Anterior Restorations Research Articles

Direct anterior restoration of hard dental tissue loss – case report

This article presents an important topic in the field of resto­ra­tive dental medicine: the direct restoration of hard dental tis­sue loss in the frontal area of the dental arches. This can be achieved with great success nowadays, even though the volume of loss of dental hard substance is important. Mo­­dern techniques and materials allow for longevity and long-term stability of the restoration, and the physiognomic as­pect is fully reproduced, with reduced costs for the pa­tient. The modern composite resins, with which direct resto­ra­tions are carried out in this area, have both increased bio­lo­gi­cal and adhesion properties, but at the same time they of­fer a faithful reproduction of the enamel and dentine, from an aesthetic point of view. This is the main re­quire­ment of the patients in the modern society, in which the plea­sant aspect is a condition of social integration.

Clinical performance of the composite resin veneers: the minimally invasive approach

Minimally invasive approach lead composite resin veneers restorations as a conservative and alternative treatment option, with the aim to improve the aesthetics anterior dentition. Clinically, this treatment reducing the clinical time and has a lower cost than indirect technique. In addition, new resin composite was developed to support the clinician to make more natural restorations. The present case report aim to evaluated the clinical performance of direct composite veneer technique was restored with 100% supra-nano spherical filler composite. A 39-year-old female, searched for restorative treatment of anterior teeth, which were unaesthetically altered. In the clinical examination, it was observed color alterations in maxillary left and right incisors and canines due to use of medicines, and bruxism. The treatment plan included an in-office dental bleaching, removal of inadequate anterior restorations and confection of composite veneers restorations. The dental bleaching was performed with hydrogen peroxide 35% activated by LED/laser in two sessions. Those restorations were performed using supra-nano spherical resin-based composite, color A1 for dentin and enamel, with direct composite laminate veneer technique. After six-month follow-up, the restorations presented good clinical aspect, absence of biofilm accumulation and abrasive wear. Therefore, direct veneer restorations may be alternative treatment for anterior teeth esthetic problems, suggesting a promising performance of these new composites.Descriptors: Esthetics, Dental; Composite Resins; Dental Veneers.

Is composite repair suitable for anterior restorations? A long-term practice-based clinical study.

This study investigated the impact in survival, when repair is seen as failure or not, in anterior composite restorations with a retrospective 15-year follow-up study. Data was collected from patients' files of a private dental practice, including patients with direct composite restorations placed in anterior teeth (class III, class IV, or veneer) between January 1994 and December 2009. Data were analyzed considering or not repair as failure. Statistical analysis was performed with log rank test, Kaplan-Meier, and Cox regression (p< .05). One hundred forty-four patients' files were included, with 634 restorations. At 15years, Class III / IV restorations showed 69% survival and 2.4% annual failure rate (AFR) when repair was not considered as failure, and 64% and 2.9% AFR, respectively, when repair was seen as failure. For direct veneers, at 5 and 10years of follow-up, survival dropped from 85% to 74% and from 52% to 38% respectively, when repair was considered as failure. In general, restorations placed in the upper jaw showed increased risk for failure compared to the lower jaw (p< .01), and restorations in central incisors presented a higher risk for failure compared to canines (p< .01). Composite repair seems a suitable alternative for class III, class IV, and veneer restorations since it was able to increase the survival of restorations performed in anterior teeth. Composite repair for anterior restorations is a suitable restorative treatment option and presents benefits over replacement, including the preservation of sound tooth structures, reduced clinical chair time, and patient anxiety.

A Comparative Study of Relative Translucency of Six All-Ceramic Restorations

Purpose: Compared relative translucency of IPS e.max CAD,Vita Suprinity,Lava Zirconia,Cercon Zirconia,Zenostar and upcera Zirconia, to provide a reference for the clinical aesthetic choice. Method: Relative translucency were calculated from the luminous reflectance (Y) of the specimens with a black (Yb) and a white backing (Yw) to give Yb/Yw with Minolta CR-321.One-way analysis of variance and Tukey’s multiple comparison test were used to analyze the data (P&lt;0.05). Results: Relative translucency of control group was 0.577-0.843,while experimental group was from 0.798(IPS e.max CAD) to 0.947(upcera Zirconia),there were significantly different between the groups. The relative translucency of the six systems are as follows: IPS e.max CAD &gt;Vita Suprinity &gt;Lava Zirconia &gt;Cercon Zirconia &gt;Zenostar &gt;upcera Zirconia. Conclusion: There were significantly different between the six groups, for patients with anterior tooth areas restoration and high aesthetic requirements, IPS e.max CAD and Vita Suprinity are recommended; For patients with poor transmittance of adjacent teeth, and the abutments are dark which need to be covered can choose Lava Zirconia and Cercon Zirconia; For low transparency like posterior areas and severe tetracycline teeth, upcera Zirconia and Zenostar ceramic blocks may be considered.

Anterior restoration longevity among nursing facility residents: a 30-year retrospective study.

To assess factors influencing anterior dental restoration longevity among the institutionalized elderly. Among a sample of Eastern Iowa nursing facility dental patients, one anterior restoration placed from 1985 to 2014 was selected at random from each subject. Kaplan-Meier survival curves were generated, with restoration failures defined as subsequent restorative codes involving the same surface; endodontic procedures; or extractions. Bivariate and multivariable Cox proportional hazards modeling were performed. In multivariable analyses, the 1985 to 1999 cohort (n=496) had longer restoration survival in in females<75 years old versus males<75 years old (P=0.016), males ≥75 years old (P=0.026) and females ≥75 years old (P=0.030); one- versus three-surface restorations (P<0.001); and restorations placed by faculty/residents versus pre-doctoral students (P=0.009). The 2000 to 2014 cohort (n=521) had longer restoration survival in females<75 years old versus males ≥75 years old (P=0.012) and females ≥75 years old (P=0.019); residents who paid out-of-pocket versus those on Medicaid (P=0.019); and composite resin versus glass ionomer cement restorations (P<0.001). Knowing how long restorations last, and what factors affect their longevity, could improve treatment planning, informed consent, and communication with residents and caregivers, and also help inform practice guidelines for restorative care among the institutionalized elderly.

Clinical effect of zirconia all-ceramic crown on repairing the anterior teeth and its influence on the quality of life of patients

Objective To investigate the clinical effect of zirconia all-ceramic crown for anterior teeth restoration, and its influence on the quality of life. Methods Eighty-four patients with anterior teeth repair[4 cases were lost during the follow-up, and there were 80 cases (106 teeth)] were selected.According to different surgical methods, they were divided into control group(56 teeth) and study group(50 teeth). The control group used Ni Cr alloy porcelain crown, the study group used two zirconia all-ceramic crown.The patients were followed up for 1 year, the repair effect, incidence rate of adverse reactions and quality of life score were compared between the two groups. Results After 1 year of crown restoration, the color, integrity, edge coloring in the study group were significantly better than those in the control group(all P 0.05). The quality of life scores in the study group after repair were significantly higher than those in the control group(t=18.623, 22.389, 20.724, 10.190, all P<0.05). Conclusion The clinical effect of zirconia all-ceramic crown for anterior teeth restoration is better.It can improve the aesthetic effect, safety and quality of life score of patients.It is worthy of popularizing and application in clinic. Key words: Tooth preparation, prosthodontic; Metal ceramic alloys; Dental alloys; Quality of life

CAD/CAM Custom Abutments for Esthetic Anterior Implant-Supported Restoration: Materials and Design

The purpose of this review is to discuss the use of computer-aided design and computer-aided manufacturing (CAD/CAM) custom abutments in the anterior region with a focus on abutment design and material selection. Advantages, disadvantages, and complications of CAD/CAM abutments are also considered. CAD/CAM abutments are available in various materials and with different connection platforms to the implant in order to meet esthetic, functional, and biological demands. Use of CAD/CAM concepts in the fabrication of custom abutments allows for definite advantages over both stock abutments and conventional cast custom abutments. CAD/CAM technology should be considered when restoring dental implants in the esthetic zone.

Spectrophotometric Evaluation of Anterior Maxillary Tooth Color Distribution According to Age and Gender

To determine the effects of age and gender on the color distribution of the right maxillary central, lateral incisors, and canine teeth. The tooth color was measured using the VITA Easyshade V spectrophotometer with a total of 202 volunteers (89 men, 113 women). The age distribution in this study was between 15 and 70 years old (average: 31). A grey background color was used to prevent background reflection while performing the color measurements. According to the VITAPAN Classical shade guide, the tooth color distribution of the central and lateral incisors showed a maximum of A2, with a maximum of B3 for the canine teeth. When comparing the International Commission on Illumination L* , a* , and b* values (CIELab color space coordinates) of the teeth with subject gender, statistically significant differences were not found between gender and the L* and b* values (p > 0.05); however, a statistically significant difference was observed between gender and the a* values (p < 0.05). When the distribution ratio of tooth color was examined, different ratios were determined based on gender and age and between the maxillary central, lateral incisors, and canine teeth. A uniform tooth color should not be chosen for anterior restorations, and factors such as gender and age should be considered when making a color selection for patients.

Validation of assessment of intraoral digital photography for evaluation of dental restorations in clinical research

ObjectivesThe aim of this study was to investigate the validity of assessment of intraoral digital photography in the evaluation of dental restorations. MethodsIntraoral photographs of anterior and posterior restorations were classified based on FDI criteria according to the need for intervention: no intervention, repair and replacement. Evaluations were performed by an experienced expert in restorative dentistry (gold standard evaluator) and 3 trained dentists (consensus). The clinical inspection was the reference standard method. The prevalence of failures was explored. Cohen’s kappa statistic was used. Validity was accessed by sensitivity, specificity, likelihood ratio and predictives values. ResultsHigher prevalence of failed restorations intervention was identified by the intraoral photography (17.7%) in comparison to the clinical evaluation (14.1%). Moderate agreement in the diagnosis of total failures was shown between the methods for the gold standard evaluator (kappa = 0.51) and consensus of evaluators (kappa = 0.53). Gold standard evaluator and consensus showed substantial and moderate agreement for posterior restorations (kappa = 0.61; 0.59), and fair and moderate agreement for anterior restorations (kappa = 0.36; 0.43), respectively. The accuracy was 84.8% in the assessment by intraoral photographs. Sensitivity and specificity values of 87.5% and 89.3% were found. ConclusionsUnder the limits of this study, the assessment of digital photography performed by intraoral camera is an indirect diagnostic method valid for the evaluation of dental restorations, mainly in posterior teeth. This method should be employed taking into account the higher detection of defects provided by the images, which are not always clinically relevant.

Clinical performance of full rehabilitations with direct composite in severe tooth wear patients: 3.5 Years results

ObjectivesTo evaluate the mid-term clinical performance of direct composite restorations placed in patients with pathological tooth wear needing full rehabilitation with an increase of vertical dimension of occlusion. MethodsIn a prospective trial 34 patients (34.0 ± 8.4 years; 25 males, 9 females) were treated with a minimal invasive additive technique using composite restorations. The restorative treatment protocol was to provide all teeth with composite build-up restorations in an increased vertical dimension of occlusion (VDO) using the DSO-technique. Recall appointments were planned after 1 month, 1 and 3 years after treatment. Restorations were scored for clinically acceptability (FDI-criteria) and scores 4 and 5 were recorded as clinically unacceptable. Frequencies of failures and Kaplan Meier survival curves are presented and effect of relevant variables was calculated with a multifactorial Cox regression (p < 0.05). Results1256 Restorations were placed, 687 anterior, 324 premolar, and 245 molar restorations. After a mean observation time of 39.7 months a total of 69 failures were observed, of which 61 restorations were repaired (score 4) and 8 were replaced (score 5). Most common reasons for failure were (chip) fractures (n = 43) and caries (n = 11). Placement of anterior restorations in two sessions led to significant 4.6 times more failures then placed in one session. ConclusionsIn patients with severe tooth wear a full rehabilitation, in an increased vertical dimension of occlusion, direct composite resin restorations show a 94.8% success and 99.3% survival rate after a period of 3.5 years.

Anterior restorations: The performance of ceramic veneers.

Adhesive bonding techniques in combination with tooth-colored restorative materials are one of the greatest achievements of restorative dentistry. Adhesively bonded veneers made from various silicate ceramic materials have contributed significantly to this. Ceramic veneers had long been considered to be only esthetic implements. However, their range of indications has been steadily increasing, making ceramic veneers a highly viable alternative to classic, far more invasive forms of restorative treatment. Today these veneers are used to restore the biomechanics of the dentition, to establish adequate function, to mask highly discolored endodontically treated teeth, and for many other purposes. The present article explains the principles of modern veneer technology based on clinical examples, with special emphasis on collaboration with the dental laboratory and communication within the dental team. This includes analyzing the case, defining the treatment goal, determining the right shade, selecting the most suitable ceramic material, finding the best preparation design, and choosing the most appropriate adhesive concept. The article will also explore the long-term prognosis of ceramic veneers as reported by a number of scientific studies.

Achieving the Optimal Esthetic Outcome of Anterior Restorations: Traditional or Digital Approach?

Achieving the Optimal Esthetic Outcome of Anterior Restorations: Traditional or Digital Approach?

Analysis of the golden proportion and width/height ratios of maxillary anterior teeth in Arab and Kurdish populations

Statement of problemDentists providing anterior restorations are guided by the principles of anatomic tooth dimension. Dental biometrics should consider ethnicity to produce a more comprehensive evaluation. PurposeThe purpose of this clinical study was to analyze the anatomic crowns of maxillary central incisors (CI), lateral incisors (LI), and canines (C) with respect to the golden proportion (GP) and width/height (W/H) ratio in Kurdish and Arab populations. Material and methodsMaxillary gypsum casts were obtained from 100 participants (50 from a Kurdish and 50 from an Arab population). Standardized digital photographs of each cast were recorded. The apparent and actual anterior tooth dimensions were determined by ImageJ software for the calculation of the GP and W/H ratio. Data were statistically analyzed using ANOVA to investigate ethnic, sex, and arch side differences. The chi-square test was used to explore the GP, and the 1-sample t test was used to test the ideal W/H ratio (α=.05). ResultsThe GP was found in both the Kurdish and Arab groups in the LI/CI mean (0.62, 0.63), but not in the C/LI mean (0.69, 0.73). No difference due to sex was detected in the LI/CI in either ethnic group, but Kurdish men had significantly larger C/LI than women (0.73, 0.66, P=.006) and larger right-side LI/CI than left (0.63, 0.60, P=.049). The W/H ratio was higher than the predicted ideal ratio of 80% (range, 88% to 90%). The LI W/H ratio in Arabs was significantly larger than in Kurds (90.3% versus 82.7%, respectively; P<.001). ConclusionsThe GP was found to exist between the apparent widths of maxillary anterior teeth LI/CI for the both populations in both men and women but not for C/LI. No ideal ratio was detected for the W/H ratios. Specific population characteristics must be taken into consideration, especially when applying the proportions to Kurdish individuals.

Providing Aesthetic by Direct Laminate Veneer Restorations of Three Patients with Enamel Defects at Anterior Region

One of the most important aspects of modern dentistry is the restoration of the lost dental aesthetic of the patient Over the years new treatment materials and methods for this purpose have emerged Dentists generally prefer more conservative approaches such as laminate veneers instead of full ceramic crowns in anterior restorations where aesthetic is important Laminate veneers applied by two different methods direct and indirect are used to correct existing abnormalities colorations and aesthetic defects Direct composite laminate veneers based on the direct application of the composite resin in the clinic which do not require a laboratory stage are preferred due to their convenient cost and single seance finish

Observation on the efficacy of keratoplasty combined with cataract and vitreoretinal surgery for severe ocular injuries

Objective To observe the efficacy of keratoplasty combined with cataract and vitreoretinal surgery under temporary keratoprosthesis for the treatment of anterior and posterior segments severe ocular injuries. Methods The data of 18 eyes of 16 cases with anterior and posterior segments severe ocular injuries were collected and analyzed retrospectively. They received combined surgery under temporary keratoprosthesis.The etiology, operation indication, anterior and posterior segment functional restoration and complications were analyzed.The followed-up period was 10-48 months. Results The visual acuity after surgery were improved in 15 eyes(83.33%). Transparent grafts occurred in 8 eyes(44.44%)after operation.Corneal translucence occurred in 3 eyes(16.67%). The rejective corneal grafts of 7 eyes(38.89%) were cloudy and swelling. Among them, corneal grafts were not rejected after secondary corneal transplantation in 4 eyes.Four eyes(22.22%) with retinal detachment were followed up for retinal reposition, and they received silicone oil tamponade.Secondary glaucoma happened in 2 eyes (11.11%). Medicine conservative treatment was invalid. After trabeculectomy the normal intraocular pressure was controlled.No persistent low intraocular pressure was found. The eyeball structure integrity of 18 eyes were preserved. Conclusion Keratoplasty combined with cataract and vitreoretinal surgery under temporary keratoprosthesis for the treatment of anterior and posterior segments severe ocular injuries is effective. Key words: Ocular injury, severe; Keratoprosthesis, temporary; Keratoplasty, penetrating; Surgery, cataract; Surgery vitreoretinal

Anterior Restoration Splinting Implant with Natural Tooth: A Clinical Report

Anterior Restoration Splinting Implant with Natural Tooth: A Clinical Report <!--Anterior Restoration Splinting Implant with Natural Tooth: A Clinical Report-->

Anterior Restoration Splinting Implant with Natural Tooth: A Clinical Report

The maxillary anterior region is considered the “esthetic zone” because of its importance on facial appearance and high visibility. Especially in the anterior region, implant prosthesis with proper soft tissue contours is important for successful esthetic results, this method may also help to reduce soft tissue complications with a gradual molding of the soft tissues profile. Commonly, it is recommended that dental implants should not be splinted with natural teeth due to the difference in biomechanics and mobility. However, in some cases, the splinting of a natural tooth with an implant seems to be needed. Several studies have described clinical cases where fixed partial dentures are supported by a connection between implants and natural teeth. In a 39-year-old man who showed periapical abscess of maxillary right central incisor, extraction were planned and after healing period, provisional crown was restored. After transferring the emergence profile of provisional crown, splinted zirconia prostheses were delivered.

200 A Retrospective Study of Thoracolumbar Burst Fractures Treated with Fixation and Non-fusion Surgery of Intra-vertebral Bone Graft Assisted with Balloon Kyphoplasty

Abstract INTRODUCTION horacolumbar fractures are common spinal injuries. Posterior fixation and fusion is the primary treatment, although this may sacrifice range of motion (ROM) to achieve stability, rather than treating the fracture itself. Two issues addressed when treating thoracolumbar fractures include: 1) replacing the fractured vertebrae, especially the upper endplate of the injured vertebrae, and 2) provide strong fixation with biomechanical stability and flexibility. METHODS This retrospective study included 75 consecutive patients with thoracic or lumbar fractures treated from October 2010 to May 2014. A total of 61 patients met inclusion criteria. Patients were divided into one of two groups: group A, intra-vertebral bone graft with balloon kyphoplasty (non-fusion surgery); and group B, traditional posterior fixation and fusion surgery. The Visual Analog Scale (VAS) was done preoperatively as well as at three months, one year, and two years. X-ray, CT, and MRI were done preoperatively. X-rays were done postoperatively at three months and two years. Postoperatively at 3 months, CT was used to confirm healing of the vertebral fracture. RESULTS &gt;Patient demographics and baseline characteristics were similar in the two groups. All fractures in both groups were reduced successfully, deformity was improved, and the anterior vertebral height restoration (AHR) was 98.76% ± 3.78% of PDS group and 95.38% ± 5.07% of Fusion group. After removal of hardware in group A, ROM at the injury level recovered (mean ROM 8.57°), and at 2 years, there was no loss of vertebral height or recurrence of deformity. There was no hardware failure in group A, but there was evidence of screw loosening three screws in group B. CONCLUSION Non-fusion treatment of intra-vertebral bone graft assisted with balloon kyphoplasty demonstrated good fracture reduction, deformity correction, fracture healing, and ROM maintenance. There were no complications associated with the implant. With the continued development of surgical techniques and materials, we believe that an increasing number of spinal fracture patients can avoid spinal fusion.

In vitro evaluation of a silica whitening toothpaste containing blue covarine on the colour of teeth containing anterior restoration materials

ObjectivesTo investigate the effects of a silica-based whitening toothpaste containing blue covarine on the colour of restorations in extracted human teeth. MethodsHuman extracted teeth were mounted in acrylic resin. A cavity was cut into the enamel surface and the specimen restored with either glass ionomer or composite dental materials. Following 4 weeks storage in water, specimens were treated with either water, red wine or a toothpaste containing blue covarine (n=10) for 24h followed by brushing with a silica-based toothpaste. Specimens were imaged with a digital imaging system at baseline, after 24h treatment and after brushing with a silica-based toothpaste. CIELAB colour parameters were determined for the restoration and the whole specimen and overall mean colour changes calculated (ΔE). Baseline and post-brushing images were compared subjectively for overall stain and staining around the restoration margin. ResultsRed wine produced the largest ΔE values for whole specimens and for all restoration materials and the largest subjective stain scores for whole specimens and restoration margins. The red wine stain was not completely removed by brushing with a silica-based toothpaste. Comparisons of the red wine group with either the blue covarine toothpaste group or the water group were of statistical significance for all parameters (ANOVA, Tukey-Kramer, p<0.05). Following brushing with the silica-based toothpaste, specimens from the blue covarine toothpaste group were not significantly different (p>0.05) to the water group, for all restoration material types. ConclusionsExaggerated treatment with a blue covarine containing toothpaste does not significantly affect the colour of the restoration or the restoration margin of the dental materials tested versus a water alone treatment. Clinical significanceThe silica-based blue covarine containing toothpaste does not permanently stain the restorative materials tested or their margins.

Residents' journal review

Residents' journal review