Bonding Effectiveness of Saliva-Contaminated Monolithic Zirconia Ceramics Using Different Decontamination Protocols.

Objective: This research study investigated the effect of new decontamination protocols on the bonding capacity of saliva-contaminated monolithic zirconia (MZ) ceramics cemented with two different monomer-containing self-adhesive resin cements. Materials and Methods: Standardized tooth preparations (4 mm. axial height) were performed for eighty human maxillary premolars under constant water cooling system. Eighty monolithic zirconia crowns (Whitepeaks Supreme Monolith) (n = 8/10 groups) were manufactured by CAD-CAM. Specimens were kept in the artificial saliva at pH = 7.3 for 1 minute at 37°C except control groups. The specimens have not been prealumina blasted and grouped according to cleaning methods and resin cements: control groups (C) (no saliva contamination + GPDM + 4-META (N) (CN) and 10-MDP (M) containing resin cement (CM), alumina blasted (AL) + GPDM + 4-META (ALN) and 10-MDP containing resin cement (ALM), zirconium oxide containing universal cleaning agent (IC) applied + GPDM + 4-META (N) (ICN) and 10-MDP containing resin cement (ICM), pumice (P) applied + GPDM + 4-META (PN) and 10-MDP containing resin cement (PM), and air-water spray (AW) applied + GPDM + 4-META (AWN) and 10-MDP containing resin cement (AWM)). Monobond Plus was applied to all surfaces for 40 seconds before cementation. The thermal cycle was applied at 5,000 cycles after cementation. The crowns were tested in tensile mode at a speed of 1 mm/min. The mode of failure was recorded. SEM examinations were carried out at different magnifications. Data were analyzed using rank-based Kruskal-Wallis and Mann-Whitney tests. Results: No significant differences were found between the surface treatments and between the two types of resin cements. Interaction effects between surface treatments and resin cements were found to be significant by two-way ANOVA analysis. ICM group resulted in significantly better bond strength results compared with CN. ICM was found to result in better bond strength results compared with PM. The combination of universal cleaning agent and 10-MDP containing resin cement had significantly the highest cementation bond strength values. The increasing order of mean tensile bond strength values of decontamination protocols was C < AW < P < AL < IC. The mean tensile bond strength of 10-MDP containing resin cement was slightly higher than GPDM + 4-META containing resin cement. Conclusions: Universal cleaning agents can be preferred as an efficient cleaning method with 10-MDP-containing cement after saliva contamination for better adhesive bond strength of 4 mm crown preparation height of monolithic zirconia ceramics.

Effectiveness of Different Methods in Removing Dentin Caries of Primary Teeth: Micro-CT and SEM Evaluation.

OBJECTIVES: With the recent improvements in technology, the expectation of minimal invasion and maximal comfort in caries removal techniques is increasing. This study aims to examine the effectiveness of six caries removal methods in primary teeth. STUDY DESIGN: Sixty primary molars (10 teeth in each groups) were used. The groups were: Group I (Tungsten Carbide Bur), Group II (Sono abrasion), Group III (Air abrasion), Group IV (Carisolv), Group V (Er:YAG Laser), Group VI (ART). In micro-CT scanning, mineral density at the cavity floor was examined before and after caries removal. After caries removal, the patency of the dentinal tubules was examined in two teeth from each group on SEM images. Statistical analyses were performed using Kruskal-Wallis, Wilcoxon tests. RESULTS: For six different caries removal methods, tooth mineral (inorganic, total) densities at cavity floors were compared among the groups after the procedures, and no statistically significant difference was found (p>0.05). On the SEM images, it was seen that the dentinal tubules were exposed and no smear layer was formed in the Carisolv group. Significant rough surfaces were exposed in the laser group. CONCLUSION: It was observed that alternative caries removal methods are at least as effective as the traditional method in primary teeth for clinical applications.

3D micro-CT analysis of void formations and push-out bonding strength of resin cements used for fiber post cementation.

PURPOSE: To investigate the void parameters within the resin cements used for fiber post cementation by micro-CT (µCT) and regional push-out bonding strength. MATERIALS AND METHODS: Twenty-one, single and round shaped roots were enlarged with a low-speed drill following by endodontic treatment. The roots were divided into three groups (n=7) and fiber posts were cemented with Maxcem Elite, Multilink N and Superbond C&B resin cements. Specimens were scanned using µCT scanner at resolution of 13.7 µm. The number, area, and volume of voids between dentin and post were evaluated. A method of analysis based on the post segmentation was used, and coronal, middle and apical thirds considered separately. After the µCT analysis, roots were embedded in epoxy resin and sectioned into 2 mm thick slices (63 sections in total). Push-out testing was performed with universal testing device at 0.5 mm/min cross-head speed. Data were analyzed with Kruskal-Wallis and Mann-Whitney U tests (α=.05). RESULTS: Overall, significant differences between the resin cements and the post level were observed in the void number, area, and volume (P<.05). Super-Bond C&B showed the most void formation (44.86 ± 22.71). Multilink N showed the least void surface (3.51 ± 2.24 mm(2)) and volume (0.01 ± 0.01 mm(3)). Regional push-out bond strength of the cements was not different (P>.05). CONCLUSION: µCT proved to be a powerful non-destructive 3D analysis tool for visualizing the void parameters. Multilink N had the lowest void parameters. When efficiency of all cements was evaluated, direct relationship between the post region and push-out bonding strength was not observed.

Physical properties of different orthodontic cements.

INTRODUCTION: We evaluated the water absorption, solubility, and compressive strength of different cements and resin-modified glass ionomer cements (RMGICs), namely Adhesor®, Ketac(™) Cem, Ortho Band Paste LC(™), Glass Ionomer Band Cement, and Transbond(™) Plus. Our aims were to compare the mechanical and physical properties of the cements widely used in orthodontics and to define the most suitable cements in an oral environment in terms of those characteristics. MATERIALS AND METHODS: To assess compressive strength, the cements were subjected to compression tests done on a universal testing machine. To test water absorption and solubility, the weight changes in cement specimens were determined after immersion in distilled water for 1, 7, and 30 days. RESULTS: Adhesor® and Ketac(™) Cem presented significantly higher solubility values than other cements after water immersion for 1, 7, and 30 days (p < 0.001). CONCLUSION: Our results revealed that the traditional orthodontic cements have higher water solubility and water absorption values as well as lower compressive strength values than the RMGICs used in this study. Furthermore, Transbond(™) Plus revealed the highest compressive strength, whereas Adhesor® showed the lowest.

Effectiveness of two different splints to treat temporomandibular disorders.

Nearly 5% of the the world's population has temporomandibular disorder (TMD) severe enough to make them seek treatment. A third of the total population has at least one TMD symptom. There are different types of splints to treat TMD. In our study, we compared the success of two different appliances [stabilization splint (ss), nociceptive trigeminal inhibition splint (NTI)] by using Fonseca's questionnaire, the OHQoL-UK and visual analog scale (VAS). A total of 40 patients suffering from TMD were included in this study and answered questionnaires twice, at the beginning of the treatment and 3 months later. Regarding TMD alone, 39 patients (97.5%) had some degree of the disorder, 7 of of these cases being mild (17.5%), 15 moderate (37.5%), and 17 severe (42.5%). We analyzed posttreatment changes compared to baseline. Pain complaints decreased in both groups, and the OHQoL-UK revealed better quality of life after treatment. Based on the posttreatment Fonseca's questionnaires, significant changes in the patients' complaints in the group SS (p < 0.01) were observed. The group NTI also displayed changes but these were not statistically significant after treatment (p > 0.05). Patients in both groups had fewer TMD complaints after TMJ treatment. According to the Fonseca's questionnaire, the patients' major TMD complaint was clenching-grinding, followed by pain in the craniomandibular joint, or earache.

Evaluation on shear bond strength of different glass ionomer and hydroxy apatite cements used in ossiculoplasty.

BACKGROUND: Glass ionomer cements (GIC) have been widely used in dentistry for many years. In recent years, GIC have also been used for ossiculoplasty. The bond strength of GIC used in ossiculoplasty and the way they may change over the years in the cementation area are being questioned. The bonding strength of the substance may be of importance for long-term outcomes. AIMS: The aim of this study was to investigate the bond strength of different GIC on ossicles. STUDY DESIGN: In vitro study. METHODS: Twenty ossicles were obtained from patients who had undergone ear surgery. All specimens were randomly divided into four subgroups. All specimens were inserted into a specially designed apparatus for shear bond strength (SBS) testing. The tested materials [Aqua Meron (AM), Aqua Cem (AC), Ketac Cem (KC), and Otomimix CPB (OH)] were prepared and applied according to the manufacturer's instructions. The SBS was tested using a universal testing machine at a crosshead speed of 0.5 mm/min. RESULTS: The mean SBSs were found to be 13.28 MPa, 23.43 MPa, 8.51MPa, and 1.78 MPa for AM, AC, KC, and OH, respectively. AC had the highest SBS, which was statistically significantly different from that of KC and OH (p<0.05). Both AM and KC had higher SBS than OH (p<0.05). CONCLUSION: The results obtained in this study by investigating the bone-bonding strength of cements widely used in ossiculoplasty demonstrate that some of these substances have a greater ability to bond to ossicles compared to others. Further clinical investigations are needed to test different parameters.

Cytotoxicity of temporary cements on bovine dental pulp-derived cells (bDPCs) using realtime cell analysis.

PURPOSE: To evaluate the cytotoxicity of temporary luting cements on bovine dental pulp-derived cells (bDPCs). MATERIALS AND METHODS: Four different temporary cements were tested: Rely X Temp E (3M ESPE), Ultratemp (Ultradent), GC Fuji Temp (GC), and Rely X Temp NE (3M ESPE). The materials were prepared as discs and incubated in Dulbecco's modified eagle's culture medium (DMEM) for 72 hours according to ISO 10993-5. A real-time cell analyzer was used to determine cell vitality. After seeding 200 µL of the cell suspensions into the wells of a 96-well plate, the bDPCs were cured with bioactive components released by the test materials and observed every 15 minutes for 98 hours. One-way ANOVA and Tukey-Kramer tests were used to analyze the results of the proliferation experiments. RESULTS: All tested temporary cements showed significant decreases in the bDPCs index. Rely X Temp E, GC Fuji Temp, and Rely X Temp NE were severely toxic at both time points (24 and 72 hours) (P<.001). When the cells were exposed to media by Ultratemp, the cell viability was similar to that of the control at 24 hours (P>.05); however, the cell viability was significantly reduced at 72 hours (P<.001). Light and scanning electron microscopy examination confirmed these results. CONCLUSION: The cytotoxic effects of temporary cements on pulpal tissue should be evaluated when choosing cement for luting provisional restorations.

Micro-CT Detection and Characterization of Porosity in Luting Cements.

PURPOSE: To evaluate porosity volume and localization in luting cements under fixed dental prostheses after cementation using micro-computed tomography (CT). MATERIALS AND METHODS: Seventy-seven sound molars were circumferentially prepared to receive all-ceramic crowns, and IPS e.max ceramic copings were fabricated according to the manufacturer's instructions. For this study, different dental luting cements were used: eight resin-based cements (Variolink II, RelyX ARC, Clearfil Esthetic, BisCem, RelyX U100, Panavia EX, Super Bond C&B, and Multilink Automix), one resin-modified glass ionomer (Ketac Cem Plus), one glass ionomer (Ketac Cem), and one polycarboxylate (Durelon). Specimens were scanned with a micro-CT (SkyScan) for detection and comparison of the cements' porosities. Statistical analyses were performed using Kruskal-Wallis one-way ANOVA and Bonferroni's adjusted Mann-Whitney U tests. RESULTS: Multilink Automix (Volume = 0.11 ± 0.08 mm3 ; Surface Area = 1.63 ± 1.31 mm2 ), Ketac Cem Plus (Volume = 0.22 ± 0.21 mm3 ; Surface Area = 4.32 ± 3.71 mm2 ), and Variolink II (Volume = 0.34 ± 0.38 mm3 ; Surface Area = 6.47 ± 5.10 mm2 ) contained less porosity (p < 0.001) than all other cements. All other cements were not significantly different from one another (p > 0.05); however, the volume and surface area of the porosity found in the other tested luting cements were significantly greater than those of the Multilink Automix, Ketac Cem Plus, and Variolink II (p < 0.001), all of which demonstrated no significant differences (p > 0.05). CONCLUSION: The liquid and powder forms prepared by manually mixing the cements were found to cause greater porosity.

Porcelain laminate veneer conditioning for orthodontic bonding: SEM-EDX analysis.

The purpose of this in vitro study was to evaluate and compare the effects of different surface treatments and laser irradiation on the bond strength of brackets bonded to porcelain laminate veneer. Porcelain laminate veneer specimens were embedded in the centers of acrylic resin blocks. Thirty-nine teeth were used for shear bond strength testing and the remaining three (one tooth for each group) were used for evaluation of the debonded bracket interface. Specimens were randomly divided into three groups, each containing 13 specimens. The details of the groups are as follows: Group SB, sandblasting with alumina particles (50 µm); Group HFA, 9.6 % hydrofluoric acid etching; Group ER, erbium-doped yttrium-aluminum-garnet (Er: YAG) irradiation (from 1 mm distance, 2 W, 10 Hz for 10 s). After conditioning, the upper central brackets were bonded to the porcelain surfaces. Porcelain laminate veneers were examined under stereomicroscope for adhesive remnant index and surface damage after debonding. The highest shear bond strength values were obtained with Group HFA (10.8 ± 3.8 MPa) and Group ER (9.3 ± 1.5 MPa), whereas Group SB revealed the lowest values. Scanning electron microscopy energy-dispersive X-ray (SEM-EDX) analysis revealed that the silicon level in the porcelain decreased after debonding in all groups. The sandblasting method did not demonstrate any ideal bond strength values; however, the 9.6 % hydrofluoric acid etching and Er: YAG laser did. There were no significant differences among all groups in terms of laminate surface damages. The Er: YAG laser therefore can be selected for ideal bond strength and minimal damage to porcelain laminates.

Evaluation of the marginal fit of full ceramic crowns by the microcomputed tomography (micro-CT) technique.

OBJECTIVE: To evaluate the marginal gap (MG) and absolute marginal discrepancy (MD) of full ceramic crowns with two finish line designs, shoulder and chamfer, using microcomputed tomography (micro-CT) before and after cementation. MATERIALS AND METHODS: Sixty extracted human maxillary premolar teeth were divided into two groups based on the finish line design: Group I: 90° shoulder and Group II: 135° chamfer. The specimens were further grouped based on the type of full ceramic crown they received: Group A: Feldspathic Cerec inLab ceramic system, Group B: Cerec inLab aluminum oxide ceramic system and Group C: Lithium disilicate press ceramic system. Before cementation, five crowns from each group were scanned using micro-CT in two sections, sagittal and coronal, to determine the MG and MD values for four regions of the crown (sagittal buccal, sagittal lingual, coronal mesial and coronal distal). After cementation and thermal cycling, the scanning was repeated. Measurements were obtained from 10 points for each region, 80 points totally, to evaluate the MG and MD values. Files were processed using NRecon and CTAn software. Results were statistically analyzed using one- and two-way ANOVA and Tukey HSD tests (P = 0.05). RESULTS: Full ceramic systems showed clinically acceptable marginal adaptation values. The Feldspathic Cerec inLab ceramic system generally presented the lowest variance, except in the MG values of the coronal mesial region. The MG and MD values of all ceramics increased significantly after cementation, except in the shoulder preparation design (sagittal buccal region) for MG and in the chamfer preparation design (sagittal lingual region) for MD values. CONCLUSIONS: Full-ceramic crowns showed clinically acceptable marginal adaptation values. The Feldspathic Cerec inLab ceramic system (Vitablocs Mark II) generally presented the lowest variance when compared with the other ceramics, except for the MG values on the mesial surface of the coronal section.

Effects of Er:YAG laser on mineral content of sound dentin in primary teeth.

The aim of the present study was to evaluate the mineral content of sound dentin in primary teeth prepared using an Er:YAG laser at two different power settings. Thirty-six primary second molars were used in this study. Three dentin slabs were obtained from each tooth, and the slabs were randomly divided into three groups: Group A, control; Group B, Er:YAG laser at 3.5 W, 175 mJ, and 20 Hz, short pulse mode; and Group C, Er:YAG laser at 4 W, 200 mJ, and 20 Hz, medium-short pulse mode. One dentin slab per group was used to evaluate the dentinal morphology and surface roughness values using SEM and profilometer, respectively. Mineral content in the dentin slabs were calculated by inductively coupled plasma-atomic emission spectrometry (ICP-AES). The data were analyzed by one-way analysis of variance and Tukey's HSD tests. No significant differences in Ca, K, Mg, Na, and P levels or Ca/P ratio were found among the groups (P > 0.05). SEM micrographs showed that surface irregularities increased with a higher power setting. The surface roughness after laser treatment in Group B and Group C was found to be similar, unlike Group A.

Level of residual monomer released from orthodontic acrylic materials.

OBJECTIVE: To quantify, with high-pressure liquid chromatography (HPLC), the amount of residual monomer leached from different orthodontic acrylic materials prepared with two different manipulation methods. MATERIALS AND METHODS: Eighty cylindrical specimens (5 × 25 mm) were divided into eight groups (n  =  10). The specimens were prepared with four acrylic materials-Orthocryl Neon Blue (Dentaurum), Orthocryl EQ (Dentaurum), Orthoplast (Vertex), and O-80 (Imicryl)-and with two different manipulation methods: doughing and spray-on. HPLC measurements were made at intervals of 2 hours, 6 hours, 1 day, 1 week, and 3 months. One-way analysis of variance (ANOVA) and Tukey's honestly significant difference multiple-comparison test were used to assess the amount of monomer eluted from the various groups. To assess the differences within each group over the various periods, repeated-measures ANOVA and paired t-tests were used. RESULTS: Statistically significant differences were found within the groups in the amount of residual monomer in the specimens at different time intervals (P < .001). HPLC showed statistically significant differences among the groups (P < .05) in the amount of eluted monomer. Evaluation of the manipulation techniques showed that the monomer release rate was higher in the specimens prepared with the doughing method. When the four acrylic materials were compared, the specimens made from Orthoplast (Vertex) showed the highest rate of monomer release with both manipulation techniques. CONCLUSION: The spray-on method can be recommended to clinicians for the preparation of orthodontic appliances.

The effect of repeated porcelain firings on corrosion resistance of different dental alloys.

PURPOSE: The aim of this study was to evaluate the effects of repeated porcelain firing process on the corrosion rates of the dental alloys. MATERIALS AND METHODS: Cr-Co, Cr-Ni and Pd-Ag alloys were used for this study. Each metal supported porcelain consisted of 30 specimens of 10 for 7, 9 and 11 firing each. Disc-shaped specimens 10 mm diameter and 3 mm thickness were formed by melting alloys with a propane-oxygen flame and casted with a centrifuge casting machine and then with the porcelain veneer fired onto the metal alloys. Corrosion tests were performed in quintuplicate for each alloy (after repeated porcelain firing) in Fusayama artificial saliva solution (pH = 5) in a low thermal-expansion borosilicate glass cell. Tamhane and Sheffe test was used to compare corrosion differences in the results after repeated firings and among 7, 9 and 11 firing for each alloy. The probability level for statistical significance was set at α=0.05. RESULTS: The corrosion resistance was higher (30 mV), in case of 7 times firing (Commercial). On the other hand, it was lower in case of 11 times firing (5 mV) (P<.05). CONCLUSION: Repeated firings decreased corrosion resistance of Pd-Ag, Cr-Co and Cr-Ni alloys. The Pd-Ag alloy exhibited little corrosion in in vitro tests. The Cr-Ni alloy exhibited higher corrosion resistance than Cr-Co alloys in in vitro tests.

Effect of various laser irradiations on the mineral content of dentin.

OBJECTIVE: THE AIM OF THIS STUDY WAS TO EVALUATE THE MINERAL CONTENT OF DENTIN IRRADIATION WITH ERBIUM: yttrium-aliminum-garnet (Er:YAG), Neodmiyum:yttrium-aliminum garnet (Nd:YAG) and potassium titanium phosphate (KTP) laser used for in the treatment of dentin hypersensitivity. METHODS: Six extracted wisdom, unerupted molar teeth were used in this study. The enamel of the teeth was removed with a conventional bur under water cooling to expose the dentin surface. The teeth were mounted in a slow-speed, diamond-saw, sectioning machine. Two dentin slabs were obtained from each tooth and each slab was sectioned so that 4 slabs were made from each teeth. Then dentin slabs were randomly divided into four groups. Group A: Control Group, Group B: Er:YAG laser, Group C: Nd:YAG laser, Group D: KTP laser. The levels of Ca, K, Mg, Na,P and Ca/P mineral ratio in each dentin slab were measured by inductively coupled plasma-atomic emission spectrometry (ICP-AES). Data were analysed by one way analysis of variance (ANOVA) and Tukey HSD tests. One sample from each group was prepared for scanning electron microscopy (SEM). RESULTS: There were no significant differences between the groups for Ca, K, Mg, Na,P and Ca/P mineral ratio (P>.05). SEM photographs indicated that there were melted areas around the exposed dentin tubules in groups treated with Er:YAG and KTP lasers. CONCLUSION: This study demonstrated that laser etching with the Er:YAG, Nd:YAG, KTP laser systems did not affect the compositional structure of the dentin surfaces.

Intranasal midazolam may prevent gagging reflex: a case report.

BACKGROUND: Gagging can become a conditioned response that makes dental treatment difficult or impossible for both the individual and the dentist. The aim of this study is to report a 50 year old female and two children (15 and 11 years old) with exaggerated gag reflex referred to Faculty of Dentistry of Selçuk University. METHODS: During obtaining records, taking impression procedure was elicited the patients' hypersensitive gagging reflex. Therefore, it was decided to administer intranasal midazolam to facilitate the taking of accurate dental impressions. After given verbal information about the procedure, 2.5 mg intranasal midazolam (Demizolam, Dem Medikal, Istanbul) were applied incrementally in both nostrils. RESULTS: Five minutes later; patients had no gagging reflex and allowed the clinician to take satisfying impressions. No serious adverse effects were observed and the patients remained cooperative during the entire procedure which was completed to the full satisfaction of all involved. The short absorption time and the fast relief process of anaesthetics transferred to the systemic circulatory system are important advantages of nasal application. CONCLUSIONS: Intranasal midazolam may be very useful for the treatment of gag reflex probably effecting on the depression of upper airway reflex sensitivity.

Evaluation of mineral content of dentin treated with desensitizing agents and neodymium yttrium-aluminium-garnet (Nd:YAG) laser.

The aim of this study was to evaluate the mineral content of dentin prepared using three different desensitizing agents and the Nd:YAG laser. The occlusal third of the crowns of 30 molar teeth were cut with a slow-speed diamond saw sectioning machine under water cooling. Dentin slabs from the 30 teeth were randomly divided into five experimental groups, each comprising six slabs. The five groups were treated as follows: group A, no treatment; group B, treatment with oxalate-containing desensitizing agent (BisBlock); group C, treatment with resin-based desensitizing agent (Admira Protect); group D, treatment with glutaraldehyde-containing desensitizing agent (Systemp); and group E, irradiation with the Nd:YAG laser (DEKATM ) at 0.40 W. The levels of Mg, P, Ca, K, and Na in each slab were measured by inductively coupled plasma-atomic emission spectrometry (ICP-AES). Data were analyzed by one-way analysis of variance and the Tukey HSD test. The effect of desensitizing agents and laser irradiation on the dentin surface were evaluated using a scanning electron microscope. There were no significant differences between the groups (p > 0.05). Group E was showed the lowest Ca/P ratio. SEM showed that the resin-based agent occluded the dentinal tubules, the glutaraldehyde-containing agent increased the Ca/P ratio, and Nd:YAG laser irradiation decreased the Ca/P ratio. The mean percentages by weight of Ca, Mg, K, Na and P were not affected by Nd:YAG laser irradiation or any of the desensitizing agents.

Effects of laser and acid etching and air abrasion on mineral content of dentin.

The aim of this study was to evaluate the mineral content of dentin prepared using an Er,Cr:YSGG laser at four different power settings, acid etching, and air abrasion. The study teeth comprised 35 molars which were randomly divided into seven equal groups. The occlusal third of the crowns were cut with a slow-speed diamond saw. The groups were as follows: group A, control group; group B, dentin etched with 35% buffered phosphoric acid for 30 s; group C, dentin abraded at 60 psi with 50-µm aluminium oxide for 1 s; groups D-G, dentin irradiated with the Er,Cr:YSGG laser at 1.50 W (group D), 2.25 W (group E), 3.00 W (group F), and 3.50 W (group G). The levels of Mg, P, Ca, K and Na in each dentin slab were measured by inductively coupled plasma-atomic emission spectrometry (ICP-AES). Data were analysed by one way analysis of variance and Tukey HSD tests. There were no significant differences between the groups in the levels of Ca, P and Na, and the Ca/P ratio (p>0.05); however, there were significant differences in the levels of K (p<0.001) and Mg (p=0.13). In addition, the levels of Mg in the air abrasion group were higher than in the other groups (p<0.01). Etching with the Er,Cr:YSGG laser system, air abrasion and acid etching did not affect the levels of Ca, P and Na, or the Ca/P ratio, in the dentin surface.

Implant-retained auricular prosthesis.

Auricular defects may result from congenital malformations, injuries from motor vehicle crashes, trauma, or tumor resections. An auricular prosthesis was fabricated for a patient who had an injury from a motor vehicle crash. Extraoral implants and bar-and-clip retention for the proper connection of the auricular prosthesis to implant were used. This prosthesis was acceptable to the patient because of excellent support, retentive abilities, and the patient's appearance.

The use of zirconium and feldspathic porcelain in the management of the severely worn dentition: a case report.

The management of the interim phase of a complete oral rehabilitation in patients with severely worn dentition is often challenging due to the loss of occlusal vertical dimension, loss of tooth structure, uneven wear of teeth creating an uneven plane of occlusion, and parafunctional habits. This case report describes the management of excessive tooth tissue loss in a 45 year old woman with a history of bruxism, esthetical complaints in anterior teeth, and impaired dental function due to reduced tooth height. The patient used occlusal splint for a month and than resection of the alveolar bone was performed on the vestibular sides of the maxillary anterior teeth, except the interdental alveolar crest. Maxillary anterior teeth were restored with zirconia porcelain. Feldspathic porcelain was chosen to restore remaining teeth in both jaws; the patient also was given an occlusion guard to protect the restoration against future bruxism. Regardless of the cause of occlusal instability, it is important that the restorative dentist should be able to recognize its signs such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement, and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance.