Molars In Patients Research Articles

Anatomical Risk Factors of Nerve Injuries Following Surgical Removal of Mandibular Third Molar

Introduction: Surgical removal of the mandibular third molar has its own set of complications. The mandibular impacted teeth are in proximity to the Inferior Alveolar Nerve (IAN), Buccal Nerve, and Lingual Nerve (LN). Therefore, each of these nerves is always at risk of injury during extraction. Objectives: This study was to evaluate the anatomical risk factors of nerve injury after the surgical extraction of mandibular third molars in patients visiting the department of oral and maxillofacial surgery of People’s Dental College and Hospital. Methods: This prospective study was conducted with 315 participants who presented with a mandibular third molar impaction and underwent Intraoral Periapical Radiograph (IOPAr), panoramic radiograph, as well as Cone Beam, Computed Tomography (CBCT). CBCT was done in those patients in which the mandibular third molar was in close contact with the mandibular canal. Results: Collected data from 315 patients showed that the incidence of Inferior alveolar nerve (IAN) and lingual nerve(LN)injury was 0.31%. Of which one had mesioangular class B, level II type of impaction in 17year male and the other had horizontal class C, level II type of impaction in 47year female respectively. In both cases, the tooth was lingually placed in relation to IAN. Conclusions: Various factors are responsible for nerve injury after the removal of the mandibular third molar. In our study, the incidence of nerve injury to IAN and LN was comparatively low and the most common risk factor was angulation and anatomical position of the impacted mandibular third molar.

The predictive performance of surgical treatment in upper molars with combined bony defect and furcation involvement: a retrospective cohort study.

BackgroundTo evaluate the impact of combined defects, bony destruction and furcation involvement, on disease resolution after surgery in terms of pocket elimination, absence of inflammation, furcation improvement and predictive performance.MethodsCombined bony (intrabony (+) or (−)) and furcation defects (FI degree 1 or 2) at maxillary molars in patients diagnosed as periodontitis stage III to IV, being through periodontal surgery and at least 6 months follow-up were retrospectively screened. Cumulative predictability (CR, %), failure of treatment and the change of clinical parameters from baseline at pre-operative visit to the latest maintenance care, including pocket depth (PD), horizontal and vertical furcation involvement (FI) were analyzed. Failure of treatment with low predictability was defined as residual PD > 4 mm with bleeding on probing during maintenance period.ResultsThirty-three patients with fifty-one combined defects were included. Statistical analysis showed significant overall PD reduction and FI improvement (p < 0.001). Combined FI degree 2 with intrabony (+) defects revealed more horizontal furcation improvement compared with FI degree 2 with suprabony defect (p = 0.007). However, type of combined defects was not relevant to CR (p = 0.702) and PD reduction (p = 0.707). Among all parameters, baseline PD with proximal FI degree 2 was indicated to failure of treatment.ConclusionsDifferent types of combined defects, deep baseline pocket and proximal FI degree 2 would compromise the predictability of treatment outcomes in upper molars. Nevertheless, the combination of surgical treatment and strict maintenance care could still yield high predictability and survival rate.Trial registration: retrospectively registered.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-022-02196-0.

Morphotypes of the apical constriction of maxillary molars: a micro-computed tomographic evaluation.

ObjectivesThe aim of this study was to evaluate and compare the apical constriction (AC) and apical canal morphology of maxillary first and second molars, using micro-computed tomography (micro-CT).Materials and MethodsThe anatomical features of 313 root canals from 41 maxillary first molars and 57 maxillary second molars of patients with known age and sex were evaluated using micro-CT, with a resolution of 26.7 µm. The factors evaluated were the presence or absence of AC, the morphotypes, bucco-lingual dimension, mesio-distal dimension, and the profile (shape) of AC and the apical root canal. The apical root canal dimensions, location of the apical foramen (AF), AC to AF distance, and presence of accessory canals in the apical 5 mm were also assessed. Descriptive and analytical statistics were used for data evaluation.ResultsAC was present in all 313 root canals. Patients’ age and sex did not significantly impact either AC or the apical canal dimensions. The most common AC morphotype detected was the traditional (single) constriction (52%), followed by the parallel (29%) morphotype. The mean AC dimensions in maxillary first molars were not significantly different from those in maxillary second molars. Sixty percent of AF were located within 0.5 mm from the anatomic apex.ConclusionsThe most common morphotype of AC detected was the traditional constriction. Neither patients’ age nor sex had a significant impact on the dimensions of the AC or the apical root canal. The majority of AF (60%) were located within 0.5 mm from the anatomic apex.

Mechanisms of age-related changes in the morphology of the pulp system of the first lower molars

To study the coupling of age-related systemic changes in inflammation-mediated apoptosis with the features of the anatomy of the pulp system of the first mandibular molars in patients with chronic pulpitis and periodontitis. The study included 55 patients of both sexes from 18 to 75 years of age in three age groups - young (18-44 years) (n=17), middle (45-59 years) (n=18), elderly (60-74 years) (n=20) with indications for endodontic treatment. Diagnostic measures were supplemented with New Tom 3G cone-beam tomography. The concentration of anitapoptotic protein Bcl-XL and tumor necrosis factor-a (TNF-a) was determined in the blood, and the level of the nuclear transcription factor NF-KB subunit p65 was determined in the lysates of mononuclear cells. As a result of the analysis of the sections, significant obliteration of the pulp was revealed throughout and an increase in the frequency of occurrence of slit-shaped channels in the distal root of the first molar of the mandible in elderly patients. The pathogenetic factors leading to a change in the morphology of the pulp system include old age and an imbalance in the system of anti-inflammatory cytokine transcription mechanisms, which contributes to increased apoptosis and the protracted nature of inflammation.

Assessment of Alveolar Bone and Periodontal Status in Peritoneal Dialysis Patients.

Chronic kidney disease (CKD) affects 8–13% of the global population and has become one of the largest burdens on healthcare systems around the world. Peritoneal dialysis is one of the ultimate treatments for patients with severe CKD. Recently, increasing severe periodontal problems have been found in CKD patients. Periodontitis has been identified as a new variable risk factor for CKD. The aim of this study was to investigate the periodontal status and severity of alveolar bone loss in CKD patients with peritoneal dialysis (PD). One hundred and six patients undergoing PD (PD group) and 97 systemically healthy periodontitis patients (control group) were enrolled. The differences in the dimensions of the alveolar bone between two groups were compared, and the distribution of alveolar bone defects was analyzed by cone-beam computed tomography (CBCT). Gingival index (GI), plaque index (PLI), periodontal probing depth (PPD), and attachment loss (AL) were recorded. The levels of inflammatory factors in gingival crevicular fluid were assessed by ELISA. Compared to control group, there was a higher degree of alveolar bone loss in maxillary premolars, maxillary 2nd molar and mandibular 1st molar in patients with PD (p < 0.05). A comparison of bone loss in different sites revealed that the area with the highest degree of bone loss were on the mesial-buccal, mid-buccal, distal-buccal, and mesial-lingual site in PD patients. The expression levels of inflammatory factors were higher in PD group (p < 0.01). In conclusion, PD patients presented more severe periodontal and inflammatory status than systemically healthy periodontitis patients. The loss of the alveolar bone differed between the two groups. Different sites and teeth exhibited a diverse degree of bone loss. This study highlights that clinicians should pay close attention to periodontal status of peritoneal dialysis patients and provides a new thinking to improve healthcare for CKD.

Third molar impaction position in Peruvian adults

Objective. To determine the position of the third molars in patients treated in a diagnostic imaging center in Lima during the period 2017-2020. Methodology. An observational, descriptive, cross-sectional and retrospective research was carried out; which consisted of a sample of 253 panoramic radiographs of patients treated in a private radiological center. The position of the lower third molars, the depth of impact, and their impaction position in relation to the mandibular ramus were evaluated using the Pell and Gregory classification; as well as the Winter classification. The data were analyzed in the statistical package SPSS vs. 26. Outcome. It was observed that the vertical and mesioangular position were the most common with 14.6% and 13.2%; respectively. Type I and II according to Pell and Gregory was the most common with values of 15.4% and 14.4%; as well as, class B with 15.4%. Conclusion. The vertical and mesioangular impaction position, type B and class II were the most frequent for the lower third molars.

Odontoscopic and morphometric assessment of occlusion circuits of permanent teeth in patients with physiological occlusion

A dentist needs special knowledge in odontology and odontoglyphics, which allows visualizing the space and relief of the tooth surface, as well as conducting an in-depth analysis of the individual morphometric characteristics of the tooth. Expansion of knowledge about the variability of the occlusal relief will allow achieving balanced occlusal-articulation relationships of the dentition and preserving the physiological state of the dentition. The article presents the results of odontoscopic and morphometric studies of vertical, transverse parameters of the upper large molars in patients with various physiological types of occlusion. The subject of the study was the segments of the upper molars obtained from plaster models of the jaws of 92 people with physiological occlusion, a full set of permanent teeth and various types of dental system (patients in group 1 – normodontism, patients in group 2 – macrodontism, patients in group 3 – microdontism). For morphometry in the transverse direction, the vestibular-lingual size of the crown and neck of the tooth, as well as the intertubercular distance, were used. To measure the vertical parameters, the height of the mesial (protocone, paracone) and distal (metacone, hypocone) odontomeres and tubercle of the occlusal surface was determined. The results of the study showed that in people with physiological occlusion and macrodontism of permanent teeth, vertical, transverse parameters exceed those of people with normodont and microdont types of the dental system. It is advisable to use the obtained odontometric features at the stages of diagnosing occlusal relationships and identifying various forms of pathological, physiological abrasion with varying degrees of loss of occlusal surfaces.

Extra canal in permanent maxillary first molar in patients undergoing root canal treatment at a tertiary care dental hospital, Nepal

Background: Permanent maxillary first molar normally has three root canals but it can have extra root canals for which several studies were done in many parts of the globe. However, this type of study to explore extra canal is lagging in the context of Nepal. Objectives: The objective was to determine the percentage of extra canal in permanent maxillary first molar in patients undergoing root canal treatment and to compare the same between male and female. Methods: The descriptive cross-sectional study was conducted in the department of conservative dentistry and endodontics of People’s Dental College and Hospital from 20th December 2019 to 20th December 2020 after receiving ethical approval from Nepal Health Research Council on 18th December 2019 (ERB protocol No 888/2019) . One hundred and eighty permanent maxillary first molar teeth without root canal calcification were enrolled. Convenient sampling was done. Access opening was done and all canal orifices were located and recorded. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 with frequency table. Chi-square test was used for inferential statistics. Results: Out of 180 teeth, extra canals were present in 44(24.4%) having more numbers in male than in females. Extra canal was present in the mesiobuccal root. Conclusion: Extra canal in the permanent maxillary first molar is present in Nepalese population with greater number in male than in female. Thus, exploration of the pulp chamber in search of an extra canal is necessary to prevent failure of root canal treatment.

Stress Distribution in Modified Veneer Crowns: 3D Finite Element Analysis

(1) Background: to propose a new approach for crown veneers, with the use of an aesthetic porcelain coating, only in part of the zirconia infrastructure, and to analyze its biomechanical behavior to minimize chipping failures. (2) Methods: a maxillary molar was modeled using CAD software, preparing for traditional crowns and veneer crowns with various lengths. Five groups were formed: M—control group (monolithic crown of ultra-translucent zirconia); B—conventional (bilayer crown of ultra-translucent zirconia and ceramic covering); V—veneer (ultra-translucent zirconia crown with reduction only in the buccal and application of covering ceramics); V1—ultra-translucent zirconia crown with buccal reduction and 1 mm occlusal extension for covering ceramic application); V1.5—ultra-translucent zirconia crown with buccal reduction and 1.5 mm occlusal extension for application of covering ceramics. A load of 600 N was performed axially to a fossa bottom to simulate parafunction, and 300 N to the cusp tip to obtain the maximum principal stress results. (3) Results: group B showed a higher stress concentration in the occlusal region of the restorations, while the other groups absorbed the stress and dissipated it throughout the crown, presenting a higher stress concentration in the interface region with the tooth. (4) Conclusion: the highly translucent zirconia ceramic only associated with buccal covering ceramic could add aesthetic gain and rigidity to the system and could be a good option to restore maxillary molars in patients who do not have parafunction.

Decision making regarding management of compromised first permanent molars in patients with molar incisor hypomineralisation: A comparison of orthodontists and paediatric dentists.

To obtain the views and opinions of specialist members of the British Orthodontic Society (BOS) and British Society of Paediatric Dentistry (BSPD) in relation to (1) the multidisciplinary management of patients affected by molar incisor hypomineralisation (MIH) and (2) the diagnosis and management of MIH-affected first permanent molars (FPMs) in four clinical scenarios, and compare the responses to those of an expert panel consensus. A prospective cross-sectional study. Part 1: Eastman Dental Institute and part 2: online questionnaire. Four clinical scenarios showing patients with differing severities of MIH affected FPMs were considered by a panel of orthodontists and paediatric dentists to agree on the severity of MIH and management. A 21-item online questionnaire sent to both specialist groups, after pilot study. The questionnaire covered demographics, access to multidisciplinary clinics, clinicians' opinions on various management aspects, and questions relating to the management of the same 4 clinical scenarios. The overall response was 21.9% (20% of the orthodontists and 45% of the paediatric dentists). Approximately half of the respondents from both groups felt that these patients should be managed through a multidisciplinary treatment type clinic (49.0% of the orthodontists and 47.2% of the paediatric dentists). Only 40.3% of the orthodontists and 35.0% of the paediatric dentists agreed completely with the panel consensus on all management options. When assessing overall agreement on all four FPMs for all scenarios, agreement was predicted by severity of MIH (P<0.001) and complexity of malocclusion (P<0.001) where more complex malocclusions and more severe MIH resulted in poorer agreement, but specialty was not a significant predictor (P=0.21). The majority of the respondents from both groups, felt that managing patients with MIH affected FPMs is challenging. Approximately half of the orthodontists and the paediatric dentists, felt that MIH affected patients should be managed through a multidisciplinary type clinic. Managing more severe cases on multidisciplinary clinics is indicated, to incorporate specialist input into decision making.

The effects of a corticotomy on space closure by molar protraction using TSADs in patients with missing mandibular first molars.

The purpose of this study was to evaluate the effects of a triangular-shaped corticotomy on the protraction of second and third molars in patients with missing mandibular first molars. The corticotomy and non-corticotomy groups consisted of sixteen first molars in fifteen patients (28.6±9.4years) and nineteen first molars in fifteen patients (26.6±8.4years), respectively. A triangular-shaped corticotomy was performed between the second premolar and molar. Temporary skeletal anchorage devices (TSADs) were placed between the first and second premolars in both groups. Mandibular dentition variables were measured on the pre and post-treatment panoramic radiographs and lateral cephalograms. Analysis of covariance was performed. The corticotomy group exhibited 2.8mm more inter-radicular correction between the second molar to second premolar roots (P<.001) and 1.6mm more inter-radicular distance correction between the third molar to second premolar roots compared to the non-corticotomy group (P<.01). The corticotomy group required 5.5months less treatment time for space closure (P<.05), but the total treatment time was the same for both groups. The inter-radicular distance between the mandibular second premolar and molar and treatment times for space closure was significantly reduced in the corticotomy group.

Class II division 1 malocclusion treatment with extraction of maxillary first permanent molars: cephalometric evaluation of treatment and post-treatment changes

Abstract Objective To investigate the cephalometric outcome and post-treatment changes following the orthodontic treatment involving the extraction of maxillary first molars in patients presenting with a Class II division 1 malocclusion. Methods A retrospective longitudinal study was conducted involving 83 patients treated by fixed appliances and the extraction of 16 and 26. The mean age at commencement was 13.2 ± 1.5 years. Lateral cephalograms were available pre-treatment (T1), immediately post-treatment (T2), and at 2.6 years post-treatment (T3). The sample was divided into hypodivergent (n = 18), normodivergent (n = 17), and hyperdivergent (n = 48) facial types. Mean increments, standard deviations, and 95% confidence intervals were calculated for T2–T1 and T3–T2. Increments were tested using paired-samples t-tests, and variables between groups by applying ANOVA followed by Tukey’s post hoc test. Linear regression was used to examine the effect of facial type, age, and gender. Results Significant changes occurred during treatment for most cephalometric variables. Post-treatment, the growth pattern showed a tendency to return to the original form. Facial type had only a minor influence on cephalometric increments during and after treatment. Conclusions Post-treatment skeletal, soft tissue, and dentoalveolar changes were limited. Facial type had only a minor influence during and after treatment and care must be taken to control lower incisor inclination.

Predictive Factors to Assess the Difficulty to Extract Retained Lower Third Molars

Background: Third molar eruption occurs in a very limited space. Several difficulty scales have been used to determine the complexity when extracting retained molars, which are key for surgical planning and prediction. A scale including indicators such as quality of mucosa and bone, as well as shape and number of roots is introduced. Purpose: Evaluate the difficulty in extracting retained lower third molars, using the scale proposed by Romero-Ruiz, and thus estimate the presence of intraoperative complications and surgical time. Methods: An observational descriptive cross-sectional study was carried out, with a sample of 100 extractions of retained lower third molars in patients between 16 and 40 years of age. The following variables were evaluated: spatial relationship, depth, relationship with mandible ramus/space, integrity of bone and mucosa, roots, dental follicle, and surgical time. The data were summarized in absolute frequency tables and analyzed with Pearson's Chi2 test (p &lt; 0.05). Results: 71 % of third molars were classified as “difficult” on the scale. There were significant differences in terms of surgical time-age (p = 0.002), presence of complications-location of the third molar (p = 0.015), presence of complications-follicle size (p = 0.022), difficulty-sex (p = 0.011 ), difficulty-age (p = 0.068). Conclusions: This scale can be used to plan extraction treatments for retained lower third molars to reduce surgical times and anticipate complications.

Assessment of impacted third molars in patients with temporomandibular disorders

Assessment of impacted third molars in patients with temporomandibular disorders

Effect of Pain Relief After Extraction of Maxillary 3rd Molars in Patients Clinically Diagnosed with Temporomandibular Disorders

Effect of Pain Relief After Extraction of Maxillary 3rd Molars in Patients Clinically Diagnosed with Temporomandibular Disorders

Study of the antero-posterior position of the mental foramen in the Nepalese population using digital Panoramic Radiograph

Background: Mental foramen is an important landmark to be considered when operating in the anterior mandible. It is mandatory to identify the location of the foramen to prevent injury to mental nerve and subsequent paresthesia.&#x0D; Objectives: The objective of this study was to identify the position of the mental foramen in relation to the mandibular premolars and first molar in patients visiting Kathmandu Medical College, Department of Oral Surgery, Duwakot using the Orthopantomogram.&#x0D; Methodology: A total of 200 digital panoramic radiographs of 92 males and 108 females in the age range of 20-50 years were collected. Consequently, 184 mental foraminain males and 216 mental foraminain females were evaluated. The outline of the mandible along with canine, first premolar, second premolar, and first molar was traced. The mental foramen opening was also traced and the position wasevaluated in relation to the first, second premolars and first molar.&#x0D; Results: Out of 400 foramina, 217 (54.2%) were located between the first and second premolar, i.e. position 3. The second most commonlocationof 152 (38%) foramina was in line with the second premolar, i.e. position 4. Position 2, i.e. in line with the first premolar was seen in 4% and position 5, i.e. between the second premolar and first molar was seen in 3.5%. The left side (29.2%) had a higher occurrence of position 3 as compared to the right side (25%).&#x0D; Conclusion: The location of mental foramen should be identified in all surgeries involving the anterior mandible as this will help us prevent injury to the mental nerve.In our population, position 3 was the most common location of the mental foramen.

Evaluation of Mandibular Third Molar Extractions Performed By Intra Alveolar Method as Opposed to Transalveolar Method

The aim of the present study was to retrospectively analyse the prevalence of intra-alveolar and transalveolar extraction of mandibular third molars in patients at Saveetha Dental college. Retrospective dataof 1747 patients was obtained and segregated. The inclusion criteria included 18-90 years are group,underwent extraction and visited between June 2019 to April 2020. Once the data was obtained it wasstatistically analyzed using SPSS by IBM version 20. The most commonly used method of extraction wasthe conventional technique (90.8%) comprising the majority whereas the trans alveolar method comprised(9.2%). A high association and significance was noticed between the age of the patient and type of extractionperformed( P= 0.000)Extraction being one of the most common dental procedures that is being done, it isimportant to approach the same with the adequate and appropriate technique to prevent further complicationsas a result of the procedure

Class II Division 1 malocclusion treatment with extraction of maxillary first molars: Evaluation of treatment and post-treatment changes by the PAR Index.

ObjectiveTo investigate occlusal result and post‐treatment changes after orthodontic extraction of maxillary first permanent molars in patients with a Class II division 1 malocclusion.Setting and SampleRetrospective longitudinal study in a private practice, with outcome evaluation by an independent academic hospital. Ninety‐six patients (53 males, 43 females) consecutively treated by one orthodontist with maxillary first permanent molar extraction were studied, divided into three facial types, based on pre‐treatment cephalometric values: hypodivergent (n = 18), normodivergent (n = 21) and hyperdivergent (n = 57).MethodsOcclusal outcome was scored on dental casts at T1 (pre‐treatment), T2 (post‐treatment) and T3 (mean follow‐up 2.5 ± 0.9 years) using the weighted Peer Assessment Rating (PAR) Index. The paired sample t test and one‐way ANOVA followed by Tukey's post hoc test were used for statistical analysis.ResultsPAR was reduced by 95.7% and 89.9% at T2 and T3, respectively, compared with the start of treatment. The largest post‐treatment changes were found for overjet and buccal occlusion. Linear regression analysis did not reveal a clear effect (R‐Square 0.074) of age, sex, PAR score at T1, incremental PAR score T2‐T1, overjet and overbite at T1, and facial type on the changes after treatment (incremental PAR score T3‐T2).ConclusionsThe occlusal outcome achieved after Class II division 1 treatment with maxillary first permanent molar extractions was maintained to a large extent over a mean post‐treatment follow‐up of 2.5 years. Limited changes after treatment were found, for which no risk factors could be discerned.

Reliability Assessment of the Clinical and Radiographic Diagnosis of Furcation Involvement

Aim: The aim of the present study was to compare and assess the relationship and agreement between the clinical and radiographic detection of Furcation Involvement (FI) in the mandibular molars of patients with periodontitis. Materials and Methods: The sample size included 360 molars from 283 participants with a total of 180 molars involved with furcation clinically and 180 without. The inclusion criteria involved records of patients in the age range 35-76 years, diagnosed with generalized periodontitis, Stage II to IV, Grade B and C, and existing periapical radiographs/dental panoramic radiographs. The periodontal charts (Hamp’s classification) and radiographs were used to evaluate furcation on the buccal and lingual sites of first and second mandibular molars. Results: Of the 360 molars, half of the molars (50%, n=180) had clinical FI. Of the clinical FI group, the majority (73%, n=131) demonstrated FI in the radiological assessment with the periapical radiographs. In the not-clinically detected FI group, just less than half (49%, n=89) demonstrated FI in the radiological assessment. The sensitivity of the radiographic detection of FI as a diagnostic marker was 50.6%, and the specificity was 72.8%. Of the 180 sites analyzed with FI clinically, a slight agreement was found between the clinical assessment and radiographic findings using the kappa analysis (k=0.18). The first mandibular molars showed a fair agreement (k= 0.21) compared to the second mandibular molars (k=0.15). In terms of the individual sites, the lingual sites (k=0.24) had a fair agreement compared to the buccal sites with a slight agreement. The Spearman Correlation analysis for the first mandibular molar showed a moderate positive correlation (r=0.4, p&lt;0.001) compared to the second mandibular molar with no or negligible relationship (r=0.19, p&lt;0.001). Comparatively, the DPT radiograph showed a weak correlation and poor agreement. Conclusion: Both diagnostic tools, intraoral radiography and clinical assessment should be used for diagnosing FI in mandibular molars.

CLINICAL EVALUATION OF RESTORATIONS OF ENDODONTICALLY TREATED TEETH

For endodontically treated lateral teeth, direct restoration made of photocomposites is most often used, and indirect ceramic restoration appears to be more promising, for which, however, additional retention is required.&#x0D; The aim of the study was the clinical evaluation of direct photocomposite and indirect ceramic restorations of endodontically treated lateral teeth.&#x0D; The object and methods of the research. We examined 118 people aged from 24 to 53 years, in whom 249 lateral teeth with cavities were endodontically treated according to the 2nd class by Black. Group 1 included 38 patients (32.2% of the total number of subjects) who underwent direct restoration of 89 molars (35.7% of the total number of restorations) made of photocomposite; 41 patients (34.7%) with 81 indirect ceramic restorations (32.5%) were included in group 2 according to the generally accepted requirements; group 3 consisted of 39 people (33.1%), who underwent 79 indirect ceramic restorations (31.7%) with the formation of cavities with additional retention elements.&#x0D; Direct restorations in the subjects from group 1 were performed with a photocomposite using a 5th generation adhesive system in a layered technique with light polymerization by “soft start”. In the molars of persons from groups 2 and 3, cavities were prepared taking into account the generally accepted requirements, while in the cavities of the molars in patients from group 3, we formed retention elements in dentin in the form of depressions. Intraoral optoelectronic scanner CEREC AC Connect Omnicam, Dentsply Sirona was used for scanning, restorations were modeled in Exocad software and made of ceramic CAD-blocks based on lithium disilicate using an inLab MC X5 assembler, Dentsply Sirona. The restoration was fixed on a self-adhesive composite cement of double hardening. Clinical evaluation of restoration was performed in 18 and 24 months. Impairments and the number of restorations with them were registered.&#x0D; Research results and their discussion. In the period of 18 months, out of 70 direct photocomposite restorations (78.7% of the initial number) in persons of group 1, 2 restorations (2.2%) were partially absent, in 4 restorations (4.5%) anatomical impairments were revealed, in 5 (5.6%) – impairments of the marginal adaptation, in 8 (9.0%) – marginal color, also in 8 cases (9.0%) there were impairments of contact points. All impairments were identified in 12 restorations (13.5%). In patients of 2 groups, in 78 indirect ceramic restorations (96.3%) we revealed a partial destruction and shift of 1 restoration (1.2%), disturbance of an anatomic form – in 2 restorations (2.5%), in 3 restorations (3.7% each) there were defects of marginal adaptation and marginal color, contact points were impaired in 4 cases (4.9%). In total, impairments were detected in 5 restorations (6.2%). In 77 indirect ceramic restorations (97.5%) in patients of group 3, 1 restoration (1.3% each) had impairments of anatomical shape, marginal adaptation and contact points, 2 restorations (2.5%) had marginal color. Impairments pertained to only 2 restorations (2.5%).&#x0D; In 24 months, out of 58 direct restorations (62.5%) of patients in group 1, 3 restorations (3.4%) were partially or completely absent, anatomical impairments were found in 6 restorations (6.7%), and marginal defects were found in 7 (7.9%), marginal color – in 11 (12.4%), 15 contact points (16.9%) were with impairments. The number of direct restorations with impairments was 20 (22.5%). In 77 indirect restorations (90.1%) in persons of the 2nd group, we revealed a partial destruction and displacement of 3 restorations (3.7%), 2 restorations (2.5% each) had impairments of anatomical shape and marginal adaptation, 4 each (4 , 9%) – marginal color and defects of contact points. In total, there were 7 indirect restorations (8.6%) with impairments. In patients of group 3, among 75 indirect restorations (94.9%) 1 restoration (1.3% each) had disturbances of anatomic shape and marginal adaptation, 2 restorations (2.5%) were with marginal coloring, 3 (3.8 %) – with defects of contact points. There were 3 indirect restorations with impairments (3.8%).&#x0D; Conclusion. During both terms with impairments, we detected 32 direct photocomposite restorations (36.0%), 12 indirect ceramic restorations (14.8%) and only 5 indirect ceramic restorations (6.3%) made with additional retention elements.