Application of the Kvaal method to CBCT reconstructed panoramic images for age estimation.

As the teeth are more durable than other parts of the skeleton, they provide valuable data for age estimation. Age estimation from adult teeth is mainly based on secondary dentin production. The present study aimed to devise a regression formula for age estimation specific to the Anatolian population using the Kvaal method on CBCT reconstructed panoramic images. In total, 201 individuals aged between 20 and 69 were divided into two groups: data from the study group (n = 101) were used to create the regression formulae, and data from the control group (n = 100) were used to test the formulae. Pearson's correlation coefficients and linear regression analyses were performed. Maxillary teeth provided more accurate age estimates than mandibular teeth. The regression formulae derived in this study are found to be statistically applicable and reasonably accurate. However, these results should be interpreted with caution.

Influence of psychiatric symptom profiles of parents on sleep bruxism intensity of their children.

OBJECTIVE: The objective of this study was to evaluate the effects of parental anxiety, depression levels and psychiatric symptom profiles of parents on the occurrence of sleep bruxism in children. MATERIAL & METHODS: This cross-sectional study was carried out with a sample of 94 children aged 6 to 12 years, divided into two groups: with sleep bruxism (bruxism group-BG) and without sleep bruxism (control group-CG). Beck Depression Inventory (BDI), Symptom Checklist (SCL-90-R), Symptom Checklist and Screen for Child Anxiety Related Emotional Disorders-Parent (SCARED-P) scale were used to assess anxiety and depression levels of parents. All questionnaires were filled out by parents of children. Intraoral and extraoral examinations were carried out of children in the clinic and sleep bruxism was determined. All stress conditions were investigated by logistic regression analysis. In the comparison of the qualitative data, chi-square and Fisher exact tests were used. RESULTS: The data revealed that participants whose mothers had high anxiety and interpersonal sensitivity scores, and participants whose fathers had a medium level of obsessive-compulsive disorder were more likely to have an SB problem (p < 0.05). According to the results of BDI, the fathers' results between the BG and the CG were not statistically significant (p > 0.05). However, the mothers' results between the BG and the CG were statistically significant (p < 0.05) When all subscales of SCARED-P were evaluated, the separation anxiety disorder subscore was statistically significant in the bruxism group. CONCLUSION: The psychological status of parents is a significant risk factor associated with SB development in school-age children.

Full digital workflow of a 2-piece obturator with polyetherketoneketone in a patient with maxillectomy and trismus: A clinical and laboratory report.

The computer-aided design and computer-assisted manufacturing of a 2-piece definitive palatal obturator 3D printed from polyetherketoneketone and 2 acrylic resins with a fully digital workflow are presented for a patient who was diagnosed with adenoid cystic carcinoma and who developed severely limited mouth opening after surgery and radiotherapy. The 18-month follow-up period revealed satisfactory function, tissue compatibility, retention, and esthetics for this patient with a maxillectomy and severe trismus.

Perception of color mismatch or conspicuous marginal adaptation in extraoral prostheses with eye-tracking.

STATEMENT OF PROBLEM: Color matching and marginal integrity are major challenges when providing extraoral maxillofacial prostheses. Which of the color and marginal harmony features are more important for the extraoral prostheses to be inconspicuous is unclear. Studies on the perception of these prostheses with objective evaluation criteria are lacking. PURPOSE: The purpose of this observational study was to investigate the significance of color mismatch and conspicuous marginal adaptation in the perception of extraoral maxillofacial prostheses using eye-tracking technology. The secondary aim was to evaluate the perception of extraoral maxillofacial prostheses with regard to the observers' sex. MATERIAL AND METHODS: Twenty-seven face images, in 3 groups, representing well-fitting orbital prostheses with a color mismatch (IC), prostheses with a good color match but distinct marginal adaptation (IM), and symmetrical face images, were viewed for 5 seconds by 52 laypeople. Time to first fixation (TFF), fixation duration (FD), and fixation count (FC) at defined areas of interest were recorded and analyzed by an eye-tracking device. Because of the nested structure of data, a sex- and age-adjusted random intercept linear mixed effects model was used to assess the difference between IC, IM, and SI. Bonferroni corrected P values were used for pairwise comparisons. The difference between observers' sex was evaluated with random intercept mixed model by adjusting for age for each image. For repeated measurement analysis, the lm4, lmerTest, and emmeans libraries in R version 4.3.1 (R Foundation for Statistical Computing) were used (α=.05 for all tests). RESULTS: Significant differences were found between the symmetrical image group and other study groups at the facial prosthesis region in all parameters (each P<.001). Observers first focused on the facial prostheses in IC (0.72 seconds) and in IM (0.789 seconds). Longer fixation durations, 1.909, 1.989 seconds for IC and IM (PIC<.001, PIM<.001), respectively, and a higher fixation count for IC (5.28) (P<.001) and for IM (5.45) (P<.001) were recorded on facial prostheses compared with other areas of interest. Women were more focused on the prosthesis than men in the IC and IM groups considering FD (PIC=.003, PIM<.001) and FC values (PIC=.016, PIM<.001, PSI<.001). Fixation duration for women and men was 2.097 seconds and 1.739 seconds in the IC group, 2.219 seconds and 1.78 seconds in the IM group, and 1.364 seconds and 1.222 seconds in the SI group, respectively. CONCLUSIONS: Since the color mismatch and distinct marginal adaptation of maxillofacial prostheses were recognized using eye-tracking technology, both features appeared to be equally significant to be considered in fabrication procedures.

The effect of various surface treatments on the repair bond strength of denture bases produced by digital and conventional methods.

There is limited information on the repairability of prostheses produced with digital technology. This study aims to evaluate various surface treatments on flexural bond strength of repaired dentured base resins produced by digital and conventional methods. A total of 360 samples were prepared from one heat-polymerized, one CAD/CAM milled and one 3D printed denture base materials. All of the test samples were subjected to thermocycling (5-55 °C, 5000 cycles) before and after repair with auto-polymerizing acrylic resin. The test samples were divided into five subgroups according to the surface treatment: grinding with silicon carbide (SC), sandblasting with Al2O3 (SB), Er:YAG laser (L), plasma (P) and negative control (NC) group (no treatment). In addition, the positive control (PC) group consisted of intact samples for the flexural strength test. Surface roughness measurements were performed with a profilometer. After repairing the test samples, a universal test device determined the flexural strength values. Both the surface topography and the fractured surfaces of samples were examined by SEM analysis. The elemental composition of the tested samples was analyzed by EDS. Kruskal-Wallis and Mann-Whitney U tests were performed for statistical analysis of data. SB and L surface treatments statistically significantly increased the surface roughness values of all three materials compared to NC subgroups (p < 0.001). The flexural strength values of the PC groups in all three test materials were significantly higher than those of the other groups (p < 0.001). The repair flexural strength values were statistically different between the SC-SB, L-SB, and NC-SB subgroups for the CAD/CAM groups, and the L-SC and L-NC subgroups for the 3D groups (p < 0.001). The surface treatments applied to the CAD/CAM and heat-polymerized groups did not result in a statistically significant difference in the repair flexural strength values compared to the NC groups (p > 0.05). Laser surface treatment has been the most powerful repair method for 3D printing technique. Surface treatments led to similar repair flexural strengths to untreated groups for CAD/CAM milled and heat-polymerized test samples.

Bacterial adhesion to composite resins produced by additive and subtractive manufacturing.

The aim of this study was to evaluate the surface roughness and contact angle of composite resins produced by CAD/CAM milling and three-dimensional (3D) printing for permanent restorations as well as the adhesion of S. mutans and S. sanguinis bacteria to these composites. Three CAD/CAM milling composite resins (Vita Enamic-VE, Cerasmart-CE, Lava Ultimate-LU) and three 3D printing resins (Varseo Smile Crown plus-VSC, Saremco print Crowntech-SPC, Formlabs 3B Permanent crown-FLP) were selected. Twenty samples were prepared for each group. Using a contact profilometer, the surface roughness was determined, and an optical goniometer was used to quantify the contact angle. To evaluate the bacterial adhesion, composite specimens were immersed in mucin containing artificial saliva. All samples were incubated for 24 h at 37°C in 5% CO2. CFUs were determined by counting colonies after the incubation period. Surface roughness values of test samples were the highest in the Group VSC [0.46 (0.14) µm], whereas the lowest values were found in the Group LU [0.23 (0.05) µm]. There was no statistically significant difference between the groups in contact angle values (p > 0.05). The S. mutans adhesion extent on the Group SPC was statistically higher compared to all other materials with p < 0.05. For S. sanguinis, the lowest bacterial adhesion value was recorded in Group CE (3.00 × 104 CFU/ml) and statistically significant differences were found with Group VE and VSC (p < 0.05). Different digital manufacturing techniques and material compositions can affect the surface roughnesses of composite resins. All composite resin samples have hydrophobic characteristics. Microbial adhesion of the tested composite resins may be varied depending on the bacterial species. S. mutans showed much more adhesion to these materials than S. sanguinis.

How can excess residual cement be reduced in implant-supported restorations?: An in vitro study.

OBJECTIVE: The aim of this study was to investigate the effect of different cements and cementation techniques used in implant-supported restorations and the application of various vent modifications and extraoral replica techniques on the amount of overflowing cement in cemented systems. MATERIALS AND METHODS: In this study, three different abutment designs were used as fully closed, occlusal vented, and occlusal + proximal vented. An extraoral replica was produced by milling the CAD/CAM ceramic block. The number of groups with and without replicas was determined as six (n = 10). For the cementation procedures, three different cements were tested: dual-cure resin, eugenol-free zinc oxide, and polycarboxylate cements. Cobalt-chromium superstructures to be cemented to the implant analog-abutment complex were produced by direct metal laser sintering method. Twenty-four hours after the cementation process, residual cement were measered with Micro-CT. In comparisons between groups, ANOVA test was used for normally distributed variables and Kruskall-Wallis H test was used for non-normally distributed variables at a significance level of p < 0.05. RESULTS: The difference in residual cement volumes between the groups in terms of both cementation techniques (whether or not to use an extraoral replica and different vent desings) and cement types was found to be statistically significant (p < 0.05). There was significantly less residual cement in all groups that used extraoral replicas than those that did not. As for the cement types, the most residual cement occurred in the resin cement. CONCLUSION: The use of extraoral replicas and vent designs on the abutment significantly reduces the amount of residual cement. Regardless of the cementation technique, the type of cement used affects the amount of excess cement. CLINICAL RELEVANCE: To reduce residual cement, both the type of cement and the cementation technique used must be considered.

Improvement of speech by facial prosthesis in a midfacial defect with a gunshot injury: A case report.

Gunshot wounds in the maxillofacial region may cause serious defects that result in functional and esthetic disabilities. A 14-year-old male patient was referred to the prosthodontics clinic for provisional prosthetic restoration 5 months after an injury involving the midline midfacial region. An interim extraoral silicone maxillofacial prosthesis (MFP), also known as an epithesis, replacing the nose and upper lip, was fabricated to enhance appearance and speech intelligibility. The effect of the prosthesis insertion on speech outcome was assessed over 6 months. Blood pulse oxygen saturation levels and heart rate were monitored to assess ventilation following the prosthesis insertion. Results of the Assessment of Articulation Subtest revealed the patient produced the target speech sounds of 31 more words correctly at 6 months follow-up. Bilabial, labiodental, and postalveolar speech sounds in the phonetic inventory improved. Fabrication of an extraoral silicone MFP, modifying substructure design, and prosthesis usage over time contributed to the significant enhancement of speech intelligibility and did not significantly change the blood pulse oxygen saturation levels and heart rate. It led to an improvement in overall aesthetic outcomes and was a useful tool for the patient's social integration.

Ultrasonographic and electromyographic evaluation of three types of occlusal splints on masticatory muscle activity, thickness, and length in patients with bruxism.

OBJECTIVE: To evaluate occlusal splint type differences in patients with bruxism. METHODS: Seventeen controls and 51 patients were divided into three subgroups, each assigned to use a different occlusal splint (hard, soft, or semi-soft) for 3 months and assessed by ultrasonography and electromyography (EMG) before (BT) and 3 months after treatment (AT). RESULTS: EMG values in all of the occlusal splint groups were significantly lower AT than BT (p < 0.05). BT and AT EMG values in the control group did not differ. Mean muscle thicknesses in bruxism patients was greater than in controls, and the greatest muscle thickness changes occurred with the hard occlusal splint (p < 0.05). DISCUSSION: A decrease in EMG activity occurred with all three splint types and was most prominent in the hard occlusal splint group. Ultrasonographic measurements of muscle length and thickness should be used alongside EMG to measure muscle activity in bruxism patients.

Perception of orbital epitheses evaluated with eye tracker.

PURPOSE: Orbital epitheses replace a missing eyeball and surrounding soft tissue. Perception of epithesis in public gaze and the attention areas on the face are of interest. This study aimed to examine the differences in perception of orbital epitheses by prosthodontists, dentistry students, and laypeople with an objective evaluation tool that utilized eye-tracking technology. MATERIALS AND METHODS: Twenty-four frontal facial images of 12 patients who had orbital epitheses were viewed by 81 observers (prosthodontists, dentistry students, laypeople) in random order for 5 seconds each. Gaze data were analyzed. Kruskal-Wallis H test with Bonferroni correction was used to compare parameters in groups and areas of interest. RESULTS: First fixation duration at the mouth for symmetrical images were 0.30, 0.28, and 0.25 seconds for prosthodontists, students, and laypeople, respectively. Fixation duration at the mouth for the laypeople (0.27 second) was shorter than students (0.29 second) and prosthodontists (0.31 second) at symmetrical images. Time to the first fixation to epithesis, nose, and eye was significantly lower than the forehead and mouth for all groups. Fixation count at epithesis was 6.36 for prosthodontists, 5.64 for students, and 5.34 for laypeople. CONCLUSION: Eyes were of most significant interest for all observer groups in symmetrical images. Individuals dealing with dentistry, especially prosthodontists, paid more attention to the mouth region along with the eyes in symmetrical images, considering fixation duration and fixation count. Attention directed to epithesis by all groups was verified with objective and measurable criteria. Prosthodontists' attention to epithesis and mouth was evident considering the four parameters measured.

Does cad software affect the marginal and internal fit of milled full ceramic crowns?

Although the effects of different intraoral scanners, model scanners, and CAM units on the marginal and internal fitting of restorations have been investigated, the effects of CAD software in particular has not been evaluated. The marginal and internal fit of indirect restorations may vary according to the CAD software used, even when using the same intraoral scanner and milling machine. The purpose of this study was to evaluate the marginal and internal fit of milled full ceramic crowns designed with three different CAD systems. Eleven typodont maxillary first premolar teeth were prepared and scanned using a 3Shape TRIOS Intraoral Dental Scanner. The obtained STL scan data were exported and used to design a full crown using three different CAD systems (CEREC, KaVo, and Planmeca). An independent milling unit was used to manufacture the crowns for each group (n = 11). The marginal and internal fit were evaluated for each restoration using 2D and 3D micro-CT analysis. For 2D analysis, 18 measurements for each sample were made, covering the marginal (Marginal Gap Buccal (MG-A), Marginal Gap Palatinal (MG-B), Finish Line Buccal (FL-A), Finish Line Palatinal (FA-B)) and internal fit locations (Axial Wall Buccal (AW-A), Axial Wall Palatinal (AW-B), Lingual Cusp (LC), Buccal Cusp (BC), and Occlusal Central Fossa (OCF)). Statistical analyses were performed using Open Source R Statistical Software (α = 0.05) The results of Duncan's multiple range test showed that the values for the marginal measurement points MG-A, MG-B, FL-A, and FL-B in the Planmeca group were significantly higher than the values obtained in the CEREC and KaVo groups (p < 0.05). In AW1, values of the CEREC group were found to be higher than those of the KaVo and Planmeca groups (p < 0.05). CAD software showed an effect on the marginal fit values of crowns whereas no significant difference was observed in terms of the internal fit, except for a single measurement point made from the buccal direction.

Does cad software affect the marginal and internal fit of milled full ceramic crowns?

Abstract: Although the effects of different intraoral scanners, model scanners, and CAM units on the marginal and internal fitting of restorations have been investigated, the effects of CAD software in particular has not been evaluated. The marginal and internal fit of indirect restorations may vary according to the CAD software used, even when using the same intraoral scanner and milling machine. The purpose of this study was to evaluate the marginal and internal fit of milled full ceramic crowns designed with three different CAD systems. Eleven typodont maxillary first premolar teeth were prepared and scanned using a 3Shape TRIOS Intraoral Dental Scanner. The obtained STL scan data were exported and used to design a full crown using three different CAD systems (CEREC, KaVo, and Planmeca). An independent milling unit was used to manufacture the crowns for each group (n = 11). The marginal and internal fit were evaluated for each restoration using 2D and 3D micro-CT analysis. For 2D analysis, 18 measurements for each sample were made, covering the marginal (Marginal Gap Buccal (MG-A), Marginal Gap Palatinal (MG-B), Finish Line Buccal (FL-A), Finish Line Palatinal (FA-B)) and internal fit locations (Axial Wall Buccal (AW-A), Axial Wall Palatinal (AW-B), Lingual Cusp (LC), Buccal Cusp (BC), and Occlusal Central Fossa (OCF)). Statistical analyses were performed using Open Source R Statistical Software (α = 0.05) The results of Duncan's multiple range test showed that the values for the marginal measurement points MG-A, MG-B, FL-A, and FL-B in the Planmeca group were significantly higher than the values obtained in the CEREC and KaVo groups (p < 0.05). In AW1, values of the CEREC group were found to be higher than those of the KaVo and Planmeca groups (p < 0.05). CAD software showed an effect on the marginal fit values of crowns whereas no significant difference was observed in terms of the internal fit, except for a single measurement point made from the buccal direction.

Micro-CT Evaluation of the Marginal and Internal Fit of Crown and Inlay Restorations Fabricated Via Different Digital Scanners belonging to the Same CAD-CAM System.

PURPOSE: To evaluate the marginal and internal adaptation of all-ceramic crowns and inlays fabricated by different scanners of the same CAD/CAM system. MATERIALS AND METHODS: All-ceramic crown preparations were performed on typodont maxillary first premolars, and mandibular first molars were prepared for ceramic Class II mesio-occlusal inlays. Two intraoral scanners (CEREC Bluecam and Omnicam, Dentsply Sirona) and one model scanner (CEREC inEos X5, Dentsply Sirona) were used to scan the preparations. All restorations were fabricated by milling single-feldspathic ceramic blocks (CEREC Blocks). The marginal and internal discrepancies of restorations were evaluated via micro-CT analyses. RESULTS: For linear crown measurements, the marginal gaps were 63.75 µm, 88.24 µm, and 90.89 µm for Bluecam, Omnicam, and inEos X5, respectively. For crowns at central groove areas, the maximum values for Bluecam, Omnicam, and inEos X5 were found to be 144.78 µm, 165.19 µm, and 129.49 µm, respectively. For inlays, the highest range at the midpoint of the axiopulpal line angle for Bluecam, Omnicam, and inEos X5 were determined as 138.57 µm, 184.33 µm, and 179.71 µm, respectively. In volumetric measurements, inEos X5 showed lower gap for both crowns (11.47 mm3) and inlays (5.65 mm3) compared to both intraoral scanners. These results are within a clinically acceptable range. CONCLUSION: When all-ceramic crowns were evaluated, there were generally no significant differences found between scanners for the regional linear measurements, but more gaps occurred in restorations obtained with intraoral scanners for volumetric measurements. On the other hand, when the inlay restorations were evaluated, significant differences were found between groups except for the midpoint of the axio-pulpal line angle and the midpoint of the mesio-gingival margin. However, marginal and internal gaps of both crowns and inlays presented mean values less than 150 µm in many surfaces, which could be considered clinically acceptable.

Evaluation of Denture Base Adaptation Fabricated Using Conventional, Subtractive, and Additive Technologies: A Volumetric Micro-Computed Tomography Analysis.

PURPOSE: An in vitro study to compare the adaptation of denture bases fabricated with 4 different techniques using volumetric 3-dimentional (3D) analysis. MATERIAL AND METHODS: Edentulous maxillary and mandibular casts were scanned, and standardized denture bases were designed using CAD design software. The same standard tessellation language (STL) data were used to produce the denture bases with 4 different fabrication methods: compression molding (CM), injection molding (IM), PMMA milling (PM), and 3D printing (3D) (n = 11/group). Milled wax denture bases were used to fabricate CM and IM groups. Denture bases placed on edentulous casts were scanned using micro-computed tomography (micro-CT). Volumetric gap between denture base and cast was calculated from 6 locations for maxilla (anterior ridge crest, posterior ridge crest, labial vestibule, buccal vestibule, palate, and posterior palatal seal) and 3 locations for mandible (intermolar, molar, and retromolar) in addition to overall gap measurements for edentulous arches. The data were analyzed with factorial analysis of variance (ANOVA), 1-way ANOVA, and post-hoc Duncan tests. Reproducibility of fabrication methods with regard to each location was assessed using Z test (α = 0.05). RESULTS: In the maxilla, the highest and lowest palatal gap measurements were recorded for CM (898.44 ± 87.73 mm3 ) and PM (357.16 ± 57.68 mm3 ) (p = 0.05). The highest gap measurements for CM and 3D were at palate and, for IM and PM were at posterior ridge crest. In mandible, the volumetric gap measurements for CM were the highest and for PM were the lowest irrespective of location (p = 0.05). PM group showed the best reproducibility and adaptation with the lowest overall mean gaps for both edentulous arches (p = 0.05). CONCLUSIONS: Denture bases milled from PMMA blocks showed better adaptation than 3D printed, or wax milled and conventionally fabricated denture bases for both maxillary and mandibular arches. PMMA milling is a reproducible technique that enables the construction of accurate dentures. Clinicians should be cautious about the palatal gap when the compression molding technique is used. Micro-CT is a valid technique for evaluating the denture base adaptation.

Marginal and internal fit of feldspathic ceramic CAD/CAM crowns fabricated via different extraoral digitization methods: a micro-computed tomography analysis.

The aim of this study was to compare the fit of feldspathic ceramic crowns fabricated via 3 different extraoral digitizing methods. Twelve maxillary first premolars were prepared and 36 single crowns were fabricated via 3 extraoral digitizing methods using a laboratory scanner (n = 12): (1) scanning the typodont (ST [control] group); (2) scanning the impression (SI group); (3) scanning the stone cast (SC group). Micro-computed tomography was used to calculate two-dimensional marginal-internal gap and the three-dimensional volumetric gap between the crowns and their corresponding dies. The measured gaps were divided into 6 location categories as follows: marginal gap (MG), finish line gap (FLG), axial wall gap (AWG), cuspal gap (CG), proximal transition gap (PTG), and central fossa gap (CFG). The correlation between each of the 3 extraoral digitizing methods and the adaptation status of the crown margins were also evaluated. The Wilcoxon signed-rank test, Spearman's rank test, and Chi-square test were used for data analysis (α = 0.05). The marginal gaps in the ST, SI, and SC groups differed significantly (24, 198 and 117.6 µm, respectively) (p < 0.05). Significant differences were found between the groups with regard to internal gap measurements, with SI representing higher gap measurements at FLG, PTG and CFG locations (p < 0.05). 3D volumetric gap measurements did not differ significantly (p > 0.05). Under-extended margins observed in the SI and SC groups were correlated with the digitizing method (Cramer's V-square: 0.14). When performing extraoral digitalization, clinicians should choose to scan the stone cast as scanning the stone cast resulted in better internal and marginal fit compared to scanning the impression.

Effect of endodontic access simulation on the fracture strength of lithium-disilicate and resin-matrix ceramic CAD-CAM crowns.

OBJECTIVES: The purpose of this in vitro study was to compare the effect of simulated endodontic access preparation on the failure loads of lithium disilicate crowns and resin-matrix ceramic (RMC) crowns. MATERIALS AND METHODS: Eighty maxillary first premolar crowns were manufactured by using four different CAD/CAM blocks (n = 20): lithium disilicate (LD; IPS e.max CAD), resin nanoceramic (RNC; Lava Ultimate), flexible nanaoceramic (FNC; GC Cerasmart), and polymer-infiltrated ceramic (PIC; VITA Enamic). Half of each group was accessed and repaired to simulate endodontic treatment. After cyclic loading, all specimens were loaded to failure. Data were analyzed with two-way ANOVA followed by Tukey-HSD test (α = .05). RESULTS: The load to failure results showed significant differences for material types (P < .001), but not for endodontic access simulation (P = .09). The highest and lowest mean failure loads were obtained for LD (1546 N) and PIC (843 N), respectively. CONCLUSION: The endodontic access preparation was not found to affect the fracture strength of LD and RMC crowns. The LD showed higher fracture strength than RMC crowns. Even though significant differences were noted for failure loads regarding different crown materials, all could reasonably withstand masticatory forces. CLINICAL SIGNIFICANCE: The endodontic access preparation through a restoration is known to be a common challenge in clinical practice. Maintaining a repaired LD or RMC crown is feasible and replacement may not be necessary.

Biomechanical Comparison of a New Triple Cylindrical Implant Design and a Conventional Cylindrical Implant Design on the Mandible by Three-Dimensional Finite Element Analysis.

PURPOSE: The aim of this study was to evaluate the effect of implant designs with different lengths and diameters on the stress distribution in abutments, implants, and cortical and trabecular bone of the edentulous mandible via three-dimensional finite element analysis. MATERIALS AND METHODS: Eight different finite models (cylindrical 3.5 × 6; cylindrical 3.5 × 10.5; cylindrical 4.5 × 6; cylindrical 4.5 × 10.5; triple cylindrical 3.5 × 6; triple cylindrical 3.5 × 10.5; triple cylindrical 4.5 × 6; and triple cylindrical 4.5 × 10.5) were created. Abutments, abutment screws, and metal-retained porcelain crowns were modeled on the implants. A 200-N oblique load was applied on the buccal cusp of the crown. The highest maximum principal (Pmax) and minimum principal (Pmin) stresses were calculated for trabecular and cortical bone, and von Mises stress values were calculated for the implant and abutment. RESULTS: The triple cylindrical implant abutments showed lower stress values than cylindrical implant abutments. The highest von Mises stress values were observed in the cervical third of the abutments. The stress values on implants were found at the neck of the implants, and cylindrical implants showed higher stress values than triple cylindrical implants. The peak Pmax and Pmin values in cortical bone were detected around the implant neck. For implants with a 3.5-mm diameter, the triple cylindrical implant design showed lower stresses in cortical bone than the cylindrical implant design; however, similar stresses were observed in 4.5-mm implants for both designs. Implant length did not affect the stresses in cortical bone. Implants with a 10.5-mm length showed lower Pmax values than implants with a 6-mm length in trabecular bone. For Pmin values in trabecular bone, the triple cylindrical implant design had lower values than did the cylindrical implant design. CONCLUSION: Within the limitations of this study, the triple cylindrical implants, with a new implant design, showed appropriate results in terms of abutment, implant, and bone tissue stress.

Cytotoxic effects of contemporary bulk-fill dental composites: A real-time cell analysis.

The aim of this study was to evaluate the cytotoxicity of contemporary flowable and paste-like bulk-fill dental composites by using a real-time cell analysis. In the present paper, cytotoxicity levels of five flowable, five paste-like bulk-fill composite materials and one conventional flowable, one conventional paste-like resin composite were examined on L929 mouse fibroblast cell line. After seeding 25,000 cells/300 µL/well cell suspensions into the wells of an E-plate, test materials were added and observed at every 30 min intervals for 72 h. Kruskal Wallis H and Mann Whitney U multiple comparison tests were used to analyze the results. Pre-reacted glass-ionomer (PRG) containing bulk-fill composites were severely toxic at all time points (24, 48 and 72 h, p<0.05). None of the tested composites demonstrated high cell viability (>70%) at 48 and 72 h. Flowable and paste-like composites of the same brand exhibited similar cytotoxic properties (p>0.05).

In Vitro Evaluation of Bond Strength between Zirconia Core and CAD/CAM-Produced Veneers.

PURPOSE: To evaluate the shear bond strength between various CAD/CAM veneer materials and the zirconia ceramic core. MATERIALS AND METHODS: Ninety square prism zirconia specimens (10 specimens per each group, n = 10) in dimensions of 10 × 5 × 5 mm were prepared. Eighty square prism veneering specimens (40 feldspathic ceramic [Cerec Bloc] and 40 lithium disilicate [IPS e.max CAD]) in dimensions of 3 × 3 × 1 mm were connected to zirconia specimens. Conventional layering was applied to the remaining zirconia specimens as control group (n = 10). CAD/CAM-produced veneers were connected to the zirconia specimens using fusion porcelain or resin cement. One of following treatments were applied to the cemented specimens: no surface treatment, HF etching of the veneering material, or HF acid etching of the veneer in combination with the application of a glaze layer to the zirconia surface. Following the veneering procedures, a shear bond strength test was performed at a speed of 1 mm/min using a universal testing machine. Univariate ANOVA (α = 0.05) was performed for statistical analyses of the obtained data. RESULTS: Statistically significant differences were not found among the materials (F = 0.176, p = 0.656), while statistically significant differences were found amongst the veneering procedures (F = 57.921, p < 0.001). Statistical differences were observed between the groups (F = 13.766, p < 0.001). The highest shear bond strength values were observed in IPS e.max CAD specimens connected to zirconia with low fusion porcelain (27.11 ± 7.7 MPa), and the lowest values were observed in IPS e.max CAD specimens connected to zirconia with resin cement without surface treatment (9.82 ± 2.8 MPa). The application of fusion porcelain with IPS e.max CAD (p = 0.967) and Cerec Blocs (p = 1.00) showed statistically similar results to those with conventional layering. CONCLUSIONS: The application of fusion porcelain to bond zirconia and digitally produced veneering material can serve as an alternative veneering method to the conventional layering method by accelerating and facilitating clinical and laboratory stages.

Effect of Various Treatment Modalities on Surface Characteristics and Shear Bond Strengths of Polyetheretherketone-Based Core Materials.

PURPOSE: To investigate the effect of different surface treatments on the surface roughness (Ra), wettability, and shear bond strength of polyetheretherketone (PEEK) to composite resin. MATERIALS AND METHODS: One hundred ninety eight PEEK specimens were divided into six groups (n = 33). Specimen surfaces were treated with the following surface treatment modalities: silicoating (CoJet), acetone treatment, acid etching (H2 SO4 ), airborne particle abrasion (Al2 O3 ), laser irradiation (Yb:PL laser), and the nontreated surface serving as the control. Surface roughness was measured with an profilometer (n = 11) and a goniometer was used to measure the surface wettability through contact angle (θ)(n = 11). PEEK surfaces were veneered with a composite resin (n = 11). The specimens were then thermocycled for 10,000 cycles at 5 to 55°C. Shear bond strengths between the PEEK and composite resin were measured with an universal test machine. One-way ANOVA was used to analyze the data. Tukey's post-hoc test was used to determine significant differences between groups (α = 0.05). RESULTS: Surface roughness and wettability of PEEK surfaces along with shear bond strength of PEEK to composite resin were influenced by the surface treatments. (p < 0.01) Highest mean Ra values were obtained for PEEK surfaces treated by laser irradiation (2.85 ± 0.2 µm) followed by airborne particle abrasion (2.26 ± 0.33 µm), whereas other surface treatment modalities provided similar Ra values, with the acid-etched PEEK surfaces having the lowest mean Ra values (0.35 ± 0.14 µm). Silicoating provided the most wettable PEEK surfaces (48.04 ± 6.28º), followed by either acetone treatment (70.19 ± 4.49º) or acid treatment (76.07 ± 6.61º). Decreased wettability was observed for airborne particle abraded (84.83 ± 4.56º) and laser-treated PEEK surfaces (103.06 ± 4.88º). The highest mean shear bond strength values were observed for acid-etched PEEK surfaces (15.82 ± 4.23 MPa) followed by laser irradiated (11.46 ± 1.97 MPa), airborne particle abraded (10.81 ± 3.06 MPa), and silicoated PEEK surfaces (8.07 ± 2.54 MPa). Acetone-treated (5.98 ± 1.54 MPa) and untreated PEEK surfaces (5.09 ± 2.14 MPa) provided the lowest mean shear bond strengths. CONCLUSIONS: The highest mean shear bond strengths were observed for acid-etched PEEK surfaces, followed by laser-irradiated, airborne particle abraded, and silicoated PEEK surfaces providing similar mean shear bond strengths. Since shear bond strengths higher than 10 MPa are considered acceptable, acid etching, laser irradiation, and airborne particle abrasion of PEEK surfaces may be considered viable surface treatment modalities for the PEEK material tested.