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1.
Pediatr Dent ; 43(4): 290-295, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34467846

RESUMO

Purpose: The purpose of this study was to evaluate the treatment outcomes of multisurface caries in primary molars treated with intracoronal restorations versus stainless steel crowns (SSCs) through a retrospective split-mouth study. Methods: Dental records were screened for patients who had treatment of one primary molar with a multisurface restoration and one primary molar with an SSC. Teeth were followed until a loss to follow-up, exfoliation, or failure. Results: A total of 988 primary molars were evaluated, with a mean follow-up time of 22 months. The survival probabilities for: SSCs were 95.5 percent at one year of service and 92.8 percent at two years of service; and for intracoronal restorations were 92.0 percent at one year of service and 80.0 percent at two years of service. Overall survival analysis showed SSCs to be significantly more successful than restorations (P<0.001), particularly in children treated at ages four years and younger (P<0.001). No statistically significant difference (P=0.10) was found for children treated at ages five years and older. Conclusions: Stainless steel crowns have a higher survival probability versus restorations for multisurface caries. In children ages four years and younger, more aggressive treatment of multi-surface caries with SSCs should be considered, as conservative treatment leads to an increased need for retreatment.


Assuntos
Cárie Dentária , Aço Inoxidável , Criança , Pré-Escolar , Coroas , Cárie Dentária/terapia , Falha de Restauração Dentária , Restauração Dentária Permanente , Humanos , Dente Molar , Estudos Retrospectivos , Dente Decíduo
2.
Int J Oral Maxillofac Implants ; 36(4): 669-689, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34411206

RESUMO

PURPOSE: The aim of this systematic review with meta-analysis was to compare the survival rate of single crowns supported by extra-short implants (≤ 6 mm) to those supported by conventional implants, with or without previous maxillary sinus augmentation. The proportion of failures was described according to the type of complication and follow-up periods. MATERIALS AND METHODS: Randomized and prospective clinical trials were selected from six databases and gray literature. The risk of bias was evaluated by Joanna Briggs Institute Critical Appraisal Checklist, and the certainty of the evidence was analyzed with Grading of Recommendations Assessment, Development, and Evaluation. Meta-analyses were processed with RevMan and MedCalc Statistical Software. RESULTS: Single crowns supported by extra-short implants had a similar risk of failure to those supported by conventional implants, regardless of previous maxillary sinus augmentation (P > .05). Overall failure proportion of extra-short implants was 5.19%, but it varied according to follow-up (1.18% before loading, 1.56% at 12 months, 1.20% at 24 months, 2.10% at 48 months). Biologic failure complications were 37.90% for bleeding on probing, 22.45% for peri-implantitis, and 11.29% for infection. Prosthodontics failure complications were 14.88% for abutment failures and 14.73% for prosthetic screw loosening. Considering the risk of bias, most studies were classified at moderate risk. CONCLUSION: The risk of failure of single crowns supported by extra-short implants is similar to those supported by conventional implants, regardless of previous maxillary sinus augmentation or follow-up period. The most frequent biologic and prosthetic complications were bleeding on probing and abutment failures, respectively.


Assuntos
Implantação Dentária Endo-Óssea , Implantes Dentários , Coroas , Implantes Dentários/efeitos adversos , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Estudos Prospectivos
3.
Int J Oral Maxillofac Implants ; 36(4): 723-729, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34411211

RESUMO

PURPOSE: To assess the impact of abutment angulation on loosening torque, torque loss, and percentage of torque loss in the prosthesis and abutment screws after aging of the implant-supported prosthesis. MATERIALS AND METHODS: Fifty epoxy maxillary casts with missing central, lateral, and canine teeth were used, and each cast received two implants. All casts were divided into five groups (n = 10): (1) both implants received straight abutments (0-0); (2) the central implant received a straight abutment and the canine implant received a 17.5-degree angled abutment (0-17.5); (3) the central implant received a straight abutment and the canine implant received a 35-degree angled abutment (0-35); (4) both implants received 17.5-degree angled abutments (17.5-17.5); and (5) both implants received 35-degree angled abutments (35-35). For each cast, a three-unit zirconia restoration was fabricated, and a torque meter was utilized to tighten the abutment screw (25 Ncm) and prosthesis screw (18 Ncm). The reverse torque value was recorded for each screw. All restorations were subjected to 3,500 thermal cycles between 5°C and 55°C and load cycled for 150,000 cycles with 50-N load. After the loosening torque was measured for each screw, the torque loss and percentage of torque loss were calculated. RESULTS: There was a statistically significant difference in the torque loss of the central prosthesis screw (P < .001) and canine prosthesis screw (P < .001) between study groups. The 35-35 group showed the highest percentage of torque loss, while the 0-0 group showed the lowest value. A significant difference was found regarding the torque loss of the central abutment screw (P < .001) and canine abutment screw (P < .001). The abutment screws of the 35-35 group showed the highest percentage of torque loss, while the 0-0 groups showed the lowest percentage of torque loss. CONCLUSION: Screw loosening of the prosthesis and abutment screws increases with increasing abutment angulation after aging. In the same fixed prosthesis, the torque loss in the prosthesis and abutment screws was higher in canine screws employing different angled abutments.


Assuntos
Projeto do Implante Dentário-Pivô , Implantes Dentários , Parafusos Ósseos , Dente Suporte , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Análise do Estresse Dentário , Humanos , Torque
4.
Int J Oral Maxillofac Implants ; 36(4): 799-806, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34411223

RESUMO

PURPOSE: The aim of this study was to evaluate maxillary full-arch implant-supported fixed rehabilitations by identifying biologic complications, implant survival and success rates, and patient satisfaction with treatment. In addition, the study verified the influence of attendance at maintenance appointments on the occurrence of complications. MATERIALS AND METHODS: Data were collected from clinical follow-up appointments. RESULTS: The sample consisted of 52 patients (363 implants) with follow-up of 1 to 12 years (mean: 4.69). The main biologic complication was soft tissue recession (20.8%) at the implant level. Tissue hyperplasia was observed in eight patients (15.4%), and 17 (4.7%) implants had bone loss ≥ 2 mm. The peri-implantitis rate was 3.1% (11 implants). Implant survival and success rates were 97.8% and 93.4%, respectively. Rates of patient satisfaction with treatment were as follows: 21 (40.4%) completely satisfied, 28 (53.8%) satisfied with some complaint, and 3 (5.8%) expected more from treatment. The main complaint was the difficulty of cleaning (64.5%). Patients who attended annual follow-up appointments were associated with less bone remodeling and peri-implant disease, but no significant difference was found in biofilm accumulation. CONCLUSION: This type of rehabilitation is susceptible to biologic complications, but high survival and success rates and patient satisfaction were found. Periodic maintenance was associated with reduced complications, such as bone loss or peri-implantitis.


Assuntos
Implantes Dentários , Prótese Dentária Fixada por Implante , Estudos Transversais , Implantes Dentários/efeitos adversos , Falha de Restauração Dentária , Seguimentos , Humanos , Estudos Retrospectivos
5.
Int J Oral Maxillofac Implants ; 36(4): e72-e89, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34411212

RESUMO

PURPOSE: To analyze the effect of implant placement and loading protocols (protocol types) on the survival of single implant tooth replacements in different locations. MATERIALS AND METHODS: An electronic search was conducted to identify clinical trials regarding outcomes of single implants subjected to different treatment protocols. A weighted mean survival rate for each protocol type in the anterior maxilla, anterior mandible, posterior maxilla, and posterior mandible was calculated. Study design, sample size, and outcome homogeneity were used to evaluate the validation of each protocol type in different locations. RESULTS: A total of 45 publications (13 RCTs, 21 prospective studies, and 11 retrospective studies) were included. The anterior maxilla was the most reported site (35 studies, 1,391 implants, weighted survival rate: 97.5% to 99.6%). Immediate placement + conventional loading (Type 1C) and late placement + immediate restoration/loading (Type 4A) were scientifically and clinically validated (SCV). For the posterior maxilla (19 studies, 567 implants, weighted survival rate: 85.7% to 100%), Type 1C was SCV. The anterior mandible was the least-reported site (three studies, 42 implants, weighted survival rate: 98.5% to 100%). For the posterior mandible (13 studies, 447 implants, weighted survival rate: 95.0% to 100%), late placement + conventional loading (Type 4C) was SCV. It was not possible to perform a metaanalysis due to the limited number of controlled studies that had the same comparison and considerable heterogeneity in study design. CONCLUSION: Differences were found in the level of scientific evidence between the anterior and posterior and the maxilla and mandible, indicating that location is a consideration when selecting treatment protocol for a single implant.


Assuntos
Implantes Dentários , Carga Imediata em Implante Dentário , Protocolos Clínicos , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Maxila/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
6.
Clin Oral Implants Res ; 32(9): 1021-1040, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34352130

RESUMO

OBJECTIVES: To summarize the clinical performance of anodized implants connected to different prostheses design after immediate/early (IL) or conventional loading (CL) protocols. MATERIALS AND METHODS: Seven databases were surveyed for randomized (RCTs) and non-randomized controlled clinical trials (CCTs). Studies comparing IL vs. CL protocol of anodized implants supporting single crown, fixed partial denture (FPD), full-arch fixed dental prosthesis (FDP), or overdenture were included. Risk-of-bias was evaluated using Cochrane Collaboration tools. Meta-analyses for different follow-up were analyzed, followed by heterogeneity source assessment and GRADE approach. The outcomes included implant survival rate, marginal bone loss (MBL), implant stability quotient (ISQ), probing depth (PD), plaque index (PI), and peri-implantitis prevalence. RESULTS: From 24 eligible studies, 22 were included for quantitative evaluation. Most RCTs (58%, n = 11) and all the 5 CCTs had high and serious risk-of-bias, respectively. Overall, pooling all prosthesis design, no difference between IL vs. CL protocols was observed for all outcomes (p > .05). However, according to prosthesis type subgroups, CL reduced MBL for full-arch FDP (p < .05). In a point-in-time assessment, with overdenture, although IL presented higher PI (12 months), it showed lower MBL (≥24 months), higher ISQ (3 months), and lower PD (6 and 12 months) (p < .05). Conversely, PD was higher for IL in single crown (3 and 6 months) (p < .05). Regarding MBL, IL demonstrated higher mean difference for full-arch FDP (36 months) and FPD (12 and 36 months) (p < .05). CONCLUSION: Within the limitations of this study, overall, there is no significant difference in the outcomes between IL and CL loading protocols.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Carga Imediata em Implante Dentário , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Int J Oral Implantol (Berl) ; 14(3): 241-257, 2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34415127

RESUMO

PURPOSE: To investigate whether implant position (adjacent to teeth/implants vs most distal position in the arch) influences the clinical outcomes of short (≤ 6 mm) non-splinted implants. MATERIALS AND METHODS: A systematic electronic search of human randomised clinical trials and prospective cohort studies was performed using the PubMed, Embase and Cochrane Central Register of Controlled Trials (Central) databases. A manual search of implant-related journals was also performed. A meta-analysis was conducted to compare survival rate, marginal bone loss and prosthetic complications based on implant position. RESULTS: Overall, 11 studies were included to give a total of 388 non-splinted short implants (269 adjacent, 119 distal) followed up over a period ranging from 12 to 120 months. No significant differences in survival were found when comparing adjacent and distal positioning for both arches, and no significant differences were found for marginal bone loss or prosthetic complications between groups regardless of position. CONCLUSIONS: Short implants supporting single crowns presented similar outcomes when placed in the most distal position in the arch or between adjacent teeth or other implants.


Assuntos
Implantes Dentários , Implantes Dentários/efeitos adversos , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Estudos Prospectivos
8.
Pan Afr Med J ; 38: 378, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367457

RESUMO

Introduction: implant supported prosthesis has become a viable treatment option for missing teeth. An important tool to detect early changes around implants is the standardized assessment of peri-implant hard and soft tissue parameters. The purpose of this prospective study was to clinically and radiographically assess the soft and hard tissues around implants. Methods: ten (10) patients with 13 implant supported prosthesis were included in the study. Clinical parameters plaque index (PI), gingival index (GI), modified sulcus bleeding index (mSBI), peri-implant Probing Depth (PD), gingival margin Level, width of keratinized mucosa (WKM) and implant mobility were measured at loading and at 3 and 6 months. The radiographic crestal bone loss and peri-apical implant radiolucencies were also evaluated at loading and at 3 and 6 months. Student paired t test and correlation and regression analysis was done to evaluate the effect of clinical variables over bone loss. Results: there was decrease in the site specific PI, GI, mSBI and peri-implant PD and an increase in the gingival recession from baseline to 6 months. The WKM remained stable throughout the study. Significant crestal bone loss was observed around implants more on the distal as compared to the mesial aspect. No mobility or peri-apical implant radiolucency was observed. Regression analysis of the confounding variables with bone loss showed no significant effect. Conclusion: the occlusal loading of implants after 6 months showed significant bone loss (<1mm), which was within acceptable limits and the soft tissues around implants were in good health.


Assuntos
Prótese Dentária Fixada por Implante/efeitos adversos , Falha de Restauração Dentária , Arcada Parcialmente Edêntula , Adolescente , Adulto , Idoso , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/etiologia , Planejamento de Prótese Dentária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
9.
J Leukoc Biol ; 110(3): 591-604, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34231923

RESUMO

As the most successful therapy for missing teeth, dental implant has become increasingly prevalent around the world. A lot of papers have reported diverse local risk factors affecting the success and survival rate of dental implants, either for a short or a long period. However, there are also many types of systemic disorders or relatively administrated medicine that may jeopardize the security and success of dental implant treatment. Additionally, the coronavirus disease 2019 pandemic also poses a challenge to dental implant clinicians. Some of these risk factors are clinically common but to some extent unfamiliar to dentists, thus optimal measurements are often lacking when they occur in dental clinics. In this review, we analyze potential systemic risk factors that may affect the success rate of dental implants. Some of them may affect bone mineral density or enhance the likelihood of local infection, thus impeding osseointegration. Others may even systemically increase the risk of the surgery and threaten patients' life. In order to help novices receive high-risk patients who need to get dental implant treatment in a more reasonable way, we accordingly review recent research results and clinical experiments to discuss promising precautions, such as stopping drugs that impact bone mineral density or the operation, and addressing any perturbations on vital signs.


Assuntos
Densidade Óssea , Implantes Dentários/normas , Falha de Restauração Dentária/estatística & dados numéricos , Osseointegração , Humanos , Fatores de Risco
10.
Cochrane Database Syst Rev ; 7: CD013039, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34280957

RESUMO

BACKGROUND: Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC). OBJECTIVES: To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps. SEARCH METHODS: An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies.  SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions). DATA COLLECTION AND ANALYSIS: Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions. MAIN RESULTS: We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth.  Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing  with sealant materials (2); sealant materials versus no sealing (2).  Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT. AUTHORS' CONCLUSIONS: Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.


Assuntos
Coroas , Tratamento Dentário Restaurador sem Trauma/métodos , Cárie Dentária/terapia , Selantes de Fossas e Fissuras/uso terapêutico , Adolescente , Adulto , Viés , Criança , Pré-Escolar , Cárie Dentária/patologia , Falha de Restauração Dentária/estatística & dados numéricos , Dentina , Dentição Permanente , Humanos , Pessoa de Meia-Idade , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Dente Decíduo
11.
BMC Oral Health ; 21(1): 371, 2021 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-34301217

RESUMO

BACKGROUND: Glass ionomer cements (GIC) have been considered the top option to restore primary teeth by dentists. The most common supply forms are hand mixed and encapsulated GIC. There is a lack of information about the impact of different GIC supply forms on restoration survival. METHODS: This randomized clinical trial compared the survival rate of occlusal and occlusoproximal restorations in primary molars using two glass ionomer cements versions: hand-mixed (H/M) and encapsulated (ENC) after 24 months. Children aged 3-10 years who presented dentin caries lesions in primary molars were selected at School of Dentistry, University of São Paulo, Brazil. They were randomly assigned to groups: H /M (Fuji IX®, GC Europe) or ENC (Equia Fill®, GC Europe). The occurrence of restoration failure was evaluated by two blinded and calibrated examiners. The analyses were performed in Stata 13 (StataCorp, USA). To evaluate the primary outcome (restoration survival), we  performed a survival analysis. Additionally an intention to treat (ITT) analysis were done at 24 months of follow-up. Cox Regression with shared frailty was performed to assess association between restoration failure and independent variables (α = 5%). RESULTS: A total of 324 restorations were performed in 145 children. The survival for H/M group was 58.2% and 60.1% for ENC, with no difference (p = 0.738). Occlusoproximal restorations had lower survival rate when compared to occlusal ones (HR = 3.83; p < 0.001). CONCLUSIONS: The survival rate in primary molars is not influenced by the different supply forms of GIC. Also, occlusoproximal restorations present reduced performances when compared to occlusal cavities. TRIAL REGISTRATION: This randomized clinical trial was registered on ClinicalTrials.Gov on 10/15/2014 under protocol (NCT02274142).


Assuntos
Tratamento Dentário Restaurador sem Trauma , Cárie Dentária , Brasil , Criança , Cárie Dentária/terapia , Falha de Restauração Dentária , Restauração Dentária Permanente , Europa (Continente) , Cimentos de Ionômeros de Vidro/uso terapêutico , Humanos , Dente Molar , Taxa de Sobrevida , Dente Decíduo
12.
Int J Esthet Dent ; 16(3): 262-279, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34319663

RESUMO

AIM: To investigate whether different restoration designs, overlay types, and full crowns in posterior teeth have similarly acceptable marginal sealing and quality. MATERIALS AND METHODS: For Part 1 of the present study (investigation of fracture resistance), 70 extracted molars were divided into five groups (N = 14), prepared with four different posterior indirect adhesive restoration (PIAR) overlay design types, according to the adhesthetics classification. The groups were: 1. Butt Joint; 2. Full Bevel; 3. Shoulder; 4. Full Crown; 5. Sound Tooth. For Part 2 of the study (present article; marginal quality), there was no group 5, and only 56 of the 70 extracted molars were used. Seven expert dentists performed all the preparation and cementation phases with codified protocols. A CAD/CAM workflow was used to realize the 56 monolithic lithium disilicate restorations. The samples were tested with thermomechanical loading (TML) and the marginal quality evaluated. The data relating to fracture resistance are presented in Part 1 of this study (Int J Esthet Dent 2021;16:2-17). RESULTS AND CONCLUSIONS: In terms of marginal quality after TML, within the limitations of the present study, in molar teeth (without endodontic treatments) restored with different monolithic ceramic lithium disilicate PIAR designs, it is possible to present the following conclusions.


Assuntos
Coroas , Planejamento de Prótese Dentária , Cimentação , Cerâmica , Desenho Assistido por Computador , Cimentos Dentários , Porcelana Dentária , Falha de Restauração Dentária , Análise do Estresse Dentário , Humanos , Teste de Materiais
14.
J Contemp Dent Pract ; 22(4): 422-426, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-34267013

RESUMO

AIM: The aim of this literature review is to determine whether endocrowns are a reliable alternative for endodontically treated teeth with extensive loss of tooth structure, the indications and contraindications of this restorative choice, the principles that should be followed for tooth preparation and which material is most appropriate for endocrown fabrication. BACKGROUND: Rehabilitation of endodontically treated teeth with severe coronal destruction has always been a challenge for the dental clinician. Until recently, the fabrication of a metal-ceramic or all-ceramic full-coverage crown along with a metal or glass fiber post has been the "gold standard" proving its efficacy via numerous clinical studies. With the development of CAD/CAM technology and the evolution of dental materials, new minimally invasive techniques have been introduced with less need for adjustments and less incorporation of structural defects. One of them, the "monoblock technique," proposed by Pissis in 1995, was the forerunner of endocrown restoration, a term used by Bindl and Mörmann to describe an all-ceramic crown anchored to the internal portion of the pulp chamber and on the cavity margins, thus obtaining macromechanical retention provided by the axial opposing pulpal walls and microretention attained with the use of adhesive cementation. REVIEW RESULTS: Endocrowns require a decay-oriented preparation taking advantage of both the adhesion and the retention from the pulp-chamber walls, they are strongly indicated in endodontically treated molars in cases where minimal interocclusal space and curved or narrow root canals are present and they should be manufactured from materials that can be bonded to the tooth structure. CONCLUSION: Endocrowns are a reliable alternative to traditional restorative choices, given that the clinicians respect the requirements and indications describing this technique. CLINICAL SIGNIFICANCE: Traditional restorative techniques demanding tooth substance removal and minimizing the opportunity for reinterventions should be reconsidered.


Assuntos
Coroas , Dente não Vital , Porcelana Dentária , Falha de Restauração Dentária , Análise do Estresse Dentário , Humanos , Teste de Materiais
15.
Artigo em Inglês | MEDLINE | ID: mdl-34328470

RESUMO

This multicenter retrospective study assessed clinical and radiographic outcomes of 686 parallel-walled conical-connection implants consecutively placed in 281 partially and fully edentulous patients. Implants were placed in healed and postextraction sites and subjected to immediate, early, or delayed loading. With a mean follow-up of 10 ± 6.7 months, the implant survival rate was 97.7%, while mean marginal bone loss was 0.7 ± 1.5 mm between implant placement and 1 year (n = 290 implants) and 0.1 ± 0.6 mm between 1 and 2 years (n = 72 implants). Advanced patient age and longer implants were associated with fewer implant failures, while different crestal positions at implant placement were not associated with differences in implant survival or changes in marginal bone level over time.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Carga Imediata em Implante Dentário , Perda do Osso Alveolar/diagnóstico por imagem , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Humanos , Estudos Retrospectivos
16.
Br Dent J ; 231(1): 43-48, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34244647

RESUMO

Introduction A retrospective cross-sectional study of early patient-reported failures of restorations was initiated to understand the reasons and factors associated with early failure. Early patient-reported failures are defined as restorations requiring replacement within three months of placement.Aim To investigate if restorative material placed or any other tooth/restoration/patient factors may be associated with early patient-reported failures.Methods In total, 360 restorations were replaced from January 2016 to December 2017. Multivariable analyses (logistic regression model) were used to identify any patient/tooth/restoration factors that were associated with early patient-reported failures.Results Dislodgement, fracture and pain/sensitivity were the three main failure modes. There was significant association between restorative material type and dislodgement and restoration fracture. The odds of dislodgement for composite resin (CR) were 4.3 times higher compared to amalgam. The odds of dislodgement for glass-ionomer cement (GIC) and resin-modified GIC were 3.7 times higher compared to amalgam. The odds of fracture for CR were ten times lower compared to amalgam. The odds of pain for teeth with a history of restoration failure for a particular tooth were five times lower compared to no history of restoration failure for a particular tooth.Conclusions Restorative material type affected patient-reported failures.


Assuntos
Cárie Dentária , Restauração Dentária Permanente , Resinas Compostas , Estudos Transversais , Amálgama Dentário/efeitos adversos , Assistência Odontológica , Falha de Restauração Dentária , Cimentos de Ionômeros de Vidro , Humanos , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos
17.
Artigo em Inglês | MEDLINE | ID: mdl-34069084

RESUMO

INTRODUCTION: The aim of this retrospective study was to analyze the radiographic peri-implant bone loss of bone level implants and tissue level implants with a convergent neck in screw-retained single crowns and in screw-retained fixed partial prostheses, after two years of functional loading. MATERIALS AND METHODS: The sample was divided into two groups according to their type: Group I: supracrestal implants with convergent transmucosal neck; Group II: crestal implants. In each group we distinguish two subgroups according to the type of prosthetic restoration: single crowns and a three-piece fixed partial prosthesis on two implants. To quantify bone loss, parallelized periapical radiographs were analyzed at the time of implant placement and after two years of functional load. RESULTS: A total of 120 implants were placed in 53 patients. After statistical analysis it was observed that for each type of implant bone loss was 0.97 ± 0.91 mm for bone level and 0.31 ± 0.48 mm for tissue level. No significant differences were found regarding the type of prosthesis and the location (maxilla or mandible) of the implants. CONCLUSIONS: Tissue level implants with a convergent transepithelial neck exhibit less peri-implant bone loss than bone level implants regardless of the type of prosthesis.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/etiologia , Implantes Dentários/efeitos adversos , Falha de Restauração Dentária , Seguimentos , Humanos , Mandíbula/cirurgia , Maxila , Estudos Retrospectivos , Resultado do Tratamento
18.
Clin Implant Dent Relat Res ; 23(4): 520-529, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34101342

RESUMO

BACKGROUND: The ability to restore missing teeth with dental implants is dictated by the available bone and by the presence of anatomical structures. The potential to insert ultrashort implants avoids additional surgical procedures and its inherent complications. The last European Association of Dental Implantologists consensus in 2016 defined ultrashort implants and standard-length dental implants as <6 and >8 mm, respectively. PURPOSE: The present study aimed to investigate whether single standing ultrashort dental implants (US) could provide a viable therapeutic alternative to osteotome mediated sinus floor elevation in combination with standard-length dental implants (SL) 10 mm in posterior maxillary rehabilitation with reduced bone height. MATERIALS AND METHODS: The study was conducted as a prospective parallel group controlled clinical trial with a 12 month follow-up, where 48 implants were randomized into two groups; US-group (5.5 mm) and SL-group (10 mm) implants placed with osteotome-mediated sinus floor elevation. Crestal bone loss (CBL) was defined as the study's primary outcome, while implant survival, buccal bone thickness, implant stability, probing depth, gingival recession, and adverse effects were assessed as secondary outcomes. RESULTS: Mesial CBL was 1.13 ± 0.52 mm in SL- and 0.72 ± 0.52 mm in US-group (P = .021), while distal CBL was 1.44 ± 0.72 mm in SL- and 0.91 ± 0.69 mm in US-group at 12 months (P = .0179). Regarding implant stability, probing depth, and gingival recession there was no statistically significant difference between the two groups. Regarding implants' survival, three implants were lost in the US-while only one implant was lost in the SL-group (P = .6085; Fisher's exact test). Nevertheless, the ultrashort implants were associated with a tripling of the failure rate and uncertainty where the true failure rate is uncertain (relative risk 3.0; confidence interval 0.3-26.8). CONCLUSIONS: Within the current trial's limitations, US-appear appear promising as they are associated less postoperative discomfort, minimal invasiveness and less CBL. However, larger sample size is required to determine whether the ultrashort have an acceptable survival rate.


Assuntos
Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Falha de Restauração Dentária , Maxila/cirurgia , Seio Maxilar/cirurgia , Estudos Prospectivos , Resultado do Tratamento
19.
Oper Dent ; 46(2): E68-E79, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-34192333

RESUMO

STATEMENT OF PROBLEM: Extensive carious lesions and/or large preexisting restorations possibly contribute to crack formation, ultimately resulting in a fracture that may lead to the loss of a tooth cusp. Hence, preparation design strategy in conjunction with the restorative material selected could be influential in the occurrence of a cuspal fracture. PURPOSE: The purpose of this in vitro study was to evaluate the fatigue behavior and fracture strength of maxillary premolars restored with direct composite and indirect ceramic inlays and overlays, with different preparation depths in the presence or absence of cuspal coverage, and analyze their failure types. METHODS AND MATERIALS: Sound maxillary premolars (N=90; n=10) were divided into nine groups: group C: control; group DCI3: direct composite inlay 3 mm; group DCI5: direct composite inlay 5 mm; group ICI3: indirect ceramic inlay 3 mm; group ICI5: indirect ceramic inlay 5 mm; group DCO3: direct composite overlay 3 mm; group DCO5: direct composite overlay 5 mm; group ICO3: indirect ceramic overlay 3 mm; group ICO5: indirect ceramic overlay 5 mm. In indirect ceramic, lithium disilicate restoration groups, immediate dentin sealing was applied. After restoration, all specimens were tested in fatigue (1,200,000 cycles, 50 N, 1.7 Hz). Samples were critically appraised, and the specimens without failure were subjected to a load to failure test. Failure types were classified and the data analyzed. RESULTS: Zero failures were observed in the fatigue testing. The following mean load to failure strengths (N) were recorded: group ICO5: 858 N; group DCI3: 829 N; group ICO3: 816 N; group C: 804 N; group ICI3: 681 N; group DCO5: 635 N; group DCI5: 528 N; group DCO3: 507 N; group ICI5: 482 N. Zero interaction was found between design-depth-material (p=0.468). However, significant interactions were found for the design-depth (p=0.012) and design-material (p=0.006). Within restorations at preparation depth of 3 mm, direct composite overlays obtained a significantly lower fracture strength in comparison to indirect ceramic onlays (p=0.013) and direct composite inlays (p=0.028). In restorations at depth 5 mm, significantly higher fracture load values were observed in indirect ceramic overlays compared with the inlays (p=0.018). Indirect ceramic overlays on 3 mm were significantly stronger than the deep inlays in ceramic (p=0.002) and tended to be stronger than the deep direct composite inlays. Severe, nonreparable fractures were observed with preparation depth of 5 mm within ceramic groups. CONCLUSIONS: The preparation depth significantly affected the fracture strength of tooth when restored with either composite or ceramic materials. Upon deep cavity preparations, cuspal coverage proved to be beneficial when a glass ceramic was used as the restorative material. Upon shallow cavity preparations, a minimally invasive approach regarding preparation design used in conjunction with a direct composite material was favorable.


Assuntos
Resistência à Flexão , Fraturas dos Dentes , Dente Pré-Molar , Resinas Compostas , Preparo da Cavidade Dentária , Porcelana Dentária , Falha de Restauração Dentária , Análise do Estresse Dentário , Humanos , Restaurações Intracoronárias , Teste de Materiais
20.
J Mech Behav Biomed Mater ; 121: 104647, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34171717

RESUMO

Cracked endodontically treated molars (ETMs) are commonly treated with full crowns. Less invasive techniques could include fiber-reinforced composite (FRC) base and adhesively bonded endocrowns. The purpose of this study was to assess the fatigue resistance of ETMs restored with CAD/CAM resin composite endocrowns and reinforced with different FRC bases. Cracks were simulated in fifty mandibular molars by cutting the teeth longitudinally and reassembling the two parts. After performing endodontic treatments and preparing cavities, teeth were restored in one of the following methods (n = 10). In Group 1, cavity floors were lined with 0.5 mm of flowable composite (Universal Injectable; GUI, shade A2). In Groups 2 and 3, the cavity floors were covered with one and three layers of FRC-net (ES Net) respectively, whereas in Groups 4 and 5 with 1 mm and 2 mm of flowable FRC-resin (EverX Flow Dentin; EXFD) respectively. Endocrowns (Cerasmart 270; CE, A2 HT) with 5 mm thickness were adhesively luted with preheated composite and all specimens were subjected to cyclic loading in water at 5 Hz, starting with a load of 600 N (5000 cycles), followed by stages of 1000, 1300, 1600, 1900, 2200 and 2500 at a maximum of 20 000 cycles each. Results were analyzed using Kaplan-Meier survival analysis and the Log-Rank test (p = 0.05). The fatigue failure load of ES Net applied in three layers (1617 N ± 371) or in one layer (1499 N ± 306), as well as EXFD applied in 2 mm (1496 N ± 264) or in 1 mm (1434 N ± 372) did not differ significantly (p > 0.05). Control teeth fractured at 1255 N ± 350 (p > 0.05). In the fiber-reinforced groups, restorable fractures were observed in 50%-80%, with only 30% deemed restorable in the control group. The fractures originated mainly at the occlusal contact points and the main crack propagated in the corono-apical direction. No crack origin (primary or secondary) starting from the artificial pre-existing crack was observed in fractured specimens. FRC bases did not improve the fatigue resistance of cracked ETMs, but favorably influenced the failure mode.


Assuntos
Cerâmica , Resinas Compostas , Desenho Assistido por Computador , Falha de Restauração Dentária , Análise do Estresse Dentário , Teste de Materiais , Dente Molar , Propriedades de Superfície
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