Restorative Techniques Research Articles

Employing innovation to enhance the safety and reliability of restorative surgical techniques for patients with familial adenomatous polyposis at a national referral centre

Employing innovation to enhance the safety and reliability of restorative surgical techniques for patients with familial adenomatous polyposis at a national referral centre

Design and Development of Infiltration Resins: From Based Monomer Structure to Resin Properties.

The resin infiltration technology concept is one of the most widely used minimally invasive restorative techniques in restorative dentistry with the most outstanding therapeutic effect, and it is also one of the key research directions in restorative dentistry. "Infiltration resin" is the specialty restorative material for the technology, which is the key factor to success. The specialized restorative material is commonly known as "infiltrant/infiltration resins" "resins infiltrant" "infiltrant" or "resins," which will be consistently referred to as "infiltration resins" throughout the article.-The paper aims to provide a comprehensive overview of infiltration resins by introducing the development of their therapeutic mechanisms, basic components, current challenges, and future trends, Based on existing literature, we analyze and compare how changes in the base monomer's structure and ratio affect the effectiveness of infiltration resins, from the material's structure-effective relationship. After compiling the information, the existing solution strategies have been listed to offer substantial support and guidance for future research endeavors.

Evolution of the Guided Direct Composite Resin Technique in Restorative Dentistry: A Systematic Review.

This systematic review aims to understand the limitations and benefits of the guided direct restorative technique, to optimize the final outcomes, considering the evolution from analog to digital, including planning, the diversification of guides, and the different resins employed. A search was conducted in the electronic databases PubMed, Cochrane, and through manual searches, initiated in May 2023 and updated in April 2024. The following search strategy was used: ((injectable composite resin) OR (direct pressed composite)) OR (3D-guided), utilizing the PICO framework. Initially, 739 articles were retrieved. After applying inclusion and exclusion criteria, 33 studies were considered suitable for data extraction, including 12 in vitro studies and 21 case reports or technique descriptions. The articles focused on comparisons of techniques, flowable, heated, and conventional resins, as well as various technique reports with variations in guides, materials, and planning, potentially aiding clinicians in more effective and safer execution of this restorative technique. The utilization of digital workflows presents greater solutions to the challenges of the guided direct restorative technique. Understanding the properties of the resins used is crucial for the results and should be chosen according to the patient's needs. A guided direct restorative procedure can deliver previously planned dental treatment based on individualized planning. This method ensures greater reproducibility in aesthetics and occlusion, resulting in superior quality work for the patient.

Biomimetic Tissue Engineering Strategies for Craniofacial Applications.

Biomimetics is the science of imitating nature's designs and processes to create innovative solutions for various fields, including dentistry and craniofacial reconstruction. In these areas, biomimetics involves drawing inspiration from living organisms/systems to develop new materials, techniques, and devices that closely resemble natural tissue structures and enhance functionality. This field has successfully demonstrated its potential to revolutionize craniofacial procedures, significantly improving patient outcomes. In dentistry, biomimetics offers exciting possibilities for the advancement of new dental materials, restorative techniques, and regenerative potential. By analyzing the structure/composition of natural teeth and the surrounding tissues, researchers have developed restorative materials that mimic the properties of teeth, as well as regenerative techniques that might assist in repairing enamel, dentin, pulp, cementum, periodontal ligament, and bone. In craniofacial reconstruction, biomimetics plays a vital role in developing innovative solutions for facial trauma, congenital defects, and various conditions affecting the maxillofacial region. By studying the intricate composition and mechanical properties of the skull and facial bones, clinicians and engineers have been able to replicate natural structures leveraging computer-aided design and manufacturing (CAD/CAM) and 3D printing. This has allowed for the creation of patient-specific scaffolds, implants, and prostheses that accurately fit a patient's anatomy. This review highlights the current evidence on the application of biomimetics in the fields of dentistry and craniofacial reconstruction.

Fechamento de diastemas com faceta direta de resina composta: relato de caso

The search for an aesthetic standard is increasingly frequent and restoring a harmonious smile represents a real challenge for restorative dentistry. Composite resins are aesthetic and adhesive materials that have received special attention for ensuring predictable and lasting results with minimal tooth sacrifice. The technique of making direct veneers is simple, but requires discretion and attention from its indication to the final stages of its execution. The procedure has high success rates and predictable results with desirable longevity for anterior teeth. The objective of this study was to present a clinical case of diastema closure with direct composite resin veneers on anterior teeth and maxillary first premolars, with the aid of diagnostic wax-up for better accuracy of work on anterior teeth. It is concluded that the application of the direct restorative technique allowed a fast, low, cost and less invasive treatment. Providing a satisfactory result, raising self-esteem and allowing a restoration of the patient's facial aesthetics.

"Evaluation of Silver Diamine Fluoride Modified Atraumatic Restorative Treatment (SMART) on hypomineralized first permanent molar"- a randomized controlled clinical study.

Restoring first permanent molars affected with molar incisor hypomineralization (MIH) is challenging. Focusing on improving the quality of life for children affected by MIH, at least until the complete eruption of first permanent molars to receive full coverage, to decrease the hypersensitivity and to be able to perform proper oral hygiene measures, the purpose of this study was to compare silver modified atraumatic restorative technique (SMART) versus the conventional restoration and fluoride varnish application on moderate to severe hypomineralized molars. The comparison considered the restoration survival, hypersensitivity, and digital surface area changes after one year follow up. Twenty-eight children were selected (20 girls and 8 boys) with at least 2 MIH molars with the same defect severity. The study comprised 2 groups; MOD group (moderate hypomineralized molar severity) and SEV group (Severe hypomineralized molar severity) (n = 28 tooth). Each group was further subdivided into 2 subgroups according to the technique of restoration: SMART subgroup and CONV subgroup (high viscosity glass ionomer restoration and fluoride varnish application) (each = 14 tooth). Evaluation was done in terms of the restoration survival (6 months and 12 months), hypersensitivity at 1 weak, 6 months and 12 months and occlusal surface area changes at 12 months). Professional Fluoride varnish application and home prophylaxis using MI paste were the protocol for each child patient. There was no significant difference between the 4 subgroups, regarding tooth restoration integrity at 6-months vs. 12-months. However, a statistically significant difference in tooth restoration integrity between the 4 subgroups at 12-months (P = .049). Also, the hypersensitivity score, there was a statistically significant difference between the 4-time intervals (P < .001) and a statistically significant difference in surface area changes between the 4 subgroups. Selective removal of carious tissue and SMART restoration, combined with dental home and professional preventive measures every 3 months maintained the integrity of restorations in severely and moderately affected permanent molars up to 1 year. The study protocol was retrospectively registered on Clinical Trials (NCT05931822-05/ 07/2023).

Long-term success of inlay and onlay procedures in dental repairs

Inlays and onlays are vital restorative techniques in dentistry, offering a conservative alternative to full crowns while preserving more of the natural tooth structure. These restorations, typically made from ceramic or composite resin materials, provide both aesthetic and functional benefits and are increasingly favored for their durability and longevity. In contrast to direct restorations, inlays and onlays are fabricated outside the mouth, allowing for greater precision and a more customized fit. The clinical success of these restorations largely depends on factors such as material choice, bonding technique, and patient-related variables like oral hygiene and habits. Ceramic materials are particularly noted for their resistance to wear and their ability to closely mimic the natural appearance of teeth, making them an attractive option for both patients and clinicians. Composite resins, while slightly less durable, offer a cost-effective alternative with satisfactory long-term results. Proper bonding techniques and high-quality materials are essential for ensuring the durability of inlays and onlays, with many restorations lasting over a decade. Patient-related factors also play a significant role in the success of inlays and onlays. Effective oral hygiene, regular dental check-ups, and the avoidance of habits like bruxism are essential for maintaining the integrity of these restorations over time. Despite the challenges and technical demands associated with their placement, inlays and onlays are highly successful when properly executed, offering patients a durable, aesthetically pleasing solution for dental repairs. The discussion of this review focuses on the critical elements that influence the long-term success of inlays and onlays, including material selection, clinical technique, and patient management, highlighting their effectiveness as a restorative option in modern dentistry.

Multifactorial Contributors to the Longevity of Dental Restorations: An Integrated Review of Related Factors.

This integrated review aims to identify and analyze the multifactorial contributors to the longevity of direct restorations, focusing on tooth-, patient-, and dentist-related factors. A search of the literature was performed using an electronic database, PubMed/Medline, Web of Science, and Scopus, on papers published between 1980 and 2024. The titles and abstracts of papers that evaluated aspects categorized into tooth-related, patient-related, and dentist-related factors influencing restoration failure were selected and screened. Full-text assessments were conducted, and the extracted data were compiled, summarized, and synthesized. The reference lists of the collected papers were also screened, and relevant citations were included in this review. Data were gathered from clinical and laboratorial studies, systematic reviews, and meta-analyses to provide a comprehensive understanding of restoration longevity. Among the tooth-related factors, multiple-surface restorations, deep margins, tooth location, and tooth vitality significantly impact restoration survival. Patient-related factors such as medical conditions, risk predictors of caries, age, sex, parafunctional habits, smoking, periodontal health, number of restorations, and socioeconomic status all play crucial roles. Regarding dentist-related factors, the decision-making process, age, experience, and dentist manual dexterity are vital aspects. Furthermore, the technique used, including isolation methods for moisture control, as well as the type of dental practice (large group vs. small practice), notably influenced the restoration survival. The longevity of dental restorations is influenced by a complex interplay of tooth-related, patient-related, and dentist-related factors. Strategies to improve restoration outcomes should consider all these multifactorial contributors. Continuing professional education, diligent patient guidance on the factors that influence restoration survival, careful material selection and restorative technique, and tailored individual treatment are crucial factors to reduce failure rates and improve the lifespan of restorations.

Research and Proposal of 3D Domain Processing Techniques in Woodblock Model Restoration

Research and Proposal of 3D Domain Processing Techniques in Woodblock Model Restoration

Is SDF better than the SMART (silver modified atraumatic restorative technique) in the management of molar incisor hypomineralisation molars with initial caries?

A prospective, randomized, split-mouth clinical study by thetwo previously trained and calibrated pediatric dentists without blinding operators and patients due to different protocols in both treatment groups. An SDF + potassium iodide (KI) and SDF + KI + glass ionmer cement(GIC) on International Caries Detection and Assessment System (ICDAS) 1/2 molar was received by each patient on either sideof mouth. The local Ethics Committee approved this study. Sample size calculation was not performed due to the lack of published studies on the longevity of SMART sealant on MIH-affected molarsand the absence of research on the apparent difference between the effectiveness of SMART and SDF treatments in preventing further caries and sensitivity. These were children between the ages of 6 years to 13 years, who visited the Pediatric Dentistry Clinic at XX University School of Dentistry for routine exams and treatment between July 2019 to May 2020. They were in good health and had at least two fully erupted permanent first molars with MIH as per the European Academy of Pediatric Dentistry, ICDAS code 1/2. This study recorded 12 months of treatment outcomes on hypomineralised molars of 48 children with a follow-up of three years. Children were excluded with specific syndromes associated with enamel malformation, lack of cooperation, ongoing orthodontic treatment, and teeth with ICDAS 3/4/5/6 lesions, existing restorations, fluorosis, or pulpal symptoms. Mann-Whitney U Test was used to assess differences between independent groups (SDF and SMART) and the Friedman Test between dependent groups at different time points. Kaplan-Meier analysis to evaluate the cumulative survival of SMART sealants and survival of caries-free hypomineralised molars in both groups. Chi-Square test was used to compare the success percentages of the SDF and SMART groups. To assess the changes in success percentages at three different time intervals for the caries preventive effect of SDF and SMART, and to evaluate the retention percentages for the SMART group. McNemar's test with a Bonferroni correction was used for significant differences. Cohen's kappa test indicated that the inter-examiner reliability determining the presence of MIH was 0.87. The intra-examiner reliability for US Public Health Service (USPHS)-Modified criteria was 0.90. The statistical significance level was set at p < 0.05 for all statistical analyses. At 12, 24 and 36 months the caries preventive effect was 100%, 67.9%, and 65.4% for SDF + KI-treated teeth; and 100%, 97.6%, and 94.7% for SMART (SDF + KI + GIC) respectively. During the recall period, there was no substantial difference in hypersensitivity scores between the groups. There was no hypersensitivity in teeth at 18 months and beyond. Compared to the baseline Schiff Cold Air Sensitivity Scale (SCASS) score 26 molar with initial hypersensitivity to hypomineralisation had a massive reduction at evaluation periods. The mean survival probabilities for the caries-preventive effect were considerably lower in SDF + KI-treated teeth (31.01 months) than in SMART-treated teeth (35.61 months) (p < 0.001). Considering the limitation of the study, both SMART (SDF + KI + GIC) sealants and 6-monthly application of SDF + KI, provided similar and substantial levels of desensitisation on the permanent MIHmolars. When used as a sealing material on non-cavitated permanent MIHmolars, the clinical retention rate for SMART was 88.7%, 73.1%, and 66.6% at 1, 2, and 3 years respectively. The caries preventive effect of SMART (SDF + KI + GIC) sealants was superior to SDF + KI application in hypomineralised teeth, however, a long-term monitoring and review is essential due to the gradual decrease in retention of SMART sealants.

Progressive Tooth Wear Against Resin-Based Restorative Composites.

The composition and properties of resin-based composite materials could affect tooth wear and lead to clinical problems. Therefore, the study objective was to characterize human tooth wear behavior against a bulk-fill restorative (BF) compared to a conventional resin composite (RC) and a CAD/CAM resin nano ceramic (RN). Square-shaped specimens of each material were prepared and sub-divided according to the number of testing cycles (n=8): 100,000, 250,000, and 500,000 cycles. An occlusal wear test was performed using a chewing machine with 49 N, 2 Hz, in 37°C distilled water. Human premolar cusps were used as antagonists. Micro-CT and laser scanner were used to scan antagonists and specimens, respectively. Wear volume was assessed using a software and the wear pattern was examined with SEM. Softening in solvent analysis was performed by measuring the materials' Knoop microhardness (KHN) before and after immersion in ethanol. Wear volume data were analyzed with two-way ANOVA and Student-Neuman-Keuls test (α=0.05). For tooth and specimen wear volume, there was statistical significance for material and number of cycles, but not for the interaction between factors. BF resulted in less tooth (p=0.008) and specimen (p=0.030) wear than RN and RC, which were similar (p⟩0.05). Volume loss increased from 100,000 to 500,000 cycles. BF showed the lowest microhardness (KHN1); and %ΔKHN similar to RC, but greater than RN. BF induced less volume loss to the tooth than RC and RN, while presenting greater wear resistance. The tooth wear pattern and damage progression were mild for all materials. Resin composites show favorable wear behavior, leading to low volume loss and mild structural damage of the tooth. Regular bulk-fill resin composite stands out for its efficient restorative technique, low wear susceptibility and reduced capacity to wear down the tooth.

Evaluation of stress distribution in restorations of maxillary central incisor with post-traumatic enamel-dentin fracture using two different techniques: A micro-computed tomography study

Aim: The aim of this study is to investigate the stress distribution created by two restorative techniques, adhesive reattachment of the fractured fragment and direct composite restoration, used in the treatment of a maxillary central incisor with enamel-dentin fracture. The analysis is conducted using the finite element stress analysis method on a three-dimensional (3D) model prepared based on micro-computed tomography data, following the application of different adhesive procedures on fractured teeth. Methodology: The avulsed left maxillary central incisor was scanned using a micro-computed tomography device. The obtained data was transferred to a computer and used for 3D modeling. In the models, a fracture line was created obliquely at a 45° angle, 3 mm away from the mesial surface towards the distoincisal corner of the tooth. Six restorations were planned on this model: three direct composite restorations and three adhesives, reattachments followed by composite application. The models for the adhesive reattachment method included: (1) internal dentin groove, (2) palatal composite laminate veneer, and (3) double palatal retentive groove. The models for the composite restoration technique included: (1) composite laminate veneer, (2) direct composite restoration following enamel beveling, and (3) composite application after double palatal groove preparation. Upon completion of the restorations, a 100-N force was applied from the palatal direction using the finite element stress analysis method. The results were analyzed to examine the amount and distribution of stress on the restorations and the tooth. Results: In all models, the highest stress values within tooth structures were observed in the enamel. The lowest stress value in the enamel layer was seen in model R-1, whereas the highest stress value was observed in model K-2. For direct composite restorations, the stresses on enamel, dentin, and restoration were relatively similar in each model, with no significant differences noted among these values. Among all applied composite restorations, the lowest stress value was observed in model R-3. When analyzing the stresses generated at the tooth-restoration and tooth-fractured fragment interface of the six models, the lowest stress in the enamel was observed in models R-1 and K-3, while the highest stress was seen in model R-3. Conclusion: According to the data obtained from the models, the shape of the restoration applied on the tooth, the technique used, and the location of the restoration affect the amount and distribution of stress accumulated in the tooth and restoration. However, the stress analysis results are not sufficient to evaluate the clinical success of restorations. There is a need for further studies utilizing different techniques to support the models used. How to cite this article: Olgaç Akgönül Ş, Çelenk S, Adıgüzel Ö. Evaluation of stress distribution in restorations of maxillary central incisor with post-traumatic enamel-dentin fracture using two different techniques: A finite element analysis based on micro-computed tomography data. Int Dent Res 2024;14(2):76-83. https://doi.org/10.5577/intdentres.535

Survival of the fittest: does Riva Self Cure outperform Equia Forte when used to restore mesio-occlusal cavities in atraumatic restorative technique?

Double-blind (participant and outcome assessor), randomised, non-inferiority, two-arm (1:1 allocation) clinical trial. The study included children aged 4-8 years old from public schools in Tietê, Brazil, who had mesio-occlusal carious lesions, into dentine, in primary molars. The carious teeth had to be asymptomatic of pulpal involvement. The children had to be medically fit and cooperative for dental treatment within their classroom environment. Consent was gained from a parent/guardian prior to entering the study. Children with carious lesions in multiple teeth, only one tooth was included, which was selected by a random draw. Treatment on other teeth would be carried out in the nearest health centre. The primary outcome was the 2-year survival of the restorations, analysed using Kaplan-Meier survival curves and Cox regression (α = 5%). Costs for materials and professional services were recorded in Brazilian Reais (R$), converted to US dollars (US$), and analysed using Monte Carlo simulation. Of the 152 children enrolled (76 per group), 121 (79%) were evaluated at the 2-year mark. Overall, the 2-year survival rate of the restorations was 39% (EF: 45%; RSC: 32%), with no significant difference between the two groups. The total cost of restorations with RSC was lower than with EF, resulting in a cost saving of US$6.18 per restoration. After 2 years, Riva Self Cure demonstrated comparable survival rates to Equia Forte for mesio-occlusal restorations in primary molars, while being more cost-effective from a Brazilian perspective.

Advanced Material Strategy for Restoring Damaged Endodontically Treated Teeth: A Comprehensive Review.

The restoration of endodontically treated teeth (ETT) remains a significant challenge in modern dentistry. These teeth often suffer from substantial structural damage due to both the original pathology and the invasive nature of endodontic procedures. Consequently, ETT are more susceptible to fractures compared to vital teeth, necessitating restorative strategies that can effectively restore both function and aesthetics while minimizing the risk of failure. In recent years, advances in adhesive dentistry and the development of high-strength ceramics have further expanded the restorative options for ETT. Bonded restorations have gained popularity as they preserve more tooth structure and enhance the overall strenght of the tooth-restoration complex. The choice of restorative material and technique is influenced by numerous factors, including the amount of remaining tooth structure, the functional requirements of the tooth, and the aesthetic demands of the patient. Despite the plethora of available materials and techniques, the optimal approach to restoring ETT remains a topic of ongoing research and debate. In this comprehensive review, the current state of and recent advances in restoring damaged endodontically treated teeth are explored. Numerous therapeutic options exist, involving a wide range of materials. This article aims to present the biomaterial advancements of the past decade and their applications, offering alternative approaches to treating damaged ETT with the goal of prolonging their retention on the dental arch and serving as a valuable resource for dental practitioners who face this issue daily.

The effect of adding chitosan nanoparticles on different properties of the adhesive and high-filled composite resin

PurposeTo evaluate the effect of adding nano-chitosan on different properties of the adhesive and high-filled flowable composite resin (viewing the graphical abstract is suggested). BackgroundIncorporating chitosan might improve the quality of adhesive and high-filled composite resin used in the deep margin elevation (DME) and other restorative methods. Materials and methodsTwo groups of composite disks (without chitosan, with 1 % chitosan) were created to evaluate antimicrobial effects, degree of conversion (DC), solubility and water sorption. Antimicrobial activity was evaluated through biofilm inhibition and disk agar diffusion tests while DC was analyzed using FTIR. For the microshear bond strength test (μSBS), extracted maxillary molars were sectioned 1 mm under the CEJ, undergoing immediate dentin sealing and DME in four groups: control, pretreatment chitosan application, adhesive+1 % chitosan, and composite+1 % chitosan. The forces and the modes of failure were recorded. ResultsAdding chitosan nanoparticles increased the antimicrobial activity, significantly (p < 0.05). The μSBS and DC did not differ significantly between the groups (p > 0.05), and the failures were mostly found in the adhesive mode. The solubility and water sorption increased significantly (p < 0.05), remaining in a clinically acceptable range though. ConclusionAdding chitosan could be a potential option to increase the antibacterial effect in the high-filled composite resin without any negative affect on μSBS or DC, and clinically unacceptable effect on solubility and water sorption. (The graphical abstract has been provided). Clinical significanceAdding chitosan nanoparticles to high-filled flowable composite resin, increases the success rate of related restorative technique by adding the antimicrobial effect without any significant negative influence on other biomechanical properties.

The Role of Bioactive Glasses in Dental Erosion―A Narrative Review

Dental erosion represents the gradual and irreversible depletion of dental hard tissues due to a chemical process, independent of bacterial influence. It has emerged as a notable clinical concern in recent years, primarily attributed to substantial lifestyle shifts resulting in the heightened intake and frequency of acid-containing foods and beverages. Apart from the extrinsic erosive agents derived from external sources, such as dietary habits or medication, intrinsic erosive agents may exist due to pathological reasons with the contents of the stomach including gastric juice, mainly composed of hydrochloric acid, being their sole source. Currently, bioactive materials are used in various forms for the prevention of dental erosion. Such materials include, among others, bioactive glasses (BAGs). BAGs are a type of glass that, when in contact with biological fluids, can elicit a specific biological response. When they come into contact with bodily fluids, they can initiate a series of processes, including the formation of a hydroxyapatite layer on the glass surface. This bioactivity is particularly advantageous in medical and dental applications, where BAGs are used for bone regeneration, tissue repair, and dental restorative or preventive techniques. The aim of this literature review was to analyze and discuss the role of BAGs in protecting the tooth structures from dental erosion. The analysis of the existing literature regarding this topic indicated that the use of BAGs in preventive treatments against tooth erosion can be useful in dental practice. Further clinical evidence is necessary to confirm the effectiveness of the particular preventive measures.

Flowable bulk-fill versus layering restorative material on Class II restorations: A randomized clinical trial

ObjectiveThis study evaluated the clinical performance of Class II restorations made with flowable bulk-fill base versus conventional layering ORMOCER-based restorative material in a split-mouth randomized clinical trial. MethodsThirty patients received two class II restorations (n = 60) performed with different strategies. All preparations received the application of the universal self-etching adhesive system according to the manufacturer's recommendation, followed by the placement of a sectional matrix, wooden wedge, and separation ring. The first restoration was performed using 4 mm of flowable bulk-fill material covered by 2 mm of conventional viscosity restorative material (Bulk-fill technique). The second restoration was performed only with the conventional viscosity material, with a maximum of 2 mm thick increments, up to fill the cavity (Layering technique). After occlusal adjustment, the same polishing system was used for all restorations. Evaluations using the FDI criteria were conducted after 7 days, 12, and 24 months. Data were analyzed with the Fisher's Exact test (α=0.05). ResultsFrom 30 participants, 24 attended the 24-month recall, and 48 restorations were evaluated. All restorations received acceptable overall scores for esthetic and biological properties after this period, while only 6.66 % of the restorations exhibited unacceptable overall scores for the functional properties in both groups. No significant differences between the tested restorative materials and techniques were found for each FDI criterion assessed. The success rate after 2 years was 93.33 % for both groups. ConclusionBoth restorative materials exhibited good clinical performance for the parameters analyzed with no differences between them after 24-month follow-up. Clinical relevanceFlowable bulk-fill ORMOCER-based material is a suitable alternative for direct Class II restorations, providing good clinical outcomes and simplifying the restorative procedure. Clinical trial registration numberRBR-6mvp9w

Digital resources for surgical and restorative treatment of excessive gingival display in one session.

This article aims to showcase the implementation of a digital workflow in addressing a case of multifactorial excessive gingival display in a patient with high esthetic demands, incorporating both surgical and restorative interventions in a single session. A 28-year-old female patient presented with excessive gingival display, attributed to a combination of short teeth due to altered passive eruption, lip hyperactivity, and a sub-nasal depression that lodged the upper lip during spontaneous smiling. The multidisciplinary treatment strategy encompassed surgical crown lengthening, the placement of a biovolume in the maxillary concavity, and the rehabilitation of the six anterior teeth with direct composite resin, all done in a single session. Smilecloud Biometrics was used to digitally plan the smile, and the final wax-up/mock-up was approved by the patient prior to any irreversible procedure. A digital planning center (GuiderLab) enabled the materialization of the virtual planning and the printing of the periodontal surgical guide, the biovolume, and the resin layering guides for the restorative technique. Adopting a digital workflow in multidisciplinary cases with excessive gingival display leads to predictable and more expedited outcomes, ensuring a favorable result between soft and hard tissues. Excessive gingival display is a condition with multifactorial etiologies, including dentoalveolar, periodontal, skeletal, or muscular origins, or a combination of these factors. The diagnoses of altered passive eruption and a hypermobile upper lip are common in daily clinical practice and can be successfully managed through surgical crown lengthening and filling of the maxillary concavity, respectively. To achieve the desired outcome, restorative procedures often complement these surgical interventions.

Stress distribution in endodontically treated external cervical resorption lesions restored with MTA and biodentine – A finite element analysis

IntroductionRoot resorption poses a significant challenge in dental practice, with external cervical resorption (ECR) being a common manifestation. ECR is often asymptomatic until advanced stages, complicating its diagnosis and management. Various factors contribute to its etiology, ranging from trauma to orthodontic treatment. The classification system proposed by Patel et al. (2018) offers a comprehensive framework for characterizing ECR lesions based on location and extent. Treatment strategies for ECR involve a combination of endodontic intervention and restorative techniques, with bioactive materials like mineral trioxide aggregate (MTA) and Biodentine emerging as promising options. However, the biomechanical behavior of teeth restored with these materials in the context of ECR remains underexplored. Materials and methodsThis study utilized finite element analysis (FEA) to assess stress distribution in teeth with simulated ECR lesions of varying sizes and locations, restored with MTA or Biodentine. Three-dimensional models of maxillary central incisors were generated based on CBCT scans, incorporating periodontal ligament and surrounding bone structures. Eight experimental models representing different ECR configurations were created and subjected to FEA using Optistruct software based on dimensional classification given by Patel et al., in 2018, A70 M & A70B: 1Ap, A130 M & A130B: 1Bp, B70 M & B70B: 2Ap, B130 M & B130B: 2Bp. All the models were tested for stress distribution by restoring the lesions with either M: MTA or B: Biodentine. Oblique load of 100 N was applied at 45°angle to the long axis 2 mm lingual to incisal edge. vonMises Stress distribution in enamel, dentine, restoration and at all the interfaces were observed. ResultsThe analysis revealed that both MTA and Biodentine restorations exhibited uniform stress distribution around ECR lesions, with no significant differences based on lesion location or size. Maximum stress concentrations were observed around the restorations, particularly in subcrestal lesions. However, overall stress levels were comparable between MTA and Biodentine restorations, indicating similar biomechanical performance. ConclusionFinite element analysis provides valuable insights into the biomechanical behavior of teeth with ECR lesions restored with MTA and Biodentine. Both materials exhibit similar stress distribution patterns and offer adequate reinforcement against mechanical forces. Clinicians can confidently utilize MTA or Biodentine in the management of ECR, considering their favorable biomechanical properties and clinical outcomes. Further research is necessary to validate these findings and optimize treatment protocols for ECR.

Clinical comparison of silver diamine fluoride (SDF) or silver-modified atraumatic restorative technique (SMART) on hypomineralised permanent molars with initial carious lesions: 3-year results of a prospective, randomised trial

ObjectivesThis study aimed to assess the clinical outcomes of utilizing silver diamine fluoride + potassium iodide (SDF + KI) treatment and Silver-Modified Atraumatic Restorative Technique (SMART/SDF + KI + Glass Ionomer Cement) over a three-year period on hypomineralised permanent molars with initial carious lesions. Methods112 hypomineralised permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF + KI and SMART (SDF + KI + GIC) groups (n = 56 teeth/group) in a split-mouth design. Hypersensitivity and caries development were evaluated in both groups. Schiff Cold Air Sensitivity Scale (SCASS) was used for evaluation of hypersensitivity, and the modified USPHS criteria were utilised for clinical assessments of SMART sealants at 1,6,12,18,24 and 36 months. Fisher's Exact test, Kaplan-Meier Survival Curves, Log-rank test, Mann Whitney U test, and Friedman test was performed for the statistical analysis. ResultsThe caries preventive effect was 100 %, 67.9 % and 65.4 % for SDF + KI-treated teeth; and 100 %, 97.6 % and 94.7 % for SMART(SDF + KI + GIC)-treated teeth at 12, 24 and 36 months, respectively. The mean survival probabilities for caries-preventive effect were significantly lower in SDF + KI-treated teeth (31.01 months) than SMART-treated teeth (35.61 months), (p < 0.001). Twenty-six molars with initial hypersensitivity due to hypomineralization demonstrated a significant reduction at all evaluation periods compared to baseline SCASS scores (p < 0.001). Additionally, there was no significant difference in hypersensitivity scores between the groups during the re-call periods, and none of the teeth exhibited hypersensitivity at the 18-month and beyond evaluations. ConclusionsDuring the three-year assessment, both groups demonstrated effectiveness in reducing sensitivity in hypomineralised molars. However, SMART (SDF + KI + GIC) sealants offered better protection against tooth decay over time, despite experiencing gradual retention loss. Clinical significanceBoth SMART (SDF + KI + GIC) sealants and SDF + KI proved effective in alleviating hypersensitivity in hypomineralised molars for up to three years. SMART (SDF + KI + GIC) sealants showed greater caries-preventive effect compared to SDF + KI. However, continuous long-term monitoring is crucial due to the gradual decline in retention of SMART (SDF + KI + GIC) sealants. ClinicalTrials registration numberNCT03862014.