Modified United States Public Health Research Articles

Randomized Controlled Clinical Trial of All-Ceramic Single-Tooth Implant Reconstructions Using Modified Zirconia Abutments: Results at 5 Years After Loading

The objective of this trial study was to assess whether submucosal veneering of internally connected zirconia abutments influences clinical, radiographic, and technical outcomes of single-tooth implant-borne reconstructions at 5 years after loading. A total of 20 patients with 20 single-tooth implants in the anterior or premolar area of the maxilla or mandible were included. The implants were randomly restored with fixed single-tooth reconstructions using either pink-veneered customized zirconia abutments (test group = 10) or nonveneered customized zirconia abutments (control group = 10). All reconstructions were adhesively cemented with all-ceramic crowns. Follow-up examinations were performed at baseline (7 to 10 days after crown insertion) and at 1, 3, and 5 years after loading, at which points the following were assessed: periodontal parameters such as probing depth (PD), bleeding on probing (BOP), and marginal bone levels, as well as technical outcomes using the modified United States Public Health Service (USPHS) criteria. Statistical comparisons were based on the Wilcoxon-Mann-Whitney test. Sixteen patients attended the 5-year follow-up. At 5 years, the implant survival rate was 100% and the prosthetic survival rate was 94.1% (one abutment fracture in the test group). Veneering of the submucosal part of zirconia abutments resulted in significantly higher mean PD values: 3.6 ± 0.4 mm (test group) and 3.0 ± 0.5 mm (control group), P = .042. Marginal bone levels at 5 years and changes up to 5 years were not significantly different between groups (P > .05). One crown exhibited an abutment fracture and two crowns a minor chipping (17.6% overall technical complication rate). Limited by a small sample size, veneering of the submucosal part of internally connected zirconia abutments led to outcomes that were less favorable biologically (PD, BOP, and KM), but similar to nonveneered abutments radiographically and technically.

Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL – a randomized controlled clinical trial

Objective The aim of this randomized, controlled, prospective clinical trial was to evaluate the performances of two different universal adhesives and one etch-rinse adhesive for restoration of non-carious cervical lesions (NCCLs).Material and Methods Twenty patients with at least seven NCCLs were enrolled. Lesions were divided into seven groups according to adhesive systems and application modes: GSE: GLUMA Universal-self-etch, GSL: GLUMA Universal-selective etching, GER: GLUMA Universal-etch-and-rinse, ASE: All-Bond Universal-self-etch, ASL: All-Bond Universal-selective etching, AER: All-Bond Universal-etch-and-rinse, SBE (Control): Single Bond2-etch-and-rinse. A total of 155 NCCLs were restored with a nano hybrid composite (Tetric N-Ceram). Restorations were scored with regard to retention, marginal discoloration, marginal adaptation, recurrent caries and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after one week, 6, 12 and 24 months. Statistical evaluations were performed using Chi-square tests (p=0.05).Results The recall rate was 81.9% after the 24-month follow-up. The cumulative retention rates for self-etch groups (GSE: 72.2%, ASE:75%) were significantly lower than other experimental groups (GSL: 93.7%, GER: 100%, ASL: 94.1%, AER: 100%, SBE: 100%) at the 24-month follow-up (p<0.05). Regarding marginal adaptation and marginal discoloration, GSE and ASE groups demonstrated more bravo scores after 6 and 12-month observations but differences were not significant (p>0.05). Only one restoration from ASL group demonstrated post-operative sensitivity at 6 and 12-month observations. No secondary caries was observed on the restorations at any recall. At the end of 24-month observations, no significant differences were detected among groups regarding any of the criteria assessed, except retention.Conclusion GLUMA Universal and All-Bond Universal showed better results in etch-and-rinse and selective etching mode compared to the self-etch mode regarding retention. Etch-and-rinse and selective etching application modes of the current universal adhesives tended to provide better clinical outcomes considering the criteria evaluated at the end of 24-month evaluation.

Clinical performance of restorative materials in primary molar teeth

Abstract The aim of this study is to determine the clinical performance of primary molar restorations placed among paediatric patients at the Polyclinic, Kulliyyah of Dentistry, IIUM. A total of 99 primary molar restorations were evaluated clinically using the modified United States Public Health Service criteria. Amalgam restorations (104 weeks) showed the highest survival time followed by glass ionomer (87 weeks), composite (84 weeks) and stainless steel crown (79 weeks). Glass ionomer showed the highest survival time for class I but for class II, it was amalgam. This results indicates that the type of material influences the survival rate of restorations. © 2018 Elsevier Ltd. All rights reserved. Selection and/or Peer-review under responsibility of Biomedical and Advanced Materials (Biocam 2017).

Clinical Outcomes of Monolithic Zirconia Crowns with CAD/CAM Technology. A 1-Year Follow-Up Prospective Clinical Study of 65 Patients.

Aim/Purpose: The primary aim of this study was to examine the clinical performance of posterior monolithic single crowns in terms of failure or complications and the secondary aim was to assess the quality of these restorations according to the United States Public Health Service (USPHS) criteria. Methods: Ιn a private dental clinic, 65 patients with need of posterior crowns were restored with monolithic zirconia crowns. All the restorations were evaluated 6 and 12 months after their cementation. The modified United States Public Health Service (USPHS) criteria and periodontal parameters were applied for the clinical evaluation of the crowns. Restorations with Alpha or Bravo rating were considered a success. Results: Descriptive statistics and nonparametric tests were used for statistical analysis. Sixty-five patients (mean age: 49.52) were restored with 65 monolithic zirconia crowns. No fracture of the restorations was recorded. The overall success rate was 98.5%. The clinical quality of all crowns was acceptable except for the marginal discoloration of one crown at the 6- and 12-month follow-up examination. Conclusions: In this study, no fracture of single-tooth monolithic crowns occurred and the success rate was high. Monolithic zirconia restorations fabricated is a viable option for the restoration of single posterior teeth.

10-year randomized trial (RCT) of zirconia-ceramic and metal-ceramic fixed dental prostheses

ObjectivesTo monitor zirconia-ceramic and metal-ceramic posterior FDPs with respect to survival and technical/biological complication rates. Materials and methodsFifty-eight patients received 76 3- to 5-unit posterior FDPs. The sites were randomly assigned to 40 zirconia-based (ZC) and 36 metal-based (MC) FDPs. FDPs were examined at baseline (cementation), at 6 months, at 1 year and then yearly up to 10 years. Technical outcomes were assessed using modified United States Public Health Service (USPHS) criteria. Biologic outcomes included probing depth, plaque, bleeding on probing and tooth vitality. Statistical analysis was performed applying Kaplan-Meier (KM) estimation, log-rank, Mann-Whitney and Fisher exact test. ResultsDuring the 10-year follow-up thirteen patients (17 FDPs) dropped out and 6 FDPs in 6 patients (5 ZC,1 MC) were considered catastrophic failures for technical and/or biological reasons. Forty-four patients with 53 FDPs (29 ZC, 24 MC) were available for examination. The median observation period was 10.3 years (ZC) and 10.0 years (MC). The 10-year KM survival estimate of ZC FDPs was 91.3% (95%CI:69.5;97.8) and 100% of MC FDPs. Minor chipping of the veneering ceramic and occlusal wear were found to a similar extent at ZC and MC FDPs. ZC FDPs demonstrated a significantly higher rate of framework fracture, de-bonding, major fractures of the veneering ceramic and poor marginal adaption. Biological outcomes were similar in both groups and between abutment and control teeth. ConclusionAt 10 years, ZC and MC posterior FDPs resulted in similar outcomes for the majority of the outcome measures (p > 0.05).

TWO YEARS CLINICAL EVALUATION OF A BULK FILL COMPOSITE RESIN COMPARED WITH A NANOHYBRIDE INCREMENTAL FILL COMPOSITE RESIN IN CLASS ΙΙ CAVITIES

Abstract: The objective of this study was to determine the two years clinical performance of a bulk fill composite and conventional nanohybride incremental fill composite in class II cavities. Materials and methods: A total of 60 class Π cavities were restored with either bulk fill material (Tetric EvoCeram bulk fill) and self-etch adhesive (AdheSE adhesive) or an incremental resin composite (Tetric N-Ceram Nano-hybrid) and self-etch adhesive (AdheSE adhesive). In group Ι: The restorative material Tetric EvoCeram Bulk-Fill was applied in one bulk. In group Π: Tetric N-Ceram Nano-hybrid was applied using an incremental filling technique starting at the gingival wall. All restorations were clinically evaluated at periods of 1 week (initial recall), after six months, after one year, after eighteen months and at the end of two years. Assessment was done according to the modified United States Public Health Service (USPHS) criteria. Data were statistically analyzed using Friedman test and Fisher’s exact at P<0.05 level of significance. Results: There was no significant difference between group Ι and group Π regarding all tested criteria at different follow up periods; where P > 0.05. Conclusion: Bulk fill composite (Tetric EvoCeram bulk fill) and incremental fill composite resin (Tetric N-Ceram Nano-hybrid) exhibited comparable acceptable clinical performance after two years of evaluation

Clinical evaluation of bulk-fill composite resin and layered composite resin restoration in class I cavity of permanent molar teeth

The purpose of the present study was to compare the clinical performance of bulk-fill composite resin with that of layered composite resin restorations in occlusal class I cavity of permanent molar teeth. This study includes a total of 104 teeth having class I cavity of 3-4 mm depth in the occlusal surface. They were restored either with layered composite resin or bulk-fill composite resin of 52 teeth in each group. To observe the retention, marginal adaptation and color match, all restorations were assessed by using modified United States Public Health Services (USPHS) and Ryge’s criteria at baseline, 3, 6 and 12 months. The results of 12 months observation showed that retention of 38 layered composite and 48 bulk-fill composite resin restorations revealed alpha rating, which was statistically significant. The marginal adaptation of 37 layered composite resin and 47 bulk-fill composite resin restorations also demonstrated alpha rating and the differences between two groups were statistically significant. However, there were no significant differences between the layered composite resin and bulk-fill composite resin restorations in respect to color match. It can be concluded that bulk-fill composite resin showed better clinical outcome than that of layered composite resin in the restorations of occlusal class I cavity.

Clinical evaluation of self-adhering flowable composite versus conventional flowable composite in conservative Class I cavities: Randomized controlled trial.

Background:Self-adhering flowable composite (SAFC) minimized the time-consuming application procedures encountered with the traditional adhesive systems and restorative materials. Self-adhering composite combines the merits of both adhesive and restorative material technologies (8th generation) in a single product, bringing new horizons, and ambitions to restorative procedures.Aim:The aim of this study was to evaluate the clinical performance of SAFC compared to conventional flowable composite in conservative Class I cavities.Materials and Methods:In a split-mouth design, after cavity preparation, 18 patients with conservative Class I cavities received randomly two pairs of restorations, either Vertise™ flow or Filtek™ Z350 XT Flowable combined with Scotchbond™ Universal Etchant and Single Bond Universal, all materials were applied according to the manufacturer's instructions. Restorations were evaluated at baseline and after 6 months by two calibrated assessors using the modified United States Public Health Service criteria measuring (retention, postoperative hypersensitivity, color match, marginal adaptation, and marginal discoloration).Statistical Analysis:Chi-square test was used to compare between flowable composite materials after different follow-up periods, Wilcoxon signed-rank test was used to explore changes over follow-up periods. A value of P ≤ 0.05 was considered statistically significant. Results: At baseline and 6 months, there was no statistically significant difference between both materials for all tested outcomes.Conclusions:SAFC has shown clinical performance similar to conventional flowable composite after 6 months of clinical service.

Clinical quality and efficiency of monolithic glass ceramic crowns in the posterior area: digital compared with conventional workflows.

The aim of this clinical study was to test whether or not digital workflows for the fabrication of crowns render different clinical outcomes from the conventional pathway with respect to (1) crown quality, and (2) time efficiency. For each of the 10 patients in need of one tooth-supported crown, five monolithic crowns were produced out of lithium disilicate reinforced glass ceramic. Four different optical impression and associated computer-aided design/computer-aided manufacturing (CAD/CAM) systems were used for crown fabrication (digital workflows): (1) Lava C.O.S. scanner and Lava C.O.S. and CARES CAD software, centralized CAM (group L); (2) Cadent iTero scanner, CARES CAD software and centralized CAM (group iT); (3) Cerec Bluecam, Cerec Connect CAD software, followed by laboratory-based CAM (group CiL); and (4) centralized CAM (group CiD). The conventional crown (group K) was fabricated based on a conventional silicone impression followed by a conventional wax-up and heat press technique. The examiners were blinded and evaluated the crowns clinically at the bisque-bake stage (initial try-in), and subsequently after finalization by a dental technician (final try-in). For the assessment of crown quality, modified United States Public Health Service (USPHS) criteria were used. Treatment times were recorded for clinical evaluation and adjustment. The quality ratings were analyzed descriptively. For both the continuous and ordinal outcomes, the non-parametric paired Wilcoxon test was applied, together with an appropriate Bonferroni correction to evaluate the differences between treatment groups. The results of the statistical analysis were interpreted globally at the significance level P = 0.05. The clinical evaluation during the initial and final try-ins demonstrated similar clinical outcome measures for crowns generated with the four digital workflows and the conventional workflow. No statistically significant differences of crown quality in any state were found between groups (P > 0.005). The total clinical treatment times measured were: 456 ± 240 s for L; 655 ± 374 s for iT; 783 ± 403 s for CiL; 556 ± 285 s for CiD; and 833 ± 451 s for K. No statistically significant differences in treatment times were found between the groups (P > 0.05). Within the limitations of the present study, the monolithic ceramic crowns resulting from the four different CAD/CAM systems did not differ from the conventionally produced crowns with respect to the clinical quality rating and the treatment time efficiency.

Comparison of Marginal and Internal Adaptation of Heat-Pressed and CAD/CAM Porcelain Laminate Veneers and a 2-Year Follow-Up.

To compare marginal and internal adaptations of porcelain laminate veneers fabricated with heat-pressed and CAD/CAM techniques, and to evaluate the clinical performances 2 years after cementation. Thirty heat-pressed and 31 CAD/CAM porcelain laminate veneers were fabricated for 12 patients. Silicone replicas of each veneer were obtained. Replicas were sectioned into 4 parts to measure adaptations of the veneers. A stereomicroscope was used to measure from 3 locations of replicas for marginal, and 9 locations for internal adaptations at 40x magnification. Clinical evaluations were done at baseline and 6, 12, 18, and 24 months after cementation according to the modified United States Public Health Service (USPHS) criteria. Independent samples t-test compared the adaptation values between heat-pressed and CAD/CAM groups. Paired t-test was used to evaluate marginal and internal adaptations of each group. Differences between the modified USPHS criteria ratings of heat-pressed and CAD/CAM groups were determined by the Mann-Whitney U test. Kaplan-Meier analysis was used to analyze the survival ratings of the veneers (p < 0.05). The mean marginal adaptation values of heat-pressed and CAD/CAM veneers were 295 and 314.98 μm, respectively, and there was no statistically significant difference (p = 0.541). Internal adaptation values of groups were not statistically different either (201.82 μm for heat pressed; 195.47 μm for CAD/CAM p = 0.734). When marginal and internal adaptation values were compared within groups, there were significant differences both for heat-pressed (p < 0.001) and CAD/CAM (p < 0.001). All veneers were rated 100% satisfactory during the 2-year period. Within the limitations of this study, fabrication method, whether CAD/CAM or heat-pressed, had no effect on the marginal and internal adaptation of porcelain laminate veneers. The results showed that both fabrication techniques performed well after 2 years of clinical performance.

Retrospective clinical evaluation of ceramic onlays placed by dental students

Statement of problemIndirect restorations with partial or complete occlusal surface coverage have been recommended to restore teeth with weakened walls in order to prevent cusp fracture. The success of these restorations when performed by dental students is unknown. PurposeThe purpose of this retrospective study was to evaluate the clinical performance of adhesively bonded ceramic onlay restorations placed by third- and fourth-year dental students. Material and methodsSixty-five ceramic onlays were placed in patients between 2009 and 2015. The onlays were laboratory or chairside fabricated with a computer-aided design and computer-aided manufacturing (CAD-CAM) system, using either IPS e.max Press or IPS e.max CAD. An adhesive technique and luting composite resin agent were used to cement the restorations. Thirty-seven onlays were evaluated clinically using the modified United States Public Health Service (USPHS) criteria. Data were statistically analyzed using the Cox proportional hazards model to compare tooth type and failures and the Fisher exact and McNemar tests to compare the USPHS criteria for significant differences (α=.05). Survival probability was calculated using the Kaplan-Meier algorithm. ResultsFive onlays were considered to be failures and needed replacement. According to the Kaplan-Meier analysis, the estimated survival rate was 96.3% after 2 years and 91.5% at 4 years. All 5 of the failures occurred on molars (13.5%) and none on premolars (P=.025). A statistically significant difference was found for marginal discoloration between onlays placed within 0 to 3 years and 3 to 6 years (P<.05) but no differences between any other criteria. ConclusionsCeramic onlays placed by dental students demonstrated acceptable long-term clinical performance.

Fiber-reinforced composite fixed dental prostheses: A 4-year prospective clinical trial evaluating survival, quality, and effects on surrounding periodontal tissues

Statement of problemAlthough fiber-reinforced composite fixed dental prostheses (FRC FDPs) are a reliable treatment option for the restoration of single missing teeth, comparatively few prospective clinical trials (PCT) exist. PurposeThe purpose of this PCT was to evaluate the survival, quality outcome, and effect of FRC FDPs on periodontal health over 4 years. Material and methodsTwenty-six consecutive patients (16 men, 10 women) receiving FRC FDPs with preimpregnated unidirectional fiber reinforcement were included in the trial. Eighteen FRC FDPs were placed in the maxilla and 8 in the mandible. Data from baseline, 12-, 36-, and 48-months of follow-up were recorded, and the prostheses were classified as “success,” “survival,” or “failure.” Periodontal parameters (probing depth, clinical attachment level, plaque index, and bleeding index were assessed, and the quality was rated according to modified United States Public Health Service (USPHS)/Ryge or World Dental Federation (FDI) criteria. ResultsFunctional survival at 4 years was 73.5% (95% confidence interval [CI], 52.9-87.3) with 17 FRC FDPs still functioning. Twelve of these were classified as “success” and 5 as “survival.” Overall survival was 53.0% (95% CI, 30.4-74.4). Six FRC FPDs failed completely. Periodontal parameters did not change over the observation period. Regression analysis showed that probing depth and clinical attachment level did not influence the survival of FRC FDPs. According to USPHS/Ryge/FDI criteria only “wear” and “surface luster” increased significantly over 4 years. ConclusionsThe survival rate of FRC FPDs confirms existing data. Negative effects on periodontal health were not seen over the period of observation. Aging effects such as wear were recorded and indicated that FRC FPDs are at risk of disintegration, as they are composed of a fiber framework and veneering composite resin.

Clinical Outcomes and Predictors of Satisfaction in Patients with Improved Lithium Disilicate All-Ceramic Crowns

Objectives: The aim of this study was to determine the clinical outcomes and predictors of satisfaction in patients with lithium disilicate (LD) ceramic crowns. Subjects and Methods: Clinical outcomes were assessed in 47 patients with 88 LD crowns using modified United States Public Health Service (USPHS) evaluation criteria and survival rates. The questionnaire for predictors included 3 aspects: (a) sociodemographic characteristics, (b) oral health habits (tooth brushing frequency, flossing frequency, and dental visits), and (c) satisfaction of the restorations (aesthetics, function, fit, cleansability, and chewing ability of the crowns, and overall satisfaction). Frequency distributions were computed using univariate and multivariate analysis. The Student t test and analysis of variance (ANOVA) were used to compare means across variables. Correlation analysis was done to assess the association between continuous variables. Results: The age of crowns was 34.7 ± 9.7 months. The survival rate was 96.6% at 35.9 ± 9.2 months. There was a significant association between successful crown function and oral hygiene measures: tooth brushing (p˂ 0.001), dental visits (p = 0.006), and flossing (p = 0.009). A strong negative correlation was observed between aesthetic satisfaction (r = -0.717, p˂ 0.001) and chewing ability (r = -0.639, p˂ 0.001) with crown age. The linear regression model was significant for all predictors (p < 0.05) except overall satisfaction (p > 0.05). Conclusion: The LD crowns had long survival rates of 96.6% up to 35.9 ± 9.2 months and provided satisfactory clinical performance (low risk of failure). Oral hygiene habits such as brushing, flossing, and regular dental visits influenced patient satisfaction with LD crowns.

Monolithic zirconia reconstructions supported by teeth and implants: 1- to 3-year results of a case series.

Today, only scarce information is available on monolithic zirconia reconstructions. The objective of this study was to evaluate the performance of monolithic zirconia for tooth- and implant-borne reconstructions. Monolithic zirconia single crowns (SCs) and fixed dental prostheses (FDPs) supported by implants or teeth were included in this study. Implant placement and prosthetic treatment were done in the same clinical setting. One technician performed all laboratory work using the same CAD/CAM workflow (DentalDesigner, Ceramill Motion 2, Amann Girrbach). The endpoints were technical outcome, color match, marginal adaptation, anatomical form, and biologic aspects. The modified United States Public Health Service (USPHS) criteria and periodontal parameters were applied for the clinical evaluation by two independent examiners. Descriptive statistics and nonparametric tests were used for statistical comparisons. Forty patients (17 men, 23 women, mean age 59.1 ± 14.7 years) with 109 reconstructions (74 SCs, 35 FDPs) supported by 38 implants and 71 teeth were assessed, resulting in a total of 238 monolithic zirconia units (including 62 pontics and 18 cantilevers). Median follow-up time was 23.8 months (12 to 36 months). No technical failures were observed. The total prosthesis survival rate was 99.6% (teeth, 100%; implants, 98.4%) due to the loss of one implant. The periodontal/peri-implant parameters stand for healthy tissue, and caries was not detected. The records obtained by the USPHS revealed good clinical outcomes. These short-term results indicate that monolithic zirconia reconstructions for teeth and implants may be a satisfactory treatment option, particularly in the posterior region.

Clinical evaluation of microhybrid composites in noncarious cervical lesions: 24-month results.

To evaluate the clinical performance of two different microhybrid resin composites in noncarious cervical lesions (NCCLs) after 24 months. Ninety-seven NCCLs were restored with either TPH Spectrum (n = 48) or Filtek Z250 (n = 49) using an etch-and-rinse adhesive in 20 patients. The restorations were clinically evaluated using modified United States Public Health Service criteria for retention, color match, marginal discoloration, marginal adaptation, surface texture, anatomic form, postoperative sensitivity, and secondary caries. The restorations were assessed 1 week after placement (baseline) and after 6, 12, and 24 months. Restoration survival rates were calculated using the Kaplan-Meier procedure estimator, and a log-rank test was used to compare the survival distributions (P < 0.05). Statistical analysis was undertaken using Pearson's Chi-square test and Fisher's exact test to assess differences among the restorative materials (P < 0.05). Cochran's Q-test was employed for evaluating differences in the same restorative material between recall periods. The retention rates were 100% at 6 months, 89.6% and 91.8% at 12 months, and 85.4% and 89.8% at 24 months for TPH and Z250, respectively. TPH showed a statistically significant difference in marginal discoloration between the baseline and 24 months results (P < 0.05). Both TPH and Z250 showed statistically significant differences in marginal adaptation between the baseline and 24 months results (P < 0.05). Over the 24-month period, both microhybrid resin composites demonstrated acceptable clinical results in NCCLs.

Clinical evaluation of fiber-reinforced composite crowns in pulp-treated primary molars: 12-month results.

Objective:The aim of this study was to evaluate the clinical performance of tooth-colored fiber-reinforced composite (FRC) crowns in pulp-treated second primary mandibular teeth.Materials and Methods:This split-mouth randomized, clinical trial performed on 67 children between 3 and 6 years with two primary mandibular second molars requiring pulp treatment. After pulp therapy, the teeth were randomly assigned to stainless steel crown (SSC) or FRC crown groups. Modified United States Public Health Service criteria were used to evaluate marginal integrity, marginal discoloration, and secondary caries in FRC crowns at intervals of 3, 6, and 12 months. Retention rate and gingival health were also compared between the two groups. The data were analyzed using Friedman, Cochran, and McNemar's tests at a significance level of 0.05.Results:Intact marginal integrity in FRC crowns at 3, 6, and 12 months were 93.2%, 94.8%, and 94.2%, respectively. Marginal discoloration and secondary caries were not found at any of the FRC crowns. The retention rates of the FRC crowns were 100%, 98.3%, and 89.7% at 3, 6 and 12 months, respectively, whereas all the SSCs were found to be present and intact after 12 months (P = 0.016). There was no statistically significant difference between the two groups in gingival health.Conclusion:According to the results of this study, it seems that when esthetics is a concern, in cooperative patients with good oral hygiene, FRC crowns can be considered as a valuable procedure.

Clinical Evaluation of Silorane and Nano-hybrid Resin Composite Restorations in Class II Cavities up to 3 Years

In this study, the clinical performance of a silorane-based resin composite (SC) vs a nano-hybrid resin composite (NHC) was evaluated in Class II cavities. From January 2012 to February 2013, a total of 29 patients (eight men, 21 women; mean age, 24 ± 5 years) received 29 pairs of restorations using both SC (Filtek Silorane, 3M ESPE) and NHC (Filtek Z550, 3M ESPE) materials. Patients were followed until February 2015. One operator performed all restorations using the corresponding adhesive resins according to the manufacturers' instructions. Two calibrated independent examiners evaluated the restorations at one week, six months, and then annually using the modified United States Public Health Service (USPHS) criteria for anatomic form, marginal adaptation, color match, surface roughness, marginal discoloration, secondary caries, and postoperative sensitivity. Changes in the USPHS parameters were analyzed with the McNemar test (α=0.05). The mean observation period was 31.2 months. Marginal adaptation was the only parameter that showed a significant difference and was worse for SC than NHC (p=0.012). At the final recall, 17 restorations from the SC group and five from the NHC group received a score of 1 (explorer catches). These scores were significantly different between baseline and final recall for SC (p<0.001) but not for NHC (p>0.05). Both NHC and SC performed similarly in Class II restorations up to three years except for marginal adaptation, for which the latter demonstrated significant deterioration at the final recall compared with baseline.

Evaluation of zirconia-based posterior single crowns supported by zirconia implants: preliminary results of a prospective multicenter study.

The aim of this uncontrolled prospective multicenter study was to determine the success and survival rate of posterior single crowns composed of zirconia frameworks hand-layered with a leucite-reinforced feldspathic ceramic supported by one-piece zirconia oral implants. In two centers, sixty patients received 71 zirconia oral implants. To obtain a clear indication of posterior implant-supported single crowns (ISSCs), 14 patients (25 implants) were excluded from the analysis (11 bridges, three anterior crowns). The remaining patients were provided with single implants in posterior regions. As one patient lost his implant and another refused further participation after final prosthesis insertion, 44 ISSCs/patients (19 females, 25 males) were available for evaluation. Of these patients, all were seen at prosthetic delivery and the 6- and 12-month follow-up appointments. Evaluations were performed using modified United States Public Health Service (USPHS) criteria. Restorations within Alpha and Bravo ratings were regarded as success. This included minor chippings, a slight roughness, slightly soundable restoration margins and minimal contour deficiencies. In case of more distinct defects that could, however, be repaired to a clinically acceptable level, restorations were regarded as surviving. Kaplan-Meier plots and log-rank tests were used for the success/survival analyses and the calculation of potential group differences (gender, jaw and center). After a mean observation period of 12.5months (SD: 0.8months), no ISSC had to be replaced, resulting in a Kaplan-Meier survival rate of 100%. The Kaplan-Meier success rate was 90.9% (one major chipping, one obvious roughness, one significant crevice and one pronounced over-contouring). Minor chippings and occlusal roughness were frequent complications. No significantly different survival/success rates could be observed between the mentioned groups. The frequent incidence of minor chippings suggests a high technique sensitivity when providing zirconia implants with veneered zirconia-based crowns questioning its suitability for this indication.

Clinical prospective evaluation of zirconia-based three-unit posterior fixed dental prostheses: Up-to ten-year results.

ObjectivesOnly a few studies exist, which assess the clinical long-term behavior of all-ceramic FDPs in the posterior region. The aim of the present prospective clinical study was to evaluate the clinical performance of posterior three-unit FDPs manufactured from Y-TZP after a service period up to 10 years. Methods55 patients received 59 three-unit FDPs in the posterior region of the maxilla or mandible. Abutment teeth were prepared and full-arch impressions were taken. Definitive casts were fabricated and optically scanned. Frameworks were fabricated with computer-aided design (CAD) and manufacturing (CAM) technology. Y-TZP frameworks were veneered and adhesively luted to the abutment teeth. Baseline and follow-up examinations (service time: ≥48months) were recorded by applying modified United States Public Health Services (USPHS) rating criteria. Cumulative survival rate was analyzed with Kaplan–Meier. Percentage of biological and technical complication was calculated. ResultsFifty-three patients with 57 FDPs attended the last follow-up visit and a mean observation period of the remaining was 6.3±1.9years was calculated. Biological complications occurred in 17.5%, technical complications in 28% of the FDPs. The 10-year cumulative survival rate amounted 85.0%. Three FDPs failed to survive, two due to a root fracture of the abutment tooth and one due to secondary caries. ConclusionsThree-unit FDPs made from Y-TZP, veneered with ceramic offer a treatment option with a high rate of chipping. However, the manufacturing processes nowadays are modified in order to avoid this complication. Clinical significanceThe results of the present investigation suggest that three-unit Y-TZP posterior FDPs may are a possible treatment option. However, a high rate of chipping can be expected.

CLINICAL EVALUATION OF SELF-ADHERING FLOWABLE COMPOSITE IN NON-CARIOUS CERVICAL LESIONS

Introduction: The clinical management of non-carious cervical lesions is a challenge concerning restoring procedures because the lesions have non-retentive cavity shape and margins lying on dentin or cementum which are unfavorable for bonding. Objective: To evaluate the clinical performance of two self-adhering flowable composites compared with flowable composite and resin modified glass ionomer in restoration of non-carious cervical lesions for 1 year. Materials and Method: A total of 60 non-carious cervical lesions (15 for each material) were restored with self-adhering resin flowable composites (VertiseTM Flow and FusioTM Liquid Dentin), flowable composite with ExciTE F dental adhesive system and resin modified glass ionomer. The outer surface of the dentinal wall was roughened with a water-cooled high-speed diamond bur. Occlusal or incisal enamel margins were beveled, and no mechanical retention was performed. The restorations were re-evaluated with the modified United States Public Health Services (USPHS) criteria at baseline, 3, 6 and 12 months. Results: After 1 year, 14 of the 15 Vertise Flow and 12 of the 15 Fusio Liquid Dentin restorations were in a clinically unacceptable condition due to retention failure. The success rates of Vertise Flow (6.7%) and Fusio Liquid Dentin (20%) were less when compared to the success rate (80%) for the 2-step etch and rinse/Flowable composite and (60%) for the resin modified glass ionomer restorations (P-value < 0.001) Conclusion: The clinical performance of the self-adhering resin flowable composites showed higher failure rate than other restorative materials after 1 year of clinical use.