Tooth Preparation Research Articles

A New Era of Tooth Preparation and Gingitage Retraction Technique: A Case Report

The demand for procedures intended to improve dental aesthetics has increased recently. Preserving the teeth and surrounding soft structures to the greatest extent possible is preferred in this situation by both patients and dentists. When using fixed prostheses, maintaining the stability and health of soft tissues is a constant struggle. Bone tissue health and soft tissue health are directly correlated. The long-term efficacy of prosthetic therapy thus depends on preserving tissue health and being free of mucositis. This case report describes the successful application of the gingitage technique in a patient requiring aesthetic enhancement of the gingival margins surrounding dental restorations. The patient presented with uneven gingival contours and mild inflammation around subgingival margins of existing restorations, compromising both function and aesthetics. Results demonstrated significant improvements in gingival health, a more balanced gingival margin, and an enhanced aesthetic outcome. Follow-up assessments revealed stable gingival contours and an overall increase in patient satisfaction. This case report underscores the effectiveness of the gingitage technique as a minimally invasive solution for enhancing soft tissue aesthetics and supporting the longevity of dental restorations.

3D Printed Dual Reduction Guide: A Feasible Alternative for Conservative Gingivectomy and Minimally Invasive Preparation for Ceramic Veneers.

This case report describes a digital workflow for designing and 3D printing a guide with the dual purpose of gingivectomy and tooth preparation in the esthetic zone, to be followed by cementation of ceramic veneers under rubber dam isolation. The patient's primary concern was to improve her smile. After clinical evaluation, our recommendation was for a minimal gingivectomy to match the gingival zenith for both central incisors, to be followed by ceramic laminate veneers. A digitally designed and 3D printed guide was used for gingivectomy and tooth preparation for the ceramic veneers. Ceramic veneers were cemented under rubber dam isolation to maximize bonding properties. A single guide can be digitally designed and 3D printed to perform controlled gingivectomy and minimally invasive tooth preparations. The outcome of the gingivectomy improved the gingival architecture for central incisors, and the ceramic veneers fulfilled the patient's esthetic demands.

Effect of immediate dentin sealing on the fracture strength of indirect posterior restorations:Systematic review and meta-anlysis protocol.

Background Immediate Dentin Sealing (IDS) is a technique that applies an adhesive layer immediately after tooth preparation, prior to the placement of indirect restorations. This method is gaining attention due to its potential to improve the bond strength and mechanical properties of restorations, particularly in the posterior region where restorations endure significant masticatory forces. The objectif of this systematic review and meta-analysis is to evaluate the effect of IDS on the fracture strength of indirect posterior restorations. Methods Following PRISMA guidelines, a comprehensive literature search was conducted in four databases: Web of Science, Scopus, Cochrane Library, and PubMed. Inclusion criteria focused on in vitro studies involving human teeth with indirect posterior restorations, published between 2014 and 2023. Studies using IDS were compared to those using conventional methods. The risk of bias was assessed using the Cochrane Collaboration’s tool, and a meta-analysis was performed with a random-effects model. The standard mean difference and 95% confidence intervals were calculated to compare fracture strength, with I2 statistics assessing heterogeneity. Forest and funnel plots were employed to visualize results and publication bias, respectively. Discussion The results indicate that IDS generally enhances the fracture strength of indirect posterior restorations, particularly with ceramic materials like lithium disilicate. However, the effectiveness of IDS varies depending on the material and restoration type. While some studies demonstrated improved fracture resistance with IDS, others showed minimal benefit, especially with composite restorations. Additionally, IDS improved marginal adaptation and internal fit but increased the risk of severe failures, such as root fractures. Systematic review registration PROSPERO: CRD42024584545 (Registered on 08/09/2024).

Evaluation of Wear on Primary Tooth Enamel and Fracture Resistance of Esthetic Pediatric Crowns Manufactured from Different Materials

Background and Objectives: Advances in dental materials and CAD-CAM technology have expanded crown options in primary teeth due to their improved appearance and mechanical properties. Thus, this study aimed to assess the enamel wear and fracture resistance of prefabricated, milled, and 3D-printed esthetic pediatric crowns. Materials and Methods: The study involved 60 extracted maxillary second primary molars and 60 3D-printed resin dies, divided into six groups based on different crown materials (n = 10): prefabricated zirconia, prefabricated composite, milled composite, milled resin matrix ceramic, milled PEEK, and 3D-printed resin. Prefabricated crowns were selected after the preparation of the typodont mandibular second primary molar tooth, while milled and 3D-printed crowns were custom produced. The specimens underwent mechanical loading of 50 N at 1.6 Hz for 250,000 cycles with simultaneous thermal cycling. The 3D and 2D wear amounts were evaluated by scanning the specimens before and after aging. Then, the fracture resistance and failure types of the restorations were recorded. Results: The results showed that the milled PEEK group had superior fracture resistance compared to the other groups, while prefabricated zirconia crown group had the lowest value. Milled resin matrix ceramic crown group displayed the lowest 3D wear volume, while 3D-printed crown group showed the highest 2D wear. Conclusions: The restorative material type did not have a significant effect on the wear of primary tooth enamel. The fracture resistance of the tested materials differed according to the material type. Although the milled PEEK group showed the highest fracture resistance, all tested materials can withstand chewing forces in children.

Analysis of occlusal clearance of crown preparations in a predoctoral clinical setting.

This study sought to assess the presence and location of inadequate tooth preparation performed by predoctoral dental students by scanning mounted casts submitted for monolithic zirconia crown fabrication METHODS: An intraoral scanner capable of volumetric measurements of crown preparations was used to analyze 56 crown preparations on mounted stone casts before submission to a lab for crown fabrication. The mounted casts were scanned individually and then a buccal bite was scanned to stitch the models together into virtual occlusion. The distance between the crown preparations and opposing dentition was displayed volumetrically, and the minimum clearance of each preparation was recorded for both the functional and non-functional cusps. Preparations were evaluated for adequate interocclusal clearance and comparisons were made using a Chi-square test with α=0.05 with respect to tooth location, functional versus nonfunctional cusp, and or single versus multi-unit preparation. Over 47% of mounted casts with crown preparations analyzed for the study exhibited a lack of occlusal clearance in at least one area. Functional cusps were more often under-reduced than non-functional (p<0.001). No other comparisons were statistically significant. The present study demonstrates a high percentage of under-reduced crown preparations in a predoctoral clinic and emphasizes the utility of quality control and analysis via digital scanning of crown preparations prior to crown fabrication.

Prevalence of Dentine Hypersensitivity in Vital Abutment Teeth being prepared for Fixed Partial Dentures or Crowns

Objective: To determine the prevalence of dentine hypersensitivity during the preparation of vital abutment teeth for Fixed Partial Dentures or Crowns and its association with patient’s gender, age, and location of tooth. Study Design &amp; Setting: This is a descriptive cross-sectional study of patients with 150 abutments of either crown or fixed partial dentures, carried out in the department of Prosthodontics at Armed Forces Institute of Dentistry (AFID) Rawalpindi from June to December 2021. Methodology: The Dentine Hypersensitivity was recorded on a VAS (Visual Analogue Scale) of 0-10 after the patient reported pain during exposure to thermal stimulus i.e. cold water from a 5cc syringe at 1cm distance during or just after the tooth preparation. Results: In this study, the prevalence of Dentine Hypersensitivity was 13.3% with a mean dentine hypersensitivity score (VAS) for cold water test (Mean ± SD) of 0.61±1.756. Independent samples t-tests were used to determine the difference in hypersensitivity between genders, two age groups, and type of tooth (anterior/ posterior). It showed significant results with p-values of 0.002, 0.002, and 0.003 respectively. Conclusion: Within the limitations of this study, it was highlighted that the preparation of vital teeth for conventional porcelain fused to metal (PFM) crown or fixed dental prosthesis results in dentine hypersensitivity in a considerable number of cases, with a higher incidence in women, younger patients, and vital anterior abutments.

Integrating virtual-reality into restorative dentistry training: A study on the acceptability and effectiveness of tooth preparation simulations.

Digital education using virtual-reality simulators is essential for precise learning in modern education. This study aimed to develop a virtual-reality dental system for tooth preparation training and assess pre-virtual-reality experiences and perceptions of its potential benefits. We evaluated the post-virtual-reality experience in terms of the effectiveness of the virtual-reality system. The virtual-reality platform development phase involved learning- and assessment-based frameworks for participants. The first step involved creating a storyboard for a virtual dental clinic environment using virtual-reality glasses. This simulated a dental chair-like setup with instruments and tools, allowing participants to practice dental procedures. This study utilized a mixed-methods approach to assess participants' experience with virtual reality in dental education using a tooth preparation simulation system and evaluated post-virtual reality measures, including the system usability scale, usefulness, educational effectiveness, and participant attitudes through structured survey questionnaires. This study included 150 participants (49 dental students, 52 dental interns, and 49 faculty members). Most participants were females (76%). Significant differences were observed in attitude scores between students and faculty members, with third-year dental students having more positive attitudes toward the integration of virtual-reality in dental education. No significant differences were found in system usability, usefulness, or assessment scores between the groups. The virtual-reality dental module system shows promise for improving dental education. The varied responses from different user groups should be considered to ensure successful implementation and acceptance.

An Evaluation of the Accuracy of Digital Models-An In Vitro Study.

Intraoral scanning technology has opened new perspectives in dental practice, and combined with CAD/CAM technology, contributes significantly to fabricating high-quality prosthetic restorations. Our in vitro study aims to assess the accuracy of digital models obtained from one laboratory and two less commonly used intraoral scanners by conducting 3D measurements on the digital models obtained. An articulated simulator cast was used. Forty-eight scans were performed before and after tooth preparation with each scanner. The Zeiss Inspect software (Version: 2023.3.0.969) was used for measurements in sagittal and transversal planes. The obtained values were compared to reference values resulting from manual measurements. Digital impressions provided discrepancies compared to the reference model. The lowest differences at the A2-L2 (the diagonal dimension of the models from the distal fossa of the second right maxillary molar and the maximum oral convexity of the artificial gingiva at the first left premolar) and the A1-B1 (transversal dimension of the model in the posterior area, from the right second molar's occlusal central fossa to the left second molar central fossa) distances were obtained for the upper models, and at the a1-b1 distance for all the lower models, except the non-prepared models scanned with the intraoral scanners (the discrepancies were not statistically significant). The discrepancies increased with the distance from the starting point of the scan. The number and position of prepared teeth can influence the accuracy of the scans. Distortions can appear in the case of multiple preparations. The scanning protocol and calibration must be optimized for the highest accuracy. Furthermore, in vivo studies are necessary to evaluate the clinical applicability of these findings.

Computer-Assisted Porcelain Laminate Veneer Preparation: A Scoping Review of Stereolithographic Template Design and Fabrication Workflows.

Computer-assisted preparation of porcelain laminate veneers (PLVs) using stereolithographic templates has been developed to enhance the accuracy of tooth preparation. However, the digital workflows involved in guided PLV preparation remain inconsistently defined across various practices. Therefore, this scoping review aimed to examine publications on computer-assisted PLV preparation to identify the key stage of digital workflows involved in designing and fabricating stereolithographic templates, as well as to highlight the limitations of various template designs. This scoping review aimed to identify publications on digital workflows for designing and fabricating stereolithographic templates in computer-assisted porcelain laminate veneer preparation. A systematic search on MEDLINE/PubMed, Web of Science and Scopus identified English-language articles published from 2014 to March 2024. Eligible articles focused on digitally designed and fabricated tooth reduction templates for porcelain laminate veneers, excluding conventional tooth preparation procedures for tooth reduction assessment. Seven clinical reports were included, demonstrating various 3D data acquisition techniques for virtual patient generation. All articles described virtual diagnostic wax-ups on digital casts, with two using a virtual articulator. Only five articles documented chair-side mock-ups with resin trial restorations to evaluate planned dental esthetics. Additionally, virtual tooth preparation prior to templates design was included in only four articles. The templates were designed using different software and ranged from simple designs with access windows to complex stacked templates with rotary instrument sleeved windows. Each template design had limitations affecting tooth reduction accuracy. All articles reported printing templates in clear acrylic resin using different technologies. In conclusion, the review highlights a lack of standardization in the digital workflow for designing stereolithographic templates for PLVs. Establishing a sound protocol for designing the tooth reduction templates is essential to ensure the accuracy and consistency of veneer preparation.

Examining gaze behavior in undergraduate students and educators during the evaluation of tooth preparation: an eye-tracking study

BackgroundGaze behavior can serve as an objective tool in undergraduate pre-clinical dental education, helping to identify key areas of interest and common pitfalls in the routine evaluation of tooth preparations. Therefore, this study aimed to investigate the gaze behavior of undergraduate dental students and dental educators while evaluating a single crown tooth preparation.MethodsThirty-five participants volunteered to participate in the study and were divided into a novice group (dental students, n = 18) and an expert group (dental educators, n = 17). Each participant wore a binocular eye-tracking device, and the total duration of fixation was evaluated as a metric to study the gaze behavior. Sixty photographs of twenty different tooth preparations in three different views (buccal, lingual, and occlusal) were prepared and displayed during the experimental session. The participants were asked to rate the tooth preparations on a 100 mm visual analog rating scale and were also asked to determine whether each tooth preparation was ready to make an impression. Each view was divided into different areas of interest. Statistical analysis was performed with a three-way analysis of the variance model with repeated measures.ResultsBased on the participants’ mean rates, the “best” and the “worst” tooth preparations were selected for analysis. The results showed a significantly longer time to decision in the novices compared to the experts (P = 0.003) and a significantly longer time to decision for both the groups in the best tooth preparation compared to the worst tooth preparation (P = 0.002). Statistical analysis also showed a significantly longer total duration of fixations in the margin compared to all other conditions for both the buccal (P < 0.012) and lingual (P < 0.001) views.ConclusionsThe current study showed distinct differences in gaze behavior between the novices and the experts during the evaluation of single crown tooth preparation. Understanding differences in gaze behavior between undergraduate dental students and dental educators could help improve tooth preparation skills and provide constructive customized feedback.

Multiple cell death modalities and immune response in pulpitis.

To investigate the level and distribution of apoptosis, pyroptosis, necroptosis, and NETosis in pulpitis with or without necrosis on a basis of histological classification. Additionally, to examine the effect of pulpitis with necrosis (PWN) on the number and activation of peripheral and bone marrow (BM) neutrophils, as well as spleen lymphocytes, in a mouse model of pulpitis. The material comprised 20 permanent teeth, with or without caries, which were classified into three histological categories based on the distribution of inflammatory cells and the presence or absence of necrosis: (i) healthy pulp (HP), (ii) pulpitis without necrosis (PWON), and (iii) PWN. The levels of the four regulated cell death (RCD) pathways were detected by immunohistochemical and immunofluorescent staining with specific markers: apoptosis (caspase-8, cleaved caspase-3), pyroptosis (cleaved caspase-1, membrane-binding gasdermin D), necroptosis (receptor-interacting kinase 3, phosphorylated MLKL), and NETosis (myeloperoxidase, citrullinated histone H3). Acute pulpitis was induced in C57BL/6J mice via pulp exposure, and the mice were divided into four groups: (i) control (no tooth preparation, n = 6), (ii) Day 1 (sacrificed at 1 day after pulp exposure, n = 3), (iii) Day 3 (n = 3), and (iv) Day 5 (n = 7). The control and Day 5 groups were used for further immunofluorescent analysis to assess the levels of RCD and flow cytometry to monitor the changes in peripheral and BM neutrophils, as well as spleen lymphocytes. Human dental pulp stem cells (hDPSCs) were isolated and cultured from extracted healthy third molars. Apoptosis and necroptosis in hDPSCs were induced by staurosporine, whilst pyroptosis was induced by lipopolysaccharide and nigericin. One-way analysis of variance (ANOVA) with Tukey's test, Welch's ANOVA with Tamhane's test, and Student's t-tests were used to compare immunohistochemical labelling and flow cytometric data amongst groups (p < .05). The pulpal tissue of PWN can be divided into the abscess core (PWN-AC) and fibrous tissue (PWN-FT). The ratio of total necrotic cells (TUNEL-positive) in PWN-AC was significantly higher than in PWN-FT and PWON (both p < .01). Compared with HP, the expression levels of markers for apoptosis and pyroptosis were increased in PWON, whilst the expression levels of markers for apoptosis, pyroptosis, and NETosis were elevated in PWN, primarily detected in PWN-AC. Interestingly, myeloperoxidase (MPO) was exclusively observed in PWN-AC, with minimal detection in PWN-FT and PWON. Additionally, the frequency of MPO+ cells was significantly higher than that of MB-GSDMD+ cells and Cl-cas3+ cells in PWN-AC (both p < .01). Histological observation and TUNEL staining showed abundant necrotic cells in mouse pulpal tissue after pulp exposure, indicating a simulation of human PWN. In mouse pulpitis tissue, markers of apoptosis, pyroptosis, and NETosis were detected. Invitro, various cell deaths including apoptosis, pyroptosis, and necroptosis were also triggered in hDPSCs under various cell death treatments. Furthermore, in terms of systemic changes, pulp exposure-induced pulpitis could increase the number (p < .05) and cellular activity (p < .01) of neutrophils from BM in a mouse model. No significant changes in peripheral blood neutrophils, spleen T cells, B cells, or the CD4/CD8 ratio were detected between the control and pulpitis mice. Our findings uncover distinct patterns of mixed cell death at different histological stages of human pulpitis and the impact of pulpitis on the number and activity of BM neutrophils. Notably, NETosis occurs specifically and predominates in the abscess area of pulpitis, suggesting a potential effect of neutrophil extracellular traps (NETs) on pulpitis progression and NETs-targeted diagnostic strategy may play a role in decision making for vital pulp therapy.

The use of air abrasion method to treat caries in autistic patients at the age of 6 years: A non-randomized controlled trial.

Autism Spectrum Disorders (ASD) encompass a range of conditions characterized by difficulties in social interaction and communication. Managing dental treatment for children with autism presents challenges due to their reluctance to interact with dentists, which can be as high as 65%. This prospective non-randomized study, conducted at the Kazakh-Russian Medical University from January 15, 2023, to June 20, 2023, aimed to assess the efficacy of air abrasion caries treatment (AAbCT) compared to the standard method. The intervention involved applying air abrasion (AAb) treatment without anesthesia using aluminum oxide powder in the AAbCT group, while the control group received cavity preparation with local anesthesia. In this study, it was noted that the AAb method of tooth preparation was not different in efficacy from the traditional method for a population of children with autism, and could be used without anesthesia. A greater willingness to cooperate was noted (p=.0372). The AAb is an effective and safe treatment for children with ASD. Further studies needed to investigate its efficacy and safety in combination with behavioral interventions.

APLICAÇÕES ESTÉTICAS DE PORCELANA NA ODONTOLOGIA CONTEMPORÂNEA – REVISÃO SISTEMÁTICA

Since the early 1800s, porcelain and ceramic materials have been used in the production of aesthetic dental restorations. Advances in dental ceramic technology and adhesive systems have made porcelain veneers a highly sought after aesthetic option. Thus, this work aims to review the literature, with the aim of discussing the use of porcelain veneers in modern dentistry, emphasizing their advantages, disadvantages, indications and limitations. The databases used were PubMed, SciELO, Google Scholar where a total of 21 articles published in the last 10 years were selected. The findings revealed that this technique has several indications and advantages, among its benefits are the minimal compromise of tooth wear during the tooth preparation phase and the achievement of harmony in the patient's smile, in addition to longevity. Its contraindications and disadvantages include, in some cases, detachments and fractures, among others.

APLICAÇÕES ESTÉTICAS DE PORCELANA NA ODONTOLOGIA CONTEMPORÂNEA – REVISÃO SISTEMÁTICA

Since the early 1800s, porcelain and ceramic materials have been used in the production of aesthetic dental restorations. Advances in dental ceramic technology and adhesive systems have made porcelain veneers a highly sought after aesthetic option. Thus, this work aims to review the literature, with the aim of discussing the use of porcelain veneers in modern dentistry, emphasizing their advantages, disadvantages, indications and limitations. The databases used were PubMed, SciELO, Google Scholar where a total of 21 articles published in the last 10 years were selected. The findings revealed that this technique has several indications and advantages, among its benefits are the minimal compromise of tooth wear during the tooth preparation phase and the achievement of harmony in the patient's smile, in addition to longevity. Its contraindications and disadvantages include, in some cases, detachments and fractures, among others.

Clinical Success Evaluation of Ultrathin Ceramic Veneers Bonded to Nonprepared Teeth: An Observational Prospective Cohort Study.

Patients' increasing interest in achieving optimal cosmetic outcomes and the widespread use of ultrathin ceramic veneers offer advantages such as high esthetic results and long-term durability. Several issues related to tooth preparation have been raised, including dental sensitivity, periodontal diseases, and increased treatment phases, in addition to complications associated with previous procedures, the treatment of which remains controversial to date. With the advancement of dental ceramic and its manufacturing techniques, it was widely used to manufacture ultrathin ceramic veneers with minimal preparation. Issues such as fracture and abfraction are the most common in ceramic veneers made of feldspathic ceramic due to their weak mechanical properties against various forces, which led to the emergence of lithium disilicate glass-ceramic manufactured using the heat-press technique. This has resulted in ultrathin ceramic veneers with a thickness of up to 0.1-0.2 mm easily bonded and finished as they have high mechanical properties and esthetic qualities that mimic natural tooth color and shape. The current cohort study aimed to evaluate the success rates of this kind of treatment for patients treated at our department. This observational cohort study's sample comprised 60 ultrathin ceramic veneers manufactured from lithium disilicate glass-ceramic bonded to nonprepared upper teeth. The clinical performance of the studied sample was evaluated and monitored at monthly intervals (one month, three months, six months, and one year) using the clinical success evaluation based on Walton's principles adopted for evaluating the success and failure of fixed restorations. Ultrathin ceramic veneers made from lithium disilicate glass-ceramic, bonded to nonprepared teeth, proved to be a successful clinical and esthetic treatment option, with a clinical success rate of 100% during the entire follow-up period. This study's findings indicate that ultrathin ceramic veneers made from lithium disilicate glass-ceramic, bonded to nonprepared teeth, area successful clinical and esthetic treatment option, with a clinical success rate of 100% during the entire follow-up period.

Cumulative effect of digital manufacturing techniques, preparation taper and finish line designs on the retention of aged temporary molar crowns − An in vitro study

ObjectiveThis study evaluated the effects of finish-line design, tooth preparation taper or total occlusal convergence (TOC), and digital production technology on the retention of provisional crowns for molars. Material and MethodsDifferent taper angles (10° TOC and 20° TOC) and finish line designs (chamfer and shoulder) were used to prepare four mandibular first molar teeth. Two subgroups of the prepared teeth received temporary crowns that were either “Computer-Aided Design” and “Computer-Aided Manufacturing (CAD/CAM) milled or 3D printed. Hence, eight test groups of temporary crowns containing 10 samples each were created. Groups 1–4 were milled, and Groups 5–8 were 3D printed specimens. A consistent procedure was used to cement 80 temporary crowns. The specimens were thermocycled for a total of 5000 heat cycles, initially at 5 °C for 30 s (dwell time) and then at 55 °C for 30 s. The pull-off force necessary to remove the temporary crowns was recorded, and the tensile strength, which served as the dependent variable, was calculated. Analysis of variance (ANOVA) was used to assess the variations in retention forces among the test groups. ResultsThe mean tensile strengths at maximum load [MPa] were higher in Groups 5, 6, 7, 8 (6.6 MPa, 6.91 MPa, 7.65 MPa, and 7.45 MPa respectively) as compared to the mean tensile strengths at maximum load [MPa] in Groups 1, 2, 3, 4 (2.35 MPa, 3.52 MPa, 3.21 MPa, and 2.45 MPa respectively). ConclusionFor extended periods, 3D-printed crowns with steeper preparation tapers (20° TOC) and shoulder finish lines exhibited enhanced retention.

Apically extruded debris evaluation with the use of ProTaper Ultimate and TruNatomy files systems with and without glider preparation in primary tooth.

Information regarding the influence of resorption and glide paths on debris extrusion in primary teeth is lacking. Therefore, we evaluated debris extrusion with and without resorption and with and without the use of a path file in primary molar teeth prepared with ProTaper Ultimate (PTU) Prime and TruNatomy (TRN) Prime rotary file systems. Forty resorbed and forty non-resorbed primary molar teeth were collected. Both groups were divided into four subgroups (n = 10). The Eppendorf tubes were weighed pre-debris. The distal canals of the teeth were prepared with PTU Prime and TRN Prime file systems, with and without the use of path files. The debris-filled tubes were weighed, and the weight of only the extruded debris was calculated by subtraction. The data were analyzed using a three-way analysis of variance (ANOVA) test. The presence of tooth resorption significantly increased debris extrusion, and the use of a path file significantly decreased debris extrusion (p < 0.001). The binary and ternary interactions of the three evaluated parameters among the groups showed no significant differences in terms of the amount of debris extruded (p > 0.05). While debris extrusion was observed in all groups, the use of a glide path file in primary teeth before the preparation process resulted in less debris extrusion.

Post-mortem Interval estimate based on dental pulp: A histomorphology approach.

Estimating the post-mortem interval (PMI) of human remains based on the histomorphology of dental pulp parameters is promising, but available evidence is scarce and sometimes contradictory without a scientific model. The aim of the study is to characterise the histomorphological changes of dental pulp associated with the decomposition of human remains by a qualitative and quantitative approach. The main aim is to establish a correlation based on post-mortem (PM) dental pulp histomorphology and the PMI, and whether pulp degradation could be an available medico-legal tool for PMI estimation beyond the first week after death (late PMI). The eligible sample consisted of 27 sound teeth from 16 healthy patients aged 16 to 72 years due to orthodontic or oral surgery treatment, to create PMI's simulating the death of the subject as the time elapsed from tooth avulsion. Data collected from patients (sex, date of birth, tooth position, date and hour of the avulsion, date and hour of pulp extraction) were anonymised in accordance with the requirements of Faculty of Dental Medicine of the University of Lisbon. The sample was divided into 9 groups of 3 teeth according to different PMI sets from T0 (baseline) up to 2 weeks (T0, 7, 12, 24, 36, 48, and 72 hours, 1 and 2 weeks). All the dental samples were stored at room temperature up to the time of pulp extraction and then prepared with haematoxylin and eosin stain. High-resolution microscopy was performed to obtain histological images. An operator performed the qualitative evaluation of blood vessels, collagen fibres, and the extra-cellular matrix (ECM) in PM pulps and measured the variation in cells/nuclei density by counting 6 different ROIs (Regions of Interest) for each pulp manually and automatically (quantitative analysis). Qualitative results showed that the degeneration of dental pulp appears 7 hours after death but histological changes in vessels, fibres, and ECM in PM dental pulp are characterised by high variability, consequently it is not possible to generalise the results for early PMIs. Quantitative measurements proved that cell count cannot be standardised due to the presence of superimposed layers of cells and nuclei fragmentation. Odontoblasts did not demonstrate evidence of cellular or nuclear lysis up to 14 PM suggesting their applicability in late PMIs. Future research will focus on late PMIs and different techniques of tooth preparation.

Influence of apical finish line location of tooth preparations on the scanning accuracy of intraoral scanners with various focal lengths and scanning technologies

Statement of problemLimited studies have reported the influence of finish line location on the accuracy of intraoral scanners (IOSs). Focal length is a hardware characteristic of IOSs. Whether there is a relationship between scanning accuracy of tooth preparations with the finish located at different apical positions and focal length and IOS technology or system remains uncertain. PurposeThe purpose of the present in vitro study was to assess the influence of the apical finish line location of tooth preparations on the accuracy of 4 IOSs with various focal lengths and scanning technologies. Material and methodsA maxillary typodont with a crown preparation on the left first molar was digitized (T710). Afterwards, a removable die was created on the prepared first molar of the virtual cast and duplicated to create 4 dies with different apical finish line locations: 2- or 1-mm supragingival, 0-mm or equigingival, and −0.5-mm or intracrevicular. The cast and die designs were additively fabricated (Asiga Pro 4K with Keystone Model Ultra). Each die was independently scanned by using the same laboratory scanner (reference scans). Four groups were created: TRIOS 5, i700, iTero, and Primescan. Four subgroups were developed depending on the apical position of the finish line (n=15). In each subgroup, the cast was assembled by positioning the corresponding die into the cast. The cast was then scanned by using the corresponding IOS. The reference scans were used as a control to compute the root mean square (RMS) error discrepancies with each experimental scan on the preparation and margin of the preparation areas. Two-way ANOVA and pairwise comparisons were used to analyze trueness (α=.05). The Levene and pairwise comparisons using the Wilcoxon Rank sum test were used to analyze precision (α=.05). ResultsTrueness discrepancies in the preparation area were found among the groups (P=.010) and subgroups (P<.001), with a significant interaction between group×subgroup (P<.001). The −0.5 mm location obtained significantly worse trueness in the preparation area. The TRIOS 5 and i700 obtained the best trueness in the preparation area. Trueness discrepancies in the margin area were found among the groups (P=.002) and subgroups (P<.001), with a significant interaction between group×subgroup (P=.004). The −0.5 mm location obtained the worst trueness in the margin area. The i700 and Primescan obtained the best trueness in the margin area. Precision discrepancies were found in the preparation area (P<.001). The TRIOS 5 obtained the best precision in the preparation area (P=.001). Precision discrepancies in the margin area were obtained (P<.001). The 1-mm subgroup obtained the best precision (P=.001). ConclusionsThe apical position of the finish line of the tooth preparation tested affected the trueness and precision of the IOSs tested.

Comparative Evaluation of Two Different Preparation Designs and Materials on the Fracture Resistance of Laminate Veneers: An In Vitro Study.

Introduction Laminate veneers are thin porcelain or composite resin shells bonded to the front of teeth for cosmetic enhancement. The design of the tooth preparation is crucial; it involves minimal enamel removal to ensure a proper fit and strong bond. This careful preparation increases the veneers' fracture resistance by preserving tooth structure and evenly distributing stress, ensuring durability and natural appearance. Aim Our aim was to determine the fracture resistance of two preparation designs with two different materials for the fabrication of laminate veneers. Materials and methods An in vitro study was conducted on 40 laminate veneers divided into two groups based on the material used: Group 1 (Cerec Tessera (Dentsply Sirona, Charlotte, NC, USA)) and Group 2 (Upcera, Shenzhen, China). Each group was further divided into two sub-groups based on tooth preparation designs: butt joint and feather edge. The fracture resistance of these veneers following thermocycling was determined, and the mode of fracture was evaluated using a stereomicroscope. Results Feather edge preparation with Cerec Tessera laminate veneer restoration demonstrated the highest fracture resistance at 111.5 N, followed by butt joint preparation with Cerec Tessera laminate veneer restoration, which showed a fracture resistance of 90.8 N. The study identified laminate fractures as the most common type of fracture observed in the veneer restorations, followed by cement interface fractures. Conclusion The study suggests that the feather edge preparation design contributed to higher fracture resistance compared to the butt joint design. This finding aligns with the idea that modifying the preparation design can have a significant impact on the overall strength and durability of veneer restorations. The use of Cerec Tessera, especially in combination with the feather edge design, yielded the maximum fracture resistance.