Rehabilitation Challenge in Patient With a High Smile Line: Case Report and Review of Surgical Protocols.

INTRODUCTION: Defects in the maxillary anterior teeth are delicate and difficult to solve because of the esthetic, functional, and psychological impairment that may arise if the rehabilitation treatment does not return the damaged tissues to the naturalness. Esthetic predictability and reduced surgical interventions are some great reasons to simplify dental treatments. During the presurgical evaluation, the clinician should review the implant esthetic risk profile, considering the patient's smile line, the esthetic demands, the hard and soft tissue thickness and width, and the gingival biotype. Thus, achieving long-term esthetic results initiates with a detailed case planning before surgical intervention. CASE PRESENTATION: The present report described a complex esthetic clinical case involving teeth and dental implant related to a high smile line. The clinical case was solved through immediate implant placement and immediate loading using a personalized prosthetic abutment and finalized with the installation of metal-free prosthetic restorations. CONCLUSION: The use of a personalized prosthetic abutment helped to achieve a better emergence of the prosthesis under the periodontal tissues. Although it was a challenging esthetic case, especially because of the high smile line, the result was a natural smile while the adjacent soft tissues maintained their esthetics and health.

Color stability of repairs on bis-acryl resin submitted to thermal aging and immersion in beverages.

OBJECTIVE: Defects/bubbles can occur during the manufacture of bis-acryl resin provisional restorations, requiring repair or new prosthesis. This study evaluated the color stability of bis-acryl resin specimens repaired, aging, and immersioned in beverages. MATERIAL AND METHODS: Eighty disks were made of bis-acryl resin. Twenty disks were not repaired (BCR), 20 disks were repaired with the same bis-acryl resin (BCR-BCR), 20 disks were repaired with flowable resin (BCR-FR), and 20 disks received an adhesive layer prior to flowable resin repair (BCR-AFR). Coordinates L*a*b* were obtained. Ten disks from each group were thermocycled (5000 cycles) and the others were immersed in coffee with sugar (n = 5) and cola-based soft drinks (n = 5) for 7 days. Color, lightness, chroma, and hue differences were calculated by the CIEDE2000 formula, analyzed by two-way analysis of variance. Multiple comparisons were made with the Tukey's HSD test (α = .05). RESULTS: BCR-FR group presented the highest color differences (5.6) between groups repaired (P < .001). BCR-BCR group showed the smallest color differences (0.9) after aging (P = .003), but the greatest variation between T0 and T1 (about 1 ΔE). BCR-ARF immersed in coffee showed the greatest color differences (20.6) (P < .001). CONCLUSIONS: Aging and immersion altered the colorimetric behavior of repairs, especially after the use of coffee. CLINICAL IMPLICATIONS: Repairs are indicated when defects and bubbles are present in the surface of the bis-acryl resin provisional restorations after its manufacture. However, they may present noticeable color changes, especially when the use of coffee is frequent.

Peri-implant tissue management after immediate implant placement using a customized healing abutment.

OBJECTIVE: The unavoidable extraction of teeth in the esthetic area can be overcome through different treatment modalities. Recently, immediate implants appeared as a minimally invasive approach to resolving these cases; however, immediate implant loading is not always possible or indicated. In these cases, an innovative approach through customized healing abutments could be used to preserve the soft tissue contour, eliminating the need for reopening surgery and the use of provisional restorations to condition the mucosal contour. CLINICAL CONSIDERATIONS: The present cases describe a simplified chairside approach to use customized healing abutments for immediate implants placed after tooth extraction in the anterior and posterior areas in order to maintain the soft tissue contours while reducing the clinical steps until delivering the final restorations. CONCLUSIONS: This technique seems to be effective to guide the soft tissue healing around dental implants allowing a natural emergence profile with implant-supported restorations, reducing the number of treatment steps. CLINICAL SIGNIFICANCE: The use of customized healing abutments prepares soft tissue for the prosthetic stage preserving its contours and eliminating the need for reopening surgery.

Adhesion behavior of conventional and high-translucent zirconia: Effect of surface conditioning methods and aging using an experimental methodology.

OBJECTIVE: Evaluate the adhesive behavior of conventional and high-translucent zirconia after surface conditioning and hydrothermal aging. MATERIALS AND METHODS: Conventional (ZrC) and high-translucent zirconia (ZrT) specimens were divided into six groups: without surface treatment (ZrC and ZrT), air-borne particle abrasion with 50-µm Al2 O3 sized particles (ZrC-AO and ZrT-AO), and tribochemical treatment with 30-µm silica modified Al2 O3 sized particles (ZrC-T and ZrT-T). Zirconia specimens were treated using an MDP-containing universal adhesive and bonded to two resins blocks with an adhesive luting cement. Microbar specimens with cross-sectioned areas of 1 mm2 were achieved. Half of the microbars were subjected to hydrothermal aging. Bond strength was evaluated by microtensile bond strength test and statistically evaluated by the Weibull analysis. RESULTS: Roughness of the ZrC-AO and ZrT-AO groups were statistically higher. Bond strength analysis revealed higher bond strength for ZrC-AO and ZrC-T groups compared to ZrT-AO and ZrT-T, respectively. Mixed failure was the most frequent for the mechanically treated groups, while no cohesive failures were obtained. CONCLUSION: Lower values of bond strength were obtained for the mechanically treated high-translucent zirconia groups when compared to their conventional zirconia counterparts. Mechanical surface treatment significantly improved the bond strength to conventional and high-translucent zirconia. CLINICAL SIGNIFICANCE: Mechanical surface treatment (air-borne particle abrasion or tribochemical treatment) associated with the use of universal adhesives containing MDP could provide a durable bonding to conventional and high-translucent zirconia.

Chipping of veneering ceramic on a lithium disilicate anterior single crown: Description of repair method and a fractographic failure analysis.

OBJECTIVE: This article presents a retrospective analysis of an anterior single crown that showed chipping of the veneering ceramic, the clinical stages of intraoral repair made in composite resin, and fractographic analysis of the causes of failure. CLINICAL CONSIDERATIONS: The ceramic chipping occurred in the incisal and labial surfaces of the crown, 1 year after installation. Clinical examination revealed the presence of occlusal interference, which was probably responsible for chipping. Vinyl-polysiloxane impression was made from the patient, and epoxy replica was produced. The replica was gold coated and inspected under the optical microscopy and scanning electron microscope (SEM) for descriptive fractography. Optical microscopy and SEM images showed that chipping initiated at the incisal edge, where it is possible to note an area of damage accumulation. At the labial surface, multiple arrest lines with their convex sides facing the incisal edge were observed. The fractured area was repaired intraorally with composite resin, and the patient's occlusion was checked and monitored. CONCLUSION: According to the fractographic analysis, occlusal interference was related to ceramic chipping in the incisal edge. Intraoral repair technique with composite resin was indicated for this moderate chipping. CLINICAL SIGNIFICANCE: Retrieval analysis of chipping ceramic delivers better understanding of the failure origin and could prevent future failures. Intraoral repair is a practical and conservative technique and may be performed in a single clinical session without requiring the removal of prosthesis.

Color stability of a bis-acryl composite resin subjected to polishing, thermocycling, intercalated baths, and immersion in different beverages.

OBJECTIVE: To evaluate the color of a bis-acryl resin after polishing, aging, and colorants. MATERIALS AND METHODS: From the 140 disks obtained, 35 were not polished (NP), 35 were polished with 3-µm (3P), 35 with 3- and 1-µm (1P), and 35 with 3-, 1-, and 0.5-µm sized particles (05P). Five disks of each group were thermocycled for 20, 100, and 200 cycles. Sixty disks were thermocycled and kept in beverages (tea, wine, and coffee) after four cycles. Sixty disks were immersed in the beverages for 24 hours, a week, and a month. The coordinates L*a*b* were measured and the color differences were analyzed by ANOVA. The lightness, chroma, and hue differences were evaluated by repeated measures ANOVA. Comparisons were made with Tukey's test (α = 0.05). RESULTS: Similar behaviors were observed between 3P and 05P groups (1.53 and 1.95ΔE00 ) (P < .05). The NP group submitted to 200 cycles showed the biggest color differences (3.02) (P = .003). The greatest color differences were observed in the NP group submitted to immersion in coffee (8.30) and wine (7.93) (P < .05). CONCLUSIONS: The polished surfaces were the least stained. Coffee and wine provided the greatest color changes, both for baths and immersions. CLINICAL SIGNIFICANCE: Polishing of provisional surfaces restorations made of bis-acrylic resin is essential to minimize staining caused by aging and use of colorants, regardless of the particle size present in the polishing paste. The contact with coffee and red wine should be avoided, especially for clinical times greater than 1 week.

Step-by-Step Resin Bonding of Ceramic Veneers in the Anterior Maxilla: A Case Report.

Applying the biomimetic principles, maximum preservation of the sound tooth structure may be achieved by means of adhesive restorations. Due to bonding, it is possible to conduct minimally invasive esthetic procedures with laminate veneers assuring a high mechanical resistance of the tooth/restoration bond. A clinical case of adhesive restorations is presented using the bonding protocol respecting the diversity of each product's commercial brands and manufacturer's recommendations.