Prosthetic Treatment Research Articles

Three-dimensional in vivo and finite element analyses of peri-implant bone remodeling after superstructure placement.

Understanding the factors affecting loading-induced longitudinal peri-implant bone changes is crucial for successful implant-supported prosthetic treatment. The purpose of the study was to assess the biomechanical factors influencing 3-dimensional changes in the peri-implant bone volume and buccal bone thickness (BBT) with follow-up cone beam computed tomography (CBCT) images and finite element analysis (FEA). Twelve study participants received dental implants without bone augmentation, resulting in the evaluation of 22 posterior dental implants. Each participant underwent 3 separate CBCT scans: the first at 3 months after loading, followed by scans at 15 months and 27 months after loading. CBCT images were superimposed at each interval with an image-processing software program. The peri-implant buccal bone area was determined as the volume of interest (VOI), and volumetric change in VOI and changes in BBT at 2, 4, and 6mm below the implant platform were measured. FEA was performed to examine the mechanical stimulation in the VOI with occlusal force data obtained from the Dental Prescale. Interobserver reliability was evaluated by 3 experienced prosthodontists and dentists experienced with dental implants. Linear regression analyses were performed to evaluate the relationship between variables. Occlusal force and mechanical stimulation (strain energy density [SED]) in the VOI demonstrated a positive correlation; moreover, a positive correlation was observed between SED and bone volume loss in the VOI at 3 and 27months after loading. Similar correlations were observed with BBT, except at a depth of 6mm under the implant platform. The interclass correlation coefficient values were 0.995 for volume and 0.982 for BBT, thereby indicating a high level of agreement among the observers' measurements. This combined FEA and clinical study suggested that force-induced bone remodeling depends on the occlusal force in the early phases after superstructure placement.

Sticky Bone added to the Split Crest technique for implant placement in an atrophic mandible. Clinical Case

Placing an implant in an atrophic alveolar ridge is a challenge regarding the reconstruction of bone defects of one or two walls. A solidified bone graft trapped in a fibrin network prevents its dispersion even when subjected to movement or shaking. The Split Crest technique offers a practical way to expand the atrophic alveolar ridge. This allows the use of bone grafts without needing a second surgical site, which reduces the risk of edema, nerve injuries, and pain. A 50-year-old patient, systematically healthy, reported difficulty chewing, swallowing, and speech due to a poorly adapted prosthesis in the jaw, which caused dissatisfaction with the prosthetic treatment already performed. This case report aimed to describe the Sticky Bone procedure by adding an autologous atrophic jaw graft using the Split Crest technique, obtaining an average bone gain of 2.5mm, having good results after eight months postoperatively, there was no peri-implant marginal bone resorption.

ML-based tooth shade assessment to prevent metamerism in different clinic lights

The aesthetic understanding has found its place in dental clinics and prosthetic dental treatment. Determining the appropriate prosthetic tooth color between the clinician, patient and technician is a difficult process due to metamerism. Metamerism, known as the different perception of the color of an object under different light sources, is caused by the lighting differences between the laboratory and the dental clinic. The traditional trial-error color determination method, coupled with the high cost of instrumental color value determination, has prompted the need for alternative technologies. The integration of AI technologies into dental practices aims to minimize errors in tooth shade assessment, reduce equipment usage, eliminate the impact of clinic lighting on color detection, and decrease costs for patients, dentists, and laboratories. In this study, a machine learning (ML) based approach that can correctly detect tooth shade even under different clinical lights has been developed. A dataset consisting of 580 dental images taken under four different clinical lights and with five repetitions was created using the Vita color shade guide. Experimental studies were performed using the HSV color space, 6 different ML algorithms and color histograms. As a result, 97.93% accuracy rate was achieved by using cross-validation (cv = 5) in the classification of 29 color values ​​independent of clinical lights. It has been shown that the tooth colors can be determined with high accuracy using ML algorithms and metamerism can be prevented.

Immediate Patient Satisfaction with Dental Esthetics After Endodontic and Prosthodontic Treatment of Dental Dyschromia.

Objectives: This study aimed to evaluate patients' satisfaction with the esthetic outcomes of combined endodontic and prosthetic treatments for devitalized or dyschromic teeth, a condition influenced by various intrinsic and extrinsic factors that present a growing concern in modern dentistry. Methods: A total of 104 patients, including 43 men and 61 women, underwent treatment using lithium disilicate restorations for esthetic zones and zirconium oxide restorations for regions with higher occlusal demands. Patient satisfaction was evaluated through a post-treatment questionnaire, classifying responses as either "satisfied" or "dissatisfied". Dissatisfied participants were further asked to specify their concerns. Results: The study revealed a high satisfaction rate of 93%. Dissatisfaction was slightly more prevalent among women than men, but this difference was statistically insignificant. The primary reasons for dissatisfaction included darker restoration color, chipping, and gingival recessions. Conclusions: Combined endodontic and prosthetic treatments, utilizing lithium disilicate and zirconium oxide restorations, achieved high levels of patient satisfaction. Nevertheless, addressing specific issues, such as color matching and gingival health, could enhance outcomes further.

The influence of prosthetic treatments and implant-supported prostheses on posterior mandibular ridge atrophy: a retrospective cohort study

AimsBone preservation is a requirement for long-term stability of dental prostheses, which is all the more important in the posterior mandible, given the particular challenges these areas pose to prosthetic treatment. The objective was to investigate the implications of different prostheses on the atrophy of posterior alveolar bone after tooth loss.Materials and methodsA total of 457 treatment cases were retrieved from the medical documentation and information network. Baseline panoramic radiographs taken at prosthetic delivery and follow-up radiographs (≥ 3 years post-treatment) were available for analysis, with a mean follow-up duration of 6.42 ± 2.37 years. Posterior mandibular bone height in these radiographs was compared using one-way ANOVA followed by the Tukey post hoc test for statistical analysis.ResultsSites supporting fixed prostheses commonly used in partially edentulous mandibles exhibited less bone atrophy compared to sites with clasp- or telescope-retained removable partial dentures (RPDs) (p < 0.001). Furthermore, sites with clasp-retained RPDs and telescope-retained RPDs demonstrated less bone atrophy when distal support was present (p < 0.001). In edentulous mandibles, bar-retained overdentures supported by four implants exhibited significantly less bone atrophy compared to mucosa-supported complete dentures, bar-retained overdentures supported by two implants, or overdentures retained by Locator abutments on two implants (p < 0.001).ConclusionBone atrophy in the posterior mandible should be expected to vary greatly with prosthetic designs. Long-term stability is possible with fixed partial prostheses, RPDs are less favorable in the absence of a distal support and bar-retained overdentures on four or more implants exhibited the lowest bone atrophy in fully edentulous mandibles.Clinical trial numberNot applicable – retrospective analysis.

Emerging Healthcare Trends in Prosthetic Treatment of Hand Osteoarthritis.

Background: For many years, advancements in hand joint replacement (JR) were relatively minor compared to those for large joints. However, the caution previously exercised due to high complication rates is gradually being replaced by the expanding use of JR therapies for small joints in the hand. Despite this progress, there is a lack of comprehensive data on the outcomes of hand JR and on the optimal infrastructure required to meet the growing demand for these therapies. Methods: This study examined trends and revision rates of JR for thumb carpometacarpal (CMC-1) and finger (MCP and PIP) joints in both inpatient and outpatient settings in Germany. Data from the Federal Statistical Office of Germany (Destatis) and the Central Institute for Statutory Health Insurance Physicians (ZI) were analyzed, focusing on the incidence, demographics, and outcomes of these procedures. Results: This study found a substantial national increase in prosthetic treatments specifically for CMC-1, with a 2.18-fold rise in the outpatient sector compared to a 1.65-fold increase in inpatient treatments. Despite this shift, 83.7% of JR procedures were still performed in an inpatient setting. Conclusions: The overall complication rates appear to be declining, suggesting that while the management of these procedures is shifting towards outpatient care, the quality remains stable.

Method for Measuring and Correcting the Fit of Fixed Dental Prostheses

Abstract BACKGROUND: One of the key quality indicators of non-removable dentures is their tight fit to the prosthetic bed. Errors in the clinical and laboratory stages of denture manufacturing lead to the fact that ready-made non-removable dentures have different degrees of fit. Most methods for assessing the degree of fit of prostheses are mainly of scientific interest and have not found wide clinical application due to the complexity of execution and inconvenience of use. AIM: To improve the effectiveness of prosthetic treatment by enhancing the fit of fixed dental prostheses. MATERIALS AND METHODS: A silicone test and a special device called a calibrator were used to assess the fit of the completed prostheses. The calibrator allows the clinician to quickly and accurately measure the thickness of the silicone film. RESULTS: It was found that all prostheses received from the dental laboratory exhibited varying degrees of fit. The range of values was from 20 μm to 200 μm. The fit of 50% of the prostheses exceeded 100 μm. Clinical adjustment of crowns using the proposed method improved their fit by an average of 59,28%. CONCLUSION: The proposed clinical method for assessing the degree of marginal fit of fixed dentures and its correction allows the doctor to control this indicator and achieve clinically acceptable values. Keywords: fit of fixed prostheses, silicone test, test calibrator, silicone film thickness, marginal gap

Orthodontic treatment for preserving periodontally hopeless teeth in a middle-aged patient: a case report.

In this case report, we show a strategic approach to prolonging the lifespan of pathologically migrated maxillary canines with a hopeless prognosis in a 57-year-old female patient, highlighting the potential of orthodontic management for middle-aged patients to enhance both occlusion and facial esthetics while minimizing the need for extensive prosthetic treatment. According to the visual treatment objective, the nonextraction treatment plan showed advantages in the type of orthodontic tooth movement and final occlusal relationship. Therefore, considering the favorable periodontal treatment results and single-root teeth, the hopelessly migrated maxillary canines were relocated, eliminating the existing trauma from occlusion. Segmental tooth movement was performed, and orthodontic temporary skeletal anchorage devices were used to support strategic orthodontic tooth movement. After 27 months of treatment, proper occlusion was established with a significant improvement in facial esthetics. The periodontally compromised teeth were preserved with adequate periodontal support. The patient expressed satisfaction with the results, and the 30-month follow-up records confirmed the stability of treatment outcomes.

CLINICAL JUSTIFICATION OF THE EFFICIENCY OF USING IMPROVED METHODS OF DETERMINING AND FIXING OCCLUSAL RELATIONSHIPS IN PATIENTS WITH PARTIAL EDENTULOUS

Determining the optimal occlusal relationships according to the anatomical and functional features of the maxillofacial system (MFS) and subsequent adaptation till physiological functions are restored is an actual task during prosthetic treatment of patient with partial edentulous with help of fixed and removable partial denture (FPD, RPD). Purpose: to establish the effectiveness of the proposed methods of determining and fixing of the occlusal relationships based on the study of clinical indicators in patients who simultaneously use FPD and RPD for prosthetic therapy. Material and Methods. Our study included 120 patients aged 55-70 years with partial edentulous without endocrine and systemic disorders, acute forms of periodontal tissues diseases and good level of individual oral hygiene who came to the Department of Stomatology of Postgraduate Education of Ivano-Frankivsk National Medical University for prosthetic treatment. Prosthetic treatment was carried out with FPD, RPD using the proposed methods of forming occlusal relationships (group 1) and generally accepted methods (group 2). Each study group was divided into two subgroups: a – patients without occlusal disorders, and b – patients with occlusal disorders and vertical occlusion dimension (VOD) loss. The examination of each person included the collection of anamnesis and complaints, general dental examination, the determination of the Russell periodontal index (PI), the assessment of occlusal relationships and the condition of the temporomandibular joint (TMJ) according to "Hamburg protocol". Results and conclusions. The analysis of patient’s complaints and anamnesis, the data of the objective dental examination, and assessment of the periodontal tissue condition established the effectiveness of the proposed methods of determining and fixing occlusal relationships in patients with partial edentulous simultaneously treated with FPD and RPD. In addition, 23.3% more people of the 2a subgroup felt tension and fatigue of the masticatory muscles a week after treatment than in 1a subgroup, and 36.7% more - in the 2b subgroup than in 1b after a year of FPD and RPD use (p&lt; 0,05). There were significantly more patients with signs of eccentric supraocclusion in the 2a subgroup a year after prosthetic treatment than in 1a (30±0.09% (9) and 3.3±0.03% (1)), and with signs of centric supraocclusion in the 2b subgroup - 36.7±0.09% (11), against 10±0.06% (6) in 1b (p &lt;0.05). Also, there was observed a positive effect of proposed method of determining and fixing of the occlusal relationships during prosthetic treatment on TMJ a year after prosthetic treatment with FPD and RPD. There were 16.7% and 13.3% fewer people in 1a and 1b subgroups with one positive symptom of the “Hamburg protocol” and 6.7% and 40% fewer persons with two positive symptoms, compared to the data received before treatment. There was an increase by 13.3% of number of patients with one positive symptom according to “Hamburg protocol” in the 2a subgroup and by 10% of persons with two symptoms. It was determined a decrease of patients with two positive symptoms according to “Hamburg protocol” in 2b subgroup by 10% after one year. An improvement of periodontal tissues condition of abutment teeth was evaluated by PI assessment after a year of observation of patients. It was established that the average value of PI in subgroup 1b was significantly lower by 57.6% than in subgroup 2b, and it was lower in subgroup 1a by 39.3% than in patients of subgroup 2a (р&lt;0,05).

Maxillofacial prosthetic treatment to restore quality of life -prosthetic treatment-

Maxillofacial prosthetic treatment to restore quality of life -prosthetic treatment-

A comparative analysis of older patients with chewing difficulties due to temporomandibular disorders and tooth loss

Chewing difficulty can contribute to psychological stress, which reduces the quality of life for older adults. The purpose of this study was to investigate and analyze the severity of masticatory discomfort, stress response, and sleep disturbance in older patients experiencing masticatory discomfort due to tooth loss or temporomandibular disorders (TMD), to find the further treatment direction for these patients. A total of 392 patients aged 50 years and older with mastication difficulties were analyzed. Two group of patients, those seeking prosthetic treatment due to tooth loss (n=193) and those who were referred due to TMD-related pain discomfort (n=199), were identified. Numeric rating scale (NRS), stress response inventory (SRI), and insomnia severity index (ISI) were used as tools to measure patients' subjective chewing discomfort, stress response, and sleep status. Chewing discomfort and age were found to be much higher in the prosthetic group than in the TMD group. The TMD group had significantly higher scores in five SRI parameters (tension, anger, depression, fatigue, and frustration) as well as total score and a higher percentage of clinical insomnia compared to prosthetic patients. Since the number of remaining teeth has a significant impact on the masticatory discomfort severity, restoring the occlusion through prosthodontic treatment is important to improve masticatory function. In patients with TMD, it is necessary to assess stress response and sleep quality, and a multidisciplinary treatment approach may be necessary to effectively address masticatory discomfort.

Clinical and Radiographic Outcomes of Single-Unit Implant- Supported Restorations: A 12-Month Cross-Sectional Clinical Study.

This retrospective clinical study aims to analyze single-unit implant-supported restorations' clinical and radiographic outcomes comprehensively. In this retrospective study, patients who had undergone 12 months of implant-supported singleunit fixed prosthetic treatment were scanned from the archives, and a hundred patients were included in the study. Implant success and survival rates were assessed according to the consensus decisions published at the International Oral Implantology Congress in 2007. Prosthetic complications such as chipping, screw loosening, and decementation were also evaluated. In addition, success/survival rates and prosthetic compositions were associated with some surgical and prosthetic parameters. According to the success/survival criteria, 88% of the implants were successful, 10% had satisfactory survival, and 2% had compromised survival. The risk of satisfactory or compromised survival was 62.5 times higher in individuals with inadequately keratinized mucosa compared to those with adequately keratinized mucosa (p < 0.001). It was also 5.736 times greater for extractions due to periodontal disease versus endodontic reasons (p = 0.010) and 4.629 times higher for implants with diameters less than 3.75 mm compared to those between 3.75 mm and 5 mm (p = 0.037). Screw loosening was observed in 15% of the evaluated restorations, decementation in 13% and chipping in 4%, and the risk of screw loosening was 4.444 times higher for screw retention abutments compared to standard abutments (p=0.015). Insufficient keratinized mucosa, periodontal problems leading to tooth extractions, and the use of narrowdiameter implants can negatively affect the success of implant procedures. Loosening in screw-retained restorations is due solely to screw loosening, which is a high risk for screwretained restorations. Loosening in cement-retained restorations, on the other hand, is caused by the decementation of the prosthetic restoration or loosening of the abutment screw supporting the restoration.

Postoperative QOL achieved by maxillofacial prosthetic treatment − The influence of oral surgery on maxillofacial prosthetic treatment −

Postoperative QOL achieved by maxillofacial prosthetic treatment − The influence of oral surgery on maxillofacial prosthetic treatment −

Dental Auto-transplantation to Premolar Mandibullary Sites: Case report

ABSTRACT This study aims to present the success rate, advantages, and factors influencing the success, along with potential complications associated with autotransplantation to the mandibular premolar region. Autotransplantation involves the extraction of a suitable impacted, semi-erupted, or erupted tooth from an individual, followed by surgical transplantation into areas of tooth loss within the same individual. This procedure is particularly significant in addressing tooth loss, especially among young patients, with its success dependent on the careful selection of appropriate cases. Indications for autotransplantation include premature tooth loss resulting from various causes such as irreparable teeth, periodontal diseases, root fractures, dental agenesis, early tooth loss due to trauma, and impacted or ectopic teeth. The primary criteria for evaluating the success of autotransplantation involve normal periapical healing and sustained root development, without inflammatory pulpal changes or root resorption. The tooth designated for autotransplantation underwent initial treatment with a root canal, followed by complete filling with MTA to prevent root resorption. Subsequently, it was positioned and secured in the designated transplant area. The patient was called for periodic check-ups after the treatment was completed. Despite its limited practical applications, autotransplantation serves as a valid alternative to implant and prosthetic treatments due to its cost-effectiveness, relative simplicity, and ability to provide satisfactory aesthetics and functional results. Additionally, it preserves the quality and quantity of alveolar bone. In this study a 5-year follow-up of the patient revealed no criteria indicating failure in the transplanted tooth. Keywords: Autotransplantation, ectopic teeth, root resorption

Silencing the Phantom - Pregabalin Misuse in Amputation Patients: A Case Report

In the aftermath of amputation, individuals face not only physical pain but also psychological challenges as their body's integrity is suddenly disrupted. Phantom limb sensations, characterized by the feeling that the amputated limb still exists, are common after amputation. Phantom limb pain often accompanies these sensations. Beyond the physiological aspects, patients' psychological adaptation journey is pivotal. This case report delves into the intricate relationship between phantom limb sensations, psychological factors, and pregabalin use disorder in a right-arm amputee patient. A 25-year-old right-arm amputee male patient went to an addiction outpatient clinic for pregabalin addiction treatment. He had a history of cannabis use to cope with his sadness during his adolescence. While cannabis use initially provided emotional relief, it later turned to pregabalin misuse, escalating to alarming doses (3000mg/day). Many pharmacological agents, including pregabalin, are being tried to treat phantom limb pain. Beyond its positive effects in phantom limb pain treatment, many studies have been published about its addictive features recently. This case underscores the need for comprehensive care for amputees, including psychological support, early prosthetic intervention, social reintegration, and judicious medication management. This case report serves as a reminder that the post-amputation period is not just a physical struggle but also a complex psychological journey toward healing and reintegration into a fulfilling life..

Quality of Life and Oral Function in Patients With Jaw Defects Following Oral Tumour Surgery.

To evaluate various oral functions in patients with jaw defects after oral tumour surgery and to clarify factors associated with their quality of life (QoL). In patients with jaw defects, oral function and QoL are severely impaired. No studies have evaluated oral functions of patients with jaw defects and examined their relationships with QoL. The study participants were 72 patients (mean age: 70.7 ± 10.1 years, range 48-93 years) who underwent prosthetic treatment with a removable denture to treat a jaw defect following oral tumour surgery. Masticatory performance, maximum bite force, oral dryness, tongue pressure, and tongue-lip motor function (oral diadochokinesis, /pa/, /ta/, /ka/ syllables) were evaluated after prosthetic treatment. The Japanese version of the EORTC QLQ-H&N 35 was used to assess QoL. From the QoL assessment, the "Pain", "Swallowing", "Sense", "Speech", "Social eating", and "Social contact" scales were extracted. Multiple regression analysis was conducted using each QoL scale as the dependent variable and oral functions as explanatory variables. In the multiple regression model for "Swallowing", the oral diadochokinesis /ta/ was a significant explanatory variable. In the model for "Sense", tongue pressure was a significant explanatory variable. In the model for "Speech", age was a significant explanatory variable. In the model for "Social contact", tongue pressure was the significant explanatory variable. In patients with jaw defects following oral tumour surgery, lower tongue pressure is associated with poorer QoL in a wider range of ways than other oral functions are.

THE NEED FOR PROSTHETIC TREATMENT WITH DIFFERENT DENTURE DESIGNS FOR RESIDENTS OF ODESA AND THE ODESA REGION

Objective. The aim of this study is to analyze the need for orthopedic treatment with removable dental prosthetic constructions among the residents of Odesa and the Odesa region based on a retrospective analysis of outpatient dental patient records. Materials and Methods. This research was conducted using outpatient records (form 043/o) of patients who sought dental treatment with removable orthopedic constructions at healthcare institutions in the Odesa region and city dental departments from 2019 to 2023. Results. The analysis examined the proportion of removable prostheses relative to the total number of prostheses manufactured. From 2019 to 2023, 5,439 individuals (38.1%) in the Odesa region received removable dental prostheses, while 8,272 (61.9%) were from Odesa. A total of 95,237 prostheses were produced, with 65.3% (62,182) made in Odesa. In 2020, 33,488 prostheses were manufactured; in 2021, 42,026; and in 2022, 19,723. The need for prosthetic treatment in Odesa is estimated at 57% (570 individuals per 1,000 population). Patient visits were recorded as follows: 176 individuals in 2020, 212 in 2021, and 182 in 2022. In 2022, the number of visits decreased by 10,428 individuals (15.5%) compared to 2020, and by 3,001 individuals (17.95%) compared to 2021, indicating a decline in the accessibility of dental services. Conclusion. The study conducted in the Odesa region (2019-2023) revealed a high demand for orthopedic treatment, particularly for removable dental prostheses. 38.1% of patients received prostheses, with 61.9% coming from Odesa. A decrease in patient visits was observed in 2022 that was likely due to the consequences of the COVID-19 pandemic and economic difficulties. The results highlight the need for monitoring the population's demand for dental services and adapting strategies to improve accessibility and quality of treatment.

Combined Effects of Dietary Guidance and Prosthodontic Rehabilitation on Nutritional Biomarkers in Edentulous Patients: A Randomized Controlled Trial.

Background Previous studies have suggested that providing dietary guidance along with denture treatment may improve dietary diversity in edentulous patients; however, none have examined the effects on nutritional blood biomarkers. This study investigated the effects of individualized dietary guidance combined with complete denture treatment on nutritional blood biomarker levels, dietary intake, and masticatory function. Materials and methods This was a prospective, randomized, open-label, controlled trial. Patients seeking new dentures with at least one edentulous arch were randomly allocated to Group A (denture treatment only) or Group B (dietary guidance followed by denture treatment). Individualized dietary guidance was provided exclusively to Group B by dentists based on baseline assessments. Baseline and post-treatment assessments included blood tests, a dietary survey using the Brief-type Self-Administered Diet History Questionnaire (BDHQ), occlusal force measurements using pressure-sensitive film, and masticatory performance tests using gummy jelly. The results from the baseline and post-treatment assessments were compared within each group, and exploratory comparisons of changes were conducted between groups. Results A total of 39 individuals completed the protocol (20 in Group A and 19 in Group B; mean age 73.4 ± 10.6 years; 17 males, 22 females). Both groups showed a significant increase in occlusal force after treatment (P = 0.007 for Group A; P = 0.011 for Group B), while no improvement in blood biomarkers was observed. In Group B, the intake of fish with bones (P = 0.035) and non-oily fish (P = 0.030), as evaluated using the BDHQ, significantly increased after treatment. Group B also showed significantly greater increases than Group A in methionine (P = 0.012), lysine (P = 0.048), and total essential amino acids (P = 0.029), as evaluated by blood tests, as well as the intake of fish with bones (P = 0.043). Conclusion Although denture treatment may increase occlusal force, combining dietary guidance with prosthetic treatment appears to further enhance dietary habits and support the nutritional status of edentulous patients.

Esthetic and Functional Rehabilitation: Retreatment of Anterior Fixed Dental Prothesis With Biologically Oriented Preparation Technique and Digital Workflow.

This clinical case describes a multidisciplinary retreatment of a patient with anterior fixed dental prostheses (FDPs) using minimally invasive restorations and a biologically oriented preparation technique (BOPT). A 56-year-old female patient, treated 30 years ago with a metal-ceramic FDP due to dental agenesis, presented a misfit prosthesis at the gingival margin, black spaces, and food retention at the pontics. Notably, tooth number 2.6 was absent, and she exhibited a left crossbite. Her chief complaint was the compromised esthetics of her restorations. Given her coagulation disorder, von Willebrand disease, she declined mucogingival surgery. A diagnostic wax-up and mock-up was performed to establish treatment goals. The initial phase involved periodontal, orthodontic, and implant treatment. The orthodontic treatment with aligners to correct the crossbite. Subsequently, bleaching and a second mock-up were conducted to guide prosthetic treatment. In the prosthodontic treatment, the abutment teeth were prepared using a vertical BOPT to remodel the gingival tissues, achieving the esthetic goal of repositioning the gingival margin without surgery. The provisional phase was critical for soft tissue remodeling and ensured clinical success. After stabilization of the soft tissues, a monolithic zirconia FDP was delivered, with a follow-up of 2 years. A multidisciplinary treatment plan, utilizing a digital workflow, resulted in stable clinical and esthetic outcomes at the two-year follow-up, effectively retreating an anterior bridge using BOPT in a patient with a coagulation disorder that contraindicated complex surgical interventions.

ASSESSING THE IMPACT OF ACIDIC DRINKS ON THE STRUCTURAL INTEGRITY OF ENAMEL AND THEIR CONSEQUENCES FOR DENTAL AESTHETICS

Aim of the study: This study seeks to evaluate the detrimental effects of acidic beverages on tooth structure and overall dental health, with a particular focus on comparing the extent of damage at a microscopic level. While it is widely understood that acidic drinks are harmful to teeth, the precise scale of the damage is often underestimated. By examining the degree of harm caused by prolonged exposure to acidic substances, this research aims to increase awareness of the cumulative effects that sugary and acidic beverages have on dental health and aesthetics over time. Materials and methods: The teeth used in this study were obtained from private practice, from patients diagnosed with Stage 3 or 4 periodontitis. These teeth were deemed unsuitable for prosthetic treatment due to excessive clinical attachment loss (CAL) or advanced tooth mobility (grade 2 or 3). Following extraction, the teeth were preserved in artificial saliva for a maximum of 20 days.The experiment involved a sample of 30 teeth, each of which was submerged in a different beverage for a duration of 24 hours The beverages used in this study were Sprite, lime juice, apple vinegar, and white wine. Following the 24-hour exposure, the teeth were documented, and photographs were taken. The enamel surface of the teeth was then analyzed under a Scanning Electron Microscope (SEM) to examine the extent of acid-induced damage in detail. Additionally, the density of the two halves of each tooth was compared using a Diagnodent pen (KaVo) to further assess the impact of the acidic beverages. Results: The results of this study will contribute to a deeper understanding of enamel erosion caused by acidic beverages, offering valuable insights for both dental professionals and individuals aiming to protect their enamel from deterioration. Conclusions: In conclusion, the excessive and frequent consumption of acidic beverages results in irreversible enamel demineralization, leading to aesthetic concerns such as white spots, discoloration, surface roughness, and an increased risk of tooth sensitivity or loss. Additionally, the method of consumption—particularly the tendency to a prolonged the contact between these beverages and the dental structure—exacerbates the potential for damage. To minimize these effects, it is imperative to reduce both the frequency of acidic drink intake and the duration of their contact with the teeth. Effective management of acidic beverage consumption is essential for preserving oral health and maintaining dental aesthetics.