Assessment of the capacity of a pyrophosphate-based mouth rinse to inhibit the formation of supragingival dental calculus. A randomized double-blind placebo-controlled clinical trial

Background: This study aimed to analyze the efficacy of an anti-calculus mouth rinse and its possible adverse effects on the mucosa and teeth. Material and Methods: This randomized double-blind placebo-controlled clinical trial included 40 patients with treated and managed periodontal disease, all with a history of rapid calculus formation. Patients used a pyrophos-phate-based test mouth rinse (B) or a placebo (A). A range of parameters were measured for: saliva (saliva flow, pH and chemical composition); calculus (Volpe-Manhold [V-M] index, weight, and volume); adverse effects on mucosa and teeth; and the patients’ subjective perceptive of mouth rinse efficacy. Results: the test mouth rinse B produced reductions in urea, uric acid, and phosphorous, calcium, saliva flow, and increases in pH. V-M index and calculus weight decreased after using the test mouth rinse. Calculus volume decreased with both mouth rinses. No changes to the mucosa or teeth were observed. Patients perceived that the test mouth rinse was more effective

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Periodontal and prosthetic outcomes on teeth prepared with biologically oriented preparation technique: a 4-year follow-up prospective clinical study.

PURPOSE: To evaluate the clinicaland biological behavior of full coverage restorations on teeth prepared without finish line during a 4-year follow-up. METHODS: This prospective study included 149 teeth treated using biologically oriented preparation technique (BOPT). The sample (149 teeth) was divided into two groups: Seventy four teeth restored with crowns, and 75 teeth supporting fixed partial dentures (FPD). Restorations were fabricated with zirconium oxide cores and ceramic coverings. Patients attended regular annual check-ups when probe depth, presence of inflammation with bleeding on probing, presence of plaque, gingival thickness, marginal stability, biological or mechanical complications, and the patient's level of satisfaction were registered over a 4-year follow-up. RESULTS: After the 4-year follow-up, 2.1% of teeth underwent increases in probing depth; 12% of the sample presented inflammation and bleeding on probing; 20% of the restored teeth presented plaque; gingival thickening increased a 32.5%; 98.6% of teeth presented marginal stability; the restoration survival rate was 96.6%, with 2% of biological complications and 1.4% of mechanical complications. General satisfaction score was 80.73. CONCLUSIONS: Restorations placed on teeth prepared using BOPT present good periodontal behavior, increase of gingival thickening, and marginal stability over a 4-year follow-up. High survival rates after 4 years show that the technique produces predictable outcomes. CLINICAL SIGNIFICANCE: The BOPT technique is a good treatment option in cases where replacement of an old restoration is required; presenting good periodontal behavior, gingival thickening, and marginal stability.

Influence on peri-implant bone loss of different fixed partial dentures retained on 2 implants.

STATEMENT OF PROBLEM: Marginal bone loss is key to determining the success of dental implants. However, how different factors, including the extension or span of implant-supported restorations and implant position, affect bone loss is unclear. PURPOSE: The purpose of this prospective clinical study was to analyze peri-implant bone loss 3 years after loading by evaluating the influence of implant position and prosthetic type and comparing splinted crowns and 3- or 4-unit fixed partial dentures (FPDs) to determine whether 2 dental implants can achieve comparable success when replacing 2, 3, or 4 missing teeth. MATERIAL AND METHODS: Sixty-two adjacent dental implants in 23 participants were investigated. The implants supported noncantilevered restorations: 2 splinted crowns or 3- or 4-unit FPDs. Bone loss was evaluated 3 years after loading from periapical radiographs using AutoCAD software. Nonparametric comparisons were made. The Wilcoxon test was applied to determine homogeneity of related samples. The Mann-Whitney test was applied to measure homogeneity of bone loss in 2 independent samples and the presence/absence of a pontic in the restoration (α=.05). RESULTS: Mean ±standard deviation peri-implant bone loss was 0.9 ±0.7 mm. The peri-implant bone loss of the restorations analyzed was similar to the average values of 1.1 ±0.8 mm for 3- and 4-unit FPDs and 0.8 ±0.6 mm for splinted crowns. The type of prosthodontic restoration and implant position did not show significant influences on bone loss (P>.05). CONCLUSIONS: Mean bone loss values were within an acceptable range. Statistically significant relationships were not found between the restoration types, suggesting that 3 or 4 missing teeth can be replaced by 2 implants. Further studies with longer follow-ups are needed to obtain clinically applicable conclusions.

Influence of Transmucosal Area Morphology on Peri-Implant Bone Loss in Tissue-Level Implants.

PURPOSE: To analyze peri-implant bone loss around two types of tissue-level implants (convergent and divergent transmucosal morphology) placed in the same region of either the maxilla or mandible in a single surgical session. MATERIALS AND METHODS: This prospective study included 21 patients who each received two implants, one with a convergent transmucosal collar (n = 21) the other with a divergent collar (n = 21). Implants were placed in a single surgical session, by the same clinician, in the same clinical setting at the Prosthodontic and Occlusion Unit, University of Valencia (Spain). The implants (n = 42) were restored with splinted crowns screwed directly onto the prosthetic platforms. Bone loss analysis consisted of measurements taken from periapical radiographs 24 months after loading. Statistical analysis evaluated the homogeneity of the groups using Pearson's chisquare test; bone loss was compared with the Wilcoxon test. Statistical significance was set at 5% (α = .05), with a confidence interval of 95% and a power of 57%. RESULTS: Implants with convergent transmucosal morphology presented less mean peri-implant bone loss (0.29 ± 0.34 mm) than those with divergent transmucosal morphology (0.60 ± 0.63 mm), with a statistically significant difference between the two types of implants (P = .031). CONCLUSION: Less peri-implant bone loss occurs around supracrestal implants with convergent transmucosal morphology than divergent transmucosal morphology.

Influence of Implant-Prosthetic Connection on Peri-Implant Bone Loss: A Prospective Clinical Trial with 2-Year Follow-up.

PURPOSE: To analyze peri-implant bone loss around six different types of implant-prosthetic connections over a 2-year follow-up period. MATERIALS AND METHODS: A total of 120 implants were divided into six groups (n = 20), three with crestally and three with supracrestally placed implants, with different internal connections, placed in posterior sectors (molar and premolar), and bearing one-piece CAD/CAM restorations screwed directly to each implant's prosthetic platform. Bone height was measured from parallelized periapical radiographs taken at the moment of loading and 2 years later. RESULTS: The patient sample included 61 subjects, 36 men and 25 women. Significant differences were found in bone loss between groups, the implant with internal hex and convergent transmucosal collar showing the least bone loss (P < .001) in comparison with the other designs. Supracrestally placed implants underwent less bone loss than crestally placed implants (P = .025). CONCLUSION: Peri-implant bone loss is influenced by the level of implant placement in relation to the bone crest (crestal or supracrestal) and by the morphology of the prosthetic platform.

Behavior of Human Osteoblast Cells Cultured on Titanium Discs in Relation to Surface Roughness and Presence of Melatonin.

The aim of this work was to observe the behavior of osteoblast cells cultured in vitro on titanium discs in relation to disc surface roughness and the addition of melatonin to the culture medium. MG63 osteoblast cells were cultivated on 120 Grade 5 Ti divided into three groups: Group E, treated with dual acid etch; Group EP, treated with dual acid etch and calcium phosphate; and Group M, machined. Surface roughness was examined under a laser scanning confocal microscope (CLSM) and scanning electron microscopy (SEM). The proliferation and morphology of cells were determined under fluorescence microscopy and SEM. Messenger ribonucleic acid (mRNA) of different genes related to osteoblastic differentiation was quantified by means of real-time quantitative polymerase chain reaction (RT-PCR) assay. The greatest surface roughness was found in Group EP (Ra 0.354 µm), followed by Group E (Ra 0.266 µm), and Group M (Ra 0.131 µm), with statistically significant differences between the groups (p < 0.001). In the presence of melatonin a trend to a higher cell proliferation was observed in all groups although significant differences were only found in Group M (p = 0.0079). Among the genes studied, a significant increase in phosphate-regulating neutral endopeptidase, X-linked (PHEX) expression was observed in cells cultured on EP discs. The addition of melatonin increased osteoblast cell proliferation and differentiation, and may favor the osseointegration of dental implants.

Vertical preparation for fixed prosthesis rehabilitation in the anterior sector.

This clinical report describes a biologically oriented preparation technique (BOPT) for teeth and an implant for the esthetic rehabilitation of the maxillary anterior sector. The technique was designed to create an anatomic crown with a prosthetic emergence profile that simulated the shape of the natural tooth.

Post-fatigue fracture resistance of metal core crowns: press-on metal ceramic versus a conventional veneering system.

BACKGROUND: The aim of this in vitro study was to compare the mechanical failure behavior and to analyze fracture characteristics of metal ceramic crowns with two veneering systems - press-on metal (PoM) ceramic versus a conventional veneering system - subjected to static compressive loading. MATERIAL AND METHODS: Forty-six crowns were constructed and divided into two groups according to porcelain veneer manufacture. Group A: 23 metal copings with porcelain IPS-InLine veneering (conventional metal ceramic). Group B: 23 metal copings with IPS-InLine PoM veneering porcelain. After 120,000 fatigue cycles, the crowns were axially loaded to the moment of fracture with a universal testing machine. The fractured specimens were examined under optical stereomicroscopy and scanning electron microscope. RESULTS: Fracture resistance values showed statistically significant differences (Student's t-test) regarding the type of ceramic veneering technique (p=0.001): Group A (conventional metal ceramics) obtained a mean fracture resistance of 1933.17 N, and Group B 1325.74N (Press-on metal ceramics). The most common type of fracture was adhesive failure (with metal exposure) (p=0.000). Veneer porcelain fractured on the occlusal surface following a radial pattern. CONCLUSIONS: Metal ceramic crowns made of IPS InLine or IPS InLine PoM ceramics with different laboratory techniques all achieved above-average values for clinical survival in the oral environment according to ISO 6872. Crowns made with IPS InLine by conventional technique resisted fracture an average of 45% more than IPS InLine PoM fabricated with the press-on technique. Key words:Mechanical failure, conventional feldspathic, pressable ceramic, chewing simulator, thermocycling, compressive testing, fracture types, scanning electron microscope.

An implant-supported overdenture design with a horizontal path of insertion.

The rehabilitation of the atrophic maxilla by means of implant-supported prostheses cannot always be achieved with fixed prostheses because of anatomic, esthetic, or economic issues, so for some patients the treatment of choice is a removable prosthesis. This article analyzes a new design for implant-supported overdentures with horizontal or faciolingual insertion. Its retention system is based on frictional forces or stepped interlocking horizontal surfaces and is appropriate for patients with skeletal Class II or III relationships with severe maxillary atrophies. The design facilitates implant-prosthetic hygiene and improved esthetics in patients with nonparallel implants by hiding abutment screws.

Survival rates of a lithium disilicate-based core ceramic for three-unit esthetic fixed partial dentures: a 10-year prospective study.

PURPOSE: The aim of this prospective study was to evaluate the clinical efficacy and long-term survival rate of three-unit fixed partial dentures (FPDs) made from lithium disilicate-based core ceramic. MATERIALS AND METHODS: Twenty-one three-unit FPDs were placed in 19 patients to replace single lost teeth in the esthetic area, following a study protocol that took clinical, esthetic, and radiologic aspects into consideration. Each case was reviewed at 1 week following placement, at 6 months, and then annually for 10 years. Statistical analysis was performed using Kaplan-Meier survival analysis. RESULTS: Out of the 19 patients, 14.3% presented reversible postoperative sensitivity. Recession was observed in 24% of dental posts, and 7.1% presented marginal discoloration. Treatment did not increase either Bleeding or Plaque Index scores at prepared teeth; secondary caries did not appear either. The restorations' survival rate at the 10-year follow-up was 71.4%; six FPDs had fractured and one debonded. CONCLUSIONS: Fracture failure rate was 28.6% after 10 years; a high percentage corresponded to connector fractures and occurred during the first 5 years. Lithium disilicate glass-ceramic FPDs present a higher risk of fracture than standard therapies (metal-ceramic) or other more recently developed ceramic materials. The prognosis for survival improves for Class I occlusion and nonparafunctional patients.

Full maxillary rehabilitation with an all-ceramic system

With the appearance of all-ceramic systems, providing a choice of framework porcelains and allowing the samematerial to be used for the veneer, it is now possible to select the ideal structure in terms of both function andesthetics. Silicate ceramics allow porcelain laminate veneers and crowns to be used in the anterior region, providingexcellent esthetics; while for the posterior area, where function takes precedence, oxide ceramics, specificallyzirconium oxide, are preferred. The IPS e.max ceramic system, heir apparent to the IPS Empress 2 system,combines the advantages of zirconium oxide ceramics (IPS e.max Zircad) with the excellent esthetic qualities ofsilicate ceramics (IPS e.max Press).This paper presents a clinical case requiring complete maxillary rehabilitation for esthetic purposes. An overviewof some of the porcelains used in this system, analyzed from both the clinical and laboratory perspective is provided.The esthetic advantages of a single ceramic veneer, the need to select appropriate ceramics for anterior andposterior regions, and cementation and surface treatments are discussed (AU)

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A clinical longitudinal study 323 porcelain laminate veneers. Period of study from 3 to 11 years

Objective: The objective of this study was to evaluate the clinical results of 323 porcelain laminate veneers overa period of 3 to 11 years.Material and Methods: This study included 70 patients, aged between 18 and 74 years. Of the 323 total veneers,124 were of a simple design and 199 were of a functional design. The condition of the soft tissues and hygiene, inaddition to the condition of the abutment teeth, the restorations and patient satisfaction were all clinically examined.In carrying out the statistical analysis, a descriptive approach was taken in analyzing the data. The KaplanMeier method was used for statistically analyzing the survival rates of the porcelain laminate veneers.Results: Analysis of the soft tissue revealed marginal recession in 7.7% of the cases, and in 21.6% of the cases,bleeding was detected on probing. Analysis of the condition of the abutment teeth revealed secondary caries andhypersensitivity in 3.1% of the cases, and changes in pulp vitality were observed in 2.8% of the cases. In studyingthe condition of the restorations, marginal integrity was observed to be excellent in 98% of the cases, slight marginalpigmentation was present in 39.3% of the cases, fractures were present in 4% of the cases and decementationin 9% of the cases. The degree of patient satisfaction was considered to be excellent in 97.1% of the cases.Conclusions: Porcelain laminate veneers are a predicable treatment option that offer excellent results (AU)

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Selección de la ceramica a utilizar en tratamientos mediante frentes laminados de porcelana / Choice of ceramic for use in treatments with porcelain laminate veneers

El tratamiento mediante Frentes Laminados de Porcelana (FLP) se utiliza desde hace más de dos décadas para el tratamiento de problemas estéticos y/o funcionales, particularmente en el grupo anterior de las arcadas dentarias (1,2,3). La actual oferta en el mercado de cerámicas dentales aptas para este tipo de tratamiento, pero muy distintas en cuanto a composición, características ópticas y sistema de elaboración, hace complicada la selección del material más adecuado a cada paciente en particular. Proponemos un sistema sencillo de elección de la cerámica teniendo en cuenta las dos variables que más influirán en el resultado estético final: de un lado las características propias del diente (sustrato en el que nos apoyamos), y de otro las características propias del material cerámico en cuanto a resistencia y propiedades ópticas

Porcelain laminate veneers (PLVs) have been used for over two decades to treat esthetic and/or functional problems, particularly in the anterior sector (1-3). A range of dental ceramic materials are presently available on the market for these treatments, though with very different characteristics in terms of the composition, optic properties and manufacturing processes involved. As a result, selection of the material best suited for the management of each individual patient may prove complicated. The present study proposes a simple system for selecting the most appropriate ceramic material, based on the two variables that most influence the esthetic outcome: the intrinsic characteristics of the substrate tooth, and the characteristics of the ceramic material in terms of resistance and optic properties

Clasificación actual de las cerámicas dentales / Updated classification of dental ceramics

Cuando hablamos de porcelana, hablamos de la física y química del silicio y de los tres elementos derivados de él que más importancia tienen dentro de la porcelana: el cuarzo o sílice, los feldespatos y el caolín. Las porcelanas dentales están formadas básicamente por un vidrio en el que se encuentran partículas más o menos grandes de minerales cristalizados; es decir, una fase vítrea (feldespatos) de estructura atómica no periódica y por lo tanto amorfa que contiene una fase ordenada periódica y por lo tanto cristalina (sílice). El intento de clasificar las porcelanas tiene como utilidad facilitar la comunicación entre los distintos profesionales, así como el poder situar cada porcelana o nuevo producto presentado en un compartimiento donde las características tales como temperatura de sinterización, composición y manejo sean com-partidas por aquéllas que compongan el mismo grupo (AU)