Restorative Protocols Research Articles

Fracture Resistance and Failure Mode of Polyethylene Fiber-reinforced Resin-based Restorations in Structurally Compromised Premolars: an in Vitro Study.

To evaluate the effect of polyethylene fiber-reinforcement on the fracture resistance and fracture mode of extensive resin-based composite (RBC) restorations in structurally compromised maxillary premolars. Maxillary premolars (54) with specific dimensions and extracted for orthodontic reasons were used. Following mesio-occluso-distal (MOD) cavity preparation and endodontic access, teeth were randomly assigned to one of three restorative protocols (n=18): RBC applied incrementally (I) or reinforced with woven polyethylene fibers (Ribbond) placed horizontally (H) or U-shaped (U). Restored teeth were stored for 45 days in distilled water at 37°C and then loaded monotonically until fracture. Half of the specimens in each group received axial loading (A) and the other half was loaded paraxially (PA). Fracture load data was assessed using two-way analysis of variance and Tukey's post hoc test for multiple comparisons (α=0.05). The fracture initiation and propagation path were analyzed using stereomicroscopy and scanning-electron microscopy. No significant differences were observed for the fracture strength among loading configurations, except for groups IA (825 N) and HA (553 N). Fracture initiated and propagated mainly at and through the RBC restoration in the I group, whereas a shift to the interface was observed in both polyethylene fiber-reinforced groups. Blocking and bridging of cracks were identified around the fibers, especially in specimens of group U. Incorporation of woven polyethylene fibers to reinforce extensive MOD resin-based composite restorations on endodontically treated premolars reduced the occurrence of cohesive fractures in the restorative material but was unable to increase the fracture resistance of the affected teeth.

Adhesion and sealing of different universal adhesive systems associated with bulk-fill resins after using endodontic irrigation solutions: An invitro study.

This study aimed to evaluate the interface of universal adhesive (UA) with bulk-fill resin (BF) and dentin, after endodontic irrigation. The pulp chamber of 96 molars was irrigated with chlorhexidine 2% (CHX) or sodium hypochlorite 5.25% (NaOCl) and restored according to three restorative protocols. Microtensile bond strength (μTBS) and nanoleakage tests were performed after 24 h of thermocycling. Kruskal Wallis, Mann-Whitney and Wilcoxon were performed (p < 0.05). Comparing restorative systems, a difference was found only when irrigated with CHX after 24 h. CHX provided higher μTBS than NaOCl after 24 h for two restorative protocols; after thermocycling, NaOCl provided the greatest μTBS than CHX for one group. Decreased μTBS was observed for all restorative systems when CHX was used after thermocycling. NaOCl demonstrated the highest nanoleakage. The composition of UA influenced the immediate adhesion and sealing to BF when CHX was used; ageing has a deteriorating effect on adhesion and sealing for all restorative systems.

Effect of Two Different Deproteinizing Agents on Microtensile Bond Strength between Resin Composite and Deep Dentin using Two Restorative Protocols. An In-Vitro Study

Effect of Two Different Deproteinizing Agents on Microtensile Bond Strength between Resin Composite and Deep Dentin using Two Restorative Protocols. An In-Vitro Study

Clinical Comparison of Three Indirect Pulp Capping Restorative Protocols: A Randomized Controlled Prospective Study.

The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period. Deep carious lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits. There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner. After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.

Fracture resistance and bonding performance after antioxidants pre-treatment in non-vital and bleached teeth.

This study aimed to evaluate the effect of antioxidant solutions on fracture strength and bonding performance in non-vital and bleached (38% hydrogen peroxide) teeth. One hundred and eighty dentin specimens were obtained, 60 for each test: fracture strength, hybrid layer thickness, and bond strength. The groups (n=10) were randomly composed according to post-bleaching protocol: REST - restoration, without bleaching; BL - bleaching + restoration; SA - bleaching, 10% sodium ascorbate solution, and restoration; AT - bleaching, 10% α-tocopherol solution, and restoration; CRAN - bleaching, 5% cranberry solution, and restoration; CAP - bleaching, 0.0025% capsaicin solution, and restoration. Data were analyzed with ANOVA, Kruskal-Wallis, Dunn, and Qui-Square tests (α=0.05). The highest fracture strength values were observed in REST (1508.96 ±148.15 N), without significant difference for the bleached groups (p>0.05), regardless of the antioxidant use. The hybrid layer thickness in the group that was not subjected to bleaching (REST) was significantly higher than in any other group. The bond strength in the bleached and antioxidants-treated groups (SA, AT, CRAN, CAP) has no differences with the bleached group without antioxidants (BL). Adhesive failures were predominant in the groups that did not receive the antioxidant application. In conclusion, the evaluated antioxidants did not show an effect on the fracture strength, hybrid layer thickness, or bond strength of dentin bleached after endodontic treatment. The application of 10% sodium ascorbate, 10% alpha-tocopherol, 5% cranberry, or 0.0025% capsaicin solutions is not an effective step and should not be considered for the restorative protocols after non-vital bleaching.

Current state about root coverage using soft-tissue substitutes in the presence of noncarious cervical lesions: A literature review.

About half of the cases of gingival recession are associated with the noncarious cervical lesion (NCCL), resulting in combined defects (CDs). NCCL negatively affects the root coverage outcomes. In addition, considering the morbidity associated with graft harvesting, soft-tissue substitutes (STSs) appeared as a suitable option for connective tissue grafts for surgical root coverage. Currently, the literature addressing the therapy of CDs employing STSs is scarce. Thus, the present review aimed to update the literature and outline the future perspectives about root coverage of CDs using STSs. A detailed literature search was conducted on MEDLINE, Web of Science, EMBASE, LILACS, Scopus, and Google Scholar databases using keywords and Boolean operators. Randomized clinical trials (2) and case reports (6) were included. None of the selected studies reported any adverse effect using STSs. Based on the limited evidence available, we cannot state that STSs may benefit the periodontal clinical and patient-centered outcomes. Randomized controlled trials are needed to assess the long-term outcomes, surgical approaches, and restorative protocols.

Fracture resistance of root canal-treated molars restored with ceramic overlays with/without different resin composite base materials:an in vitro study.

The objective of the study was to evaluate the effect of different restorative protocols on fracture resistance of root canal-treated molars. 48 mandibular first molars were used and divided into six groups (n = 8); G1 (negative control): teeth kept intact. G2 (positive control): teeth had root canal treatment and standard MOD cavity preparations but kept unrestored. G3: prepared as G2 and directly restored with VitaEnamic ceramic overlays (CO). G4: as G3, but the pulp chamber was restored first with smart dental restorative (SureFil SDR flow = SDR) bulk-fill flowable composite base. G5: as G3, but the pulp chamber was restored first with SonicFill (SF) bulk-fill composite base. G6: as G3, but the pulp chamber was restored first with a fiber-reinforced composite (FRC) base. All samples were subjected to thermocycling between 5°C and 55°C in a water bath for a total of 2000 cycles with 10s dwell time. Then specimens were individually mounted on a computer-controlled testing machine with a load cell of 5kN, and the maximum load to produce fracture (N) was recorded. Data were analyzed using one-way ANOVA followed by Tukey's post hoc test (P = 0.05). There was a significant difference between the groups (P < 0.001). Teeth restored with FRC and ceramic overlays had the highest load-bearing capacity. Pulp chamber restoration with either FRC or SDR before ceramic overlay fabrication provided significantly better tooth reinforcement than ceramic overlay alone (P < 0.001). Fracture modes were analyzed to determine the type of fracture as repairable or catastrophic, where FRC + CO and SDR + CO groups had favorable fracture modes that were mostly repairable. When restoring root canal-treated molars with overlays, the pulp chamber should be sealed with either FRC or SDR to ensure the best possible fracture resistance. The clinical relevance of the study is that a new simple restorative protocol is presented to enhance the survival of root canal-treated molars using ceramic overlays.

Primary and Secondary Stability of Extrashort (4-mm) Implants in the Edentulous Mandible: Preliminary Results of a Prospective Clinical Trial

To compare the primary and secondary stability of conventional (≥ 8-mm) and extrashort (4-mm) implants in edentulous patients using different methods of assessment. Patients underwent implant surgery and were randomly allocated into two groups: test, with two conventional implants in the anterior region and two extrashort (4-mm) implants in the posterior region; and control, with two conventional (≥ 8-mm) implants in the anterior region only. Primary stability (S1-implant placement) was assessed by insertion torque, implant stability quotient (ISQ, Osstell), and damping capacity (PTV, Periotest), while secondary stability (S221-21 days after S1; and S2clip-at prosthetic loading, ± 3 months after S1) was evaluated by ISQ and PTV. The statistical significance level was set at P < .05. Fifty conventional implants and 24 extrashort implants were placed in 25 patients. The overall survival rate was 97.3%. There was no statistically significant difference between the insertion torque of conventional and extrashort implants (P > .05). PTV values were significantly lower for conventional implants only at S2clip (P = .041). ISQ values were significantly greater for conventional implants at S1 (P = .004), whereas at S221 and S2clip, no differences were found (P = .413 and P = .490, respectively). Damping capacity showed no significant differences between S1-S2M21 and S1-S2clip. ISQ values showed a significant increase of stability between S1-S2clip, for conventional (P = .022) and extrashort (P = .005) implants, which was different from that observed between S1-S221. There was a moderate negative correlation between the PTV and ISQ variables (r = 0.5) of extrashort implants, and between the PTV and insertion torque (r = -0.3) of conventional implants. For extrashort implants, there was a null correlation between ISQ and torque (r = 0.0). There was a moderately positive correlation between ISQ and torque (r = 0.3) in the conventional implant group. The results suggest that extrashort and conventional implants present similar primary and secondary stability values and may similarly influence restorative protocols.

Influence of Nanocoats on the Physicomechanical Properties and Microleakage of Bulk-fill and Resin-modified Glass Ionomer Cements: An In Vitro Study

To analyze the impact of two nanocoating materials, EQUIA Forte nanocoat and universal adhesive, on flexural strength, color changes, surface roughness, and microleakage of bulk-fill and resin-modified glass ionomer cements (RM-GICs). A total of 45 specimens were prepared for each group, bulk-fill (EQUIA Forte Fil) and RM-GI (Fuji II LC) cements, according to manufacturer's instructions for flexural strength, color change, and surface roughness tests. Each group was equally subdivided into three subgroups according to coating materials used; either without a coat (negative control) or covered with EQUIA Forte coat or universal adhesive. For the flexural strength test, 15 bar-shaped specimens were prepared using a rectangular-split Teflon mold (25 × 2 × 2 mm), then the test was conducted using a universal testing machine. Thirty disk-shaped specimens were prepared for color change and surface roughness tests using cylindrical-split Teflon mold (10 mm diameter and 2 mm height). The color change was measured using a spectrophotometer after immersion in tea infusion for seven days at room temperature. Surface roughness was examined using a profilometer after exposure to 2400 brushing cycles. Moreover, a microleakage test was conducted in 30 teeth restored with the same restorative protocols and evaluated using a stereomicroscope. Finally, the data were statistically analyzed. EQUIA Forte nanocoat subgroups exhibited the highest flexural strength in both tested GICs compared to other subgroups (91.07 ± 7.12 MPa for RM-GIC and 51.61 ± 4.42 MPa for bulk-fill GIC). For the color change, the lowest ΔE values for bulk-fill and RM-GICs were recorded in EQUIA Forte nanocoat subgroups (2.37 ± 0.25 and 2.97 ± 0.39, respectively) with no significant difference between both groups. The surface roughness of both GICs was significantly decreased in the coated subgroups either with EQUIA Forte coat or universal adhesive, with no significant difference between both coating agents. Also, microleakage was significantly decreased in the coated subgroups with no significant difference between the coating materials. Nanocoats, especially the EQUIA Forte nanocoat, positively impact the physicomechanical properties and adaptation of bulk-fill GICs and RM-GICs. The application of nanocoats on GI restorations is highly recommended.

Influence of dental crown topography on fracture resistance of premolars with MOD preparation and subjected to different restorative protocols.

To evaluate whether dental crown topography influences the fracture resistance of premolars treated endodontically and with MOD preparation subjected to different restorative protocols. Sixty-four human premolars with one or two roots in equal numerical proportions (n) were selected and randomly divided into four groups (n = 8): (S = single-rooted; D = double-rooted) SS: sound single-rooted; SNR: endodontics (E) + MOD cavity preparation; SR: E + MOD + resin restoration (RS); SP: E + MOD + RS + horizontal zirconia post (ZP); DS: sound double-rooted; DNR: E + MOD; DR: E + MOD + RS; and DP: E + MOD + RS + ZP. After allocation to the groups, the samples were thermocycled and then subjected to the fracture resistance test. Failures after the fracture test were classified as irreparable (with pulp floor fracture) or reparable (without pulp floor fracture). Data were analysed using one-way anova and the Tukey test (α = 0.05). Single-rooted premolars were more resistant to fracture than double-rooted premolars. The restorative treatment using a horizontally transfixed zirconia post improved fracture resistance, resembling that of a healthy tooth.

Ayurvedic paradigm for COVID-19 prophylaxis and management strategies: Perspective and evidence-based review

The prophylactic and therapeutic potential of traditional systems of medicine like Ayurveda has not being explored to its maximum in the search for effective solution of COVID-19 crisis. The present work is an attempt to strategize the strength of Ayurveda in the prophylaxis and management of COVID-19 as a standalone system or integrated with conventional medicine. The restorative protocols for COVID-19 may be planned on the line of management principles described for infectious diseases, epidemics, fever and respiratory ailments in Ayurveda with single herb and formulations having proven immunomodulatory & anti-viral properties. The way forward is to adopt integrative approach by taking leads from Ayurveda and incorporating it into the action strategy to fight this pandemic.

In Vitro Comparison of Porcelain Fused to Metal Crown Retention after Endodontic Access and Subsequent Restoration: Composite, Amalgam, Amalgam with Composite Veneer, and Fiber Post with Composite

IntroductionThe aim of this study was to evaluate the effect of different access opening restorative materials on crown retention. MethodsThirty-eight extracted molars were mounted in resin and prepared for porcelain fused to metal (PFM) crowns. The crowns were fabricated and cemented with zinc phosphate, and the force to displace it was measured with a tensile-testing machine before and after endodontic access preparations. The endodontic access area, crown preparation axial wall, and preparation surface area were measured for comparison. The crowns were then recemented, and access openings were restored with either amalgam or composite before displacement force was remeasured. The restorative material was removed from each access opening; access area was measured and restored again (amalgam with composite or fiber post with composite) for displacement force to be remeasured. Paired t test was used to compare the means of displacement between groups. One-way analysis of variance was used to compare the mean outcome measure within the groups. ResultsStatistical analyses showed retention after unfilled access was significantly lower than intact crowns. Amalgam, composite, amalgam + composite, and fiber post + composite increased retention beyond the original value. There was no statistical difference among the different restorative protocols. Qualitative results indicate that the restorative material remains in the crown after displacement regardless of the material used to restore the access. ConclusionsThe results from this study suggest that an endodontic access cavity decreases retention of a PFM crown. However, subsequent restoration with amalgam, composite, amalgam + composite, or post + composite may increase the original retention of the crown.

Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial.

This randomized clinical trial evaluated the survival of direct restorations on first permanent molars (FPMs) with molar incisor hypomineralization (MIH) and its impact on self-reported dental pain and dental anxiety. FPMs with MIH of 35 patients aged 7 to 16years were included. The FPMs were randomized into the following two groups: total-etch (TE-37% phosphoric acid etching) and self-etch (SE-no prior etching). The FPMs were restored with universal adhesive and bulk-fill resin composites. The restoration survival was evaluated according to USPHS criteria modified by a blinded examiner. Dental anxiety (Venham picture test) and dental pain (Faces pain scale-revised) were evaluated before treatment and at 1, 6, and 12months post-treatment. Survival rates were analyzed by the Kaplan-Meier method and the log-rank test. Nonparametric tests compared pain and anxiety in the follow-up periods. A total of 64 FPMs were restored (TE = 33; SE = 31). Survival rates were 96.9% (TE) and 96.7% (SE) after 1month, 90.5% (TE) and 80.6% (SE) after 6months, and 80.8% (TE) and 62.3% (SE) after 12months (p > 0.05). Self-reported dental pain and anxiety level decreased after treatment in both groups (p < 0.05). Self-reported pain decreased after 1month in SE, but it occurred at 6months in TE. Both restorative protocols presented similar longevity, decreasing self-reported pain and anxiety levels. A universal adhesive could be appropriate for restoration of MIH-affected teeth, and the survival of restorations could be higher in the total-etch technique, reducing dental pain and anxiety.

Fracture Resistance of Immature Teeth Submitted to Different Endodontic Procedures and Restorative Protocols

IntroductionThe purpose of this in vitro study was to determine whether the methods used to treat endodontically and restore anterior immature teeth with a necrotic pulp influence their resistance to fracture. MethodsAfter access opening and cleaning and shaping, 80 specimen teeth were assigned into 5 groups according to the endodontic obturation method and coronal restoration as follows: A1, apexification with a composite restoration in the crown area; A2, apexification with a composite restoration in the crown and 3 mm into the root; IR, immediate revascularization with a composite restoration in the crown area; SR, successful revascularization with a composite in the crown area; and the control group, a mature tooth treated with gutta-percha and sealer with a composite restoration in the crown area. The teeth were mounted in acrylic blocks and brought to fracture under compressive forces in a universal testing machine. Both the fracture strength and the location where the fracture occurred were recorded. ResultsThere were no statistically significant differences in the fracture resistance among the 5 groups (1-way analysis of variance, F4 = .545, P = .703). No statistically significant differences were found in the location where the fracture occurred either (χ24 = 4.1, P = .391). ConclusionsWithin the limitations of this in vitro study, it can be concluded that the treatment options used to treat nonvital immature teeth provided the same resistance to fracture.

Cavity treatment in primary molars and malocclusion: quasi-randomised clinical trial.

BackgroundAn innovative caries treatment protocol for primary teeth, termed Ultra-Conservative Treatment (UCT), restores small cavities through the Atraumatic Restorative Treatment (ART) protocol and cleans medium to large open cavities with toothbrush and fluoride toothpaste. However, UCT-treated primary molars were found to exfoliate earlier than amalgam (CRT) and ART-restored cavities, which may lead to unacceptable loss of space for normal eruption of permanent successors. The null-hypothesis tested was that there is no difference between the three treatment protocols and the intra-arch distances, and index of orthodontic treatment need (IOTN) after 4 years.MethodsDental casts were taken at baseline (T0) and four (T4) years. The space of the premolars (D + E space), arch perimeter, anterior and total arch depth were measured using a morphometric computer programme. The presence and level of malocclusion were assessed according to the IOTN index. Dependent variables were all intra-arch distances and the IOTN while the independent variable was treatment protocol (CRT, ART and UCT). Data were analysed using linear and logistic regression.ResultsThe sample consisted of 867 pairs of casts of 272 initial 6–7-year-olds. No difference was observed between the UCT protocol and the two restorative protocols for the intra-arch variables in both maxilla and mandible over the 4 year period. There was no difference between the UCT and the CRT and ART protocols regarding the occurrence of orthodontic treatment need (malocclusion). In conclusion, the UCT treatment protocol does not differ significantly from the traditional amalgam (CRT) and ART restorative protocols with respect to intra-arch distances and malocclusion. The earlier exfoliation of UCT-treated primary molars does not lead to a worsening of the eruption pattern of permanent successors.

In vitro corrosion studies of stainless-steel dental substrates during Porphyromonas gingivalis biofilm growth in artificial saliva solutions: providing insights into the role of resident oral bacterium.

Stainless-steel AISI 321 is an effective material for fabricating dental crowns and other implants utilized dental restorative protocols for elderly and pediatric populations. This unique clinical application is possible through the mechanical stability and corrosion-resistance properties of this metallic material. However, stainless-steel dental implants eventually fail, leading to the creation of surface cavities and cracks within their microstructures during persistent mechanical stresses and biocorrosion. In this study, the in vitro corrosion behaviour of a medical-grade stainless-steel dental substrate was investigated during Porphyromonas gingivalis biofilm growth process in artificial saliva culture suspension (ASCS). Among the causative bioagents of corrosion, P. gingivalis was chosen for this study since it is also responsible for oral periodontitis and a major contributing factor to corrosion in most dental implants. Increased P. gingivalis growth was observed within the incubation period under study as compact cellular clusters fouled the metal surfaces in ASCS media. This led to the corrosion of steel substrates after bacterial growth maturity within 90 days. Corrosion rate increased with higher CFU and bacterial incubation period for all test substrates due to biocorrosion incited by the volatile sulphide products of P. gingivalis metabolism. The presence of some of these volatile compounds has been observed from experimental evidences. Significant anodic degradation in the forms of localized pitting were also recorded by surface analytical techniques. Residual fluorinated ions within the ASCS media also increased the rate of anodic dissolution due to media acidity. This study has provided extensive insights into the fate of stainless-steel dental crown in oral environments infected by a resident oral bacterium. Influences of oral conditions similar to fluoride-enriched mouthwashes were reflected in a view to understanding the corrosion patterns of stainless-steel dental substrates.

EFFECTS OF MUSCLE ALTERATIONS AND REHABILITATION ON MOBILITY IN CHRONIC CONDITIONS OF AGING

Age-related changes in muscle morphology and composition are associated with the development of mobility impairments, an increased risk for institutionalization, and mortality. While primary aging may account for some of these changes, the presence of aging related co-morbid conditions such as frailty, stroke, diabetes, and Parkinson’s disease is associated with muscle fiber atrophy, increased intramuscular fat, changes in muscle fiber distribution, and vascular dysfunction that occurs in both large and small vessels. These changes ultimately result in impaired substrate delivery to the muscle, reduced capacity for muscle regeneration, and anabolic resistance leading to declines in balance, strength, and endurance. It is important to understand the biological underpinnings of the changes in muscle following each of these conditions to develop effective preventive measures and maximize restorative rehabilitation protocols. This session will discuss the changes in muscle from the fiber level (i.e., changes in innervation and muscle fiber type proportion) to the systemic level (i.e., changes in specific postural and locomotor muscles), and their relationship to mobility, balance, and function. We will describe techniques (i.e., imaging, EMG, and muscle biopsies) used to assess muscle changes and their applicability in rehabilitation research. Further, we will discuss clinical recommendations for exercise to preserve and enhance skeletal muscle in the aging adult.

Conservative and endodontic treatment performed under general anesthesia: A discussion of protocols and outcomes.

This work discusses the procedures and outcomes of restorative and endodontic treatments performed under general anesthesia, with examples from the Unit of Special Care Dentistry at the University Hospital of Clermont-Ferrand. The restorative and endodontic treatment techniques used in the Special Care Unit are described. These techniques are compared to existing reports in the literature of treatment procedures under general anesthesia. Little evidence was found in the literature regarding sealants or restorative protocols. A few studies described root canal treatment and pulpotomy protocols carried out under general anesthesia, and the results of these met academic outcome standards. Patients with equal needs should have equal access, equal quality of treatment and equal treatment outcomes, regardless of whether a facilitatory procedure is used to achieve treatment. The provision of restorative treatment under general anesthesia is essential to avoid an excessive number of extractions in patients unable to receive treatment in the chair. Restorative care provided under general anesthesia should be standardized and evaluated in the same way as treatment performed under local anesthesia. In this way, the provision of conservative dental care under general anesthesia could be promoted and the maintenance of a functional dentition encouraged.

A 2-year clinical evaluation of direct and semi-direct resin composite restorations in non-carious cervical lesions: a randomized clinical study.

The purpose of this study was to evaluate the 2-year success of resin composite restorations in non-carious cervical lesions (NCCLs) using the direct or semi-direct techniques. Thirty volunteers presenting with at least two NCCLs were included. Each participant received one restoration using the direct technique and the other using the semi-direct technique, totaling 60 restorations. Time for completing the treatment was computed. Assessments at baseline, 7days, and 6, 12, and 24months were performed using the modified United States Public Health Service criteria. Descriptive analysis was reported as a percentage of successful treatments. For inferential analysis, the Student t test was used to evaluate the differences between extension, depth, and time. The chi-square/Fisher tests were used to compare treatment success after each period (α = 0.05). The results were evaluated by using the Kaplan-Meier survival analysis. Differences were detected regarding mean ± standard deviation time, in which direct and semi-direct procedures were accomplished in 21.8 (± 14.5) and 35.3 (± 19.9) min, respectively. Of the 60 restorations placed, 7 failed in the direct group while 8 failed in the semi-direct group up to 2years. No differences were detected between restorative protocols. The cumulative survival was 88.5% and 88.4% for the direct technique and semi-direct techniques after 24months, respectively. The tested restorative protocols present similar results for NCCLs within the studied periods. The semi-direct technique exhibited clinical performance similar to direct technique for NCCL, demonstrating an alternative for restorations of these lesions.

Minimally Invasive Direct Restoration of Worn Teeth: A Simplified Technique

Historically, patients presenting with tooth wear were commonly managed with partial or full coverage cement-retained indirect restorations according to traditional restorative protocols. Conventional rehabilitations are biologically and financially expensive, time consuming and rely heavily on precise laboratory collaboration. Recent advances in adhesive technology and materials have enabled direct composite resin to be used as a minimally invasive alternative in the management of non-carious tooth tissue loss. As extensive direct composite restorations remain technique sensitive and can be time-consuming, this paper describes an innovative, simplified placement technique that uses a progressive diagnostic wax-up, transparent silicone templates and heated composite resin. CPD/Clinical Relevance: The predictable, conservative method of full mouth rehabilitation described in this article is cost-effective and time efficient and can deliver an excellent aesthetic outcome.