Metal-free materials for fixed prosthodontic restorations

ackground Fixed prosthodontic treatment (crowns, fixed dental prostheses (FDPs), complete arch prostheses) involves the use of several different materials to replace missing tooth structure. Traditionally full metal or metal frameworks veneered with ceramic (metal-ceramic (MC)) have been used. In recent years several different metal-free systems have become available to clinicians and patients. In general, metal-free restorations should allow practitioners to better reproduce natural tooth colour, avoiding shortcomings of MC restorations. The comparative in service clinical performance of fixed prosthodontic treatments of different materials is unclear. Objectives To assess the effects of metal-free materials for prosthodontic restorations compared to metal-ceramic or other conventional all-metal materials. Search methods Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (searched 3 May 2017), Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4) in the Cochrane Library (searched 3 May 2017), MEDLINE Ovid (1946 to 3 May 2017), and Embase Ovid (1980 to 3 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (searched 3 May 2017). No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria Randomised controlled trials (RCTs) in which the clinical performance of metal-free fixed prosthodontic restorations was compared with metal-ceramic (MC) or other conventional restorations in adult patients requiring prosthodontic treatment. RCTs in which the clinical performance of different kinds of metal-free systems were compared among themselves were also considered. Data collection and analysis We used standard methodological procedures expected by Cochrane. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Trial authors were contacted for missing information. Available results for the outcomes of interest of the systematic review of the studies included were tabulated as they could not be included in a formal meta-analysis. Main results Nine trials involving a total of 448 participants were included. We judged two trials to be at unclear risk of bias and seven to be at high risk of bias. The majority of items of risk of bias were evaluated to be at unclear or high risk level in more than 50% of the included trials. Each trial except two was addressing a different type of intervention. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results, the latter being due to very small sample sizes, low event rates, 95% confidence intervals including the possibility of benefit for both the test and control groups, or combinations of these problems. This means that we are very uncertain about all of the results presented in this review. One trial compared metal-free single crowns (full contour zirconia) to cast gold single crowns in 224 participants and found insufficient evidence of a difference in failure rate after one year, but after five years there was some evidence of a benefit for the gold crowns. There was insufficient evidence of a difference for crown complications at either time of assessment. One trial compared three-unit metal-free FDPs (lithium disilicate) to three-unit metal-ceramic FDPs in 37 participants. There was insufficient evidence of a difference in bridge failure at one and six years, but some evidence of a benefit for the lithium disilicate group in terms of bridge complications at six years. One trial compared zirconia-ceramic FDPs to metal-ceramic FDPs in 34 participants but found insufficient evidence of a difference in bridge failures (i.e. no failures in either treatment group), bridge complications or patients' aesthetic evaluation at any time of assessment up to three years. One trial comparedmetal-free cantilevered FDPs tometal-ceramic cantilevered FDPs in 21 participants. There was insufficient evidence of a difference for any primary outcome: bridge failures (i.e. no failures in either treatment group), bridge complications, or patients' aesthetic evaluation at any time of assessment up to three years. One trial compared metal-free implant-supported screw retained single crowns (zirconia veneered with feldspathic ceramic) to metal-ceramic implant-supported screw-retained single crowns in 20 participants. There was insufficient evidence of a difference for any primary outcome: crown failures (i.e. no failures in either treatment group), crown complications, or satisfaction/aesthetic evaluation at any time of assessment up to two years. Two trials compared metal-free implant abutments (zirconia) to metal implant abutments both supporting single crowns in 50 participants. There was insufficient evidence of a difference in abutment failure at one year. One trial compared metal-free implant-supported FDPs made of two different types of zirconia ceramic in 18 participants. There was insufficient evidence of a difference in failures at any time of assessment up to 10 years (i.e. no failures in either treatment group). There was some evidence of a benefit for the zirconia-toughened alumina group in terms of complications (chipping). One trial compared metal-free tooth-supported FDPs made with two different veneering techniques (pressed versus layered) in 40 participants. There was insufficient evidence of a difference for failures (i.e. no failures in either treatment group) or complications at any time of assessment up to three years. Authors' conclusions There is insufficient evidence to support or refute the effectiveness of metal-free materials for fixed prosthodontic treatment over metal-ceramic or other type of standard restorations. The overall quality of existing evidence was very low, therefore great caution should be exercised when generalising the results of the included trials. Until more evidence becomes available clinicians should continue to base decisions on which material to use for fixed prosthodontic treatment on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients. There is urgent need of properly designed RCTs

Status of the Hadronic tau Decay Determination of |V_{us}|

We update the hadronic tau determination of |V_{us}|, showing that current strange branching fractions produce results 2-3 sigma lower than 3-family unitarity expectations. Issues related to the size of theoretical uncertainties and results from an alternate, mixed tau-electroproduction sum rule determination (which, by construction, produces a much smaller theoretical uncertainty), are also considered.Comment: 6 pages, 4 figures. Talk presented at the 10th International Workshop on Tau Lepton Physics (TAU08), Novosibirsk, Russia, 22-25 September, 200

Multidisciplinary treatment of agenesis in the anterior and posterior areas: a long term retrospective analysis

Twenty-two implants inserted in the anterior area in 15 patients, and 24 implants inserted in the posterior area in 9 patients, for a total of 46 implants in orthodontic patients suffering from single or multiple agenesis, were analyzed retrospectively. The average time of follow-up, subsequent to the prosthetic insertion was 60.3 months. The average time from actual diagnosis of agenesis to the completion of therapy was 76.2 months. There were no implant failures, although 17.4% experienced prosthetic complications. Analysis of the sample identified 5 critical issues that are frequently underestimated at the time of determining the therapeutic strategy. 1. Timely comprehensive management of the patient; 2. management of the biological interface (surgery and hygiene maintenance); 3. prosthetic problems; 4. long term effects of bone remodeling; 5. alternative therapy

Facial volume changes during normal human growth and development

BACKGROUND: To describe normal soft tissue growth and development of the human face through volume changes and to assess the presence of sexual dimorphism. METHODS: Facial landmark identifications (2,023) were performed on 1,347 healthy Caucasian children and adolescents, ages 6-18 yr, and young adults, ages 19-32 yr. Three-dimensional coordinates of 22 facial landmarks were collected by automated infrared photogrammetry. Facial volumes and selected linear distances and ratios were calculated and averaged for age and sex. RESULTS: Whereas in females in the 14-15 age group, the face had almost completed its growth relative to the adult group, in males a large increase was still to occur, in general agreement with previous reports on craniofacial growth, which suggested a strong tendency in males for growth to continue for several years beyond that seen in females. The male vs. female comparison reflected the different growth patterns. On average, within each age group volumes were significantly larger in males than in females, with some exceptions in the 11-12 age group, where female growth velocity showed a spurt. Sexual dimorphism in facial volume did not appear in different parts of the face to the same extent: a large part of male facial volume preponderance occurred in the lower third of the face. CONCLUSIONS: From 6 yr of age to adulthood, facial soft tissues increased their volumes by >40%, with different growth patterns in boys and girl