Restoration Margins Research Articles

Retrospective assessment of patients' risk for peri-implant diseases using the implant disease risk assessment (IDRA) tool: A cohort study.

The implant disease risk assessment (IDRA) tool was designed to assess an individual's risk of developing peri-implant diseases by evaluating and integrating multiple risk factors. This study aimed to evaluate the IDRA tool to determine the risk of developing peri-implant disease in patients rehabilitated with dental implants. A retrospective observational cross-sectional study was conducted, collecting data from 92 patients with 92 selected dental implants. Data included the history of periodontitis, sites with bleeding on probing (BoP), teeth and/or implants with probing depths (PDs) ≥ 5 mm, alveolar bone loss relative to the patient's age, susceptibility to periodontitis, the frequency of supportive periodontal therapy (SPT), the distance from the restorative margin (RM) of the implant-supported prosthesis to the marginal bone crest (MBC), and factors related to the prosthesis itself. Additionally, the validated instrument periodontal risk assessment (PRA) was employed for comparison. Statistical analyses utilized Chi-square, Mann-Whitney, and ROC curve. Outcomes indicated that 62 implants (67.4%) were classified as high-risk. Among the IDRA parameters, history of periodontitis was the primary factor contributing to an increased risk (p < 0.001). IDRA revealed high sensitivity (100%) and low specificity (63%) (AUC = 0.685; 95% CI: 0.554-0.816; p = 0.047), and there was a low agreement between the IDRA and PRA tools (Kappa = 0.123; p = 0.014). The peri-implant disease developed in 16 implants with 5.44 (±2.50) years of follow-up, however, no significant association was observed between the high- and low-medium risk groups and the occurrence of peri-implant diseases. Most of the evaluated implants presented high IDRA risk. The IDRA tool exhibited high sensitivity and low specificity; no significant association was observed between the risk profile and the development of peri-implant diseases.

Traditional Versus Advanced Pulp Capping Materials in Primary Teeth.

In situations where pulp degeneration and carious lesions may coexist, pulp therapy is a regularly employed method. Mineral trioxide aggregate, a material that is now utilized for indirect pulp treatment (IPT), is nontoxic and nonmutagenic. There is proof that the restoration margin can be sealed to manage the caries lesion. In terms of the clinical and radiological outcome, it has been demonstrated that IPT is more effective and secure than direct pulp capping and pulpotomy. The pulp capping treatment's goal is to protect the pulp from microorganisms as well as from thermal, electrical, chemical, and physical stimulation. There is evidence that suggests targeted caries clearance and composite restoration may stop caries lesions more effectively than full dentin removal. Various pulp capping materials that are available in the market were highlighted in this review, and the discussion of each material was expanded to demonstrate its clinical efficacy. Articles were specifically selected and discussed for the materials used for the IPT in the primary teeth as very few studies have been done so far in relation to this subject. A literature search in various libraries, including PubMed, Cochrane, ResearchGate, Scopus, ScienceDirect, and other libraries, was done for several available materials that have been used for the IPT procedure in primary dentition in the last 20 years.

Simulated Hydrostatic Pulpal Pressure Effect on Microleakage-An Initial Study.

This study's purpose was to evaluate the effect of simulated in vitro hydrostatic pulpal pressure (HPP) on microleakage. Extracted third molars (n=12) were sectioned 5 mm below the cementoenamel junction, pulp tissue removed, and the sectioned crowns mounted on a Plexiglas plate penetrated by an 18-gauge stainless steel tube. The mounted specimen mesial surface received a 2×4×6 mm Class V preparation followed by restoration with a strongly acidic, one-step dental adhesive and a flowable microfilled resin, following all manufacturers' instructions. Restorations were finished to contour, and tubing was attached to a 20-cm elevated, 0.2% rhodamine G reservoir to the specimen steel tube for 48 hours. Specimens then received a nail polish coating to within 1 mm of the restoration margins and were placed in 2% methylene blue (MB) dye for 24 hours, followed by rinsing, embedding in epoxy resin, and sectioning into 1 mm slices using a diamond saw. Controls were intact molars (n=12) processed as above but without HPP. Specimen slices were evaluated using laser confocal microscopy with images exported to ImageJ software with microleakage assessed as the MB linear penetration as a percentage of the total interfacial wall length. Mean values were evaluated with the Kruskal Wallis/Dunn test at a 95% confidence level. The control specimens demonstrated significantly greater (p<0.0001) MB penetration than experimental specimens with simulated HPP. Under this study's conditions, simulated HPP significantly decreased MB dye penetration. Studies accomplished without simulated HPP may overestimate microleakage results.

The Evaluation of the Cervical Marginal Sealing of Direct vs. Indirect Composite Resin Restorations in MOD Cavities.

The aim of this in vitro study was to compare the quality of marginal sealing at the cervical margins of indirect and direct composite resin restorations in mesio-occluso-distal (MOD) cavities. MOD preparations were performed on 30 extracted teeth. The mesial cervical margin of each tooth was relocated using a flow composite resin (Enamel Plus HRi Flow, Micerium, Avegno, GE, Italy), then the samples were divided into three groups. In group A, the cavities were directly restored using a nanohybrid composite resin (Miris 2 Coltène Whaledent, Altstaetten, Switzerland) and a universal adhesive (ScotchBond Universal, 3M ESPE, St. Paul, MN, USA) by the etch-and-rinse strategy, for group B, the restoration procedure was similar but the self-etch strategy was used, and the samples in group C were filled using the inlay technique. Each sample was stored for 48 h in a 2% methylene blue solution, then it was cut in a mesio-distal direction using a Struers Secotom 50 device (Cleveland, OH, USA). The marginal sealing and adhesive interface were assessed for each sample at the cervical margin by optical microscopy (OM) and scanning electron microscopy (SEM). One-way ANOVA and Bonferroni post-hoc tests were used with a significance level of 0.05. Significant differences were recorded within groups A and C, between mesial and distal margins (p = 0.02 in group A and p = 0.043 in group C). The marginal sealing is more effective in MOD inlay restoration compared to direct restorations. Relocation of the cervical margin with flow composite resin and the use of different adhesive strategies do not improve the marginal sealing.

Management of Secondary Caries in Primary Molars Using Silver Diamine Fluoride: An In-Vitro Study

Introduction: We aimed to evaluate the effects of 38% silver diamine fluoride (SDF) application on the progression of secondary caries (SC) around resin-based composite (RBC) restoration margins in extracted human primary molars compared to 2.5% fluoride varnish (NaF) with hydroxyapatite and no intervention. Methods: Standardized box-shaped cavities were prepared on 30 primary teeth and restored with RBC restorations. The teeth were thermo-cycled and then immersed in a demineralizing solution for 10 days. The baseline volumes of the demineralized lesions were measured using Micro-CT (first evaluation). Next, the teeth were randomly divided into three equal groups of 10 teeth: the experimental group (38% SDF), the positive control group (2.5% NaF varnish with hydroxyapatite), and the negative control group (no intervention). All teeth were immersed again in the demineralizing solution for 10 days, followed by a second micro-CT evaluation. Results: There was a statistically significant difference in the rate of change of demineralization areas between the three groups (p &lt; 0.001). The SDF group showed the least change in the mean volume of the demineralization area between the baseline and after the second exposure (3.4 ± 0.94 mm3) compared to NaF (4.85 ± 1.97 mm3) and the negative control groups (8.78 ± 2.03 mm3). Conclusion: SDF was effective in managing primary molars with SC around resin-based composite restorations.

Radiographic evaluation of the distance between the restoration margin and the alveolar bone crest in dental implant patients: A retrospective study

ObjectivesThe recently introduced Implant Disease Risk Assessment (IDRA) identifies a restoration margin-alveolar bone crest (RM-AC) distance of less than 1.5 mm as a key risk factor for peri‑implant disease among eight major risk factors. This study evaluated the impact of the RM-AC distance on marginal bone loss (MBL) through radiographic analysis. MethodsThis retrospective cross-sectional study included 77 partially edentulous patients (39 females and 38 males, aged 22 to 76 years) with 202 platform-switched conical connection implants, cement-retained, implant-supported fixed restorations, and bone-level implants placed between 2016 and 2021. Dental implants were followed for least 6 to 36 months at follow up functional loading. Study participants were categorized into Group A (RM-AC distance ≤ 1.5 mm, n = 69) and Group B (RM-AC distance > 1.5 mm, n = 133). Twelve patients in Group B and five patients in Group A had no history of periodontal disease. The MBL was measured radiographically from the most coronal point of the implant shoulder to the alveolar bone, and the RM-AC distance was measured from the restoration margin to the alveolar crest. Multinomial logistic regression analysis was used for statistical evaluation. ResultsThe incidence of MBL in Group A was statistically significant and 3.42 times higher than that in Group B. The rate of MBL in periodontitis Stage 4 was found to be 26.31 times higher than that in periodontitis Stage 2. The incidence of MBL was 6.097 and 5.02 times higher with increasing implant diameter and length, respectively. ConclusionThis study conclusively demonstrates that RM-AC distance ≤ 1.5 significantly increases the risk of MBL, particularly in patients with a history of periodontal disease. Clinical significanceThis study highlights the critical role of maintaining an RM-AC distance greater than 1.5 mm in the prevention of MBL, particularly in patients with a history of periodontal disease. Since implant diameter and length have a significant impact on the risk of MBL, it emphasizes that implant demographics should also be carefully evaluated.

Management of midline diastema using the direct composite resin technique - A case report

Diastema or space between the anterior teeth is a common aesthetic complaint of patients. Direct composite resins in midline diastema cases allow dentists to have complete control in formation of natural smiles. This case report describes midline diastema closure with esthetic composite layering technique. A 25-year-old male patient reported to the clinic, with a complaint of spacing in the upper front tooth region of the jaw. The direct aesthetic composite laminate veneer was considered as the treatment of choice for the build-up of both maxillary central incisors as a more conservative, inexpensive, aesthetic, and quicker option. A2 &amp; A3 shades were selected; prepared tooth surface was etched for 15 seconds using 37% phosphoric acid, rinsed with water for 20 seconds, and air dried with slight air pressure. Bonding agent was applied (Adper single Bond, 3M ESPE, USA) and cured for 20 seconds using (Vivadent Blue phase) curing light. The labial surface of the restoration was flattened using red banded knife-edge tip diamond bur. The natural look of the restored teeth was achieved after finishing and polishing. At six-month and one-year recalls the general outlook of the maxillary anterior teeth was considered natural and aesthetical. Clinically, both restorations have no fractures and also the restoration margins on both maxillary central incisors demonstrated no discolorations. By taking this into consideration and according to the positive results, an experienced dentist with proper case selection, using an appropriate technique and modern materials, can perform highly aesthetic and durable direct composite resin restorations that can satisfy patients as under the conditions of the case presented.

Restoration of Teeth with Severely Compromised Tooth Structure using Digital Planning Combined with Orthodontic Magnetic Extrusion—A Report of 2 Cases

This report outlines 2 digitally planned cases in which the teeth underwent magnetic extrusion to preserve the supracrestal tissue attachment and regain the ferrule, followed by their restoration. Case 1: A 42-year-old man with the chief concern of a fractured right maxillary second premolar. Following the completion of root canal treatment, the remaining tooth structure was insufficient to create a ferrule for tooth restoration. For this scenario, a rapid magnetic extrusion technique was performed on tooth #4 to obtain an approximate 3-mm ferrule. The condition of both the dentition and the restorative margin was acceptable 18 months following treatment. Case 2: A 62-year-old man with the chief complaint of mobility on both sides of the maxillary arch in relation to a tooth-supported fixed partial denture (FPD). Following removal of the FPD, multiple extractions were carried out and tooth #6 was subjected to magnetic extrusion in 3 stages to a maximum of 4 mm to obtain a ferrule. At the 18-month and 3-year follow-up appointments, the tooth had no symptoms and the gingiva around the restorations had optimal architecture and margins. The 3-dimensional digital planning was helpful in precisely positioning the magnets within the tooth and the provisional restorations to facilitate axial extrusion. The extruded teeth were restored with zirconia crowns in both cases. The beneficial outcomes observed from these cases provides evidence that the integration of digital planning and magnetic extrusion holds promise as a method for reconstructing teeth with crowns that are significantly compromised.

The Impact of Implant Abutment Angle and Height on Peri-implant Tissue Health: Retrospective Analyses from a Randomized Controlled Clinical Trial.

To examine the influence of abutment emergence angle and abutment height on marginal peri-implant bone stability in patients not considered susceptible to peri-implantitis. Furthermore, it was analyzed whether titanium-base (Ti-base) abutments lead to wider abutment emergence angles compared to one-piece abutments. A total of 48 abutments (ie, 24 Ti-base and 24 one-piece abutments in 24 patients) were evaluated at abutment installation, after 1 year, and thereafter on a yearly basis for up to 5 years. Clinical and radiographic outcome variables were assessed. With regard to peri-implant marginal bone stability, only moderately negative, albeit significant, correlations were found on the mesial sides of the one-piece abutments after 4 and 5 years for an abutment emergence angle > 30 degrees. No statistically significant negative correlations were found for distances of ≤ 1.5 mm between the restoration margin and the crestal peri-implant bone level for either Ti-base or for one-piece abutments. Furthermore, abutments bonded to Ti-bases were not associated with larger emergence angles than one-piece abutments. For patients at low risk of developing peri-implantitis, it can be concluded that neither a larger abutment emergence angle (> 30 degrees) nor a distance of ≤ 1.5 mm between the restoration margin and the crestal peri-implant bone level are associated with marginal peri-implant bone loss. Furthermore, abutments bonded to Ti-bases are not associated with wider emergence angles than one-piece abutments.

Remineralization potential of apacider gel on enamel and cementum surrounding margin of ceramic restoration.

Modern management of carious lesions has been targeted upon using remineralizing agents. This study investigated the remineralization potential of apacider gel (AG) and casein phosphopeptide-amorphous calcium fluoride phosphate (CA) on enamel and cementum around the cavosurface area of the ceramic margin. Seventy-five extracted human mandibular molars were sectioned at 0.8 mm above and below the cemento-enamel junction (CEJ) to remove the CEJ portions and replaced them with glass ceramic disks by bonding them to the crown and root portions with resin cement. The enamel and cementum area of 4x4 mm2 surrounding ceramic was demineralized with Carbopol-907. The demineralized surfaces were treated with either AG or CA, while one group was left with no treatment (NT) and served as control. Vickers microhardness was determined before-, after demineralization, and after remineralization. The percentage of hardness recovery (%HR), and remineralization potential (%RP) were analyzed with ANOVA and Bonferroni's test (α=0.05). Polarized light microscopy (PLM) was assessed for lesion depth. Scanning electron microscopy (SEM) was investigated for surface alterations. Significant differences in remineralization were found upon various remineralizing agents compared to NT for both enamel and cementum (p<0.05). No significant difference in %HR and %RP was observed between AG and CA (p>0.05). However, AG signified greater decrease in lesion depth and better improvement in surface characteristics for both enamel and cementum than CA. AG possesses comparable remineralization ability to CA. However, decreasing in carious lesion depth was evinced with using AG more than CA. AG was recommended as a potential remineralization material for handling initial caries for both enamel and cementum. Key words:Apacider, artificial carious lesion, CCP-ACFP, remineralizationCare Team.

Staged esthetic crown lengthening: Classification and guidelines for periodontal-restorative therapy.

This article presents technical guidelines for perio-restorative esthetic crown lengthening, along with a discussion of the biologic rationale. A classification system is proposed to assist in treatment planning and sequencing the surgical and restorative phases. When esthetic crown lengthening is performed as an adjunct to restorative therapy, the surgical approach must be determined by the anticipated position of the restorative margins. The removal of sufficient bone to achieve the desired clinical crown length and preserve the supracrestal gingival tissue dimensions is facilitated by the use of a surgical guide fabricated according to the design of the restorations. A staged approach allows sequencing the provisional restoration to minimize unesthetic sequelae during the healing period. Inadequate bone resection and/or alteration of the soft tissue dimensions results in delayed healing, leading to coronal gingival rebound and biologic width impingement. The identification and preservation of appropriate restorative and biologic landmarks is essential for success in pre-prosthetic esthetic crown lengthening treatment. A staged approach improves the esthetic management during the postsurgical healing and maturation period. A restorative driven classification system for sequencing and staging adjunctive esthetic crown lengthening procedures is presented. Technical guidelines to enhance gingival margin predictability are suggested, accompanied by relevant evidence. In addition, wound healing timelines following gingival and osseous resection are provided.

Partial glass-ceramic posterior restorations with margins beyond or above the cemento-enamel junction: An observational retrospective clinical study.

This observational retrospective clinical study aimed to investigate the survival and success rates of partial indirect lithium disilicate restorations with margins extending above or beyond the cementoenamel junction (CEJ). The study included patients who underwent partial indirect lithium disilicate restorations with immediate dentin sealing (IDS) between January 2008 and October 2018. All the restorations were placed in a single general dental practice following a standardized protocol. The impact of various predictive variables on the survival rates was assessed. Moreover, modified United States Public Health Service (USPHS) criteria were used to evaluate the survival quality. Totally 1146 partial indirect lithium disilicate restorations in 260 patients were evaluated over an average period of 7.5 years. The cumulative survival and success rates were 97.3% and 95.3%, respectively. Margins extending beyond the cemento-enamel junction did not increase the risk of success or survival failure (P > 0.05). Patients with a high risk of caries, male sex, or non-vital teeth had a significantly higher risk of restoration failure (P < 0.05). Restorations with longer clinical service times exhibited marginally lower clinical quality (P < 0.001). Partial indirect glass-ceramic restorations demonstrated survival and success rates of 97.3% and 95.3%, respectively, over an extended period. However, a higher risk of restoration failure existed in patients with a high caries risk for (pre)molars that had undergone endodontic treatment and in males. In terms of the risk of success or survival failure, comparable results were obtained for the positions of the restoration margin in relation to the cemento-enamel junction.

A digital protocol for the management of the restorative margin and the emergence profile of vertical prepared teeth.

To describe a digital workflow for the management of the emergence profile and restoration's finishing line on vertical prepared teeth, utilizing a digital data set. The scan of the prepared teeth the day of the preparation, the scan of the provisional restoration placed on the preparation after soft tissue maturation and the scan of the provisional restoration outside of the oral cavity, are combined under a common data set, that can provide all the necessary information in order to design the final restoration. The presented digital technique can facilitate the implementation of the vertical preparation, as the desired finish line can be defined by the clinician and be transferred predictable to the dental lab. Current approach provides also, an alternative gingival management method, taken advantage of the displacement of soft tissue in the appointment of vertical preparation. The positioning of the final finishing line on vertical prepared teeth, the management of the soft tissue and the fabrication of the final restoration, can be facilitated combining digital data sets, that have been obtained during a distinct phase of the treatment.

Inhibition of the Biofilm Formation of Anaerobic Bacteria Involved in Secondary Caries by Dental Adhesive

Secondary caries is a type of carious lesion found at the margins of or next to an existing restoration after the filling has been used for a period of time. It generally arises from the formation of defects or cracks in the filling material after restoration. This can create gaps between the material and the tooth tissue, which will allow bacteria in the biofilm to enter the interface. Dental adhesives are commonly used to provide retention for composite cement or filling materials. A good adhesive should be able to prevent leakage along the restoration margin as well as resist the mechanical load of chewing pressure. Recently, the inclusion of calcium in the adhesive monomer has been produced as Bio-Coat Ca, and its antimicrobial property against some oral bacteria has been studied. No information was found on anaerobes. The aim of this study was to evaluate the antimicrobial potential of dental adhesive on the biofilm formation of anaerobic bacteria involved in secondary caries. An adhesive containing CMET (calcium salt of 4-methacryloxyethyl trimellitic acid) and 10-methacryloyloxydecyl dihydrogen calcium phosphate (MDCP) (Bio-Coat Ca, Sun Medical, Moriyama, Shiga, Japan) was applied to the flat-bottom surface of the saliva-coated 96-well plate. Then it was polymerized with LED light at 460 nm and sterile with UV light. Porphyromonas gingivalis ATCC 33277, Prevotella intermedia ATCC 25611, and Fusobacterium nucleatum ATCC 25586 were prepared as a suspension of approximately 1 × 108 CFU/mL and added to the well. The plate was left for 120 min at 37°C in a shaking incubator (120 r/min) to allow bacterial adhesion. After removing non-adherent cells, Schaedler broth was added and further incubated for 48-72 h to grow the biofilm. The culture medium was changed every 24 h. A biofilm formed on a 96-well plate surface without the adhesive was set up as a control. The amount of vital biofilm was assessed by the WST Microbial Cell Counting Kit (Dojindo Molecular Technologies, USA). All tests were triplicated performed and repeated three times. As a statistical analysis, the Mann-Whitney U test was applied. The results showed that dental adhesive exhibited significant anti-biofilm formation of P. gingivalis and F. nucleatum at a percent inhibition of 56% and 46%, respectively. On the other hand, no significant effect was found on P. intermedia. This was similar to our previous report on bacteria associated with primary caries, which revealed that the anti-biofilm effect of Bio-Coat Ca adhesive on Streptococcus mutans was 65% while no significant suppressive action was observed Lactobacillus casei and Actinomyces viscosus. The inhibitory effect of the adhesive was proposed to be the acidic characteristic of the monomers. This newly developed adhesive could be a promising material for the prevention of secondary caries. However, this study was done on the single-species biofilm formation in vitro and conducted in a short time. Long-term clinical studies are needed to evaluate the effect on the patients.

Effect of Three Different Liquid Medias in the Sorption and Solubility of Luting Cements: An In Vitro Study.

Background Among the various mechanical and biological properties of luting cement, the most important are its resistance to disintegration, degradation, and stability in the oral cavity. The sorption and solubility of cement alter the mechanical properties by impeding the half-life of the filling. It also leads to variations in dimensions, discoloration, and margin breakage. It is, therefore, essential to choose a low-solubility cement since there is always an interaction between teeth and restorative margins. The aim of this study is to assess and compare the solubility and sorption values of three different luting cements in three liquid media. Materials and methods Three luting cements were used for the investigation. Disc-shaped specimens of the cement, which were of 10 mm diameter and 2 mm height, were prepared. The sample included a total of 126 disc-shaped specimens made up of three materials,glass ionomer cement (GIC), resin cement, and resin-modified GIC, which were used in three liquid media (14 of each material in each medium). Fourteen specimens of each material were placed in glass vials containing 20 ml of each medium: distilled water, artificial saliva, and carbonated water. The samples were then put in an incubator at 37 °C. The measurements and masses of the samples were documented on days one, three, seven, 14, 21, 28, and 35. The samples were taken out of the solution after five weeks and stored in a desiccator with calcium sulphate for another five weeks. The weight and dimensional changes were estimated on days one, three, seven, 14, 21, 28, and 35. The values of water sorption (WSO) and solubility (WSL) were estimated. To determine the mean and standard deviation of each cohort, descriptive statistics were employed. Utilizing the Shapiro-Wilkinson test, the normality was determined. An independent test was used to determine the difference between all pairs of groups, while one-way ANOVA, Dunn test, and post hoc analysis were used to establish the distinction between the three groups. Results One-way ANOVA showed that significant differences existed among the groups: resin cement showed the least sorption and solubility, resin-modified GIC showed the highest solubility in distilled water (0.40 ± 0.03), and GIC showed the highest solubility in both artificial saliva (0.36 ± 0.03) and carbonated water (0.04 ± 0.05). Conclusion Considering the experimental outcomes and the limitations of an in vitro investigation, it was concluded that in the complex setting of the oral environment, this selection procedure is crucial for maintaining mechanical strength and for the long lifespan of dental restorations.

Adaptability of thermo-viscous versus sonicfill-activated bulk fill composite resin restorations

Purpose To in vitro evaluate the marginal and internal adaptation of Thermo-Viscous versus SonicFill Bulk Fill composite in Class I cavities. Materials and methods Twenty non-carious human maxillary premolar teeth were selected. Class I cavities were prepared with dimensions of 4 mm mesio-distal, 2.5 mm bucco-lingual width and 2 mm depth. Specimens were randomly divided into two equal groups I and II. Cavities were restored with VisCalor and SonicFill Bulk Fill, respectively. Materials were applied using the recommended adhesive and special dispenser. Specimens were then subjected to 500 thermal cycles, labelled and the restoration margins were inspected under stereomicroscope at X70 to detect and measure the marginal gap width. Specimen were then sectioned buccolingually using a microtome to detect and measure the internal gap width. Results Lower mean values of marginal gap width were recorded in VisCalor group compared to SonicFill group, however there was no statistically significant difference (P = 0.187) between both groups. While a significant difference (P = 0.002) was found regarding internal mean gap width values recorded in VisCalor group compared to SonicFill group. Conclusion Both tested materials/techniques used to reduce the viscosity of the bulk fill composites presented nearly comparable marginal integrity results, while VisCalor application technique enhanced the internal adaptation compared to SonicFill method.

Evaluation of the adjunctive use of Er:YAG laser or erythritol powder air-polishing in the treatment of peri-implant mucositis: A randomized clinical trial.

To assess the efficacy of Er:YAG laser (ERL) and erythritol powder air-polishing (AP) in addition to the submarginal instrumentation in the non-surgical treatment of peri-implant mucositis (PM). Patients with at least one implant diagnosed with PM were included in the present 6-month randomized clinical trial (RCT). Implants were randomly assigned to one of the three treatment groups after submarginal instrumentation: AP (test 1 group), ERL (test 2 group) or no adjunctive methods (control group). The primary and secondary outcomes were, respectively, bleeding on probing (BoP) reduction and, complete disease resolution (total absence of BoP) and probing pocket depth (PPD) changes. The patient and the implant were considered the statistical unit. A multivariate logistic regression analysis was performed. A total of 75 patients were enrolled in the study. At each time point, significant BoP and PPD reductions were observed within each group. Intergroup analysis did not show statistically significant differences. Complete disease resolution ranged between 29% and 31%. The logistic regression showed that supramucosal restoration margin, PPD < 4 mm and vestibular keratinized mucosa (KM) significantly influenced the probability to obtain treatment success. The adjunctive use of AP and ERL in PM non-surgical therapy does not seem to provide any significant or clinically relevant benefit in terms of BoP and PPD reductions and complete disease resolution, over the use of submarginal instrumentation alone. Baseline PPD < 4 mm, presence of buccal KM and supramucosal restoration margin may play a role in the complete resolution of PM.

Exploring the Biological Width in Dentistry: A Comprehensive Narrative Review.

Biological width (BW) is the distance established from the junctional epithelium and connective tissue attachment to the root surface of a tooth. It acts as a natural seal protecting the tooth from infections and diseases. The normal dimension of it is 2.04 mm on average. A periodontal probe is used to determine BW in routine clinical practice. Various methods are available for the determination of BW. A diagnosis of BW violation is asserted when the distance is found to be less than 2 mm at single or multiple locations. Gingival health is of utmost importance when considering the long-term health of the tooth as well as any restoration. A plethora of BW violations can lead to a myriad of complications, which are discussed briefly in this article. The article also aims to highlight BW in relation to restorative margins and implantsand its clinical assessment as well as shed light on the procedure that can be employed to correct BW violations in dental practice.

The role of interface distance and underlying substrate on the color adjustment potential of single-shade composites.

This study assessed how the distance from the composite interface and the underlying chromatic substrate affect the color adjustment potential (CAP) of two single-shade composites. Cylinder-shaped specimens were created using Vittra APS Unique (VU), Charisma Diamond One (DO), and a shaded (A3) composite. Some single-shade specimens were surrounded by the A3 composite, forming dual specimens. Color measurements of simple specimens were taken against a gray background using a spectrophotometer. All specimens were positioned at a 45° angle in a viewing booth under illuminant D65, and images were captured with a DSLR camera against gray or A3 backgrounds. Image colors were measured using image processing software and converted to CIELAB coordinates. Color differences (ΔE00 ) between the single-shade composites and the A3 composite were calculated. CAP was determined by comparing data from simple and dual specimens. No clinically significant differences were observed between color measurements obtained from images and the spectrophotometer. CAP was higher for DO compared to VU and increased as the distance from the composite interface decreased and when specimens were positioned against an A3 background. The color adjustment potential increased with decreased distance from the composite interface and against a chromatic background. Achieving satisfactory color match in restorations using single-shade composites is crucial, and selecting an appropriate underlying substrate is essential. The color adjustment gradually decreases from the restoration margins towards its center.

Comparative Effect of No Finish Line, Heavy Chamfer, and Shoulder Marginal Designs on the Fracture Resistance of Zirconia (Cercon) Ceramic Restoration: An In Vitro Study.

Background Because all-ceramic crowns are more aesthetic and biocompatible than metal-ceramic crowns, they have grown in popularity among patients and dentists. Poor finish line layout can result in restoration margin fracturing, hence, finish line arrangement is critical to maintaining the restoration's marginal integrity. The goal of this in-vitro study is to evaluate zirconia's resistance to fracture (Cercon) ceramic restorations with three marginal designs (no finish line, heavy chamfer, and shoulder). This study is important in contributing to the ongoing debate about the optimal finish line design for zirconia restorations. Methodology Three different finish lines, namely, biologically oriented preparation technique (BOPT) with a marginal width of less than 0.3 mm, heavy chamfer with a marginal width of up to 0.3 mm, and shoulder with a marginal width greater than 0.3 mm, were made on 10 extracted maxillary first premolar tooth to make 30 epoxy resin dies on which zirconia (Cercon) coping was done using CAD/CAM technology, and marginal discrepancies were measured using a three-dimensional scanner. All the copings were affixed to their respective dies using GIC luting cement, and fracture resistance was measured using a digital universal testing machine. Results The Kruskal-Wallis test revealed that the mean fracture resistance was more in the heavy chamfer finish line, followed by the no finish line (BOPT) and the shoulder finish line. No statistically significant difference was seen between the no finish line and the heavy chamfer finish line. There was a significant difference between the heavy chamfer and shoulder finish lines (p = 0.004). Conclusions To increase the biomechanical performance of posterior single zirconia restorations, heavy chamfer margins are indicated.