Effectiveness of conservative therapeutic modalities for temporomandibular disorders-related pain: a systematic review.

PURPOSE: The aim of this systematic review was to evaluate the effectiveness of conservative different therapeutic modalities for temporomandibular disorders (TMD) pain. MATERIALS AND METHODS: An electronic systematic search was conducted in the MEDLINE (PubMed) database to identify the randomized clinical trials (RCTs) published between 2001 and 2021. The following, simple or multiple conjunctions, search keywords were selected: TMD pain, TMD management or conservative treatment or treatment strategies and TMD pain, therapeutic modalities or interventions and TMD. Studies included must have patients older than 18 years, with painful TMD, which diagnosis was performed by Research Diagnostic Criteria for TMD or Diagnostic Criteria for TMD. Outcome variables were pain relief and post treatment pain intensity reduction. Data were analysed with non-parametric tests and the level of significance was set at p<.05. RESULTS: Out of 1599 articles obtained, 28 RCTs fulfilled all selection criteria and were included. The results of this study show that there was a significant decrease in short-term post-treatment TMD pain with the use of occlusal splint alone or in combination with other therapeutic modalities when compared with the control group. Statistically significant differences were also detected between laser and photobiomodulation group and the control, in short-term treatment TMD-related pain. CONCLUSIONS: The primary findings of the present systematic review showed that the occlusal splint alone or combined with other therapeutic intervention presented positive effect on short-term TMD pain reduction. Secondary outcome suggests that laser and photobiomodulation therapy had, also, a significant role in short term pain relief.

Screwmentable implant-supported prostheses: A systematic review.

STATEMENT OF PROBLEM: Screwmentable prostheses were developed to combine the benefits of screw retention and cement retention. However, data are limited on the clinical performance of this type of prosthesis. PURPOSE: The purpose of this systematic review was to collect scientific evidence on screwmentable prostheses and evaluate their long-term clinical behavior. MATERIAL AND METHODS: An electronic search was conducted by 2 independent reviewers for articles published in scientific dental journals in English from 2004 to April 2020. The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were scientific studies concerning the screwmentable type of prosthesis. RESULTS: The search provided 494 records. Of these, 24 studies fulfilled the inclusion criteria and were included in the review. The included articles presented significant heterogeneity concerning the manufacturing process and the materials used. One randomized clinical trial, 2 prospective clinical studies, 14 in vitro studies, 3 protocol descriptions, 1 case series, and 3 case reports were included. CONCLUSIONS: Based on the systematic search of the literature, it is concluded that the screwmentable prosthesis combines advantages of both cement-retained and screw-retained restorations, including passive fit, retrievability, excess cement control, tissue-friendly emergence profile, and improved esthetics. Nevertheless, data from well-designed clinical trials are limited, and further research is required to provide evidence on their long-term clinical behavior.

Effect of in vitro aging and acidic storage on color, translucency, and contrast ratio of monolithic zirconia and lithium disilicate ceramics.

STATEMENT OF PROBLEM: How the translucency and color of ceramic restorations are affected by surface changes from the corrosive environment in the oral cavity and aging of materials is unclear. PURPOSE: The purpose of this in vitro study was to compare the impact of acidic exposure and aging on the color and translucency of monolithic zirconia and lithium disilicate ceramics. MATERIAL AND METHODS: Twenty computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic zirconia specimens and 20 pressed lithium disilicate specimens were fabricated. Half of the specimens of each group were aged in an autoclave (7.5 hours, 134 °C, 0.2 MPa), and the rest were immersed in hydrochloric acid to simulate the acidic conditions in the oral cavity from gastric reflux. The color coordinates L∗, a∗, and b∗ were measured with an ultraviolet spectrophotometer before and after aging or acidic storage. The translucency parameters and contrast ratios were calculated, and the CIEDE2000 color difference formula was used to determine color differences before and after each treatment. ANOVA and ANCOVA test models were used for data analysis (α=.05), while differences of color parameters in respect to acceptability and perceptibility thresholds were evaluated with the 1-sample t test (α=.05). RESULTS: Lithium disilicate presented a significantly higher translucency parameter and lower contrast ratio at baseline compared with monolithic zirconia specimens (P<.001). Acidic storage significantly impacted all parameters compared with aging, especially for the lithium disilicate group. Color differences were above the acceptability ΔΕ00 threshold for lithium disilicate after acidic storage (P=.001) and below for monolithic zirconia after acidic storage (P=.003). CONCLUSIONS: The performance of lithium disilicate was slightly inferior compared with that of monolithic zirconia specimens, as they presented significant and clinically observable differences for the translucency parameter and ΔΕ00 after acidic storage and aging.

Variables affecting the fit of zirconia fixed partial dentures: A systematic review.

STATEMENT OF PROBLEM: Different parameters affect the marginal and internal fit of zirconia fixed partial dentures (FPDs) on natural teeth. Determining a way to optimize these restorations is essential. PURPOSE: The purpose of this systematic review was to determine the variables affecting the marginal fit and internal accuracy of zirconia FPDs on natural teeth. MATERIAL AND METHODS: An electronic search was conducted by 2 independent reviewers by using the MEDLINE, Cochrane, Web of Science, and Scopus databases, as well as Google Scholar, for studies published up to July 2018, and a manual search was conducted from the reference lists of related articles. Eligibility criteria included articles in English published in peer-reviewed journals that assessed the marginal and/or internal adaptation of zirconia FPDs on teeth with 3 or more units, with at least 1 of the experimental groups being frameworks or FPDs fabricated from zirconia. Risk of bias was assessed with the aid of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: The search provided 418 records, with 41 fulfilling the inclusion criteria. The selected studies showed considerable heterogeneity regarding materials, state of sintering, manufacturer and computer-aided design and computer-aided manufacturing (CAD-CAM) system, experimental methodology, sample size, and span length. Of the included articles, 36 were in vitro studies and 5 were clinical studies, most of which exhibited high-performance and detection biases. CAD-CAM systems provided more precise marginal and internal fit than CAM systems. An increase of framework span length to 6 or more units decreased both marginal and internal fit. The reported marginal gap tended to increase after the veneering process. The introduction of a conventional impression into an otherwise digital workflow seems to have a negative effect on the marginal fit. CONCLUSIONS: The accuracy of zirconia FPDs or frameworks is considerably influenced by the processing procedure used and the choice of CAD-CAM system.

In vitro evaluation of the shear bond strength and bioactivity of a bioceramic cement for bonding monolithic zirconia.

STATEMENT OF PROBLEM: Adhesive cementation is the most common bonding strategy for zirconia restorations. Although cementation with a bioactive luting agent has been proposed as an alternative, how the bond strength compares is unclear. PURPOSE: The purpose of this in vitro study was to evaluate shear bond strength after cementing a monolithic zirconia ceramic to human dentin with a bioceramic cement, compare it with a traditional cement, and evaluate its bioactive properties. MATERIAL AND METHODS: A total of 120 dentin specimens and 120 yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) (BruxZir) cylindrical specimens were used. Zirconia and dentin specimens were randomly divided into 8 study groups (n=15) based on 2 luting cement types (a bioceramic cement or glass ionomer cement as control), 2 airborne-particle abrasion protocols (50 µm or 110 µm), and 2 water storage durations (24 hours or 30 days). After the shear bond strength test using a universal machine at a crosshead speed of 1 mm/min, fracture patterns were evaluated under a stereomicroscope and a scanning electron microscope. Strength values were statistically analyzed with a 3-factor ANOVA model (α=.05). Bioactivity was evaluated in simulated body fluid (SBF). RESULTS: The control glass ionomer cement achieved significantly greater shear bond strength compared with the tested bioceramic cement. Mean bond strength values ranged from 2.52 MPa to 5.23 MPa for the bioceramic cement tested and from 4.20 MPa to 6.61 MPa for the control cement. The duration of water storage played a significant role in the bond strength, with groups stored for 30 days reaching higher bond strength values, whereas the particle size of airborne-particle abrasion did not have a significant effect. Failure types were primarily mixed. No apatite formation was recorded on the surface of the specimens even after 30 days of immersion in SBF. CONCLUSIONS: The evaluated cement did not develop apatite in SBF, and its bond strength values were below the control glass ionomer cement.

Fibro/chondrogenic differentiation of dental stem cells into chitosan/alginate scaffolds towards temporomandibular joint disc regeneration.

Tissue engineering (TE) may provide effective alternative treatment for challenging temporomandibular joint (TMJ) pathologies associated with disc malpositioning or degeneration and leading to severe masticatory dysfunction. Aim of this study was to evaluate the potential of chitosan/alginate (Ch/Alg) scaffolds to promote fibro/chondrogenic differentiation of dental pulp stem cells (DPSCs) and production of fibrocartilage tissue, serving as a replacement of the natural TMJ disc. Ch/Alg scaffolds were fabricated by crosslinking with CaCl2 combined or not with glutaraldehyde, resulting in two scaffold types that were physicochemically characterized, seeded with DPSCs or human nucleus pulposus cells (hNPCs) used as control and evaluated for cell attachment, viability, and proliferation. The DPSCs/scaffold constructs were incubated for up to 8 weeks and assessed for extracellular matrix production by means of histology, immunofluorescence, and thermomechanical analysis. Both Ch/Alg scaffold types with a mass ratio of 1:1 presented a gel-like structure with interconnected pores. Scaffolds supported cell adhesion and long-term viability/proliferation of DPSCs and hNPCs. DPSCs cultured into Ch/Alg scaffolds demonstrated a significant increase of gene expression of fibrocartilaginous markers (COLI, COL X, SOX9, COM, ACAN) after up to 3 weeks in culture. Dynamic thermomechanical analysis revealed that scaffolds loaded with DPSCs significantly increased storage modulus and elastic response compared to cell-free scaffolds, obtaining values similar to those of native TMJ disc. Histological data and immunochemical staining for aggrecan after 4 to 8 weeks indicated that the scaffolds support abundant fibrocartilaginous tissue formation, thus providing a promising strategy for TMJ disc TE-based replacement.

Evaluation of color stability of preshaded and liquid-shaded monolithic zirconia.

STATEMENT OF PROBLEM: The effect of thermal aging on the color stability of monolithic zirconia has not been thoroughly investigated. PURPOSE: The purpose of this in vitro study was to evaluate the color stability before and after thermocycling of monolithic zirconia specimens, which were either preshaded or characterized in the laboratory through the assessment of color parameters L*, a*, and b*. MATERIAL AND METHODS: A total of 80 specimens (10×10×15 mm) were prepared from zirconia disks (BruxZir) and divided into 2 groups. The first group consisted of preshaded specimens from disks 100, 200, 300, and 400, and the second group consisted of white specimens characterized before the sintering stage with coloring liquids in shades A2, B2, C2, and D2. Ten specimens of each shade were used. A double-beam ultraviolet-visible light recording spectrophotometer was used to assess the color parameters L*, a*, and b* before and after thermocycling. The color difference ΔE was calculated based on ΔΕ=[(ΔL*)2+(Δa*)2+(Δb*)2]½. The reliability of the examiner was investigated by MedCalc v12.5 software, and the tests of normality, homogeneity of variances, and 1-way ANOVA statistical analysis of variance were performed by IBM Statistics SPSS v20.0 software (α=.05). RESULTS: No statistically significant ΔΕ (P>.05) was observed among the different groups after thermocycling. All ΔΕ values were below the limit of the 3.7 that an untrained observer can perceive. Only for the specimens in shades 200 and 400 was ΔΕ above 1, revealing a visible color difference, which, however, was still clinically acceptable. The L*, a*, and b* values for both liquid-shaded and preshaded zirconia specimens were not significantly affected by thermocycling. A higher color stability for laboratory-characterized compared with preshaded monolithic zirconia was observed irrespective of the color shade. CONCLUSIONS: Within the limitations of this in vitro study, monolithic zirconia specimens of any shade, either preshaded or characterized in the laboratory, can be considered as color-stable materials after thermocycling.

Stress generation in mandibular anterior teeth restored with different types of post-and-core at various levels of ferrule.

STATEMENT OF PROBLEM: Pertinent evidence regarding the mechanical integrity of mandibular anterior teeth restored with a post-and-core is limited. PURPOSE: The purpose of this finite element analysis study was to compare the impact of the post type (glass fiber post-and-resin core or cast post-and-core) along with the ferrule effect on the stress fields generated in endodontically treated mandibular lateral incisors and canines. MATERIAL AND METHODS: Three-dimensional models of the segmented mandible were developed. Mandibular incisors and canines with or without a 2-mm circular ferrule and restored with a cast post-and-core or glass fiber post-and-resin core were simulated and subjected to linear elastic static analysis. The principal stress values were calculated. von Mises equivalent stresses were used to evaluate the stress. RESULTS: Maximum principal stresses in dentin were highest in incisors, with a ferrule. Stress parameters in composite resin core in both incisors and canines were critically close to the tensile failure limit of the core material. Cast post-and-cores cemented in incisors without a ferrule accumulated the highest stresses, exceeding the tensile failure limit of resin-modified glass ionomer cement. CONCLUSIONS: Tooth preparation with a ferrule led to a remarkable rise in stress in the dentin of mandibular incisors but favored the mechanical integrity of the restoration.

Color stability of lithium disilicate ceramics after aging and immersion in common beverages.

STATEMENT OF PROBLEM: The color of an esthetic restoration and its color stability are important for long-term success. However, the impact of common beverages on lithium disilicate ceramic is not well known. PURPOSE: The purpose of this in vitro study was to investigate color variations of lithium disilicate ceramics after thermocycling (TC) and immersion in commonly consumed beverages. MATERIAL AND METHODS: A total of 288 specimens (1×10×10 mm) were fabricated from IPS e-max computer-aided design (CAD) (n=72), IPS e-max CERAM ([CER] n=72), IPS e-max Press with glazing ([PG] n=72), and IPS e-max Press without glazing ([PNG] n=72) according to the manufacturer's instructions. Each group was divided into 4 subgroups (n=18): TC, coffee, black tea, and red wine. Thermocycling was performed at 21 900 cycles at 5°C, 37°C, 55°C, and 37°C (3 years' clinical simulation), whereas the specimens were soaked in the staining solutions for up to 54 hours (3 years' clinical simulation). Color parameters L*, a*, and b* were assessed with an ultraviolet-visible spectroscopy recording spectrophotometer. Color difference (ΔE) was calculated using the equation [ΔΕ= [(ΔL*)2 + (Δa*)2 + (Δb*)2]½]. Intraexaminer reliability was assessed by using the intraclass correlation coefficient. Two-way analysis of variance was used for the analysis of ΔΕ, and the parameters L*, a*, and b* were analyzed with linear mixed models for repeated measurements and the Bonferroni pair-wise comparison test (α=.05). RESULTS: Parameters ΔΕ, L*, a*, and b* were significantly affected by the interaction between material and treatment (P<.001). A ΔΕ >1 was recorded for PG with tea, wine, and coffee, PG after TC and CER after TC. For L*, greater reduction was observed for PNG with tea and CER after TC, whereas for a* significant changes were positive (to red shades), except for PNG with TC, where PNG with wine showed the greatest positive change. For b*, significant changes were negative (to blue shades) except for PNG with tea and coffee and CAD with tea. CONCLUSIONS: All groups demonstrated color changes below the clinically perceptible level (ΔΕ<3.7), except PNG in tea which showed statistically significant color differences (ΔΕ>4). CAD presented higher color stability compared with the nonglazed Press specimens.

Odontogenic differentiation and biomineralization potential of dental pulp stem cells inside Mg-based bioceramic scaffolds under low-level laser treatment.

This study aimed to investigate the potential of low-level laser irradiation (LLLI) to promote odontogenic differentiation and biomineralization by dental pulp stem cells (DPSCs) seeded inside bioceramic scaffolds. Mg-based, Zn-doped bioceramic scaffolds, synthesized by the sol-gel technique, were spotted with DPSCs and exposed to LLLI at 660 nm with maximum output power of 140 mw at fluencies (a) 2 and 4 J/cm2 to evaluate cell viability/proliferation by the MTT assay and (b) 4 J/cm2 to evaluate cell differentiation, using real-time PCR (expression of odontogenic markers) and a p-nitrophenylphosphate (pNPP)-based assay for alkaline phosphatase (ALP) activity measurement. Scanning electron microscopy (SEM) and X-ray diffraction (XRD) analysis were used for structural/chemical characterization of the regenerated tissues. Exposure of the DPSCs/scaffold complexes to the proposed LLLI scheme was associated with statistically significant increase of odontogenesis-related markers (bone morphogenetic protein 2 (BMP-2): 22.4-fold, dentin sialophosphoprotein (DSPP): 28.4-fold, Osterix: 18.5-fold, and Runt-related transcription factor 2 (Runx2): 3.4-fold). ALP activity was significantly increased at 3 and 7 days inside the irradiated compared to that in the non-irradiated SC/DPSC complexes, but gradually decreased until 14 days. Newly formed Ca-P tissue was formed on the SC/DPSC complexes after 28 days of culture that attained the characteristics of bioapatite. Overall, LLLI treatment proved to be beneficial for odontogenic differentiation and biomineralization of DPSCs inside the bioceramic scaffolds, making this therapeutic modality promising for targeted dentin engineering.

Is there a potential for durable adhesion to zirconia restorations? A systematic review.

STATEMENT OF PROBLEM: With a number of zirconia ceramic materials currently available for clinical use, an overview of the scientific literature on the adhesion methods and their potential influence is indicated. PURPOSE: The purpose of this systematic review was to classify and analyze the existing methods and materials proposed to improve adhesion to zirconia surfaces. MATERIAL AND METHODS: The current literature of in vitro studies examining the bond strength on zirconia ceramics, including clinical studies from 1998 until 2014, was analyzed. A search of the English language literature was undertaken using MEDLINE and PubMed, and a hand search was made for any relevant research paper from the library of a dental school. Papers evaluating only alumina restoration bond or ceramic-zirconia bond were excluded. RESULTS: A total of 134 publications were identified for analysis. Different adhesive techniques with different testing methods were reviewed. Results were difficult to compare in that the parameters varied in each research protocol. CONCLUSIONS: Airborne-particle abrasion and tribochemical silica coating are reference pretreatment methods. Adhesive monomers are necessary for chemical bonding. Surface contamination and aging have negative effects on adhesion to zirconia. Many factors influence each combination of zirconia material, such as surface treatment, adhesive medium, and aging conditions. Laboratory studies should be confirmed by clinical trials.

Accuracy of 3 different impression techniques for internal connection angulated implants.

STATEMENT OF PROBLEM: Making implant impressions with different angulations requires a more precise and time-consuming impression technique. PURPOSE: The purpose of this in vitro study was to compare the accuracy of nonsplinted, splinted, and snap-fit impression techniques of internal connection implants with different angulations. MATERIAL AND METHODS: An experimental device was used to allow a clinical simulation of impression making by means of open and closed tray techniques. Three different impression techniques (nonsplinted, acrylic-resin splinted, and indirect snap-fit) for 6 internal-connected implants at different angulations (0, 15, 25 degrees) were examined using polyether. Impression accuracy was evaluated by measuring the differences in 3-dimensional (3D) position deviations between the implant body/impression coping before the impression procedure and the coping/laboratory analog positioned within the impression, using a coordinate measuring machine. Data were analyzed by 2-way ANOVA. Means were compared with the least significant difference criterion at P<.05. RESULTS: Results showed that at 25 degrees of implant angulation, the highest accuracy was obtained with the splinted technique (mean ±SE: 0.39 ±0.05 mm) and the lowest with the snap-fit technique (0.85 ±0.09 mm); at 15 degrees of angulation, there were no significant differences among splinted (0.22 ±0.04 mm) and nonsplinted technique (0.15 ±0.02 mm) and the lowest accuracy obtained with the snap-fit technique (0.95 ±0.15 mm); and no significant differences were found between nonsplinted and splinted technique at 0 degrees of implant placement. CONCLUSIONS: Splinted impression technique exhibited a higher accuracy than the other techniques studied when increased implant angulations at 25 degrees were involved.

The effect of type of restoration on the stress field developed in terminal abutments with severely reduced periodontal support and coronal structure.

STATEMENT OF PROBLEM: Periodontally compromised teeth (PCT) that serve as terminal abutments (TAs) are often challenging depending on the post-and-core treatment, the type of partial fixed dental prosthesis (PFDP), and the periodontal support. PURPOSE: The purpose of this study was to investigate the biomechanical impact of 3 types of PFDP supported by cast post-and-cores on PCT serving as terminal abutments. MATERIAL AND METHODS: A 3-dimensional (3D) model of a human mandible was fabricated by using computed tomography (CT) images and parameterized in a computer-aided design (CAD) environment as follows: Right premolar preparation geometries were designed. The second premolar was assembled with 7-mm or 10-mm cast post-and-core models. Both premolar-models were designed to support single, splinted, or 1-unit cantilever splinted crowns. In each situation, their periodontium geometries were designed to be reduced by 10%, 50%, and 70%. All models were imported into a 3D finite element analysis (FEA) environment and loaded; von Mises stress values and distribution patterns were evaluated. RESULTS: Insertion of the post primarily affected the apical areas of both the root and post; the type of PFDP and periodontal support mainly affected stress distribution. In patients with a normal periodontium, splinting the teeth did not contribute to their stress relief. By extending the post length, a stressful area close to the apex of the post was developed. Splinting mitigated the stress field of the coronal part of the 50% PCT (up to 98.9%); the 30% PCT experienced a substantial decrease (up to 215.9%) in stress in the radical part as well. The increase in the length of the post produced negligible stress-related differences in the apical part of the 50% PCT (0.2% to 2.6%). The use of the 7-mm post effectively relieved the radical part of the splinted 30% PCT. The magnitude of the stress on the radical part of post-restored PCT was considerably increased in the presence of a cantilever. CONCLUSIONS: Splinted crowns supported by a 7-mm cast post-and-core are a favorable biomechanical approach for the restoration of PCT with severe loss of coronal structure. The use of a cantilever greatly aggravates the biomechanical response, especially of post-restored PCT.

Managing Temporomandibular Joint Osteoarthritis by Dental Stem Cell Secretome.

The potential therapeutic role of the Dental Pulp Stem Cells Secretome (SECR) in a rat model of experimentally induced Temporomandibular Joint (TMJ) Osteoarthritis (OA) was evaluated. Proteomic profiling of the human SECR under specific oxygen tension (5% O2) and stimulation with Tumor Necrosis Factor-alpha (TNF-α) was performed. SECR and respective cell lysates (CL) samples were collected and subjected to SDS-PAGE, followed by LC-MS/MS analysis. The identified proteins were analyzed with Bioinformatic tools. The anti-inflammatory properties of SECR were assessed via an in vitro murine macrophages model, and were further validated in vivo, in a rat model of chemically-induced TMJ-OA by weekly recording of the head withdrawal threshold, the food intake, and the weight change, and radiographically and histologically at 4- and 8-weeks post-treatment. SECR analysis revealed the presence of 50 proteins that were enriched and/or statistically significantly upregulated compared to CL, while many of those proteins were involved in pathways related to "extracellular matrix organization" and "immune system". SECR application in vitro led to a significant downregulation on the expression of pro-inflammatory genes (MMP-13, MMP-9, MMP-3 and MCP-1), while maintaining an increased expression of IL-10 and IL-6. SECR application in vivo had a significant positive effect on all the clinical parameters, resulting in improved food intake, weight, and pain suppression. Radiographically, SECR application had a significant positive effect on trabecular bone thickness and bone density compared to the saline-treated group. Histological analysis indicated that SECR administration reduced inflammation, enhanced ECM and subchondral bone repair and regeneration, thus alleviating TMJ degeneration.

Flexural strength and the probability of failure of cold isostatic pressed zirconia core ceramics.

STATEMENT OF PROBLEM: The flexural strength of zirconia core ceramics must predictably withstand the high stresses developed during oral function. The in-depth interpretation of strength parameters and the probability of failure during clinical performance could assist the clinician in selecting the optimum materials while planning treatment. PURPOSE: The purpose of this study was to evaluate the flexural strength based on survival probability and Weibull statistical analysis of 2 zirconia cores for ceramic restorations. MATERIAL AND METHODS: Twenty bar-shaped specimens were milled from 2 core ceramics, IPS e.max ZirCAD and Wieland ZENO Zr, and were loaded until fracture according to ISO 6872 (3-point bending test). An independent samples t test was used to assess significant differences of fracture strength (α=.05). Weibull statistical analysis of the flexural strength data provided 2 parameter estimates: Weibull modulus (m) and characteristic strength (σ(0)). The fractured surfaces of the specimens were evaluated by scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS). The investigation of the crystallographic state of the materials was performed with x-ray diffraction analysis (XRD) and Fourier transform infrared (FTIR) spectroscopy. RESULTS: Higher mean flexural strength (P<.001) and σ(0) were recorded for WZ ceramics. However IZ ceramics presented a higher m value and a microstructure with fewer voids and pores. The fractured surfaces presented similar fractographic properties (mirror regions followed by hackle lines zones). Both groups primarily sustained the tetragonal phase of zirconia and a negligible amount of the monoclinic phase. CONCLUSIONS: Although both zirconia ceramics presented similar fractographic and crystallographic properties, the higher flexural strength of WZ ceramics was associated with a lower m and more voids in their microstructure. These findings suggest a greater scattering of strength values and a flaw distribution that are expected to increase failure probability.

Effect of different zirconia surface pretreatments on the flexural strength of veneered Y-TZP ceramic before and after in vitro aging.

PURPOSE: The investigation of zirconia core surface pretreatments on the flexural strength of bilayered zirconia ceramics before and after artificial accelerating aging. METHODS: Ninety bar-shaped specimens were manufactured from Yttria Stabilized Tetragonal Zirconia Polycrystal (Y-TZP) and divided in three groups depending on zirconia surface pretreatment before veneering: layering with liner, pretreatment with silane-containing gas flame (SGF) with the Silano-Pen device and alumina air-abrasion. Half of the veneered specimens in each group (n=15) underwent artificial accelerating aging. A 4-point bending test was performed to determine flexural strength. Three specimens from each group were further analyzed using Scanning Electron Microscopy (SEM), X-ray Diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR) before veneering and after fracture (aged and non-aged subgroups). RESULTS: Alumina air-abrasion was correlated to increased phase transformation from tetragonal to monoclinic zirconia phase. Qualitative analysis revealed that with the majority of the specimens pretreated with the silane-containing gas flame, areas of the veneering material remained firmly attached to the zirconia core after flexural strength testing. There was no statistically significant difference on the flexural strength among the groups before or after aging. Artificial accelerating aging resulted in statistically significant higher flexural strength of the specimens after aging. CONCLUSION: SGF pretreatment can be an acceptable and feasible alternative method before the veneering of Y-TZP zirconia as it presented slightly higher bond strength compared with alumina air-abrasion which was associated with higher tetragonal to monoclinic (t→m) phase transformation. Accelerating aging leads to an increase of the mechanical properties under in vitro conditions.

Assessment of the impact of two different isolation methods on the osteo/odontogenic differentiation potential of human dental stem cells derived from deciduous teeth.

Human deciduous teeth have been proposed as a promising source of mesenchymal stem cells for application in bone and dental tissue engineering. We established cultures of mesenchymal stem cells from the pulp of human deciduous teeth (deciduous teeth stem cells, DTSCs) and analyzed their morphologic, growth, immunophenotypic, and osteo/odontogenic differentiation characteristics using different isolation methods and culturing environments. We compared the biologic behavior of DTSCs isolated either by enzymatic dissociation (DTSCs-ED) or by direct outgrowth from pulp tissue explants (DTSCs-OG). We found that different isolation methods give rise to different populations/lineages of cells with respect to their phenotypic and differentiation characteristics. DTSCs-ED cultures comprised heterogeneous cell populations, whereas DTSCs-OG comprised more homogenous spindle-shaped cells. We have characterized DTSCs as STRO-1(+)/CD146(+)/CD34(+)/CD45(-) cells. However, the percentage of STRO-1(+) and CD34(+) cells was higher in DTSCs-ED (STRO-1, 17.01 ± 5.04%; CD34, 19.79 ± 4.66%) compared to DTSCs-OG cultures (STRO-1, 5.18 ± 2.39%; CD34, 9.94 ± 3.41%), probably as a result of a higher release of stem/progenitor cells from the perivascular niche during enzymatic dissociation. DTSCs isolated using either method displayed an active potential for cellular migration and biomineralization, giving rise to 3D mineralized structures when challenged with dexamethasone, monopotassium phosphate, and ß-glycerophosphate. These cellular aggregates progressively expressed differentiation markers of functional odontoblasts, including dentin sialophosphoprotein, bone sialoprotein, osteocalcin, and alkaline phosphatase, having the characteristics of osteodentin. However, in DTSCs-ED, the mineralization rate and the amount of mineralized matrix produced was higher compared to DTSCs-OG cultures. Therefore, DTSCs-ED cells display enhanced biomineralization potential, which might be of advantage for application in clinical therapy.

Advanced in Vitro Experimental Models for Tissue Engineering-based Reconstruction of a 3D Dentin/pulp Complex: a Literature Review.

OBJECTIVE: Experimental procedures have been used to monitor cellular responses at the dentin/pulp interface. Aiming to divert from in vivo studies and oversimplified two-dimensional assays, three-dimensional (3D) models have been developed. This review provides an overview of existing literature, regarding 3D in vitro dentin/pulp reconstruction. MATERIAL & METHODS: PubMed, Scopus, Cochrane Library and Web of Science- were systematically searched for attributes between 1998 and 2020. The search focused on articles on the development of three-dimensional tools for the reconstruction of a dentin/pulp complex under in vitro conditions, which were then screened and qualitatively assessed. Article grouping according to mode of implementation, resulted in five categories: the customised cell perfusion chamber (CPC) (n = 8), the tooth bud model (TBM) (n = 3), the 3D dentin/pulp complex manufactured by tissue engineering (DPC) (n = 6), the entire tooth culture (ETC) (n = 4) and the tooth slice culture model (TSC) (n = 5). RESULTS: A total of 26 publications, applying nine and eight substances for pulp and dentin representation respectively, were included. Natural materials and dentin components were the most widely utilized. The most diverse category was the DPC, while the CPC group was the test with the highest longevity. The most consistent categories were the ETC and TSC models, while the TBM presented as the most complete de novo approach. CONCLUSIONS: All studies presented with experimental protocols with potential upgrades. Solving the limitations of each category will provide a complete in vitro testing and monitoring tool of dental responses to exogenous inputs. CLINICAL RELEVANCE: The 3D dentin/pulp complexes are valid supplementary tools for in vivo studies and clinical testing. Graphical Abstract.

Fracture strength of endodontically treated premolars restored with different post systems and metal-ceramic or monolithic zirconia crowns.

The purpose of this study was to investigate the fracture strength of endodontically treated human maxillary premolars (ETP) restored with posts and metal ceramic (MC) or monolithic zirconia (MZ) crowns. Sixty ETP were randomly divided into 3 groups. Teeth in control group (C) received a resin filling. ETP in the MC group were restored with prefabricated metal posts, composite cores and MC crowns while in the MZ group with glass-fiber posts, composite cores and MZ crowns. Half of the specimens were loaded at a 135° angle and half under axial loading until fracture. The fracture modes were divided in repairable and irreparable using optical microscopy. Mean fracture strength was significantly higher for MC than for MZ crowns and control group only under axial loading. The distribution of repairable and irreparable failures presented no significant differences. Crown placement significantly improved the fracture strength of ETP irrespectively of post and crown type.

The Use of Lasers in Dental Materials: A Review.

Lasers have been well integrated in clinical dentistry for the last two decades, providing clinical alternatives in the management of both soft and hard tissues with an expanding use in the field of dental materials. One of their main advantages is that they can deliver very low to very high concentrated power at an exact point on any substrate by all possible means. The aim of this review is to thoroughly analyze the use of lasers in the processing of dental materials and to enlighten the new trends in laser technology focused on dental material management. New approaches for the elaboration of dental materials that require high energy levels and delicate processing, such as metals, ceramics, and resins are provided, while time consuming laboratory procedures, such as cutting restorative materials, welding, and sintering are facilitated. In addition, surface characteristics of titanium alloys and high strength ceramics can be altered. Finally, the potential of lasers to increase the adhesion of zirconia ceramics to different substrates has been tested for all laser devices, including a new ultrafast generation of lasers.