1-year Recall Research Articles

Three-year clinical performance of direct restorations using low-shrinkage Giomer vs. nano-hybrid resin composite

ObjectivesThe objective of this investigation was to compare the clinical performance of a nano-hybrid resin composite and a low-shrinkage Giomer resin composite.Material and methodsIn total, 35 pairs of restorations were performed using either low-shrinkage Giomer (Beautifil II LS, Shofu Inc.) or nano-hybrid (Clearfil Majesty Posterior) resin composite in 35 patients by two operators using the relevant adhesives, i.e., FL-Bond II (Shofu Inc.) and Clearfil SE Bond (Kuraray), with the self-etching technique according to each manufacturer's instructions. Two clinicians assessed the restorations 2 weeks (baseline); 6 months; and 1, 2, and 3 years after the restorative procedures using FDI (World Dental Federation) criteria (Scores 1–5). Data were analyzed using the marginal homogeneity and McNemar tests. The survival rate was calculated using Kaplan–Meier survival analysis and the survival of the two groups was compared with the log-rank test (p = 0.05).ResultsThe mean observation period was 37.7 ± 6.8 months. All restorations completed their 3-year follow-up. The criteria were mainly rated with high (1 or 2) scores for quality in both groups. Only one restoration in the low-shrinkage Giomer resin composite group was accepted as a failure at the 2-year recall due to retention loss.ConclusionAt the 3-year follow-up, the performance of the restorations using the Giomer and the nano-hybrid resin composite were similar and clinically acceptable.Clinical relevanceThe low-shrinkage Giomer resin composite exhibited a similar clinical performance to the nano-hybrid resin composite after 3 years in service with both materials displaying minor surface deteriorations at the 3-year recall.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier: NCT02823769.

5-Year clinical performance of ceramic onlay and overlay restorations luted with light-cured composite resin

ObjectivesThis prospective clinical trial evaluated the clinical performance of ceramic partial coverage indirect adhesive restorations (PCIARs) in posterior teeth luted with a light-cured composite resin. MethodsFrom April 2016 to January 2017, a total of 60 patients (27 males, 33 females; mean age: 42.2 ± 10.86 years old) received 83 glass-ceramic PCIARs (26 onlay, 57 overlay) made of IPS Emax CAD (Ivoclar Vivadent). All restorations were luted with a light-cured composite resin (Filtek Z250, 3 M ESPE) by two operators. Two independent calibrated examiners blinded to the operators performing the treatment evaluated the restorations at baseline, 1-year, and 5-year following FDI World Dental Federation criteria including esthetic, functional, and biological properties. Data were analyzed with the Friedman test and the Wilcoxon sign test (p < 0.05). ResultsNone of the restorations failed due to fracture or retention loss. One restoration was clinically unsatisfactory because of secondary caries. Marginal staining (p:0.000), marginal adaptation (p:0.018) showed significant differences between 1-year and 5-year recall. ConclusionsThe PCIARs demonstrated excellent clinical performance at 1-year period. The degradation parameters appeared as minor staining and minor irregularities after 5-year, without any affect on the clinical performance. Clinical SignificanceOur findings provide evidence that the clinical performance of PCIARs luted with a light-cured composite resin was clinically acceptable after a five-year evaluation period. Due to secondary caries, only one restoration was considered clinically unsatisfactory. ClinicalTrials registration number: NCT04838483

What are the emerging trends in dental composite materials in permanent teeth with occlusal cavities: self-adhesive vs traditional?

The research is a systematic review and meta-analysis of randomized controlled trials (RCTs). The study aimed to compare the clinical outcomes of self-adhesive flowable composite resins (SAFCs) versus conventional flowable composite resins (FCs) used in occlusal cavity restorations in permanent teeth. This research included a search for RCTs. Multiple databases were systematically searched for RCTs with a minimum 1-year follow-up comparing SAFCs to FCs. Outcomes evaluated were retention, secondary caries, marginal adaptation, marginal discoloration, and postoperative sensitivity based on modified USPHS criteria. Risk of bias was assessed using Cochrane RoB 2 tool. Random effects meta-analyses were conducted where applicable. Certainty of evidence was rated using GRADE approach. Five RCTs (four parallel and one split mouth) comprising 138 patients were included. During 1- and 2-year recalls, there were generally no significant differences in clinical performance between SAFCs and FCs. However, FCs applied using the etch-and-rinse technique demonstrated statistically better marginal adaptation at 2 years (3 studies, RR 3.21, 95% CI 1.50-6.83) and marginal discoloration (4 studies, RR 3.40, 95% CI 1.10-10.48). The overall quality of evidence ranged from low to moderate. SAFCs showed comparable short-term outcomes to FCs in treating occlusal cavities. Further high-quality RCTs with longer follow-up are warranted to confirm long-term performance of SAFCs. Use of separate enamel etching may improve marginal adaptation and discoloration with FCs.

Clinical performance of sealants under different humidity control conditions: a split-mouth 1-year randomized trial.

Sealants are an effective method of prevention and treatment for early caries lesions. This study analyzed the 1-year clinical performance of resin-based and ionomeric sealants applied to permanent teeth under different humidity conditions. The investigation was a triple-blind randomized clinical trial (RCT) with a four arms split-mouth design, divided according to the sealant protocol: (1) Resin-based sealant applied with rubber dam isolation, (2) Resin-based sealant applied with cotton rolls isolation, (3) Ionomeric sealant applied with rubber dam isolation and (4) Ionomeric sealant applied with cotton rolls isolation. Fifty-eight patients started the study (232 teeth), and 47 (188 teeth) remained until the 1-year recall. The modified USPHS criteria were used in the analyzes to investigate surface texture, retention and the presence of secondary caries lesions around the sealants; in the following periods: baseline, after 3, 6, 9, and 12months by two calibrated examiners. Data were analyzed by the Mann-Whitney and Friedman tests. There was no difference between the types of sealants (p > 0.05). The type of humidity control influenced the superficial texture (p = 0.0012) and the retention of sealants (p = 0.0023). The sealant displacement was greater under cotton rolls isolation. Only one active caries lesion in enamel was found in the 9th month. It may be concluded that sealants effectively prevented caries, even when they were partially or totally lost, regardless of the material. The rubber dam isolation with a rubber dam promoted lower surface roughness and improved the retention rates. International Clinical Trials Registry Platform: #1111-1215-2832 (07/26/2018).

Immediate Implant Placement in the Esthetic Zone Using a Novel Tapered Implant Design and a Digital Integrated Workflow: A Case Series.

The purpose of this case series was to assess the application of a novel self-cutting, tapered implant (Straumann® BLX, Institut Straumann AG, Basel, Switzerland) in combination with a digital integrated prosthetic workflow for the immediate placement and restoration. Fourteen consecutive patients, requiring replacement of a single hopeless maxillary or mandibular tooth, meeting the clinical and radiographic indication criteria for immediate implant placement, were treated. All cases followed the same digitally-guided procedure of extraction and immediate implant placement. Immediate temporization with full contoured screw-retained provisionals was performed using an integrated digital workflow. After implant placement and dual-zone bone and soft tissue augmentation, connecting geometries and emergence profiles were finalized. The average implant insertion torque was 53.2 ± 14.9 Ncm and ranged between 35 and 80 Ncm, allowing immediate provisional restoration in all cases. Final restorations were delivered three months after implant placement. An implant survival rate of 100% was observed at the 1-year recall after loading. The results of this case series suggest that immediate placement of novel tapered implants and immediate provisionalization using an integrated digital workflow can result in predictable functional and esthetic results for the immediate transition of failing single teeth in the esthetic area.

Neuromuscular rate of force development discriminates fallers in ambulatory persons with multiple sclerosis - an exploratory study

Falls as well as fall-related injuries (e.g., bone fractures) are common in persons with multiple sclerosis (pwMS). Whilst some studies have identified lower extremity maximal muscle strength (Fmax) as one among several risk factors, no previous studies have investigated the association between rate of force development (RFD; ability to generate a rapid rise in muscle force) and falls in pwMS. Not only is RFD substantially compromised (and more so than Fmax) in pwMS, studies involving other neurodegenerative populations have shown that RFD - to a greater extent than Fmax - is crucial for counteracting unexpected perturbations and avoiding falling.To explore whether knee extensor RFD (and Fmax) can discriminate fallers from non-fallers in pwMS.Knee extensor neuromuscular function (comprising RFD50ms and RFD200ms (force developed in the interval 0-50 ms and 0-200 ms, respectively) as well as Fmax) of the weaker leg was assessed by isokinetic dynamometry. Falls were determined by 1-year patient recall, with pwMS subsequently being classified as non-fallers (0 falls), fallers (1-2 falls), or recurrent fallers (≥3 falls).A total of n=53 pwMS were enrolled in the study, with n=24 classified as non-fallers (63% females, 48 years, EDSS 2.2), n=16 as fallers (88% females, 57 years, EDSS 3.3), and n=13 as recurrent fallers (46% females, 60 years, EDSS 4.2). Compared with non-fallers, neuromuscular function was reduced in both fallers (RFD50 -4.42 [-7.47;-1.37] Nm.s-1.kg-1, -48%; RFD200 -1.45 [-2.98;0.07] Nm.s-1.kg-1, -24%; Fmax -0.42 [-0.81;-0.03] Nm.kg-1, -21%) and recurrent fallers (RFD50 -5.69 [-8.94;-2.43] Nm.s-1.kg-1, -62%; RFD200 -2.26 [-3.89;-0.63] Nm.s-1.kg-1, -38%; Fmax -0.38 [-0.80;0.03] Nm.kg-1, -19%). Across all participants, associations were observed between RFD50ms and falls (rs = -0.46 [-0.67;-0.24], between RFD200ms and falls (rs = -0.34 [-0.59;-0.09]), and between Fmax and falls (rs = -0.24 [-0.48;0.01]).In this exploratory study, knee extensor neuromuscular function was able to discriminate fallers from non-fallers in pwMS, with RFD being superior to Fmax. Routine assessment of lower extremity neuromuscular function (RFD50ms in particular) may be a helpful tool in identifying pwMS at future risk of falling.

Comparison of the Quality of Life Among the Immediate Loading Implant Overdentures Using the Single and the Double Implants: An Original Study.

In edentulous individuals, single implant-retained mandibular overdentures are an effective substitute for double implant-retained overdentures. In this current research, the oral health-related quality of life (OHRQoL) was assessed for the immediate loading overdenture using the implants. The comparisons are drawn between the single and double implants. Forty subjects received single and double implants for the placement of the mandibular overdentures. Within a week days of implant insertion, they were loaded with overdentures. Using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, the OHRQoL was measured before treatment, one month following treatment, and 12 months thereafter. In both the single implant and double implant groups, participants' mean OHIP-14 scores decreased statistically significantly for the different timelines. For the single implant group, the baseline total mean OHIP-14 score was 14.33, and for double implants, it was 19.15. Following therapy, it decreased to 8.55 in the single implant group and 9.48 for the double implant group at one month, and at 12 months, it further decreased to 3.25 in the single implant group while it was 5.15 in the double implant group. Single and double implants increase the QoL for older subjects who are edentulous at the 1-month and 1-year recall points. When two implants are used by older individuals, the single implant might offer an equivalent quality of life.

GUIDED PERI-IMPLANT AUTOGENOUS SOFT TISSUE GRAFTING: CASE REPORT.

This case report showed the proof-of-concept of a guided free gingival graft around a dental implant. A 65-year-old male presented to replace his 30 and 31. Once the osseointegration of the 2 implants placed by guided surgery has been achieved, a free gingival graft was indicated. The surgical planning of this graft was performed using the Cone Beam Computed Tomography and archs digital scanning already used for implant placement. The greater palatine foramen and gutter were radiologically located to protect their arterial content. Two surgical guides were designed, one for the palatal donor site and one for the recipient site. The first one will serve both as an incision guide and as a post-operative protective plate. The procedure was free of adverse events. At the 1-year recall, the average gain in keratinized tissue width amounted 2.5 mm. This guided surgery could be used in a patient with insufficient amount of keratinized tissue around a posterior implant. For the first time, it makes it possible to anticipate, accelerate and secure the intervention, to improve the practitioner's comfort and potentially the outcomes of free gingival grafts. Further research and clinical are needed to validate this protocol and to assess its long-term impact on peri-implant health.

Clinical and Aesthetic Outcomes of Multiple Gingival Recessions Coverage with Modified Coronally Advanced Tunnel and Subepithelial Connective Tissue Graft in Maxilla and Mandible: A 2-Year Retrospective Study.

Limited long-term data are available when analyzing gingival recession coverage between the maxillary and mandibular sites. Therefore, the aim of this study was to evaluate the influence of location (maxilla versus mandible) of multiple gingival recessions on 24 months clinical and aesthetic outcomes of modified coronally advanced tunnel with subepithelial connective tissue graft. Forty patients with multiple gingival recessions (GR) located at maxillary or mandibular teeth were treated between January 2018 and December 2019. Reduction in GR, average root coverage (ARC), complete root coverage (CRC), increase in keratinized tissue width (KTW), increase in gingival thickness (GT), and aesthetic evaluation with the root coverage esthetic score (RES) were evaluated after 24 months. Thirty patients with 270 recessions in the upper teeth and ten patients with 90 recessions in the lower teeth completed the 2-year recall. The differences between preoperative and postoperative clinical parameters showed statistical significance only within but not between groups. ARC at 2 years was 93.31% for maxillary teeth and 93.06% for mandibular teeth (p = 0.7906). Mean RES values were comparable for upper and lower teeth (9.25 versus 8.92, respectively, p = 0.6733). However, upper teeth achieved significantly higher scores for marginal tissue contour (MTC), muco-gingival junction alignment (MGJ), and gingival color (GC). Lower teeth had decreased chances of receiving better RES (OR = 0.49, CI 0.24–0.99, p = 0.0457) in regression analysis, when compared with upper teeth. MCAT + SCTG achieved comparably favorable 2-year outcomes for the treatment of multiple GR in upper and in lower teeth. However, the individual RES components were higher in maxillary teeth, and upper teeth had higher odds of receiving better RES.

Patient-reported outcomes among patients with systemic mastocytosis in routine clinical practice: Results of the TouchStone SM Patient Survey.

Systemic mastocytosis (SM) is a rare clonal neoplasm driven by KIT D816V and other mutations. Data were collected from the patient perspective on disease burden and included an SM-specific symptom assessment tool. US adults aged 18 years and older with a self-reported SM diagnosis completed an online TouchStone SM Patient Survey of 100 items, including the 12-item Short-Form Health Survey, the Indolent Systemic Mastocytosis Symptom Assessment Form, and the Work Productivity and Activity Impairment Questionnaire, as well as questions about SM diagnosis, the impact of SM on daily activities, work impairment, and health care use. The results were analyzed using descriptive statistics. Fifty-six individuals completed the survey (89% women; median age, 48 years; mean time since diagnosis, 6.7 years), reporting indolent SM (66%), aggressive SM (9%), smoldering SM (5%), and unknown SM subtype (18%). Over a 1-year recall, respondents reported seeking emergency care for anaphylaxis (30%) and taking three or more prescription medications (52%) for SM. Over one half of patients (54%) reduced their work hours because of SM, and 64% avoided leaving home because of symptoms. A majority of respondents (93%) had experienced ≥10 SM-related symptoms, noting that the most bothersome were anaphylactic episodes (18%), abdominal/stomach pain (16%), diarrhea/loose stools (13%), and fatigue (11%). Whereas an Indolent Systemic Mastocytosis Symptom Assessment Form-derived total symptom score of 28 is used to indicate moderate-to-severe symptoms, the mean total symptom score was 52.7. Mental and physical component summary scores from the 12-item Short-Form Health Survey were below population norms. Patients who were surveyed reported substantial symptom burden and unmet needs because of SM, as evidenced by seeking emergency care and reporting bothersome symptoms, poor quality of life, and reduced work hours and productivity. The objective of this research was to understand the burden and unmet needs in the rare disease of systemic mastocytosis (SM) to guide future care. Fifty-six patients completed an online survey containing questions about their diagnosis, medications, health care use, quality of life, and SM symptoms. The results demonstrated that SM is associated with severe and burdensome symptoms, anaphylactic events, emergency department visits, use of multiple medications, reduced ability to work, and poor physical and psychological quality of life. These findings suggest the need for future advances to address unmet needs in patients affected by SM.

The impact of covid-19 on a patient with a severely compromised permanent maxillary central incisor.

Abstract The SARS-CoV-2 pandemic situation led to public health measures that forced patients to remain isolated and take steps to prevent the dissemination of the virus. Many of these patients were unable to attend to the dental services or delayed seeking dental care due to a lack of private services and concerns about the SARS-CoV-2 outbreak, which in many cases complicated their situation. This case report describes the long-term clinical outcome of an endo-periodontal periapical lesion with associated bone defect of a maxillary central incisor in an esthetically demanding, systemically healthy patient, who neglected dental treatment during the pandemic outbreak. Treatment procedures included primary endodontic treatment of the periapical lesion and cause-related therapy aimed to control the infection in the rest of the mouth. Clinical examination at the 1-year recall revealed clinical attachment gain with shallow residual probing pocket depths and a slight increase in gingival recession. The esthetic appearance of the treated tooth was improved via a zirconia-ceramic crown. The present case report suggests that successful periodontal and esthetic results can be accomplished and maintained for at least 2 years after treatment of an apparently hopeless tooth with extremely compromised endoperiodontal conditions.

One-year clinical results of restorations using a novel self-adhesive resin-based bulk-fill restorative

This prospective study assessed the dual-curing self-adhesive bulk-fill restorative Surefil one. The restorations were placed and reviewed by dental practitioners who are members of a practice-based research network in the United States. Seven practitioners filled 60 cavities (20 class I, 19 class II and 21 class V) in 41 patients with Surefil one without adhesive, according to the manufacturer’s instructions. The restorations were evaluated using modified USPHS criteria at baseline, 3 months, and 1 year. Patients were also contacted to report postoperative hypersensitivity one to four weeks after placement. The only patient that showed moderate hypersensitivity after 1 year had previously reported symptoms that were unlikely associated to the class I molar restoration. One class II restoration in a fractured maxillary molar was partially lost. The remaining restorations were found to be in clinically acceptable condition resulting in an annual failure rate of 2%. Color match showed the lowest number of acceptable scores (88%) revealing significant changes over time (P = 0.0002). No significant differences were found for the other criteria (P > 0.05). The novel self-adhesive bulk-fill restorative showed clinically acceptable results in stress-bearing class I and II as well as non-retentive class V cavities at 1-year recall.

Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial.

ObjectiveThe concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth.Materials and methodsA total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal–Wallis.ResultsAt 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544).ConclusionIn the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results.Clinical relevanceSimple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.

Computer‐aided design and computer‐aided manufacturing indirect versus direct composite restorations: A randomized clinical trial

This study compared the clinical performance of large indirect restorations (IRs) versus direct restorations (DRs) in posterior teeth. Thirty subjects received two class II restorations (n=60), one fabricated from a precured composite block (Grandio Blocs, VOCO) for the indirect technique (IT) and the other with light-cured composite (GrandioSO, VOCO) for the direct technique (DT). For IT, the restoration was created using the computer-aided design and computer-aided manufacturer (CAD/CAM) system. For DT, the material was applied light-cured by using a layering technique. All restorations were evaluated by using the World Dental Federation criteria. Twenty-three subjects attended the 2-year recall, and 46 restorations were evaluated. No significant differences were detected between the techniques for most parameters analyzed (p > 0.05). For "color match" at 7 days and 6 months, better results were observed for the DT. In relation to the overall scores, all restorations were esthetically acceptable after 2 years, while 93.3% of DT and 90% of IT showed acceptable function. For biological scores, 96.67% of DRs and 100% of IRs was acceptable after 24 months. Considering all properties, the success rates were 93.3% for DRs and 90% for IRs. After 2 years, both restorations presented similar and good clinical behavior for all the properties analyzed. Light-cured direct posterior composite restorations may perform similarly to indirect composite restorations made with precured CAD/CAM composite blocks up to 2 years.

Gingival Phenotype Modification as a Result of Root Coverage Procedure with Two Human Dermal Matrices: Long-Term Assessment of a Randomized Clinical Trial.

The gingival thickness (GT) and keratinized tissue width (KTW) constitute the gingival phenotype, a concept that has received a great deal of appreciation in recent years. Gingival phenotype modification has been achieved via different surgical techniques and grafting materials. Despite the superiority of autogenous grafts, their increased patient morbidity and limited recourse has led to the development of graft substitutes. The human dermal matrix is a notable example that, depending on its processing method, can become freeze-dried or solvent-dehydrated acellular dermal matrix (FDADM and SDADM, respectively). This article reports the 9-year outcomes of a randomized clinical trial regarding gingival phenotype modification following root coverage with FDADM and SDADM. Twelve of the original 20 patients were available at the 9-year follow-up. Overall, the outcomes of gingival phenotype modification were maintained in both groups and at all sites after 9 years. For KTW, an incremental increase was observed over time in both groups, and minimal or no changes were noted in GT from the 1-year recall to the 9-year recall. However, the gingival margin level showed an apical shift for both groups.

Outcomes of a 1-Year Prospective Single-Arm Cohort Study Using a Novel Macro-Hybrid Implant Design in Extraction Sockets: Part 1.

A novel macro-hybrid implant design was introduced to afford high apical primary stability and more coronal space to preserve the circumferential extraction socket architecture. This study presents 1-year data from a prospective single-arm cohort study. The data was distilled based on the following criteria: (1) single-tooth immediate tooth replacement therapy (ITRT) in the maxillary anterior and premolar regions in intact (Type 1) extraction sockets that were (2) treated with the dual-zone grafting technique. The clinical and radiographic outcomes of 48 ITRT implants were evaluated. The mean ± SD labial plate dimension changes were 0.33 ± 0.41 mm at the implant abutment interface (L1) and 0.34 ± 0.40 mm at 5.0 mm below (L2). The mean labial plate dimension (thickness) at the 1-year recall was 2.27 ± 0.88 mm (L1) and 1.95 ± 0.95 mm (L2). At ITRT, the ridge contour at the free gingival margin and 3.0 mm below it were 7.54 ± 0.93 mm and 9.44 ± 2.36 mm, respectively; after final restoration delivery, the corresponding values were 7.45 ± 0.95 mm and 10.23 ± 2.30 mm, respectively. The peri-implant soft tissue thickness (PISTT) at the time of implant-level impression-making was 3.29 ± 0.73 mm, with an average Pink Esthetic Score of 12.79. A macro-hybrid implant design showed high levels of primary stability (~60 Ncm), stable ridge contour at 1 year, a labial plate dimension between 1.5 and 2.0 mm, and PISTT > 3.0 mm, which may be a critical factor in providing stable, long-term esthetic outcomes.

Two-Year Longevity of Posterior Zirconia Multi-Unit Fixed Dental Prostheses with Monolithic Occlusal Surface

In this prospective clinical trial we observed the 2-year clinical performance of posterior tooth-supported multi-unit fixed dental prostheses (FDP) fabricated from zirconia with monolithic occlusal surfaces. Fifty multi-unit FDPs were inserted in 50 patients. After two years of clinical service, 43 restorations were reexamined as one patient had died and six patients were not available for recall. Two biological (root canal treatment: 12 and 14 months) and one technical (debonding: 12 months) complications occurred. According to the Kaplan–Meier analysis, the success rate was 93.7%, and the survival rate was 100%. The six patients who were not available for regular 2-year follow-up were examined after the official 2-year recall interval, and none of the FDPs presented complications or failures. Within the limitations of the current study, the use of multi-unit FDPs with monolithic occlusal surfaces fabricated from zirconia can be recommended for short-term use in the posterior area.

Cracked teeth: Distribution and survival at 6 months, 1 year and 2 years after treatment

The unpredictable condition of cracked teeth warrants further investigation and clinical experiences. The purpose of this study was to collect and record data on demographics, clinical characteristics, different treatment modalities and survival of cracked teeth at 6-month, 1-year and 2-year recalls. 77 cracked teeth from 65 patients were included. Data on demographics, clinical parameters, treatment modalities and recall were collected. Binomial, multinomial and chi square tests were used for statistical analysis. Most cracked teeth occurred in patients greater than 40 years old (p<0.01). Cracked teeth themselves were most often molars (79.22%; p<0.01), a non-terminal tooth in the arch (62.34%; p<0.05) and nonendodontically-treated teeth (94.81%; p<0.01). Cracked teeth exhibited pain to percussion (63.64%, p<0.05) or biting (74.03%; p<0.01), and no or only positive mobility (76.62%; p<0.01). Cracks were most often oriented in the mesiodistal direction (68.83%; p<0.01). Higher survival rates were noted in cracked teeth lacking pre-operative pain to palpation or spontaneous pain, and with no or only positive mobility at 6-month and 1-year recalls. In vital cracked teeth, higher survival rates were noted in teethlacking pre-operative pain to palpation and with no or only positive mobility at 2-year recalls. The absence of pre-operative palpation discomfort, spontaneous pain and minimal mobility, as well as the presence of pulp vitality were associated with higher survival rates of cracked teeth at all recall times. Results are useful for diagnosis and outcomes-based treatment planning of cracked teeth.

Feldspathic and Lithium Disilicate Onlays with a 2-Year Follow-Up: Split-Mouth Randomized Clinical Trial.

The present study was a prospective, controlled, randomized, clinical short-term trial aiming to evaluate the clinical performance of adhesively luted, lithium disilicate and feldspathic glass-ceramics onlays over a period up to 2 years. A total of 11 patients (7 female, 4 male; age range: 18-60 years, mean age: 39 years) were selected for this study. Each patient received a maximum of two restorations per group in a split-mouth-design. LD: Eleven onlays, performed with lithium disilicate-based ceramic (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein), and FP: Eleven onlays, performed with feldspathic ceramic (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Recalls were performed at 2 weeks (baseline = R1), 1 year (R2) and 2 years (R3) after the cementation by three calibrated blinded independent investigators using mirrors, magnifying eyeglasses, probes and bitewing radiographs. The postoperative sensitivity, secondary caries, marginal integrity, marginal discoloration, color match, surface roughness, tooth integrity, and restoration integrity were evaluated. The Friedman test was used to determine if there was a statistically significant difference in time-to-time comparison of the parameters in the ceramics restorations. A total of 95.4% of the restorations were clinically acceptable at the 2-year recall, without a difference for any evaluation parameter for both ceramic materials. Based on the 2-year data, the CAD-CAM onlays manufactured with feldspathic and lithium-disilicate based ceramics showed similar clinical performance.

Non-surgical Furcal Perforation Management with Biodentine in Retreatment: A 1-Year Recall Review

Furcal perforation management in root canal retreatment is often challenging as the outcome of the perforation sealing depends on several parameters. The recent introduction of several bioactive cements and magnification systems has made the sealing of perforations easier and the outcome more predictable. This study highlights the clinical outcomes of furcal perforation management in root canal retreatment using biodentine.