A Comparative Evaluation of Prosthetic and Biological Outcome as Influenced by Two Different Implant Restorative Materials (Porcelain Fused to Metal and Monolith Zirconia): A Prospective, Cross-arch Study.

OBJECTIVE: To investigate the prosthetic parameters, clinical indices, crestal bone levels, and inflammatory biomarkers in peri-implant crevicular fluid as influenced by two different implant restorative materials i.e., metal ceramic and monolithic zirconia at baseline, 1 Year and 2 Years. MATERIALS AND METHODS: Twenty patients with bilateral implants placed in the same arch were selected. Monolithic zirconia (4Y-PSZ) crown was placed on one side whereas a metal ceramic (M C) crown was inserted on the contralateral side after randomization. Interproximal marginal bone level (MBL), clinical parameters, MMP-8 levels in PICF, and prosthetic characteristics (as determined by modified USPHS criteria) were evaluated at baseline, 1-year, and 2-year follow-ups. Data were descriptively examined. The results were evaluated using the Chi-Square Test, ANOVA, and student t-test. At p < .05., statistical significance was determined. RESULTS: Twenty MC crowns and twenty Mono-ZrO2 crowns were delivered. A 100% survival of the implants and the prosthetic crowns was achieved across all patients with no instances of failure noted throughout the two-year follow-up period. The periodontal changes observed in the participants were analysed and demonstrated statistically insignificant alterations. Prosthetic alterations were assessed according to USPHS criteria, revealing minor ceramic chippings and instances of screw loosening within the MC group during both the 1- and 2-year follow-up periods. These incidents were collectively categorized as technical issues. Regarding anatomical form and color match to the surrounding dentition, the Mono- ZrO2 crowns obtained much lower evaluations when compared to the M-C crowns. However, when evaluating the loss of marginal bone and level of inflammatory markers there were no discernible variations between the groups. CONCLUSIONS: The null hypothesis that there is no similarity in the survival rates and interactions at the peri-implant interface between the two types of restorations was rejected. Both monolithic zirconia and metal ceramic crowns demonstrated no statistical differences across all parameters examined in the present prospective investigation.

Validation of Digital Impressions' Accuracy Obtained Using Intraoral and Extraoral Scanners: A Systematic Review.

BACKGROUND: At present, the evidence regarding digital impressions' accuracy recorded by using digital scanners is lacking. This systematic review aimed to evaluate whether the type of scanning (intraoral/extraoral) affects the Accuracy of Digital Impressions. METHOD: Two independent reviewers performed a systematic search in the database both electronically and manually (PubMed, Ebsco HOST, the Cochrane Library, and Google Scholar) for articles published from 1 January 2010 to 1 December 2022. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42020188765) and followed the PRISMA statement. The question in focus was as follows: Does the type of scanning (intraoral or extraoral) affect the accuracy of digital impression? RESULTS: A total of 449 papers were obtained by searching electronically and manually. In total, 15 complete-text papers qualified for assessment based on eligibility criteria. After reading the full-text articles, five studies were excluded. Ten studies were selected for the qualitative analysis. The qualitative data reported that the accuracy of both types of scanners (intraoral and extraoral) lies within the range of clinical acceptability. Nevertheless, the intraoral scanners seem to be more accurate when compared to the extraoral scanners for a partial arch situation. CONCLUSIONS: Scanning type affects the accuracy of the digital impression. Various factors influence the scanning ability. Intraoral scanners seem to be more accurate compared to extraoral scanners for a partial arch situation. More studies comparing the accuracy of the intraoral scanner and extraoral scanner for a complete arch scan and in an in vivo study setting are needed.

SHED's Response to Various Pulpotomy Materials: Cytotoxicity and Gene Expression Analysis.

PURPOSE: To examine the cytotoxicity and genetic expression of SHEDs cultured in eluates of various calcium silicate based pulpotomy materials. STUDY DESIGN: MTT assay, flow cytometry, alizarin red staining and scratch assay was used to assess the cellular viability, apoptosis, calcium matrix deposits and cell migration respectively. The gene expression of ALP, OCN and BMP -2, were measured with rtPCR. One way ANNOVA and Bonferroni post test was used for statistical analysis. RESULTS: MTT assay analysis reported that all the test specimen had no cytotoxic effects. The highest number of live cells [ % ] was found in RetroMTA. The highest percentage of cell migration was observed in SHEDs cultured in EndoCem Zr. The mean absorbance for calcium matrix deposition was higher or similar in all test specimens, when compared to control groups. The expression of BMP -2 and OCN were significantly higher in cells exposed to RetroMTA and NeoMTA respectively after 24 hrs of incubation. After 72 hrs of incubation the mRNA expression of ALP was significantly higher in MTA. CONCLUSIONS: SHEDs cultured in eluates of various calcium silicate based cements exhibited cytocompatibility and maintained odontogenic like phenotype differentiation in SHEDs.

A Study to Determine the Correlation between the Intercondylar and Interdental Widths in South Indian Population: A Cross-sectional Study.

AIM: Anatomical landmarks that remain fairly constant throughout an individual's life help determine the position of the artificial teeth closer to that of their predecessors. The aim of the present study was to evaluate whether there is a relationship between the intercondylar widths (ICWs) and the interdental widths (IDWs) in the maxillary and mandibular arches in dentate subjects. MATERIALS AND METHODS: The study was conducted in two parts, with 80 dentate subjects in total. Initially, in the first 40 subjects, a mathematical index was obtained by dividing the mean ICWs by the mean IDWs. In the second part, the ICW was measured and was used along with the index obtained in the first part, to estimate the IDW. These estimated values were then verified with the real IDWs by direct intraoral measurements. An arbitrary earpiece facebow (ARTEX® Gesichtsbogen Facebow) was used to measure the ICW. Statistics was done using SPSS software version 18 using Karl Pearson's correlation test and paired t-test. RESULTS: The IDW was correlated to the ICW; the maximal correlation was found between ICW and lower 6-6 width (L6-6W) (p value 0.033) and the lowest correlation was found between ICW and upper 6-6 width (U6-6W) (p value 0.046). CONCLUSION: ICW can be used as an additional guide to position denture teeth. This method suggested would result in a better buccolingual positioning of the posterior teeth, which would help avoid encroaching on the tongue space, thereby improving phonetics and speech with dentures. CLINICAL SIGNIFICANCE: ICW bears a relationship with the IDWs in the maxillary and mandibular arches. ICW being a fairly constant anatomical landmark can be used as an additional guide aid in positioning the artificial teeth.

Maxillary hollow-bulb obturator: A paradigm shift.

Maxillary defects, whether congenital or acquired, make a patient encounter an array of physical and psychological difficulties, leading to an extremely poor quality of life. Rehabilitation of such a patient is often challenging due to the extent of the defect area coupled with the absence of adequate retention caused by the size and weight of the prosthesis. Further, providing a proper seal of the oronasal communication is of utmost importance to restore function. Taking the above factors into consideration, a combination of hollow-bulb obturator consisting of a titanium framework and a flexible, snap-on silicone cap is an effective prosthesis providing a long-term treatment, increased retention, and a happy patient. The fabrication protocol included the use of computer-aided design, titanium along with laser welding, and an intraoral trial before final fabrication, hence, reconfirming the success of the prosthetic design. The maxillary obturator presented in this article eliminates several disadvantages associated with a conventional hollow-bulb obturator, thereby providing a novel, viable option for a maxillofacial prosthodontist.

A comparative evaluation of intraoral and extraoral digital impressions: An in vivo study.

AIM: The accuracy of a dental impression is determined by two factors: "trueness" and "precision." The scanners used in dentistry are relatively new in market, and very few studies have compared the "precision" and "trueness" of intraoral scanner with the extraoral scanner. The aim of this study was to evaluate and compare accuracy of intraoral and extraoral digital impressions. MATERIALS AND METHODS: Ten dentulous participants (male/female) aged 18-45 years with an asymptomatic endodontically treated mandibular first molars with adjacent teeth present were selected for this study. The prepared test tooth was measured using a digital Vernier caliper to obtain reference datasets. The tooth was then scanned using the intraoral scanner, and the extraoral scans were obtained using the casts made from the impressions. The datasets were divided into four groups and then statistically analyzed. The test tooth preparation was done, and dimples were made using a round diamond point on the bucco-occlusal, mesio-occlusal, disto-occlusal, and linguo-occlusal lines angles, and these were used to obtain reference datasets intraorally using a digital Vernier caliper. The test tooth was then scanned with the IO scanner (CS 3500, Carestream dental) thrice and also impressions were made using addition silicone impression material (3M™ ESPE) and dental casts were poured in Type IV dental stone (Kalrock-Kalabhai Karson India Pvt. Ltd., India) which were later scanned with the EO scanner (LAVA™ Scan ST Design system [3M™ ESPE]) thrice. The Datasets obtained from Intraoral and Extraoral scanner were exported to Dental Wings software and readings were obtained. Repeated measures ANOVA test was used to compare differences between the groups and independent t-test for comparison between the readings of intraoral and extraoral scanner. Least significant difference test was used for comparison between reference datasets with intraoral and extraoral scanner, respectively. A level of statistical significance of P < 0.05 was set. RESULTS: The precision values ranged from 20.7 to 33.35 µm for intraoral scanner and 19.5 to 37 µm for extraoral scanner. The mean deviations for intraoral scanner were 19.6 µm mesiodistally (MD) and 16.4 µm buccolingually (BL) and 24.0 µm MD and 22.5 µm BL for extraoral scanner. The mean values of the intraoral scanner (413 µm) for trueness were closest to the actual measurements (459 µm) than the extraoral scanner (396 µm). CONCLUSION: The intraoral scanner showed higher "precision" and "trueness" values when compared with the extraoral scanner.

A novel and easy technique for restoring grossly decayed mandibular molar with a modified cast-post.

The article addresses the difficulty of restoring a grossly carious molar tooth, where very little tooth structure is left after caries excavation. When enough sound tooth structure is missing for satisfying the ferrule effect, a clinician can follow this technique and easily restore such teeth. A step by step procedure, including instrumentation and materials and a new impression technique, is described in detail, with clinical photographs. This technique results in the fabrication of a robust and extremely retentive post and core on which to place fixed prosthodontic restorations. A 2 and half year study showed that the tooth well in function with no signs of any problem. The author has restored around many decayed molars using this technique. Over a period of three years, no failure was reported. With an increasing demand on the dentist for restoring a structurally compromised teeth, this technique provides the patients with a robust prosthodontic solution.

A novel approach to treat peri implantitis with the help of PRF.

A new field of biomédical science, known as tissue engineering, applies the principles of biology and engineering to the development of functional substitutes for tissues and organs. Little is known about the influence of Keratinised Mucosa dimension around implants on the soft and hard tissue health The purpose of this case report is to understand the importance of healthy tissue around the implants for long term success and how biomimetic materials like PRF Membrane can be incorporated in treatment plan as an important modality in selected cases.

Effect of Topical Fluoride on Surface of Cast Titanium and Nickel-Chromium: An In Vitro Study.

OBJECTIVES: The aim of this in-vitro study was to evaluate the effect of topical fluoride on surface of cast titanium and nickel-chromium. MATERIALS AND METHODS: Thirty-nine rectangular specimens of titanium (grade 2) and 39 rectangular specimens of nickel-chromium were cast in equal dimensions and divided into three groups of 13 samples each. Group one specimens of titanium and nickel-chromium were placed in 2% neutral sodium fluoride (NaF) solution for 16 minutes. Group two specimens of titanium and nickel-chromium were immersed in 1.23% acidulated phosphate fluoride (APF) gel for eight minutes. Group three specimens of titanium and nickel-chromium were immersed in distilled water for 16 minutes. The surface roughness of the specimens was evaluated and the data were analyzed using two-way ANOVA and post-hoc comparison test with the level of significance set at 5% (P< 0.05). The surface of the specimens was further analyzed using a scanning electron microscope (SEM) and energy dispersive spectrometer (EDS). RESULTS: Group two titanium specimens showed a statistically significant increase in surface roughness (P<0.05); but no statistically significant increase was noted in the surface roughness of nickel-chromium specimens in groups one, two and three (P>0.05). Qualitative SEM and EDS analyses further revealed the surface corrosion of titanium (group two) and localized mild corrosive pitting of nickel-chromium specimens (group two). CONCLUSION: Topical fluoride with acidic pH affects the surface roughness of titanium and to a certain extent, nickel-chromium. Neutral NaF solutions cause no significant change in corrosion resistance of titanium or nickel-chromium.

Enhancing facial aesthetics with muscle retraining exercises-a review.

Facial attractiveness plays a key role in social interaction. 'Smile' is not only a single category of facial behaviour, but also the emotion of frank joy which is expressed on the face by the combined contraction of the muscles involved. When a patient visits the dental clinic for aesthetic reasons, the dentist considers not only the chief complaint but also the overall harmony of the face. This article describes muscle retraining exercises to achieve control over facial movements and improve facial appearance which may be considered following any type of dental rehabilitation. Muscle conditioning, training and strengthening through daily exercises will help to counter balance the aging effects.

Management of velopharyngeal defects: a review.

Success in Maxillofacial Prosthetics depends on full cognizance of the principles that underlie facial harmony, anchorage and retention, weight bearing and leverage, durability, tissue compatibility and tolerance. The maxillofacial prosthodontist normally provides appliances to restore aesthetics and function to the patients who cannot be restored to normal appearances or functions by means of plastic reconstructions. The velopharynx is a dynamic anatomic structure which is essential for normal breathing, eating, and speaking. The soft palate acts as a separator between oral and nasal cavities. Impairment of velopharyngeal function can be caused by insufficiency or incompetency. This article describes in brief about velopharyngeal defects and their management.

Precision attachments for aesthetics and function: a case report.

Successful restoration of the dentition requires plenty of contemporary and conventional treatment techniques and planning and attachment retained partial dentures are one such kind of treatment modality in prosthodontics. Limited space for extracoronal attachments is a serious gap in the design and the fabrication of a precision attachment Removable Partial Denture (RPD). A custom semi-precision attachment with a partial denture offers strength and improved aesthetics in cases with minimal space. This article presents a method of fabrication of semi-precision attachment to eliminate metal display and enhance aestheticity.

Prosthetic rehabilitation of hypophosphatasia with precision attachment retained unconventional partial denture: a case report.

Deficiency of the alkaline phosphatase isoenzyme can lead to a rare hereditary disorder called Hypophosphatasia. It is characterized by defective mineralization of the skeletal and dental structures of the body. Hypophophatasia is classified into six clinical forms namely, perinatal lethal, perinatal benign, infantile, childhood, adult and odontohypophosphatasia. This clinical report describes the prosthetic rehabilitation of an 18-year-old girl with Hypophosphatasia with partial anodontia and no occlusion. A precision attachment retained unconventional removable partial denture in the maxillary arch and conventional removable partial denture in the mandibular were fabricated to establish an acceptable masticatory function, speech, occlusion and aesthetics for the patient.

Efficacy of casein phosphopeptide-amorphous calcium phosphate to prevent stain absorption on freshly bleached enamel: An in vitro study.

BACKGROUND: Teeth when subjected to bleaching bring about the desiccation of the enamel, making it more susceptible to stain absorption. While subjecting the freshly bleached enamel surface to various surface treatments of Fluoride and Casein Phosphopeptide - Amorphous Calcium phosphate (CPP-ACP) brought about the reduction in stain absorption, which is assessed in this study. AIMS: The study aims to evaluate the tea stain absorption on freshly bleached enamel surface of extracted human teeth with varied surface treatment. The stain absorption was evaluated at the end of one hour and 24 hours post bleaching. MATERIALS AND METHODS: Forty extracted human permanent maxillary central incisors were subjected to bleaching with 10% carbamide peroxide for eight days. They were divided into four groups of 10 each. Group I was control group. Group II was immersed in tea solution without surface treatment, while Group III and IV were immersed in tea solution with surface treatment of topical Fluoride and CPP-ACP respectively. Spectrophotometer was used for color analysis. RESULTS: Surface treatment with CPP-ACP and topical fluoride on freshly beached enamel surface, significantly reduced the stain absorption. CONCLUSION: Remineralizing agents reduce stain absorption after tooth bleaching.