Digital and Microscopic Tools for Ultimate Esthetics and Precision

Objective: This clinical report describes and illustrates step-by-step protocols for interdisciplinary esthetic treatment with current digital and microscopic tools. Clinical Considerations: Digital dentistry is no longer limited to impression making and restoration fabrication but starts already in the diagnostic and treatment planning phase. In particular, digital smile design tools have significantly improved clinical and laboratory workflows, allowing for natural and facially driven smiles, based on the patient\u27s specific needs and preferences. Digital technologies also facilitate high precision and accuracy in the laboratory, which are interconnected with the quality of the clinical care. Precision and minimally invasive dentistry require visual magnification aids through high-power loupes or, even better, surgical microscopes. For optimal clinical success, however, these tools must be integrated into efficient workflows and made part of a comprehensive clinical and laboratory concept. Conclusions: Digital and high-magnification tools in clinics and dental laboratories facilitate highly esthetic and precise outcomes when integrated into a comprehensive treatment concept. Clinical Significance: While a plethora of new tools and technologies is available for the dental laboratory and clinical practice, they can be daunting. Clear step-by-step workflows and protocols must be followed to apply them in a most efficient and effective manner for optimal outcomes. © 2022 Wiley Periodicals LLC

The Effect of Resin Bonding on Long-Term Success of High-Strength Ceramics

Digital manufacturing, all-ceramics, and adhesive dentistry are currently the trendiest topics in clinical restorative dentistry. Tooth- and implant-supported fixed restorations from computer-aided design (CAD)/computer-aided manufacturing (CAM)–fabricated high-strength ceramics—namely, alumina and zirconia—are widely accepted as reliable alternatives to traditional metal-ceramic restorations. Most recent developments have focused on high-translucent monolithic full-contour zirconia restorations, which have become extremely popular in a short period of time, due to physical strength, CAD/CAM fabrication, and low cost. However, questions about proper resin bonding protocols have emerged, as they are critical for clinical success of brittle ceramics and treatment options that rely on adhesive bonds, specifically resin-bonded fixed dental prostheses or partial-coverage restorations such as inlays/onlays and veneers. Resin bonding has long been the gold standard for retention and reinforcement of low- to medium-strength silica-based ceramics but requires multiple pretreatment steps of the bonding surfaces, increasing complexity, and technique sensitivity compared to conventional cementation. Here, we critically review and discuss the evidence on resin bonding related to long-term clinical outcomes of tooth- and implant-supported high-strength ceramic restorations. Based on a targeted literature search, clinical long-term studies indicate that porcelain-veneered alumina or zirconia full-coverage crowns and fixed dental prostheses have high long-term survival rates when inserted with conventional cements. However, most of the selected studies recommend resin bonding and suggest even greater success with composite resins or self-adhesive resin cements, especially for implant-supported restorations. High-strength ceramic resin-bonded fixed dental prostheses have high long-term clinical success rates, especially when designed as a cantilever with only 1 retainer. Proper pretreatment of the bonding surfaces and application of primers or composite resins that contain special adhesive monomers are necessary. To date, there are no clinical long-term data on resin bonding of partial-coverage high-strength ceramic or monolithic zirconia restorations. © 2017, © International & American Associations for Dental Research 2017

Predictable Immediate Implant Placement and Restoration in the Esthetic Zone

This article describes a comprehensive step-by-step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate implant placement into fresh extraction sockets and immediate restoration have become widely accepted, demonstrating long-term success rates that are comparable with traditional delayed implant protocols. However, they are technique sensitive and require proper treatment planning as well as meticulous execution to be predictable and successful in the long term. This is particularly important in the esthetic zone, where even minor aberrations and mistakes can have devastating consequences, and especially in younger patients, where esthetic and functional outcomes should remain stable for years and possibly decades to come. The eight critical steps for predictable immediate implant placement include: provisional restoration of the failing tooth and presurgical phase, atraumatic tooth extraction, initial implant osteotomy, 3D bone graft packing, guided implant placement with a surgical guide, customized abutment insertion, provisional crown relining, and placement of a connective tissue graft from tuberosity. Immediate implant protocols in the esthetic zone require thorough planning and execution in the proper sequence. Each one of the critical steps discussed in this article has its own importance and challenges, which are critically assessed based on current scientific evidence. © 2021 Wiley Periodicals LL

Diagnosis of Biofilm-Associated Peri-Implant Disease Using a Fluorescence-Based Approach

Dental implants have become a routine component of daily dental practice and the demand for dental implants is expected to increase significantly in the future. Despite the high success rates of dental implants, failures do occur, resulting in discomfort, rampant destruction of the oral health, or painful and costly surgical replacement of a failed implant. Peri-implant diseases are inflammatory conditions affecting the soft/hard tissues surrounding a functional dental implant. Plenty of experimental evidence indicates that the accumulation of dental plaque at the soft tissue– implant interface and the subsequent local inflammatory response seems to be key in the pathogenesis of the peri-implant mucositis. Such peri-implant–soft tissue interface is less effective than natural teeth in resisting bacterial invasion, enhancing vulnerability to subsequent peri-implant disease. Furthermore, in certain individuals, it will progress to peri-implantitis, resulting in alveolar bone loss and implant failure. Although early diagnosis and accurate identification of risk factors are extremely important to effectively prevent peri-implant diseases, current systematic reviews revealed that a uniform classification and diagnostic methodology for peri-implantitis are lacking. Recent progress on fluorescence-based technology enabled rapid diagnosis of the disease and effective removal of plaques. Here, we briefly review biofilm-associated peri-implant diseases and propose a fluorescence-based approach for more accurate and objective diagnoses. A fluorescence-based diagnosis tool through headlights combined with special-filtered dental loupes may serve as a hands-free solution for both precise diagnosis and effective removal of plaque-biofilms. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Relationship Between Air-Blowing Duration and Bond Strengths of Three Adhesive Systems to Dentin After Thermal Aging

The purpose was to evaluate the effect of air-blowing duration of three different adhesive systems on immediate or thermal aged resin-dentin shear bond strength (SBS). Human dentin surfaces were bonded with: one-step (Bond Force, BF), two-step (FL-Bond II, FLB) and three-step (Scotch Bond Multi-Purpose, SBMP) adhesive systems. Bonded surfaces from each group were air-blown for 0, 5, or 10 s and cured. Composite cylinders were built on the treated surfaces and cured. Half of the specimens from each group were tested immediately and the other halves were tested after thermal aging. Statistical analysis showed signifcant decrease in SBS after thermal aging compared to immediate testing in all groups, except BF after 5 s air-blowing or FLB and SBMP with no air-blowing (p\u3e0.05). The results suggested that 5 s air-blowing is necessary to obtain a stable SBS for BF. However, extended airblowing duration of FLB and SBMP decreased the SBS significantly after thermal aging

3D Printed Complete Removable Dental Prostheses: a Narrative Review

Background: The purpose of this paper is to review the available literature on three-dimensionally printed complete dentures in terms of novel biomaterials, fabrication techniques and workflow, clinical performance and patient satisfaction. Methods: The methodology included applying a search strategy, defining inclusion and exclusion criteria, selecting studies and forming tables to summarize the results. Searches of PubMed, Scopus, and Embase databases were performed independently by two reviewers to gather literature published between 2010 and 2020. Results: A total of 126 titles were obtained from the electronic database, and the application of exclusion criteria resulted in the identification of 21 articles pertaining to printed technology for complete dentures. Current innovations and developments in digital dentistry have successfully led to the fabrication of removable dental prostheses using CAD/CAM technologies. Milled dentures have been studied more than 3D printed ones in the currently available literature. The limited number of clinical studies, mainly case reports, suggest current indications of 3D printing in denture fabrication process to be custom tray, record bases, trial, interim or immediate dentures but not definitive prostheses fabrication. Limitations include poor esthetics and retention, inability to balance occlusion and low printer resolution. Conclusions: Initial studies on digital dentures have shown promising short-term clinical performance, positive patient-related results and reasonable cost-effectiveness. 3D printing has potential to modernize and streamline the denture fabrication techniques, materials and workflows. However, more research is required on the existing and developing materials and printers to allow for advancement and increase its application in removable prosthodontics. © 2020, The Author(s)

Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study

OBJECTIVES To assess the impact of the age of resin-based composite (RBC) restorations used for deep margin elevation (DME) on the marginal quality and fracture resistance of inlays. MATERIALS AND METHODS Permanent human molars with direct RBC restorations, involving the mesial, occlusal, and distal surface (MOD), were allocated to four groups (each n = 12). Half of the teeth underwent thermomechanical loading including 240,000 occlusal load cycles and 534 thermal cycles (TML, 5 °C/55 °C; 49 N, 1.7 Hz). With RBC left in one proximal box as DME, all teeth received MOD inlays, made from lithium disilicate (LDS) or a polymer-infiltrated ceramic network material (PICN). The restored teeth underwent TML including 1.2 million occlusal cyclic loadings and 2673 thermal cycles. The marginal quality was assessed at baseline and after both runs of TML. Load-to-fracture tests were performed. The statistical analysis comprised multiple linear regressions (α = 0.05). RESULTS Simulated aging of RBC restorations had no significant effect on the marginal quality at the interface between the RBC and the tooth and the RBC and the inlay (p ≥ 0.247). Across time points, higher percentages of non-continuous margin were observed between the inlay and the tooth than between the tooth and the RBC (p ≤ 0.039). The age of the DME did not significantly affect the fracture resistance (p ≥ 0.052). CONCLUSIONS Artificial aging of RBC restorations used for DME had no detrimental effect on the marginal quality and fracture resistance of LDS and PICN inlays. CLINICAL RELEVANCE This laboratory study suggests that-in select cases-intact, direct RBC restorations not placed immediately before the delivery of an indirect restoration may be used for DME

Student-Athletes with Learning Disabilities: Unique Problems, Unique Solutions

This paper explored the issues/acing student-athletes with learning disabilities and their academic counselors. Understanding the nature of learning disabilities and their effects can enhance the counselor's ability to address the complex needs of the student-athlete with a learning disability. The increasing numbers of college student-athletes who have diagnosed learning disabilities demands notice. This paper provided an explanation of the problems of diagnosis and treatment. Suggestions for academic counselors were provided, as well

Borderline Aggregation Kinetics in ``Dry'' and ``Wet'' Environments

We investigate the kinetics of constant-kernel aggregation which is augmented by either: (a) evaporation of monomers from finite-mass clusters, or (b) continuous cluster growth -- \ie, condensation. The rate equations for these two processes are analyzed using both exact and asymptotic methods. In aggregation-evaporation, if the evaporation is mass conserving, \ie, the monomers which evaporate remain in the system and continue to be reactive, the competition between evaporation and aggregation leads to several asymptotic outcomes. For weak evaporation, the kinetics is similar to that of aggregation with no evaporation, while equilibrium is quickly reached in the opposite case. At a critical evaporation rate, the cluster mass distribution decays as $k^{-5/2}$, where $k$ is the mass, while the typical cluster mass grows with time as $t^{2/3}$. In aggregation-condensation, we consider the process with a growth rate for clusters of mass $k$, $L_k$, which is: (i) independent of $k$, (ii) proportional to $k$, and (iii) proportional to $k^\mu$, with $0<\mu<1$. In the first case, the mass distribution attains a conventional scaling form, but with the typical cluster mass growing as $t\ln t$. When $L_k\propto k$, the typical mass grows exponentially in time, while the mass distribution again scales. In the intermediate case of $L_k\propto k^\mu$, scaling generally applies, with the typical mass growing as $t^{1/(1-\mu)}$. We also give an exact solution for the linear growth model, $L_k\propto k$, in one dimension.Comment: plain TeX, 17 pages, no figures, macro file prepende