Chairside computer-aided design/computer-aided manufacturing (CAD/ CAM)-based restoration of anterior teeth with customized shade and surface characterization: a report of 2 cases

Over the last 30 years, the use of chairside computer-aided design (CAD) and computer-aided manufacturing (CAM) systems has evolved and has become increasingly popular in dentistry. Although CAD/CAM restorations have been used in the anterior dentition, satisfying the esthetic requirements of clinicians and patients, where the restorations are limited to the chairside, remains a challenge. To reproduce multi-shades of CAD/CAM restorations in the clinic, a preliminary experiment to express several shades on A2 lithium disilicate (LS2) blocks using a staining kit was performed. After measurement of the CIE L*a*b* value of specimens, it was compared with that of the commercial shade guide. This report presents two cases with individual customization of shade and surface characterization of the CAD/CAM restorations using predictable methods based on the preliminary experimental data. The anatomical shape of restoration was obtained from ‘copy and paste technique’ and ‘mirror image acquisition technique’. All treatment procedures and fabrication of restorations performed in this report were executed in the clinic itself.

Inhibition of matrix metalloproteinases expression in human dental pulp cells by all-trans retinoic acid / 国际口腔科学杂志·英文版

All-trans retinoic acid (ATRA) inhibits matrix metalloproteinase (MMP)-2 and MMP-9 in synovial fibroblasts, skin fibroblasts, bronchoalveolar lavage cells and cancer cells, but activates MMP-9 in neuroblast and leukemia cells. Very little is known regarding whether ATRA can activate or inhibit MMPs in human dental pulp cells (HDPCs). The purpose of this study was to determine the effects of ATRA on the production and secretion of MMP-2 and -9 in HDPCs. The productions and messenger RNA (mRNA) expressions of MMP-2 and -9 were accessed by gelatin zymography and real-time polymerase chain reaction (PCR), respectively. ATRA was found to decrease MMP-2 level in a dose-dependent manner. Significant reduction in MMP-2 mRNA expression was also observed in HDPCs treated with 25 µmol⋅L(-1) ATRA. However, HDPCs treated with ATRA had no effect on the pattern of MMP-9 produced or secreted in either cell extracts or conditioned medium fractions. Taken together, ATRA had an inhibitory effect on MMP-2 expression in HDPCs, which suggests that ATRA could be a candidate as a medicament which could control the inflammation of pulp tissue in vital pulp therapy and regenerative endodontics.

Use of temporary filling material for index fabrication in Class IV resin composite restoration

When a patient with a fractured anterior tooth visits the clinic, clinician has to restore the tooth esthetically and quickly. For esthetic resin restoration, clinician can use 'Natural Layering technique' and an index for palatal wall may be needed. In this case report, we introduce pre-restoration index technique on a Class IV defect, in which a temporary filling material is used for easy restoration. Chair-side index fabrication for Class IV restoration is convenient and makes a single-visit treatment possible.

Long-term follow-ups of revascularized immature necrotic teeth: three case reports / 国际口腔科学杂志·英文版

Revascularization of immature necrotic teeth is a reliable treatment alternative to conventional apexogenesis or apexification. In case 1, a 12-year-old boy had his necrotic, immature mandibular left second premolar treated with a revascularization technique. At a24-month follow-up, periapical radiolucency had disappeared and thickening of the root wall was observed. In cases 2 and 3, a10-year-old boy had his necrotic, immature, bilateral mandibular second premolars treated with the same modality. At 48-month(in case 2) and 42-month (in case 3) follow-ups, loss of periapical radiolucencies and increases in the root wall thickness were also observed.

The effects of different pilot-drilling methods on the mechanical stability of a mini-implant system at placement and removal: a preliminary study / 대한치과교정학회지

OBJECTIVE: To investigate the effects of different pilot-drilling methods on the biomechanical stability of self-tapping mini-implant systems at the time of placement in and removal from artificial bone blocks. METHODS: Two types of artificial bone blocks (2-mm and 4-mm, 102-pounds per cubic foot [102-PCF] polyurethane foam layered over 100-mm, 40-PCF polyurethane foam) were custom-fabricated. Eight mini-implants were placed using the conventional motor-driven pilot-drilling method and another 8 mini-implants were placed using a novel manual pilot-drilling method (using a manual drill) within each of the 2-mm and 4-mm layered blocks. The maximum torque values at insertion and removal of the mini-implants were measured, and the total energy was calculated. The data were statistically analyzed using linear regression analysis. RESULTS: The maximum insertion torque was similar regardless of block thickness or pilot-drilling method. Regardless of the pilot-drilling method, the maximum removal torque for the 4-mm block was statistically higher than that for the 2-mm block. For a given block, the total energy at both insertion and removal of the mini-implant for the manual pilot-drilling method were statistically higher than those for the motor-driven pilot-drilling method. Further, the total energies at removal for the 2-mm block was higher than that for the 4-mm block, but the energies at insertion were not influenced by the type of bone blocks. CONCLUSIONS: During the insertion and removal of mini-implants in artificial bone blocks, the effect of the manual pilot-drilling method on energy usage was similar to that of the conventional, motor-driven pilot-drilling method.

A maxillary canine with two separated root canals: a case report / 대한치과보존학회지

Maxillary canines have less anatomical diversities than other teeth. They usually have a single root and root canal. This report describes an endodontic treatment of a maxillary canine with two separated root canals which have not been reported through the demonstration of radiography and computerized tomography (CT). Even though appropriated endodontic treatment has been performed, the severe pain could happen due to lack of consideration of anatomical variations of the teeth. Therefore, the clinicians should be well aware of the possibility of anatomical variations in the root canal system during endodontic treatment even if the number of root canals is obvious such as in this case.

Optical characteristics of resin composite before and after polymerization / 대한치과보존학회지

OBJECTIVES: The aim of this study was to evaluate the optical characteristics such as color and translucency changes before and after light curing, to quantify the CQ and to measure refractive indices of body and opaque shade of resin composites materials. MATERIALS AND METHODS: Resin composites used in this study were A2 body and A2 opaque shade of Esthet-X, Filtek supreme, Gradia Direct, Clearfil Majesty and Beautifil?? Color and translucency changes before and after light curing were evaluated by colorimeter, the CQ was quantified by GC-MS and refractive index changes were measured by spectroscopic ellipsometer. RESULTS: Translucency parameter (TP) was significantly increased after curing. The CQ content of body shades are higher than that of opaque shades in all resin composites. Refractive index increased after polymerization in all materials and significant difference in Deltarefractive index was found between body and opaque shade (significance level 0.05). CONCLUSIONS: For an accurate shade match, direct shade matching of resin composite should be performed by using the cured material.

The effect of tumor necrosis factor (TNF)-alpha to induce matrix metalloproteinase (MMPs) from the human dental pulp, gingival, and periodontal ligament cells / 대한치과보존학회지

OBJECTIVES: In the present study, three kinds of tissues cells (pulp, gingiva, and periodontal ligament) were investigated if those cells express MMP and TIMP when they were stimulated with neuropeptides (substance P, CGRP) or proinflammatory cytokine, TNF-alpha. MATERIALS AND METHODS: The cells cultured from human dental pulp (PF), gingiva (GF) and periodontal ligament were (PDLF) stimulated with Mock, SP, TNF-alpha, and CGRP for 24 hrs and 48 hrs. for an RNase protection assay and Enzyme Linked Immunosorbent Assay. Cells (PF, GF and PDLF) seeded in 100 mm culture dish were stimulated with SP (10(-5), 10(-8) M) or only with medium (Mock stimulation) for 4hrs and for 24 hrs for RNase Protection Assay, and they were stimulated with CGRP (10(-5) M) and TNF-alpha (2 ng/mL) for 24 hrs and with various concentraion of TNF-alpha (2, 10, and 100 ng/mL) for Rnase Protection Assay with a human MMP-1 probe set including MMP 1, 2, 8, 7, 8, 9, 12, and TIMP 2, 3. In addition, cells (PF, GF and PDLF) were stimulated with Mock and various concentraion of TNF-alpha(2, 10, and 100 ng/mL) for 24 hrs and with TNF-alpha(10 ng/mL) for 48 hrs, and the supernatents from the cells were collected for Enzyme Linked Immunosorbent Assay (ELISA) for MMP-1 and MMP-13. RESULTS: The expression of MMPs in PF, GF, PDLF after stimulation with SP and CGRP were not changed compared with Mock stimulation for 4 hrs and 24 hrs. The expression of MMP-1, -12, -13 24 hrs after stimulation with TNF-alpha were upregulated, however the expression of TIMP-3 in PF, GF, PDLF after stimulation with TNF-alpha were downregulated. TNF-alpha (2 ng/mL, 10 ng/mL, 100 ng/mL) increased MMP-1 and MMP-12 expression in PF dose dependently for 24 hrs. CONCLUSIONS: TNF-alpha in the area of inflammation may play an important role in regulating the remodeling of dentin, cementum, and alveolar bone.

The effect of solvent evaporation of dentin adhesive on bonding efficacy / 대한치과보존학회지

OBJECTIVES: The purpose of this study is to evaluate bonding efficacy by means of measuring the effect of remained solvent on Degree of conversion(DC) and microTBS and FE-SEM examination. MATERIALS AND METHODS: Two 2-step total etching adhesives and two single-step self etching adhesives were used in this study. First, volume weight loss of 4 dentin adhesives were measured using weighting machine in process of time in normal conditions and calculate degree of evaporation (DE). Reaction/reference intensity ratio were measured using micro-Raman spectroscopy and calculate DC according to DE. Then 2 experimental groups were prepared according to air-drying methods (under, over) and control group was prepared to manufacturer's instruction. Total 12 groups were evaluated by means of micro tensile bond strength and FE-SEM examination. RESULTS: Degree of evaporation (DE) was increased as time elapsed but different features were observed according to the kind of solvents. Acetone based adhesive showed higher DE than ethanol and butanol based adhesive. Degree of conversion (DC) was increased according to DE except for S3 bond. In microTBS evaluation, bond strength was increased by additional air-drying. Large gaps and droplets were observed in acetone based adhesives by FE-SEM pictures. CONCLUSIONS: Additional air-drying is recommended for single-step self etching adhesive but careful consideration is required for 2-step total etching adhesive because of oxygen inhibition layer. Evaporation method is carefully chose and applied according to the solvent type.

The study of fractural behavior of repaired composite / 대한치과보존학회지

OBJECTIVES: This study evaluated microtensile bond strength (microTBS) and short-rod fracture toughness to explain fractural behavior of repaired composite restorations according to different surface treatments. MATERIALS AND METHODS: Thirty composite blocks for microTBS test and sixty short-rod specimens for fracture toughness test were fabricated and were allocated to 3 groups according to the combination of surface treatment (none-treated, sand blasting, bur roughening). Each group was repaired immediately and 2 weeks later. Twenty-four hours later from repair, microTBS and fracture toughness test were conducted. Mean values analyzed with two-way ANOVA / Tukey's B test (alpha = 0.05) and correlation analysis was done between microTBS and fracture toughness. FE-SEM was employed on fractured surface to examine the crack propagation. RESULTS: The fresh composite resin showed higher microTBS than the aged composite resin (p < 0.001). Mechanically treated groups showed higher bond strength than non-mechanically treated groups except none-treated fresh group in microTBS (p < 0.05). The fracture toughness value of mechanically treated surface was higher than that of non-mechanically treated surface (p < 0.05). There was no correlation between fracture toughness and microtensile bond strength values. Specimens having high KIC showed toughening mechanism including crack deviation, microcracks and crack bridging in FE-SEM. CONCLUSIONS: Surface treatment by mechanical interlock is more important for effective composite repair, and the fracture toughness test could be used as an appropriate tool to examine the fractural behavior of the repaired composite with microtensile bond strength.

The effect of bonding resin on bond strength of dual-cure resin cements / 대한치과보존학회지

The objective of this study is to evaluate the effect of an additional application of bonding resin on the bond strength of resin luting cements in both the light-cure (LC) and self-cure (SC) modes by means of the microTBS tests. Three combinations of One-Step Plus with Choice, Single Bond with Rely X ARC, and One-Up Bond F with Bistite II were used. D/E resin and Pre-Bond resin were used for the additional application. Twelve experimental groups were made. Three mandibular 3rd molars were used in each group. Indirect composite blocks were cemented on the tooth surface. 1 x 1 mm2 dentin-composite beam for microTBS testing were made and tested. When total-etching dentin adhesives were used, an additional application of the bonding resin increased the bond strength (P 0.05). In conclusion, the results suggest that an additional application of the bonding resin increases bond strength and enhances quality of bonding when using total-etching dentin adhesives.