Effect of different instrumentation techniques on students' performance and outcomes of nonsurgical root canal treatment.

OBJECTIVES: This study compared, retrospectively, the incidence of clinical errors and effects on treatment outcomes, when students were exposed to two different instrumentation techniques: a hybrid rotary technique (HYB), consisting of both hand instrumentation with hand stainless steel and Ni-Ti files plus the use of a rotary system (Vortex Blue, Dentsply Sirona), versus a full reciprocation instrumentation technique (WaveOne Gold [WOG], Dentsply Sirona). METHODS: A total of 368 endodontic cases (n = 184) in anterior and premolar teeth, completed by dental students at the University of Michigan School of Dentistry from 2013 to 2022, were used for the study. The groups were evaluated by two calibrated clinicians, observing the incidence of clinical errors: file separations, over-instrumentation, ledges and transportations. Treatment outcomes were also observed. Data were analyzed statistically by Fisher's exact test and Mann-Whitney U test (p < 0.05). RESULTS: No significant difference in file separations, ledges, and transportation was observed between the two groups. However, the WOG Group experienced significantly more over-instrumentation than HYB group, although this did not significantly affect tooth survival or periapical index (PAI). Cases with PAI scores of 5 were found to have significantly less tooth survival compared to the other PAI scores. CONCLUSIONS: It can be concluded that both techniques in our study are well suited to advancing the endodontic dental education of students and novice operators, anticipating relatively successful outcomes of tooth survival, as long as the cases selected are less severe in progression preoperatively.

Thickness and internal adjustment of monolithic resin composite milled crowns: Effect on the load-bearing capacity under fatigue.

OBJECTIVES: To evaluate the fatigue failure load (FFL), cycles for fatigue failure (CFF) and survival rates of different occlusal thicknesses of resin composite simplified crowns with internal adjustments (IA) or without as control (C). METHODS: 30 monolithic simplified crowns of CAD/CAM resin composite (Tetric CAD, Ivoclar) were milled in three different occlusal thicknesses (0.5 mm, 1.0 mm, and 1.5 mm). Half of the crowns were submitted to restricted adjustment with diamond burs on the crown's inner surface and half remained milled without internal adjustment. The samples were treated and adhesively luted onto a prosthetic preparation made of epoxy resin reinforced by glass-fiber substrate. The sets were subjected to a fatigue test (cyclic fatigue: initial load of 200 N; step-size of 50 N; 10,000 cycles/step; 20 Hz; maximum load: 2800 N).Microscopic analysis of tested representative samples was performed. The fatigue data were statistically analyzed (α= 0.05) and the micrograpic images were qualitatively evaluated. RESULTS: All specimens from groups 1.0C and 1.5C survived the cyclic loads, while all 0.5C samples failed during the test. The 1.0IA and 1.5IA crowns showed no statistical difference for FFL (2530 N= 2670 N) and CFF (471,000 cycles= 499,000 cycles) between them, and they were both statistically superior to the 0.5IA (FFL= 1812.50 N; CFF= 327,500 cycles). The 1.0 mm and 1.5 mm crowns presented superior fatigue behavior (2530 N-2800 N) compared to the 0.5 mm crowns (1812 N-2140 N), whether internal adjustment was performed or not. A statistically significant difference was found for FFL and CFF of 0.5 mm crowns with and without internal adjustment, with a deleterious impact of the adjustment for both parameters (FFL and CFF: 0.5C > 0.5IA). SIGNIFICANCE: Resin composite milled crowns can bear high cyclic fatigue loads despite thickness, although thicker crowns had better mechanical behavior; however, the internal adjustment in the composite resin crown leads to a detrimental effect on its fatigue behavior, which presents a risk of mechanical failure due to premature fatigue.

Do resin cement viscosity and ceramic surface etching influence the fatigue performance of bonded lithium disilicate glass-ceramic crowns?

OBJECTIVE: To assess the effects of a resin cement in high and low viscosity and distinct conditioning of the intaglio surface of lithium disilicate glass-ceramic crowns on fatigue performance of the crowns. METHODS: Prosthetic preparations (full-crown) in resin epoxy and crowns in lithium disilicate glass-ceramic were machined and allocated considering 2 factors (n = 10): "surface treatment" (HF - 5% hydrofluoric acid etching, followed by silane application; or E&P-self-etching ceramic primer) and "resin cement" (high or low viscosity). The preparations were etched with 10% hydrofluoric acid and an adhesive was applied. The intaglio surfaces of the ceramic crowns were treated as aforementioned (HF or E&P) and luted with high or low viscosity. The bonded sets were subjected to fatigue testing (step-stress approach: initial load of 200 N, step-size of 50 N, 10,000 cycles/step, 20 Hz) and complementary analyses (fractographic, topographic, and cross-sectional bonded interfacial zone analyses) were performed. RESULTS: Treatment with HF and silane with high viscosity resin cement (955 N/156,000 cycles) and E&P with low viscosity resin cement (1090 N/183,000 cycles) showed the best fatigue performance (statistical similarity between them). The failures originated from defects of the cement-ceramic interface, and the HF treatment induced a more pronounced topographical alteration. SIGNIFICANCE: Distinct topographical patterns from the HF and E&P treatments induced better fatigue results for the specific viscosity of the resin cement. Therefore, the fatigue performance depended on the existing topography, type of intaglio surface's defects/irregularities after surface treatment, and how the luting agent filled the irregularities.

Alumina particle air-abrasion and aging effects: Fatigue behavior of CAD/CAM resin composite crowns and flexural strength evaluations.

The aim of this study was to characterize the flexural strength and elastic modulus of CAD/CAM resin composite material and to evaluate the influence of different surface treatments and storage conditions on the fatigue behavior of bonded composite crowns. Bars (flexural strength, n= 30; elastic modulus, n= 5) (1.2 × 4 × 12 mm) were produced for three-point bending test and CAD/CAM milled crowns (n= 5) (thickness= 1 mm) adhesively cemented to an epoxy resin substrate for fatigue tests. Bars and crowns were randomly allocated into two "surface treatments": no surface treatment (CTRL) and air-abrasion with 110 µm Al2O3 particles (AlOx); while the crowns were also subdivided into "aging condition" (baseline - storage for 24 h to 7 days, and aging - storage for 150 days + 25,000 thermal cycles). The three-point bending test was performed according to ISO 6872 and the luted crowns were subjected to step-stress fatigue test (initial load of 200 N; step-size of 50 N; 10,000 cycles per step; 20 Hz). Complementary analysis by Stereomicroscopy and Field Emission Scanning Electron Microscopy (FE-SEM) were performed. The flexural strength and fatigue data were submitted to statistical tests (α= 0.05). The results showed that air-abrasion reduces the flexural strength and the characteristic strength of the resin composite, without modifying its elastic modulus or its structural reliability (Weibull Modulus). Air-abrasion did not influence the fatigue behavior of the cemented crowns. Notwithstanding, a decrease in the survival rate was observed after 445,000 cycles (2,400 N) when subjected to aging at both the CTRL or AlOx conditions. FE-SEM micrographs of the crowns showed that alumina particle air-abrasion treatment can modify the topography of its treated inner surface. Therefore, air-abrasion with alumina powder introduces defects onto the surface of the CAD/CAM resin composite material, decreasing the flexural strength, but without changing its elastic modulus and reliability. Adhesive cementation onto an epoxy resin substrate prevented an influence of the introduced defects on the fatigue performance of the resin composite restoration. Nevertheless, the fatigue behavior may be damaged by aging regimen.

Surface Evaluation of Resilient CAD/CAM ceramics after Contouring and Polishing.

OBJECTIVE: This in-vitro study measured the differences in surface roughness for computer assisted design/computer assisted manufacturing (CAD/CAM) resilient ceramic and CAD/CAM composite materials. MATERIALS AND METHODS: The materials included Lava Ultimate (3 M), Cerasmart (GC America), Vita Enamic (Vita Zahnfabrik), and Brilliant Crios (Coltene). One calibrated operator polished each material with three polishing sytems: spiral polishers (Diacomp FeatherLite/Brasseler), rubbercup polishers (Enhance/DentsplyCaulk), and brush-paste (Diashine/VH Technologies). Surface roughness was assessed using a confocal laser microscope (Lext OLS4000/Olympus). RESULTS: A two-way ANOVA revealed statistically significant differences in mean surface roughness values (Sa) among materials and polishers. Tukey multiple comparisons showed that mean Sa values for Lava Ultimate, Enamic, Cerasmart and Brilliant Crios polished with brush-paste as well as Lava Ultimate and Cerasmart values polished with spiral polishers were not significantly different from each other. CONCLUSIONS: The finished surfaces were significantly smoother than milled surfaces for all materials. The brush-paste polishing technique created the lowest surface roughness values for all CAD/CAM materials and values were comparable to what was achieved by spiral polishers for Lava Ultimate and Cerasmart. Rubber polishers did not provide a clinically smooth surface for CAD/CAM resilient ceramic/composite materials. CLINICAL SIGNIFICANCE: The results of the study indicate that polishing creates smooth surfaces for CAD/CAM resilient ceramic and CAD/CAM composite restorations.

Open Proximal Contact with Implant-Supported Fixed Prostheses Compared with Tooth-Supported Fixed Prostheses: A Systematic Review and Meta-analysis.

PURPOSE: To investigate the odds of developing open proximal contact (OPC) between implant-supported fixed prostheses and adjacent teeth compared with that between tooth-supported fixed prostheses and adjacent teeth. MATERIALS AND METHODS: A search was conducted in the Ovid MEDLINE, Embase, and Web of Science databases for clinical studies on OPC developed with implant-supported prostheses or tooth-supported prostheses. A meta-analysis was performed using statistical software to estimate the odds of developing OPC with implant-supported prostheses compared with tooth-supported prostheses, with a 95% confidence interval (CI). The statistical significance was defined as P < .05. RESULTS: The odds ratio (OR) of developing OPC with implant-supported prostheses was 2.46 compared with tooth-supported prostheses (95% CI [1.21 to 5.01]; P = .013]. However, the data were highly heterogenous (τ2 = 0.40, I2 = 95.67%). The total estimates of developing OPC were 41% (95% CI [30% to 54%]) with implant-supported prostheses and 22% (95% CI [18% to 26%]) with tooth-supported prostheses. OPC was more prevalent at the mesial side than at the distal side of implant-supported prostheses (OR = 2.38, 95% CI [0.94 to 6]; P = .066), whereas OPC was more prevalent at the distal side than at the mesial side of tooth-supported prostheses (OR = 1.94, 95% CI [1.09 to 3.45]; P = .024). There was no statistically significant difference in developing OPC with covariates of sex, age, arch, splinting of implants or adjacent teeth, region, and vitality of adjacent teeth, retention type, opposing dentition, occlusal force, parafunctional activities, and follow-up time. OPC was found to increase 9% per year with implant-supported prostheses (OR = 1.09). The estimate of interproximal gap next to implant-supported prostheses was 245.8 µm (95% CI [86.4 to 405.3 µm]). CONCLUSION: Within the limitations of this systematic review and meta-analysis, the odds of developing OPC were significantly higher with implant-supported prostheses than with tooth-supported prostheses. However, the data were highly heterogenous, and thus, a well-designed randomized clinical study needs to be conducted to validate the results of this systematic review.

Three-Dimensional Digital Evaluation of the Fit of Endocrowns Fabricated from Different CAD/CAM Materials.

PURPOSE: A wide variety of CAD/CAM materials are available for single-tooth restorations. CAD/CAM material characteristics are different and may influence CAM fabrication accuracy. There is no study investigating the influence of different CAD/CAM materials on the final fit of the restoration. The aim of this study was to evaluate the fit of endocrowns fabricated from different CAD/CAM materials using a new 3D evaluation method with an intraoral scanning system. The null hypothesis was that there are no significant differences for the fitting accuracy of different CAD/CAM materials. MATERIALS AND METHODS: Preparation for an endocrown was performed on a maxillary right first molar on a typodont, and restorations were fabricated with a chairside CAD/CAM system (CEREC Omnicam, MCXL). Three groups using three different CAD/CAM materials were established (each n = 10): zirconia-reinforced lithium silicate ceramic (Celtra Duo; CD), leucite-reinforced silicate ceramic (Empress CAD; EM), resin nanoceramic (Lava Ultimate; LU). A 3D digital measurement technique (OraCheck, Cyfex AG) using an intraoral scanner (CEREC Omnicam) was used to measure the difference in fit between the three materials for a master endocrown preparation. The preparation scan and the endocrown fit scan were matched with special difference analysis software OraCheck. Three areas were selected for fitting accuracy measurements: margin (MA), axial (AX), occlusal (OC). Statistical analysis was performed using 80% percentile, one-way ANOVA, and post-hoc Scheffé test. Significance level was set to p = 0.05. RESULTS: Results varied from best 88.9 ± 7.7 µm for marginal fit of resin nanoceramic restorations (LU_MA) to worst 182.3 ± 24.0 µm for occlusal fit of zirconia-reinforced lithium silicate restorations (CD_OC). Statistically significant differences were found both within and among the test groups. Group CD performed statistically significantly different from group LU for marginal fit (MA) and axial fit (AX) (p < 0.05). For occlusal fit (OC), no statistically significant differences were found within all three test groups (p > 0.05). Deviation pattern for differences was visually analyzed with a color-coded scheme for each restoration. CONCLUSIONS: Statistically significant differences were found for different CAD/CAM materials if the CAM procedure was identical. Within the limitations of this study, the choice of CAD/CAM material may influence the fitting accuracy of CAD/CAM-fabricated restorations.

Digital evaluation of the fit of zirconia-reinforced lithium silicate crowns with a new three-dimensional approach.

OBJECTIVE: Several methods for the evaluation of fit of computer-aided design/computer-assisted manufacture (CAD/CAM)-fabricated restorations have been described. In the study, digital models were recorded with an intraoral scanning device and were measured using a new three-dimensional (3D) computer technique to evaluate restoration internal fit. The aim of the study was to evaluate the internal adaptation and fit of chairside CAD/CAM-fabricated zirconia-reinforced lithium silicate ceramic crowns fabricated with different post-milling protocols. The null hypothesis was that different post-milling protocols did not influence the fitting accuracy of zirconia-reinforced lithium silicate restorations. METHOD AND MATERIALS: A master all-ceramic crown preparation was completed on a maxillary right first molar on a typodont. Twenty zirconia-reinforced lithium silicate ceramic crowns (Celtra Duo, Dentsply Sirona) were designed and milled using a chairside CAD/CAM system (CEREC Omnicam, Dentsply Sirona). The 20 crowns were randomly divided into two groups based on post-milling protocols: no manipulation after milling (Group MI) and oven fired-glazing after milling (Group FG). A 3D computer method was used to evaluate the internal adaptation of the crowns. This was based on a subtractive analysis of a digital scan of the crown preparation and a digital scan of the thickness of the cement space over the crown preparation as recorded by a polyvinylsiloxane (PVS) impression material. The preparation scan and PVS scan were matched in 3D and a 3D difference analysis was performed with a software program (OraCheck, Cyfex). Three areas of internal adaptation and fit were selected for analysis: margin (MA), axial wall (AX), and occlusal surface (OC). Statistical analysis was performed using 80% percentile and one-way ANOVA with post-hoc Scheffé test (P = .05). RESULTS: The closest internal adaptation of the crowns was measured at the axial wall with 102.0 ± 11.7 µm for group MI-AX and 106.3 ± 29.3 µm for group FG-AX. The largest internal adaptation of the crowns was measured for the occlusal surface with 258.9 ± 39.2 µm for group MI-OC and 260.6 ± 55.0 µm for group FG-OC. No statistically significant differences were found for the post-milling protocols (P > .05). The 3D difference pattern was visually analyzed for each area with a color-coded scheme. CONCLUSION: Post-milling processing did not affect the internal adaptation of zirconia-reinforced lithium silicate crowns fabricated with a chairside CAD/CAM technique. The new 3D computer technique for the evaluation of fit of restorations may be highly promising and has the opportunity to be applied to clinical studies.

Restauração utilizando-se implante unitário em região anterior de maxila: relato de caso / Single-unit implant restoration in maxillary anterior region: case report

O tratamento para substituição de dentes utilizando-se implantes osseointegrados tem sido utilizado de maneira eficaz para resolução de casos que envolvem espaços edêntulos unitários em áreas estéticas. A busca por restaurações estéticas deve promover uma transição harmoniosa entre a restauração e o tecido periimplantar, e isso pode ser alcançado por meio de um planejamento cirúrgico e protético criterioso e integrado, permitindo maior previsibilidade no contorno gengival de uma restauração sobre implante em área estética. Este artigo apresenta um caso clínico de restauração sobre implante osseointegrado em um incisivo central superior, por se tratar de opção de tratamento conservadora, proporcionando, de maneira eficaz, resultados para obtenção do sucesso reabilitador estético, funcional e biológico.

Replacing lost teeth using osseointegrated implants is effective to solve cases involving single-unit edentulous spaces in esthetic areas. Esthetic restorations should produce a harmonious transition between the restoration and peri-implant tissues. This can be obtained by a thoughtful, comprehensive surgical and prosthetic planning, allowing greater predictability to the gingival contour of the implant-supported restoration in the esthetic area. This article presents a case report of a single-unit implant-supported restoration in a maxillary central incisor. This treatment was chosen because it is a conservative treatment option that effectively produces successful esthetic, functional and biological results.

Reconstrução unitária posterior com coroas endocrown: relato de caso / Single-unit reconstructions using endocrown restorations: a case report

Há crescente demanda de pacientes que solicitam restaurações em que se utilizam materiais estéticos, dentre eles, os principais são as resinas compostas e as cerâmicas. Quando se tratar de cavidades extensas, a cerâmica deve ser indicada, pela maior possibilidade de obtenção de bons resultados em longo prazo. Dentes tratados endodonticamente geralmente possuem grandes cavidades, e as restaurações do tipo endocrown são uma opção bastante conservadora em relação aos pinos intrarradiculares associados às coroas totais. Este artigo descreve uma sequência clínica e técnica de uma coroa adesiva indireta do tipo endocrown em dente posterior, utilizando-se cerâmica como material restaurador, por meio de um sistema CAD/CAM para confecção.

There is an increasing demand for esthetic restorations using composite and ceramic materials. Ceramics should be the material of choice when restoring large posterior cavities, due to its higher long-term predictability. Endodontically-treated posterior teeth usually presente wide cavities, and endocrowns are a safe alternative when compared to posts associated to full-coverage crowns. This article is a clinical report using an endocrown fabricated with a CAD/CAM ceramic system.

Uso de mini-implantes para distração alveolar. Uma nova técnica / Use of mini implants for alveolar distraction. A new technique – case report

Este artigo teve como objetivo apresentar um caso clínico de distração óssea alveolar com a utilização de mini-implante osseointegrado colocado em região posterior de mandíbula. Um mini-implante foi colocado na região da perda óssea alveolar. Após constatada a sua osseointegração foi realizada a cirurgia de osteotomia do bloco ósseo a ser distracionado. Com a utilização de uma barra metálica suportada pelos dentes vizinhos, um parafuso de tracionamento foi instalado no interior do mini-implante e sua cabeça foi ancorada em orifício especialmente realizado para esta finalidade. O bloco ósseo foi distracionado até alcançar a altura planejada. Após um período de contenção de 90 dias, a paciente foi submetida a nova cirurgia para remoção do mini-implante e colocação de dois implantes osseointegrados de 3,25 mm x 10 mm, de hexágono externo. Após o período de espera para osseointegração foi realizada a abertura dos implantes e finalizado o tratamento com prótese implantossuportada

This article presents a clinical case of alveolar bone distraction with the use of mini dental implants placed in the posterior mandible. A mini implant was placed in the region of alveolar bone loss. After osseointegration we performed the osteotomy of the bone block around the mini implant. With the use of a metal bar supported by neighboring teeth, a traction screw has been installed inside the mini implant and its head was held anchored in a hole specially created for this purpose. The bone block was distracted to reach the planned height. After 90 days, the patient underwent another surgery to remove the fractured implant and mini implant. Finally, two 3.75 x 10 mm dental implants were placed. Then, implants were exposed and an implant-supported prosthesis was delivered to the patient