States Public Health Service Criteria Research Articles

Long-term performance of ceramic in/-onlays vs. cast gold partial crowns – a retrospective clinical study

ObjectivesTo assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality.Material and methodsIn a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan–Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed.ResultsThe cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration.ConclusionsBoth CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management.Clinical relevanceCIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

Evaluation of pre-heated composite resins with soft-start polymerization and conventional composite restorations in class-I carious lesions – A randomized clinical trial

BackgroundBy increasing fluidity and conversion, pre-heated composites enhance adaptability and strength, while soft-start polymerization decreases internal stresses. AimOver a period of a year, this split-mouth design, randomized controlled clinical trial (RCT) compared pre-heated composites with soft-start polymerization to conventional composites in class-I lesions, with the goal of improving restoration outcomes. Methodsand Findings: Immediately following ethical approval and registration with CTRI, 37 patients with in-formed permission who met specified inclusion and exclusion criteria for class-I lesions were chosen for enrollment. Using a 1:1 ratio, teeth were randomly assigned to Group-A (pre-heated composite with soft-start polymerization) or Group-B (traditional composite restoration). At three-time intervals, the evaluation was blinded and calibrated using Modified United States Public Health Service (USPHS) criteria: baseline, six-month, and one-year marks. Statistical analysis was performed using SPSS 21.0 and the Mann-Whitney U test for inter-group comparisons and the Friedman test for intra-group comparisons. InterpretationPre-heated composites with soft-start polymerization performed better in terms of marginal adaptation with a statistically significant difference (p = 0.019) and in terms of color match they performed better clinically (p = 0.062) at 12 months. Other variables like marginal discolouration, sec-ondary caries, anatomic form, post-operative sensitivity, surface texture and retention showed no statistically significant difference (p < 0.05). Pre-heated composites with soft-start mode performed marginally better than nanofilled composites. However, both techniques can be used to successfully restore simple class-I carious lesions.

Clinical outcomes of self-glazed zirconia veneers produced by 3D gel deposition: a retrospective study

BackgroundSelf-glazed zirconia (SZ) restorations are made by a novel additive three-dimensional gel deposition approach, which are suitable for a straightforward completely digital workflow. SZ has recently been used as minimally invasive veneer, but its clinical outcomes have not been clarified yet. This study aimed to evaluate the preliminary clinical outcomes of SZ veneers compared with the widely used lithium disilicate glass–ceramic veneers made by either pressing (PG) or milling (MG) process.MethodsFifty-six patients treated with SZ, PG, and MG veneers by 2 specialists between June 2018 and October 2022 were identified. Patients were recalled for follow-up at least 1 year after restoration. Clinical outcomes were assessed by 2 independent evaluators according to the modified United States Public Health Service (USPHS) criteria. Overall patient satisfaction was assessed using visual analogue scale (VAS), and analyzed by one-way ANOVA. Chi-square test was applied to compare the difference in the success and survival rates among the 3 groups.ResultsA total of 51 patients restored with 45 SZ, 40 PG, and 41 MG veneers completed the study, with a patient dropout rate of 8.9%. Mean and standard deviation of follow-up period was 35.0 ± 14.7 months. All restorations performed well at baseline, except for 2 SZ veneers with mismatched color (rated Bravo). During follow-up, marginal discrepancy (rated Bravo) was found in 4 MG veneers and 1 PG veneer, and partially fractured (rated Charlie) was found in another 2 PG veneers. The survival rate of SZ, PG, and MG veneers was 100%, 95%, and 100%, with a success rate of 95.56%, 92.50%, and 90.24%, respectively, none of which were significantly different (p = 0.099 and 0.628, respectively). The mean VAS score of SZ, PG, and MG was 95.00 ± 1.57, 93.93 ± 2.40, and 94.89 ± 2.00 respectively, without significant difference (p > 0.05).ConclusionSZ veneers exhibited comparable preliminary clinical outcomes to PG and MG veneers, which could be considered as a feasible option for minimally invasive restorative treatment.

Clinical performance and wear resistance of milled resin composite material versus direct nanohybrid bulk-fill resin composite in the restoration of endodontically treated posterior teeth over 1 year: Randomized clinical trial

Abstract Context: The restorative complexities associated with endodontically treated teeth surpass those encountered with vital ones. The field of adhesive dentistry experienced a significant advancement that led to a shift in treatment approach toward bonded restorations. Aim: The aim of the study was to assess the clinical performance of using indirect Milled composite or direct bulk-fill resin composite restorations for endo-treated teeth, as well as to measure the amount of wear on the occlusal tables of both restorations using a digital scanner. Subjects and Methods: Participants were divided into two groups, where R1 represents the endodontically treated teeth restored with Milled composite, R2 represents the endodontically treated teeth restored with direct bulk-fill composite where 13 patients in each group were treated with a total number of 26 restorations in all patients. Where each restoration was assessed immediately at baseline (T0), 6 months (T6), and 12 months (T12) using the modified United States Public Health Service criteria. Moreover, wear was measured immediately at (T0) and (T12) intraorally and extraorally using intraoral scanners and three-dimensional surface-based superimposition software. Statistical Analysis Used: Chi-squared test, Mann–Whitney U-test, Friedman’s test, Nemenyi post hoc test, Shapiro–Wilk test, paired t-tests, intraclass correlation coefficient. Results: At all intervals, the majority of the cases in both groups had an alpha score. Some cases exhibited bravo scores in both groups at T6 and T12 regarding the color match, marginal adaptation, marginal discoloration, and marginal integrity without statistically significant difference (P &gt; 0.05). Direct nanohybrid bulk-fill resin composite showed a greater amount of wear without a statistically significant difference (P &gt; 0.05). Extraoral measurement was significantly higher than intraoral measurement (P &lt; 0.001). There was no significant reliability/agreement between both methods. Conclusions: Both milled composite and direct bulk-fill resin composite restorations in endodontically treated teeth demonstrated appropriate clinical performance and minimal wear over an 1-year follow-up period.

Clinical evaluation of “Snowplow” technique versus Bulk-fill technique in restoration of class II cavities: A randomized clinical trial

Abstract Aim: This study assessed the clinical performance of the “Snowplow” technique compared with the Bulk-fill technique in restoration of proximal cavities for 1 year using modified United States Public Health Service (USPHS) criteria. Materials and Methods: The study was a 12-month, double-blinded, two parallel arms, randomized clinical trial with a 1:1 allocation ratio. A total of 32 patients with proximal caries were separated into two groups (n = 16): group 1: “Snowplow” technique using co-cured X-tra base flowable Bulk-fill composite/X-tra Fil Bulk-fill composite, whereas group 2: Bulk-fill technique using X-tra Fil Bulk-fill composite. Modified USPHS criteria were employed to assess the restorations at baseline, after 3, 6, 9, and 12 months. The MedCalc software, version 19 for Windows was used to statistically analyze the collected data. Intergroup comparisons were carried out using the chi-squared test with a statistical significance level set at P ≤ 0.05 after Bonferroni correction. Results: The results suggested that there was no statistically significant difference found between “Snowplow” and Bulk-fill techniques at different time intervals in terms of marginal integrity, marginal discoloration, anatomic contour, surface texture, gross fracture, and secondary caries, where P = 0.150550. Conclusion: This study concluded that the clinical performance of the “Snowplow” technique and Bulk-fill technique was similar and clinically acceptable following a full year of clinical use. Bulk-fill and “Snowplow” techniques are highly recommended restorative techniques in proximal cavities.

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study

ObjectivesThis study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. MethodsThe children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. ResultsDuring the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). ConclusionDirect composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. Clinical significanceSFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

Optical behavior and marginal discoloration of a single shade resin composite with a chameleon effect: a randomized controlled clinical trial

Objective/aimEvaluating the optical behavior and marginal discoloration of a Single-shade universal resin composite over 12 months. To achieve this, a split-mouth with a double-blinded randomized strategy was employed.Materials and methodsTwenty adult patients, each presenting with at least two caries lesions in their posterior teeth, were selected and randomly subdivided into two identical groups: Group I received Single-shade universal resin composite (Omnichroma), and Group II received multi-shade nanohybrid resin composite (Tetric®N-Ceram). Color measurements and marginal discoloration were assessed visually by three blinded operators at baseline followed after 1,3,6,9, and 12‑month periods utilizing the Modified United States Public Health Services (USPHS) criteria. Statistical analysis was adopted utilizing the Wilcoxon test with a 0.05 significance level.ResultsThe two groups revealed non-statistically significant differences up to 6 months regarding color match and color stability. After 9 and 12 months, the multi-shade group demonstrated a statistically significant higher prevalence of color match (Alpha) scores than the single-shade universal group. Regarding marginal discoloration, all restorations in the two groups had no discoloration (Alpha scores).Discussion/conclusionSince the percentage of Alpha and Bravo scores was considered clinical success, both the single-shade universal and the multi-shade nanohybrid resin composites demonstrated satisfactory optical performance and marginal discoloration as posterior restorations after a 12-month follow-up period.

Clinical performance of computer-aided design/computer-aided manufacture lithium disilicate ceramic endocrown restorations: A 2-year study.

Optimal restoration methods for endodontically treated teeth (ETTs) have always remained an ongoing discussion among physicians in this day and age. ETTs have a tendency to fracture when chewing, compared to initial teeth. From the perspective of biology, preserving and restoring tooth structure is critical to maintaining biomechanical, functional, and esthetic harmony. Dental bonding techniques have lessened the necessity for post-and-core restorations in ETTs with severe substance loss. A minimally invasive endodontic restoration technique called "endocrown" was initially introduced by Bindl and Mörmann in 1999. The aim of the study was to clinically evaluate all-ceramic mandibular molar endocrowns made using computer-aided design/computer-aided manufacturing (CAD/CAM) following 2 years of follow-up. This unblinded study contains 56 patients with 56 mandibular molars, which had severe substance loss. After teeth preparation, lithium disilicate ceramic endocrowns were manufactured with the CEREC CAD/CAM system, and cementation was performed using a composite luting agent. The endocrowns were assessed using the modified United States Public Health Service criteria at baseline, 6 months, 1 year, and 2 years following placement. Patient satisfaction was evaluated using a questionnaire. This study used descriptive statistics, including mean, standard deviation, and 95% confidence intervals. Data were processed using STATA version 14.0 (StataCorp LLC, USA). Two endocrowns (3.6%) failed throughout the period of observation. The high clinical rating criteria (96.4%, count of 54) and the increased satisfaction percentage (94.6%, count of 53) remained practically stable during the follow-up assessments at 6 months and after 1-2 years. Endocrown offers a less invasive treatment option that may be a better method for endodontically treated mandibular molars. With contemporary CAD/CAM technology and new materials, time in the chair and esthetics optimally improved, bringing satisfaction to the patient.

Evaluation of Clinical Performance and Colour Match of Single and Multiple Shade Composites in Class-I Restorations: A Randomised Clinical Study

Introduction: Biomimetic dentistry primarily focuses on achieving aesthetics that closely resemble natural enamel and dentin. This approach ensures that dental restorations seamlessly match the appearance of enamel and dentin, rendering them virtually invisible. Additionally, biomimetic dentistry aims to mimic not only the visual characteristics but also the physical properties of enamel and dentin, thereby ensuring functional acceptability. The introduction of new composite materials in the market is a gradual progression aimed at attaining the mentioned objectives. Aim: To compare clinical performance and colour matching of single and multiple shade composites in simple Class-I carious lesions after one year. Materials and Methods: This randomised clinical study included 21 patients with a total of 72 Class-I carious lesions with patients who provided informed consent. Teeth were randomised into two groups: Group-A (n=36) received multishade composite (3M Filtek z350), and Group-B (n=36) received single-shade composite (Omnichroma). Clinical performance was assessed by two blinded evaluators at baseline, six months, and one year using modified United States Public Health Service (USPHS) criteria. Colour matching was evaluated by capturing digital photographs with a DSLR camera, ring flash, and 100 mm macro lens. Colour measurements (L*, a*, b*) were analysed using Adobe Photoshop, and ΔE was calculated immediately after restoration. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 21.0 software, employing Chi-square test, Friedman test, and independent t-test. Results: No significant difference was found in clinical outcomes after one year using modified USPHS criteria (p&gt;0.05). However, both Group-A (p=0.002) and Group-B (p=0.007) showed increased marginal discolouration, and decreased colour match (p&lt;0.001) from baseline to one year. There was no statistically significant difference in colour matching potential between the two groups (p=0.056). Conclusion: Single-shade composites effectively treat Class-I carious lesions, demonstrating satisfactory colour matching and clinical performance.

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.

Clinical performance of bonded partial lithium disilicate restorations: The influence of preparation characteristics on survival and success

ObjectivesThe aim of this study was to investigate the influence of preparation characteristics on the survival, success, and clinical performance of partial indirect lithium disilicate restorations with immediate dentin sealing. MethodsThis retrospective clinical study evaluated partial indirect lithium disilicate restorations placed in conjunction with Immediate Dentin Sealing (IDS) in (pre)molar teeth between March 2018 and May 2021. The restorations were luted using pre-heated composite. The study focused on survival, success, and clinical performance, which was evaluated using the modified United States Public Health Service (USPHS) criteria. Results were analyzed using the Kaplan-Meier estimates, log-rank tests, and Fisher exact tests. ResultsPartial indirect lithium disilicate restorations (N = 454) were evaluated in 214 patients. The mean evaluation time was 37 months, with a cumulative survival rate of 99.2 % and a cumulative success rate of 97.6 %. Fourteen failures occurred, with endodontic pathology as the predominant failure mode, followed by secondary caries, debonding, and tooth fracture. No statistically significant influence of the preparation variables on survival and success was observed (p > .05). The short-term clinical performance was clinically acceptable in > 90 % of the evaluations. ConclusionsThis retrospective study on partial indirect lithium disilicate restorations in conjunction with IDS demonstrates survival and success rates of 99.2 and 96.7 % over a mean evaluation period of 37 months. A marked influence of the studied preparation characteristics on the survival, success and clinical performance of lithium disilicate partial restorations could not be demonstrated. Partial lithium disilicate restorations exhibit good clinical performance in >90 % of the cases. Clinical significanceThe results of this study suggest that preparation characteristics had no significant impact on the survival, success, and clinical performance of partial lithium disilicate restorations in conjunction with IDS. Results show good clinical performance and high survival and success rates, regardless of preparation characteristics.

Clinical Performance of Two CAD/CAM Fabricated Ceramic Restorations with Different Designs for MIH Rehabilitation: A Randomized Controlled Trial

Background: Molars affected with severe molar incisor hypomineralisation (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations. Objective: A randomized clinical trial evaluated the clinical performance of two CAD/CAM fabricated ceramic restorations, Vita Suprinity (VS) and Vita Enamic (VE), with different preparation designs, occlusal veneer and endocrown, for rehabilitation of the first permanent molar affected by MIH. Materials and Methods: The study was registered with NCT05434884 clinical trial ID with 68 patients ranging from 8 to 13 years old, who attended the dental clinic of Al-Azhar University, Girls Branch, and suffering from a severe form of molar incisor hypomineralization. The patients were divided equally into two groups, group I, i.e., occlusal veneer (OV) group, and group II, i.e., endocrown (EN) group, according to different preparation designs related to different severity levels of first permanent molars’ hypomineralization (moderate and severe); each group was subdivided equally and randomly into two subgroups, subgroup A, i.e., Vita Suprinity (VS), and subgroup B, i.e., Vita Enamic (VE), according to the material used for fabrication of the restoration. The survival and success rates of restorations were assessed using the clinical United States Public Health Service (USPHS) criteria at 1 week, and 3, 6, 12, and 18 months' recall times after cementation, and statistical analysis was performed. Results: There was no statistically significant difference between groups and subgroups in terms of all evaluation parameters during the whole observational period. Conclusion: Based on observations, occlusal veneer and endocrown designs fabricated from CAD/CAM VS and VE showed similar clinical success in the rehabilitation of first permanent molars with severe MIH over 18 months of evaluation.

Prefabricated zirconia crown versus resin-bonded composite strip crown in the restoration of primary incisors: A 36-month parallel randomized controlled trial

AimThe trial aimed to compare the gingival health and clinical performance of prefabricated zirconia crown (PZC) versus resin-bonded composite strip crowns (RCSC) in the restoration of primary maxillary incisors over 36-month. Materials and methodsA parallel randomized controlled trial included 200 maxillary primary incisors (100 teeth per group) restored either with PZCs or RSCS. The gingival health and plaque accumulation were assessed using gingival index (GI) and plaque index (PI) respectively. To evaluate the clinical performance, the modified United States Public Health Service (USPHS) criteria were used. Intergroup comparison was performed using a Chi-square test. Restoration longevity was assessed over the predetermined intervals using Kaplan-Meier analysis. Generalized Estimating Equation (GEE) with robust standard errors was used to test the effect of time over the changes of repeated measures. The significance level was set to 5%. ResultsThe gingival health around PZCs is significantly better than that of RCSCs after 6 months. However, at the following follow-ups, GI scores of both restorations were comparable (p > 0.05). All PZCs showed no plaque accumulation with a significant difference compared to the RCSCs over the follow-up intervals. The clinical performance of PZCs was significantly superior to that of RCSCs over the follow-ups in terms of retention and anatomical contour after 24 and 36 months. The survival rates of PZC and RCSC were 100% and 87% respectively. ConclusionsAfter 36 months, the gingival health of PZC and RCSC was comparable. The retention and anatomical continuity of PZC were superior compared to RCSC.

Prolonged application time effects on universal adhesives in non-carious cervical lesions: An 18-month split mouth randomized clinical trial

ObjectiveThis double-blind, split mouth randomized clinical trial aimed to assess the clinical performance of Clearfil Universal Bond Quick (CBUq) universal adhesive under different application times (no waiting and waiting) compared to Clearfil SE Bond adhesive in non-carious cervical lesions (NCCLs) over 18 months. MethodsOne hundred and eighty-three restorations were distributed randomly into three groups based on the adhesive system and waiting time: CUBq without waiting time (CUBq-NW), CUBq with a 20 s waiting time (CUBq-W), and CSE with a 20 s waiting time. After placement, restorations were evaluated after 18 months using the International Dental Federation (FDI) and United States Public Health Service (USPHS) criteria. Statistical analyses involved Friedman repeated measures analysis of variance and Wilcoxon tests, with a significance level set at 5 %. ResultsOver the 18-month period, no restorations were lost across the tested groups. Marginal adaptation evaluation indicated minor discrepancies in 21 restorations (8 CUBq-NW, 6 CUBq-W, and 7 CSE). There were no significant differences observed among the three groups following the 18-month clinical assessment (p > 0.05). Only two restorations showed marginal discoloration after 18 months (1 CUBq-NW and 1 CSE). ConclusionsThe application of Clearfil Universal Bond Quick using either the "waiting" or "no-waiting" technique exhibited excellent clinical results in NCCLs during the 18-month follow-up period, demonstrating comparable performance to Clearfil SE Bond in all assessed outcomes. Clinical significanceThe findings suggest that the new universal adhesive applied using the no-waiting technique demonstrates promising clinical performance when compared to conventional application methods. Trial registrationClinicalTrials.gov identifer RBR-69p7mpr.

Retrospective evaluation of factors affecting long-term clinical performance of CAD-CAM laminate veneers.

The purpose of the study was to assess the clinical performance of CAD-CAM laminate veneers placed by a single operator and systematically evaluated for up to 10 years. A total of 197 laminate veneers fabricated using either feldspathic ceramic (VMII) or lithium disilicate ceramic (EmaxCAD) were followed up to 10 years in 32 patients. Technical, esthetical, and biological findings of each restoration were evaluated using modified United States Public Health Service criteria. The survival and complication rates were assessed using Kaplan-Meier survival analysis and compared using the Log Rank test. Statistical significance was set at p<0.05. The estimated Kaplan-Meier survival rate was 91.9% after the mean observation period. According to ceramic system used, the estimated Kaplan-Meier survival rate amounted to 92.7% for Emax-CAD and to 89.1% for VMII. Survival rates were significantly affected by the location of veneer according to Log Rank test (p < 0.05). A range of survival rates between 83.3% and 98.6% were observed based on the location of veneer. CAD-CAM laminate veneers milled of feldspathic or lithium disilicate ceramics have comparable long-term survival rates. Oral positioning affects the survival of veneer. Veneers of incisors have higher survival rates than the veneers of maxillary canines and premolars.

Survival and complications of 3D-printed, non-invasive restorations for prosthetic rehabilitations: A 12-month preliminary observational study.

The adjustment and transfer of a stable occlusion can be a major challenge in prosthetic rehabilitations. The aim of this study was to assess a non-invasive treatment option for complex prosthetic rehabilitations and occlusal analyses using 3D-printed restorations clinically. Eleven patients received a partial or complete rehabilitation with the aid of 3D-printed restorations (n=171). After 12 months of clinical service, all restorations were analyzed using the United States Public Health Service (USPHS) criteria. The 12-month clinical data revealed that 3D-printed restorations showed a survival rate of 84.4%. Complications occurred mostly regarding the anatomical form (7%) or marginal integrity (6AC%) and were consequently rated "Charlie" or "Delta." Color stability and color match of 3D-printed restorations were rated "Alpha" in 83% and 73%, respectively, of all restorations. Marginal inflammation was rated "Alpha" in 89% of all restorations. An excellent surface texture and no secondary caries or postoperative sensitivities (100%) were observed. 3D-printed restorations might be an alternative treatment option for initiating complex prosthetic rehabilitations. Technical complications rarely occurred. Biological complications did not occur at all. The color stability showed promising results after 12 months of clinical service. However, the results should be interpreted with caution. Long-term results with a high number of restorations should be awaited.

A Randomized Controlled Clinical Trial Evaluating the Performance of Bis-GMA Free Resin Composite Posterior Restorations

Objective: This study aims to assess the clinical performance of Bis-GMA free resin composites (RCs) in comparison with Bis-GMA based resin composites as posterior restorations during 1,3,6,9, and 12 months, using a split-mouth, double-blinded randomized design. Methods and Materials: The study included 20 participants who received a pair of class I or II bulk-fill composite restorations. One side of the mouth was filled with Bis-GMA free RC (Admira Fusion x-tra), while the other side received Bis-GMA based RC (X-tra fil). Restoration placement was done by a single operator following the manufacturer's guidelines and was finished and polished immediately following placement. Modified United States Public Health Services (USPHS) criteria have been adopted for restoration assessment at baseline (1 week), 1, 3, 6, 9, and 12 months. The statistical analysis was accomplished utilizing Wilcoxon tests, with a 0.05 significance level. Results: After 12 months, all patients attended the recall visits with a 100% recall rate. The Wilcoxon signed rank tests revealed insignificant differences between both groups (p?0.05) for all USPHS parameters. The two studied materials showed a decline from 100% clinically excellent scores, with a few recordings of clinically good scores at 12 months. However, most restorations maintained clinical Alpha and Bravo score throughout the 12-month period. Conclusions: The Bis-GMA-free RCs' clinical performance was comparable to that of Bis-GMA-based RCs in posterior permanent teeth restorations after 12 months. These findings suggest that Bis-GMA-free RCs can be considered a viable alternative to Bis-GMA-based RCs in clinical practice.  

Evaluation of Giomer Using Eighth Generation Bonding Agent and Resin-Modified Glass Ionomer Cement Restoration in Non-Carious Cervical Lesions.

Non-carious cervical lesions (NCCL) raise a considerable restorative challenge for the dentist in bonding, as adhesion is not as strong and predictable as enamel bonding. A critical factor for restorative success is the selection of restorative material. Clinicians have tried many restorative materials and techniques to obtain the best performance. The aim of the present study was to evaluate and compare the clinical outcome of a Giomer and Resin modified glass ionomer cement (RMGIC) restoration in NCCL using united states public health service (USPHS) criteria at baseline, 3, 6 and 12 months. Patients from age 25 - 50 years having non-carious cervical lesions on both the sides and requiring restorations were screened. 20 patients were selected and further divided into 2 groups using simple random sampling technique. Group A- Beautifil II restoration using G-Premio bond (n = 10) and Group B- Ketac N100 restoration (n = 10). Restorations were done according to manufacturer's instructions and consequently evaluated at baseline, 3, 6 and 12 months using the USPHS criteria for marginal discolouration, marginal integrity, surface texture, colour match, gross fracture and post-operative sensitivity. Giomer restorations showed better results than RMGIC. There was decrease in alpha ratings in both the study groups i.e., Giomer and RMGIC from 6 to 12 months. The overall findings suggest that both Giomer and RMGIC gave satisfactory clinical results when used to restore non-carious cervical lesions. Both the materials can successfully be used since there was no statistically significant difference in the clinical outcome.

Survival and success of veneered zirconia crowns.

The aim of the present study was to evaluate the long-term clinical survival and success rate of veneered zirconia crowns with a modified anatomical framework design after 10 years in function. In total, 36 zirconia crowns were fabricated for 28 patients. An anatomically modified framework design was developed. Crowns were inserted between 2008 and 2009. A follow-up of 19 patients with 28 crowns was conducted in 2020 to document mechanical and biologic parameters. Additionally, a modified version of the pink esthetic score (PES) was documented. Patient satisfaction was assessed using United States Public Health Service (USPHS) criteria. The success and survival rates were calculated using the Kaplan-Meier analysis. After more than 10 years of clinical service, the survival rate of the zirconia crowns was 92.9%. Biologic complications occurred in 12% of the examined crowns, whereas technical complications occurred in 54%. Mostly, chippings (50%) and insufficient marginal gaps (50%) were observed. Most crowns were positively evaluated for more than one technical complication. Periodontal conditions with probing depths of up to 3 mm were comparable with measured values before crown delivery (73% to 75%). Most of the crowns had modified PES values of 10 or higher. Patient satisfaction was high. The modified framework design led to a high survival rate of the crowns but a relatively low success rate. High patient satisfaction and inconspicuous periodontal conditions were demonstrated. Biologic complications occurred far less frequently than technical complications.

A 32-month evaluation of lithium disilicate cantilever resin-bonded fixed dental prostheses to replace a missing maxillary incisor

The absence of a tooth in the esthetic zone can cause emotional and social distress. The use of minimally invasive and visually pleasing lithium disilicate resin-bonded fixed dental prostheses (RBFDPs) may be a suitable option for replacing a missing maxillary incisor. However, the available literature on lithium disilicate cantilever RBFDPs is limited. This retrospective multicenter study assessed the survival and success rates of lithium disilicate anterior cantilever RBFDPs with an average follow-up period of 3 years up to 9 years. RBFDPs delivered by 3 operators were clinically assessed for survival using a modified United States Public Health Service criteria list. The incidence density was determined for each criterion and operator. The standard error and 95% confidence interval were calculated for each incidence density difference (α=.05 for all analyses). A total of 108 RBFDPs were evaluated after a mean period of 32.45 months, ranging from 14 days to 111 months. None of the restorations exhibited failure, carious lesions, or fractures during the follow-up period. The primary reasons for reduced success rates were inflammation of the surrounding soft tissues and discoloration, with incidence densities of 0.074 and 0.057 per year, respectively. Significant differences were observed among RBFDPs from different operators for criteria that included adaptation, color match, marginal adaptation, polishability, surface staining, gingival health, and antagonist wear. Cantilever lithium disilicate RBFDPs appear to be suitable for short-term restoration. RBFDPs exhibited visible changes after short-term follow-up. However, these changes did not result in failure.