Using Sparfloxacin-Capped Gold Nanoparticles to Modify a Screen-Printed Carbon Electrode Sensor for Ethanol Determination.

Alcohol is a dangerous substance causing global mortality and health issues, including mental health problems. Regular alcohol consumption can lead to depression, anxiety, cognitive decline, and increased risk of alcohol-related disorders. Thus, monitoring ethanol levels in biological samples could contribute to maintaining good health. Herein, we developed an electrochemical sensor for the determination of ethanol in human salivary samples. Initially, the tetra-chloroauric acid (HAuCl4) was chemically reduced using sparfloxacin (Sp) which also served as a stabilizing agent for the gold nanoparticles (AuNPs). As-prepared Sp-AuNPs were comprehensively characterized and confirmed by UV-visible spectroscopy, X-ray diffraction, field emission scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDS), and elemental mapping analysis. The average particle size (~25 nm) and surface charge (negative) of Sp-AuNPs were determined by using dynamic light scattering (DLS) and Zeta potential measurements. An activated screen-printed carbon electrode (A-SPE) was modified using Sp-AuNPs dispersion, which exhibited greater electrocatalytic activity and sensitivity for ethanol (EtOH) oxidation in 0.1 M sodium hydroxide (NaOH) as studied by cyclic voltammetry (CV) and differential pulse voltammetry (DPV). DPV showed a linear response for EtOH from 25 µM to 350 µM with the lowest limit of detection (LOD) of 0.55 µM. Reproducibility and repeatability studies revealed that the Sp-AuNPs/A-SPEs were highly stable and very sensitive to EtOH detection. Additionally, the successful electrochemical determination of EtOH in a saliva sample was carried out. The recovery rate of EtOH spiked in the saliva sample was found to be 99.6%. Thus, the incorporation of Sp-AuNPs within sensors could provide new possibilities in the development of ethanol sensors with an improved level of precision and accuracy.

Compositional profile of mucosal bacteriome of smokers and smokeless tobacco users.

INTRODUCTION: Smoked, and especially smokeless, tobacco are major causes of oral cancer globally. Here, we examine the oral bacteriome of smokers and of smokeless tobacco users, in comparison to healthy controls, using 16S rRNA gene sequencing. METHODS: Oral swab samples were collected from smokers, smokeless tobacco users, and healthy controls (n = 44). Microbial DNA was extracted and the 16S rRNA gene profiled using the Illumina MiSeq platform. Sequencing reads were processed using DADA2, and taxonomical classification was performed using the phylogenetic placement method. Differentially abundant taxa were identified using DESeq2, while functional metagenomes based on KEGG orthology abundance were inferred using LIMMA. RESULTS: A significantly higher microbial diversity was observed in smokeless tobacco users and smokers relative to controls (P < 0.05). Compositional differences in microbial communities were observed in all comparisons with healthy controls (PERMANOVA P < 0.05) but not between smokers and smokeless tobacco users. Levels of Fusobacterium spp., Saccharibacterium spp., and members of Shuttleworthia were elevated in smokers when compared to controls (BH adj P < 0.01). In addition, the relative abundance of three bacterial taxa belonging to genera Fusobacterium spp., Catonella, and Fretibacterium spp. was significantly increased in smokeless tobacco users relative to controls (BH adj P < 0.01). Major functional pathways significantly increased in smokeless tobacco users relative to both controls, and smokers were similar and involved amino acid metabolism including glutamate and aspartate biosynthesis and degradation (log FC > 1.5; BH adj P < 0.01). CONCLUSIONS: A distinct taxonomic and functional profile of oral microbiome in smokers and smokeless tobacco users as compared to healthy controls implicates a significant role of microbes and their metabolites in diseases associated with tobacco use including oral cancer. CLINICAL RELEVANCE: Future efforts in preventive, diagnostic, curative, and prognostic strategies for diseases associated with tobacco use in smokers and smokeless tobacco users could incorporate the oral microbiome.

Assessment of intraoral scanning technology for multiple implant impressions - A systematic review and meta-analysis.

BACKGROUND: Intraoral scanner (IOS) is a medical device used for capturing direct optical impressions and composed of a handheld camera (hardware), a computer and software. Digital impressions by intraoral scanning have become an increasingly popular alternative to conventional impressions. The aim of this systematic review is to assess the studies regarding the various available technologies for IOS and evaluate the most accurate IOS system for cases with multiple implants and identify the factors that can influence its accuracy. MATERIALS AND METHODS: A comprehensive electronic search was done in online databases, 'Pubmed', 'Google Scholar' and 'Cochrane' based on pre-determined eligibility criteria. In-vitro studies, In-vivo studies and Randomized controlled trials assessing the accuracy of intra-oral scanner technology were selected after thorough screening. The search strategy covered all studies published until February 2019 and yielded a total of 11 articles out of which 8 studies were determined to fulfil the inclusion criteria and were selected for this review. Data extraction from the included studies was conducted by the primary author and reviewed by the second author. RESULTS: The information collected included sample size and population, study design, intervention, scanning methods, comparisons and outcome measures. 5 out of 8 included studies compared the distance deviation of the acquired scans from the true values while the remaining 3 studies gave trueness and precision values as the outcome variables. A forest plot on scanner precision displayed slightly higher precision levels in the TRIOS scanner compared to the other intraoral scanners. CONCLUSION: Despite the limitations this study, it can be concluded that active wavefront sampling is more accurate than the other intraoral scanning technology employed by commercial scanners.

Lip Bumper Prosthesis for an Acromegaly Patient: A Clinical Report.

Prosthetic rehabilitation is done to regain function, speech and esthetics. This article describes the treatment for an acromegaly patient with bony defect. Two piece magnet retained hollow lip bumper prosthesis was fabricated to reduce the weight of the denture and to attain esthetics.

Comparative Analysis of Periodontal Parameters and Patient Satisfaction Utilising Different Temporary Crown Fabrication Techniques: A Parallel-Group Randomised Controlled Trial.

Aim The study aims to evaluate the efficacy of different techniques for temporary crown fabrication in maintaining periodontal health and patient satisfaction, addressing a critical gap in the existing literature and informing evidence-based clinical practices. Materials and methods This study, conducted in accordance with CONSORT guidelines, was a parallel-group randomised trial conducted at a dental institute in India. In total, 36 participants aged 18-65 requiring anterior tooth region crowns were randomly assigned to three groups: direct (control), indirect (Test Group 1) and direct-indirect (Test Group 2) fabrication techniques. Participants were selected from outpatient departments based on eligibility criteria, and interventions were allocated using randomization tables. Outcome assessments included gingival health metrics and patient satisfaction levels, with statistical analyses performed using the Kruskal-Wallis test. Results Significant differences were observed in the pink esthetic score (PES) and patient satisfaction (P=0.029) among the three groups, with the direct-indirect technique group demonstrating the highest median PES (9 out of 10). However, no significant disparities were noted in the plaque index (PI) or probing depth (PD) among the groups. Conclusion The direct-indirect technique demonstrated superior PES and patient satisfaction, indicating potential benefits for periodontal health and patient experiences. Integration of virtual preparation workflows may optimise outcomes, but further research is needed for validation and guideline development.

Laboratory Information Management Systems in Oral Pathology: A Comprehensive Review.

Efficiency in oral pathological laboratory processes is paramount for timely and accurate diagnosis. This review explores various strategies and methodologies that help streamline oral pathological laboratory workflows to enhance productivity and reduce turnaround times. Key focus areas include specimen collection, handling, processing, and analysis. Optimization techniques such as automation, digitalization, and standardization are discussed in detail, emphasizing their role in minimizing errors and maximizing throughput. Additionally, the integration of advanced technologies such as artificial intelligence and machine learning is examined for their potential to improve laboratory operations. Moreover, the importance of quality control measures and compliance with regulatory standards is underscored as essential components of any successful laboratory streamlining initiative. By implementing a comprehensive approach that addresses the entire diagnostic pathway, oral pathological laboratories can achieve significant efficiency, ultimately leading to better patient care and outcomes.

Maxillofacial Reconstruction With Three Dimensional Resin Bone Substitutes as an Alternative to Transition Group of Metals: A Structured Review.

In recent years, novel technologies and techniques have allowed today the production of controlled architecture materials. Although autogenous bone graft substitutes remain the gold standard, enormous defects require supplementary alloplastic substitutes for reconstruction. Polymers have lately been explored for the same purpose and their biological performance has been under research since the last decade. The aim of this review is to analyse maxillofacial reconstruction with three-dimensional resin bone substitutes. A Problem Intervention Comparison Outcomes (PICO) analysis was done and a search was carried out in the Cochrane Database, PubMed, Google Scholar etc databases and a hand search was done to collect the related literature. All articles for maxillofacial reconstruction with three-dimensional resin bone substitutes were scrutinised. The manuscripts published from 1990 till May 2021, were included in this review. A total of 106 articles were obtained from a PICO-based keyword search, and 91 manuscripts were retrieved after excluding the duplicates. Out of these 57 manuscripts were excluded on the basis of title and abstract. From the remaining 34 studies, 17 were excluded after reading the full text based on the inclusion and exclusion criteria. During data extraction, four studies were removed and finally, 13 studies were included in this research. From this scoping review, we could conclude that polymethylmethacrylate and polylactic acid formulations are very promising resin bone substitutes for 3-dimensional reconstruction of maxillofacial defects. However, rigorous long-term clinical trials are needed to validate this conclusion.

Denture base materials: An in vitro evaluation of the mechanical and color properties.

OBJECTIVES: This study aimed to compare the physical and mechanical properties of four denture base materials: Polyan IC (PA), milled polymethylmethacrylate (PMMA), three-dimensional (3D)-printed resin (3DP), and SR Ivocap (SR). METHODS: Ninety-six samples were prepared and divided into four groups as follows. Group A consisted of 3DP (Asiga DentaBASE, Asiga) fabricated using a manufacturer-recommended 3D printer (Asiga Pro 4k, Asiga). Group B comprised milled PMMA (MP) (Ivotion Base, Ivoclar Vivadent). Group C included PA (BredentSenden), meanwhile, group D involved SR (Ivoclar VivadentSchaan). Cuboid samples (65 mm x 10 mm x 2.5 mm) were used for biaxial flexure strength testing in a universal testing machine (UTM). Cylindrical samples of 20 mm x 40 mm were used for compressive strength testing in a UTM. Additionally, cuboid samples (65 mm x 10 mm x 2.5 mm) were used for Vickers surface hardness testing in a microhardness tester. disk samples (10 mm x 2.5 mm) were employed for color stability testing both in a coffee solution and Coca-Cola, using a digital spectrophotometer. Statistical analyses were performed using one-way analysis of variance and Tukey's post hoc analysis (α=0.05). RESULTS: MP demonstrated superior compressive strength (p = 0.002) and color stability compared to that exhibited by 3DP (p < 0.001) while displaying similar flexure strength (p = 0.336) and hardness (p = 0.708). MP and PA displayed similar compressive strength (p = 0.081), flexure strength (p = 0.159), and color stability in coke (p = 0.071). However, MP had reduced hardness (p < 0.001) and color stability in coffee (p < 0.001). Moreover, MP demonstrated a higher compressive strength (p < 0.001) than that displayed by SR. However, the flexure strength, hardness, and color stability were similar (p > 0.05). Furthermore, 3DP exhibited comparable compressive strength (p = 0.334) to that of PA but demonstrated significantly lower flexure strength (p = 0.005), hardness (p < 0.001), and color stability (p < 0.001) compared to PA. In comparison to SR, PA had a higher compressive strength (p < 0.001), hardness (p = 0.001), and color stability in coffee (p < 0.001), although they demonstrated similar (p > 0.05) flexure strength and color stability in coke. CONCLUSIONS: The MP and PA demonstrated superior compressive strength than that exhibited by the other materials tested. The tested materials had similar flexure strengths, except for PA which demonstrated superiority over the 3DP. Among all tested materials, PA exhibited the highest hardness, while the 3DP was the least color-stable. CLINICAL SIGNIFICANCE: Considering the mechanical properties and color stability, Polyan and milled polymethylmethacrylate are preferred for complete denture fabrication. However, the limited repairability and complex handling of Polyan should be considered.

Comparative analysis on efficiency and accuracy of parallel confocal microscopy and three-dimensional in motion video with triangulation technology-based intraoral scanner under influence of moisture and mouth opening - A crossover clinical trial.

Aim: The intraoral scanners are digital devices used to digitise the oral tissues. The accuracy of the intraoral scanners has been studied under different environmental conditions, but there might be differences that occur in the actual oral environment, which is still in question. The aim of the study was to evaluate the accuracy and efficiency of Parallel Confocal Microscopy and 3D in motion video with triangulation technology-based intraoral scanners under the influence of moisture and mouth opening. Settings and Design: This was an Cross over clinical controlled study. Materials and Methods: The controlled in vivo study included healthy subjects who were in need of CBCT for the purpose of locating the position of unerupted third molars before going abroad for a job. The subjects were exposed to scans in the upper and lower jaws with two intraoral scanners based on 3D motion video technology with triangulation (Medit) and parallel confocal microscopy (Trios) under the influence of two oral conditions, which were moisture (presence and absence of moisture) and mouth opening (30 mm and 50 mm, respectively). A total of 96 scans were obtained and superimposed individually over the reference CBCT scans to find the deviations in the Geomagic Rapidform (version 2020, USA) software. The efficiency of the scanners was calculated by recording the time taken and the number of images obtained after each scan. Statistical Analysis Used: The significance was calculated by using the independent and paired sample t test in SPSS software (IBM, version 23). Results: Based on the surface analysis, the trueness of the intra-oral scanners had statistically significant differences when compared between 3D in motion video technology with Triangulation and Parallel Confocal Microscopy (P < 0.05) whereas no statistical significance was observed in precision. There was a significant difference observed in the efficiency of the intra-oral scanners (P < 0.05). Conclusion: There is a significant difference in the accuracy and efficiency of the intraoral scanners under the influence of oral conditions, such as different moisture levels and mouth opening conditions. 3D in motion video technology with Triangulation showed better results with the least deviation than Parallel Confocal Microscopy.

An in vitro comparison of the marginal fit of provisional crowns using the virtual tooth preparation workflow against the traditional technique.

Aim: This study investigates the effectiveness of an innovative virtual tooth preparation workflow for the fabrication of dental crowns using cone-beam computed tomography (CBCT) and intraoral scanners (IOSs) with conventional workflow using extraoral/laboratory scanners. Settings and Design: This in vitro experimental study was conducted in the laboratory of a university in Chennai, India. The dental laboratory and research facilities at the institution were utilized for the fabrication of the temporary crowns and the data acquisition process. Materials and Methods: Institutional approval was obtained from the university. It was basically a comparison between the virtual prep technique using CBCT and IOS and the conventional digital technique using extra oral scanners (EOS) for temporary crown fabrication. The sample size was estimated using an effect size of 1.5004, assuming a normal distribution, a significance level of 0.05, and a power of 0.95 in G power software. Based on this calculation, an extracted second lower molar was used to fabricate 10 samples in each group. The samples were divided into three groups: the CBCT (Group 1), the IOS (Group 2), and laboratory scanner (Group 3 as control) groups. The vertical marginal gap of all the surfaces of the crown was evaluated using a scanning electron microscope. Statistical Analysis Used: Data were analyzed using one-way ANOVA using the SPSS software version 26.0, IBM, Armonk, NY, USA. Results: Acceptable marginal discrepancy values were obtained in all three groups. There was no significant difference in the marginal discrepancy recorded (P = 0.113). Conclusion: Virtual tooth preparation using CBCT and IOSs can be used as an alternative to the conventional workflow for provisional crown and bridge fabrication.

An Invitro Chewing Simulation Study Comparing the Wear Resistance Behavior of Polyetheretherketone-Layered Composite Crown and Ceramic-Layered Zirconia Crown.

OBJECTIVE: This study aimed to compare the wear resistance and color stability of fixed dental prostheses (FDPs) fabricated using two different materials: zirconia veneered with feldspathic porcelain and polyetheretherketone (PEEK) veneered with indirect composite. The assessment included samples subjected to thermocycling and wear simulation. METHODS: Two groups of FDPs were examined: one made of zirconia veneered with feldspathic porcelain (control and thermocycled) and the other made of PEEK veneered with indirect composite (worn and thermocycled). The samples were evaluated for wear resistance, antagonist wear, and color stability. Computer-aided design (CAD) software and a digital spectrophotometer were used for analysis. RESULTS: Zirconia veneered with porcelain demonstrated higher wear resistance compared to PEEK veneered with indirect composite. PEEK veneered with indirect composite exhibited significantly lower antagonist wear, indicating a protective effect on opposing teeth. There was no significant difference in color stability between the two groups, even after subjecting them to thermocycling and wear simulation. CONCLUSION: The study concludes that FDPs fabricated with PEEK veneered with indirect composite may have lower wear resistance compared to zirconia veneered with porcelain. However, PEEK FDPs appear to be safer for antagonists due to reduced antagonist wear. Importantly, both materials exhibited similar color stability, making PEEK a viable alternative for FDPs when aesthetic appeal and antagonist protection are primary considerations.

2D MXene/graphene nanocomposite preparation and its electrochemical performance towards the identification of nicotine level in human saliva.

The quantitative analysis of neurological drugs is critical since the kinetics of body fluids is strongly dependent on the dosage of the drug levels. Thus, the study of neurological medicines is significant because of the major diseases connected to it, for instance, Alzheimer's and Parkinson's diseases. Herein, a 2D hybrid MXene/graphene (MX/Gr) film was synthesized through a top-down approach and utilized to prepare an electrochemical transducer for the electrochemical sensing of nicotine. The X-ray diffraction (XRD), Raman and X-ray photoelectron spectroscopy (XPS) confirmed the successful incorporation of MX with Gr sheets. The high-resolution scanning electron microscopy (HR-SEM) and transmission electron microscopy (TEM) have been used to confirm the formation of MX, graphene sheets and the MX/Gr hybrid film. Furthermore, the MX/Gr hybrid film composite modified glassy carbon electrode (GCE) was prepared to selectively detect the nicotine in phosphate buffer medium (0.1 M PBS, pH~7.4). Under the optimized condition, the MX/Gr/GCE based sensor provided a linear response against nicotine from 1 to 55 µM and 30 nM - 600 nM with the lowest limit of detections (LOD) of 290 nM and 0.28 nM by differential pulse voltammetry (DPV) and amperometry, respectively. This newly developed MX/Gr hybrid film modified electrode displayed a remarkable selectivity, sensitivity, and reproducibility for accurate detection of nicotine. Finally, this new sensor was applied to detect nicotine in human/artificial saliva samples with high accuracy.

Synthesis of various dimensional metal organic frameworks (MOFs) and their hybrid composites for emerging applications - A review.

Metal organic frameworks (MOFs) represent the organic and inorganic hybrid porous materials. MOFs are low dense and highly porous materials which in turn provide large surface area that can accumulate and store numerous molecules within the pores. The pore size may also act as a mesh to separate molecules. The porous nature of MOFs is beneficial for altering the intrinsic properties of the materials. Over the past decade, different types of hybrid MOFs have been reported in combination with polymers, carbon materials, metal nanoparticles, metal oxides, and biomolecules for various applications. MOFs have also been used in the fabrication of electronic devices, sensors, energy storage, gas separation, supercapacitors, drug delivery and environmental clean-up. In this review, the unique structural orientation, exceptional properties and recent applications of MOFs have been discussed in the first section along with their porosity, stability and other influencing factors. In addition, various methods and techniques involved in the synthesis and designing of MOFs such as solvothermal, electrochemical, mechanochemical, ultrasonication and microwave methods are highlighted. In order to understand the scientific feasibility of MOFs in developing new products, various strategies have been applied to obtain different dimensional MOFs (0D, 1D, 2D and 3D) and their composite materials are also been conferred. Finally, the future prospects of MOFs, remaining challenges, research gaps and possible solutions that need to be addressed by advanced experimental design, computational models, simulation techniques and theoretical concepts have been deliberated.

Electrochemical Sensing of Glucose Using Glucose Oxidase/PEDOT:4-Sulfocalix [4]arene/MXene Composite Modified Electrode.

Glucose is one of the most important monosaccharides found in the food, as a part of more complex structures, which is a primary energy source for the brain and body. Thus, the monitoring of glucose concentration is more important in food and biological samples in order to maintain a healthy lifestyle. Herein, an electrochemical glucose biosensor was fabricated by immobilization of glucose oxidase (GOX) onto poly(3,4-ethylenedioxythiophene):4-sulfocalix [4]arene (PEDOT:SCX)/MXene modified electrode. For this purpose, firstly, PEDOT was synthesized in the presence of SCX (counterion) by the chemical oxidative method. Secondly, MXene (a 2D layered material) was synthesized by using a high-temperature furnace under a nitrogen atmosphere. After that, PEDOT:SCX/MXene (1:1) dispersion was prepared by ultrasonication which was later utilized to prepare PEDOT:SCX/MXene hybrid film. A successful formation of PEDOT:SCX/MXene film was confirmed by HR-SEM, Fourier transform infrared (FT-IR), and Raman spectroscopies. Due to the biocompatibility nature, successful immobilization of GOX was carried out onto chitosan modified PEDOT:SCX/MXene/GCE. Moreover, the electrochemical properties of PEDOT:SCX/MXene/GOX/GCE was studied through cyclic voltammetry and amperometry methods. Interestingly, a stable redox peak of FAD-GOX was observed at a formal potential of -0.435 V on PEDOT:SCX/MXene/GOX/GCE which indicated a direct electron transfer between the enzyme and the electrode surface. PEDOT:SCX/MXene/GOX/GCE also exhibited a linear response against glucose concentrations in the linear range from 0.5 to 8 mM. The effect of pH, sensors reproducibility, and repeatability of the PEDOT:SCX/MXene/GOX/GCE sensor were studied. Finally, this new biosensor was successfully applied to detect glucose in commercial fruit juice sample with satisfactory recovery.

Prosthognathic rehabilitation of a patient with underlying skeletal discrepancy- a case report.

Vertical and anterioposterior maxillary excesses can be treated with a combination of orthopaedic functional appliances, orthodontics and surgery. Treatment varies according to the age, patient reports for treatment. In patients who are treated with either of the above mentioned treatment modalities, if they require prosthetic replacement on a later date, especially of anterior teeth, prosthetic treatment alone does not give an aesthetic outcome. A partially edentulous, elderly patient with underlying skeletal discrepancy (Class II Skeletal deformity) in relation to 12,11,21,22 was treated with a combination of orthognathic surgery and prosthetic rehabilltation. An orthognathic surgery (leforte I osteotomy) was performed to manage vertical maxillary excess, class II skeletal pattern of maxilla and increased lower third facial height. Dental compensations in the mandibular arch were decompensated surgically with lower subapical osteotomy. Prosthetic restorations of missing anterior teeth were done later, such that facial and dental aesthetics. The records showed that the results were stable 12 months after prosthognathic (prosthodontic and orthognathic) treatment. A team approach enabled the female patient in her fifth decade of life, to receive better function, aesthetics and increased quality of life. Doing prosthetic restorations in patients with underlying skeletal discrepancies may become a challenge , which should be achieved without compromising on final outcome, with a calculated risk benefit ratio.

Full mouth rehabilitation of a patient with mandibular implant screw retained Fp-3 prosthesis opposing maxillary acrylic removable over-denture.

A hybrid denture is one that is fabricated over a metal framework and retained by screws threaded into the implant abutments. The anterior part of a mandibular hybrid denture is fixed on implants while the posterior part of the denture is extended and cantilevered from implants. This article presents the fabrication of a maxillary over-denture opposing mandibular implant retained hybrid prosthesis. A total of four implants were placed in the mandibular arch. Castable abutments were used to produce the optimal angulations. Framework was waxed, cast recovered, and the fit was refined until the framework seated passively on the master cast. The mandibular denture teeth were waxed to the hybrid framework, and a final wax try-in was performed to verify and correct maxillomandibular relations before processing. The prosthesis was inserted after verification of occlusion, retention, and stability. The rehabilitation of edentulous patients with hybrid dentures has been observed to achieve greater masticatory function and psychological satisfaction than with conventional over-dentures. Producing a passive-fitting substructure for a fixed removable screw retained hybrid prosthesis is arguably one of the most technically complex tasks in implant dentistry. The technique presented may not initially produce a perfectly passive framework, but use of disclosing media and adjusting the internal aspect of the casting can result in non-binding, fully seated prostheses.

Full mouth rehabilitation of a patient with reduced vertical dimension using multiple metal ce ramic restorations.

Rehabilitation of a patient with severely worn dentition after restoring the vertical dimension is a complex procedure and assessment of the vertical dimension is an important aspect in these cases. This clinical report describes the full mouth rehabilitation of a patient who was clinically monitored to evaluate the adaptation to a removable occlusal splint to restore vertical dimension for a period 1 month and provisional restorations to determine esthetic and functional outcome for a period of 3 months. It is necessary to recognizing that form follows function and that anterior teeth play a vital role in the maintenance of oral health. Confirmation of tolerance to changes in the vertical dimension of occlusion (VDO) is of paramount importance. Articulated study casts and a diagnostic wax-up can provide important information for the evaluation of treatment options. Alteration of the VDO should be conservative and should not be changed without careful consideration.