Presence Of Restoration Research Articles

Clinical longevity and trend analysis of 801 ultrathin ceramic veneers: A clinical cohort study

Statement of problemWhether ultrathin ceramic veneers are a suitable treatment alternative to conventional ceramic veneers is unclear. PurposeThe purpose of this prospective clinical cohort study was to evaluate the efficacy and longevity of nonpreparation and minimally invasive ceramic veneers and the influence of existing restorations and ceramic type and to define the relationship between the number of veneers placed on different teeth and in different locations, as well as age and sex correlations. Material and methodsA total of 801 veneers were placed on incisors, canines, and premolars on maxillary and mandibular teeth between January 2011 and August 2019 (ABR number: RNN/92/19/KE). Feldspathic or feldspathic and lithium disilicate veneers were made, etched, silanated, and cemented. The restorations were evaluated 2 weeks after placement and then every 6 months by using the modified United States Public Health Service (USPHS) criteria. The relationship between participant age and number of veneers was analyzed by using the Spearman rank coefficient test and the Mann-Whitney U test. Changes in the number of participants and veneers in subsequent years were analyzed based on the Spearman rank correlation coefficient. The trend between the location of veneers and the sex of the participants was analyzed by using the chi-squared test for trend. Longevity tables and a survival curve for the veneers were prepared based on the Kaplan-Meier method. The relationships between veneer longevity and the type of ceramic used and the presence of restorations were compared by using the Taron-Ware test (α=.05). ResultsThe mean longevity of the intact veneers was 8.45 years. Clinical success was 99.7% after 1 year and 97.9% after 4 years; this value remained constant until the end of the study. Most participants were women (n=122; 84.1%), and the mean age was 41 years; median 40 years. The number of veneers placed on mandibular teeth each year increased over the subsequent years. ConclusionsThe longevity of ultrathin veneers after 9 years of observation was not related to the ceramic used or to the presence of a composite resin restoration. Veneers were more commonly placed in middle-aged women and in mandibular anterior teeth.

Influence of Enamel Preservation on Failures Rates of Porcelain Laminate Veneers

The purpose of this study was to evaluate the failure rates of porcelain laminate veneers (PLVs) and the influence of clinical parameters on these rates in a retrospective survey of up to 12 years. Five hundred eighty laminate veneers were bonded in 66 patients. The following parameters were analyzed: type of preparation (depth and margin), crown lengthening, presence of restoration, diastema, crowding, discoloration, abrasion, and attrition. Survival was analyzed using the Kaplan-Meier method. Cox regression modeling was used to determine which factors would predict PLV failure. Forty-two veneers (7.2%) failed in 23 patients, and an overall cumulative survival rate of 86% was observed. A statistically significant association was noted between failure and the limits of the prepared tooth surface (margin and depth). The most frequent failure type was fracture (n = 20). The results revealed no significant influence of crown lengthening apically, presence of restoration, diastema, discoloration, abrasion, or attrition on failure rates. Multivariable analysis (Cox regression model) also showed that PLVs bonded to dentin and teeth with preparation margins in dentin were approximately 10 times more likely to fail than PLVs bonded to enamel. Moreover, coronal crown lengthening increased the risk of PLV failure by 2.3 times. A survival rate of 99% was observed for veneers with preparations confined to enamel and 94% for veneers with enamel only at the margins. Laminate veneers have high survival rates when bonded to enamel and provide a safe and predictable treatment option that preserves tooth structure.

Comparison of Carbon Dioxide versus Refrigerant Spray to Determine Pulpal Responsiveness

There is little evidence for which cold delivery method is most accurate in determining pulp responsiveness. This study compared carbon dioxide dry ice sticks (CO2) versus refrigerant spray (RS) to generate a patient response from different types of teeth restored to varying degrees. Fifteen human patients were selected. In each quadrant, three teeth were identified and the restoration type recorded. Blindfolded patients were randomly tested with either CO2 or RS in a crossover design at two different sessions. Responsiveness was recorded as yes/no and the interval (in seconds) from application to response was determined. Results showed that (a) CO2 and RS were equivalent in producing a pulpal response regardless of tooth and presence of restoration, and (b) CO2 took significantly (p < 0.05) longer to evoke a response than RS using paired t tests. In conclusion, RS and CO2 were equivalent in determining pulpal responsiveness, but the elicited response from RS was faster.

Restoration of renal response to atrial natriuretic factor in experimental low-output heart failure

The renal response to atrial natriuretic factor (ANF) has been shown to be blunted in several experimental models of acute and chronic congestive heart failure. The mechanism responsible for this blunted response has been postulated to be activation of the renin-angiotensin system with associated potent antinatriuretic effects and/or the reduction in renal perfusion pressure (RPP) characteristic of heart failure. The present study was designed to examine the relative role of these two factors in mediating the blunted response to ANF in a model of acute low output heart failure produced by thoracic inferior vena cava constriction (TIVCC) in the anesthetized dog. TIVCC was produced in five groups of dogs. In group 1, ANF was infused after TIVCC to document the blunted natriuretic response. In group 2, ANF was infused after TIVCC in the presence of blockade of intrarenal angiotensin II (ANG II) by the intrarenal infusion of saralasin (Sar) at a dose without systemic effects. In group 3, ANF was infused after TIVCC in the presence of restoration of RPP by infusion of ANG II at a dose titrated to restore RPP to the level present before TIVCC. In group 4, ANF was infused in the presence of restoration of RPP with ANG II and blockade of intrarenal ANG II with Sar. Group 5 served as an additional control group where the effect of ANG II and Sar in TIVCC was examined in the absence of ANF. Restoration of RPP but not blockade of intrarenal ANG II resulted in a restoration of the response of sodium excretion and glomerular filtration rate to ANF. ANG II plus Sar in the absence of ANF did not produce a natriuresis. We conclude that RPP, more than intrarenal ANG II, modulates the blunted renal response to ANF observed in this model of acute low-output heart failure.