 0.70 mm). Seventy teeth (n = 70) were distributed in 7 groups (groups 1 to 7a and groups 1 to 7b; n = 10). Try-in pastes and their corresponding resin cements were used according to the value: groups 1a and 1b (value -3); groups 2a and 2b (-2); groups 3a and 3b (-1); groups 4a and 4b (0); groups 5a and 5b (+1); groups 6a and 6b (+2); groups 7a and 7b (+3). Color measurements were performed with spectrophotometer, and the coordinates L* , a* , and b* were obtained. The final color change (ΔE) was calculated from these coordinates: ΔE0 (trial - substrate), ΔE1 (cementation - substrate), and ΔE2 (cementation - trial). The data were analyzed using the Kolmogorov-Smirnov test, the Wilcoxon test, or t-test for paired samples and repeated-measures ANOVA, post hoc Bonferroni, or the Friedman test (p < 0.05). RESULTS: The results indicated no statistically significant difference between the groups comparing ΔE0 and ΔE1 for 0.35 mm thickness laminate veneers, except for groups 2a and 5a. For 0.70 mm thickness laminate veneers, no statistically significant differences were observed between the groups comparing ΔE0 and ΔE1. ΔE2 values for 0.35 mm and 0.70 mm thickness laminate veneers ranged from 1.77 ± 0.81 to 4.99 ± 3.80 and from 1.01 ± 0.73 to 4.66 ± 2.96, respectively. CONCLUSIONS: Try-in pastes correspond with their respective resin cements for most colors investigated. The color of the resin cement may influence the final color of laminate veneers. Thickness of the ceramic was the most relevant variable for color change.

Effects of modifying implant screw access channels on the amount of extruded excess cement and retention of cement-retained implant-supported dental prostheses: A systematic review.

STATEMENT OF PROBLEM: Cement-retained implant-supported prostheses eliminate screw loosening and enhance esthetics. However, retrievability and the possibility of removing extruded excess cement (EEC) have been problematic. PURPOSE: The purpose of this systematic review was to analyze the effects of modifying the screw access channel (SAC) on the amount of EEC and the retention of cement-retained implant-supported prostheses. MATERIAL AND METHODS: PubMed, Web of Science, Scopus, and Google Scholar databases were searched with appropriate key words. Related titles and abstracts published up to June 2017 were screened and selected on the basis of defined inclusion criteria. Full texts of all studies were read and subjected to quality assessments. After the initial search, 1521 articles were included in the study. Of these, 11 studies were subjected to critical appraisal, and 10 of them were reliable enough in methodology to be systemically reviewed. RESULTS: All the studies were in vitro and described a total of 260 specimens. According to the interpreted results, closed SACs caused lower retention with a higher amount of EEC, whereas open SACs caused the reverse. Also, as the abutment height decreased, retention decreased. CONCLUSIONS: Extending the crown's margin into the SAC, leaving the SAC open, and using internal vents in the SAC space are possible methods of modifying the SAC to gain higher retentive values. Also, the use of internal vents in the SAC system and open or partially filled SAC space reduce the amount of EEC.

Randomized controlled clinical study of veneered zirconia abutments for single implant crowns: Clinical, histological, and microbiological outcomes.

OBJECTIVES: To analyze the effect of veneering of the submucosal part of zirconia abutments and the type of retention (cemented vs screw-retained) on clinical, microbiological, and histological outcomes of single-tooth implant crowns. MATERIAL AND METHODS: A total of 44 patients with a single missing tooth to be replaced by an implant in the anterior region participated in the study. Implants were randomly assigned to receive zirconia-based CAD/CAM reconstructions using either one of four treatment modalities: cement-retained with submucosal veneering (CR-P), cement-retained without submucosal veneering (CR-W), screw-retained with submucosal veneering (SR-P), and screw-retained without submucosal veneering (SR-W). Clinical parameters were assessed at baseline (after crown insertion), at 6 and 12 months. Histological and microbiological analyses were performed at 6 months. Descriptive statistics and the Kruskal-Wallis test were applied. RESULTS: The clinical evaluation revealed, in general, stable peri-implant soft tissues with minimal differences for all measured parameters between the four groups, except for bleeding on probing with the two cemented groups exhibiting higher values at 12 months (35.0% ± 26.5% for CR-W and 25.0% ± 38.8% for CR-P versus 13.1 ± 14.8 for SR-W and 13.0 ± 18.2 for SR-P). The descriptive and semi-quantitative histology showed a trend for a higher inflammatory reaction in the two cemented (a medium to high number of inflammatory cells) compared to the screw-retained groups (low number of inflammatory cells) at 6 months. The microbiological test demonstrated low bacterial counts and a similar distribution in between the groups except for two species (Tannerella forsythia and Peptostreptococcus micros) that were found in higher counts in the cemented groups at 6 months. CONCLUSION: Submucosal veneering of zirconia abutments did not negatively affect the health of the peri-implant tissues. The cemented groups, though, did show a clinical and histological trend to higher levels of inflammation.

Evaluation of Radiopacity of Luting Cements Submitted to Different Aging Procedures.

PURPOSE: To evaluate the radiopacity of luting cements submitted to different aging procedures. MATERIALS AND METHODS: Twenty discs (1 × 4 mm) of each of the following cements were prepared: zinc phosphate, RelyX Luting 2, Variolink 2, AllCem, RelyX U200, Multilink, Panavia F2.0, and RelyX ARC. Then, they were randomly divided into two groups (n = 10/group), according to the aging procedure: thermal cycling group and water storage group. Before and after aging procedures, specimens were x-rayed with an aluminum step-wedge (11 steps, 1 mm thick each) and three dental slices (1 mm thick). The radiopacity was evaluated by means of optical density, which was measured using ImageJ software. The values were converted into millimeters of aluminum with a logistic regression calibration curve. The data were analyzed by one-way ANOVA and Tukey post-hoc test (α = 0.05). RESULTS: In the thermal cycling group, RelyX Luting 2, RelyX U200, and Panavia F2.0 showed a statistically significant reduction in radiopacity (p < 0.05). In the water storage group, all cements showed a significant reduction in radiopacity (p < 0.05), and RelyX Luting 2 and Panavia F2.0 performed below the desired ISO 4049 standard. CONCLUSIONS: The radiopacity of luting cements can decrease after aging, especially after 1-year water storage.

Tooth color change due to different etching and debonding procedures.

OBJECTIVES:: To compare the effects of different etching techniques, 12-, 24-bladed tungsten carbide burs, and polishing discs on tooth color changes during orthodontic treatment. MATERIALS AND METHODS:: 59 individuals (mean age: 15.20 ± 1.59 years) were divided into four groups: 37% phosphoric acid and adhesive primer was used in Groups I and II whereas self-etch primer was used in Groups III and IV for enamel preparation. After orthodontic treatment, residual adhesives were cleaned with 12-bladed tungsten carbide burs in Groups I and III, while 24-bladed tungsten carbide burs were used in Groups II and IV. All teeth were polished with medium and fine Sof-Lex XT discs (3M ESPE, St Paul, Minnesota). Color measurements were taken from upper incisors and canines at pretreatment (T0), after cleaning with tungsten carbide burs (T1) and polishing with discs (T2). Wilcoxon test was used for evaluation of L*, a*, b* changes and Kruskal-Wallis for intergroup comparison of color changes. RESULTS:: L*, a*, b* values, except a* at Groups I, II, IV, and b* at Group III, changed significantly ( P < .05). Groups III and IV showed significantly different color alterations from T0 to T1 ( P < .05). After polishing, tooth color alterations were not significantly different among the groups. CONCLUSIONS:: In self-etch bonding groups, a 12-bladed tungsten carbide bur caused less color change than the 24-bladed tungsten carbide bur. Orthodontic treatment resulted with visible and clinically unacceptable tooth color alterations regardless of the enamel preparation and clean-up techniques. Polishing reduced the effect of tungsten carbide burs, but did not affect the total influence of orthodontic treatment on the tooth color.

Impact of dental cement on the peri-implant biofilm-microbial comparison of two different cements in an in vivo observational study.

BACKGROUND: The type of cement used in cemented fixed implant-supported restorations influences formation of undetected excess cement and composition of the peri-implant biofilm. Excess cement and dysbiosis of the biofilm involve the risk of peri-implant inflammation. PURPOSE: The aim of the study was to investigate the impact of two different cements on the peri-implant biofilm and inflammation. MATERIALS AND METHODS: In an observational study, the suprastructures of 34 patients with cemented fixed implant-supported restorations were revised. In 20 patients, a methacrylate cement (Premier Implant cement [PIC]) and in 14 patients, a zinc oxide eugenol cement (Temp Bond [TB]) were used. After revision, TB was used for recementation. During revision and follow-up after 1 year, microbial samples were obtained. RESULTS: Excess cement was found in 12 (60%) of the 20 patients with PIC. Suppuration was observed in two (25%) implants with PIC without excess cement (PIC-) and in all 12 (100%) implants with PIC and excess cement (PIC+). Implants cemented with TB had neither excess cement nor suppuration. The taxonomic analysis of the microbial samples revealed an accumulation of periodontal pathogens in the PIC patients independent of the presence of excess cement. Significantly, fewer oral pathogens occurred in patients with TB compared to patients with PIC. TB was used in all cases (PIC and TB) for recementation. In the follow-up check, suppuration was not found around any of the implants with PIC-, only around one implant with PIC+ and around one implant with TB. Bacterial species associated with severe periodontal infections that were abundant in PIC- and PIC+ samples before the revision were reduced after 1 year to levels found in the TB samples. CONCLUSIONS: The revision and recementation with TB had a positive effect on the peri-implant biofilm in cases with PIC. The cementation of suprastructures on implants with TB is an alternative method to be considered.

Platform Switching and Screw- and Cement-Retained Restorations: Effects on Peri-Implant Tissue Health and Disease.

As dental implant therapy has evolved since its early days more than five decades ago, its effects have been mostly extremely positive. However, over the course of time, several undesirable, unanticipated consequences have also materialized, most notably peri-implant disease. In this article, the authors propose that many of the challenges clinicians see today regarding increased peri-implant disease represent negative effects of interventions that, though well-intended, had unforeseen shortcomings. Sufficient time has now passed for these adverse effects to manifest, and clinicians today are better able to understand how their attempts to solve problems in some ways produced new challenges. The article also shows how new innovations in engineering and digital technology allow clinicians to address the problems of the past and avoid increasing the risk of peri-implant disease.