Análisis de la reproductibilidad de los márgenes verticales subgingivales mediante escaner óptico intraoral (IOS): Un ensayo controlado ramdomizado piloto

El objetivo de este ensayo clínico controlado aleatorizado fue probar la capacidad de un dispositivo IOS, utilizado en condiciones estandarizadas,para detectar márgenes de pilares preparados con knife edge finish line ubicados en tres niveles diferentes en relación con el surco gingival. La hipótesis nula fue que no había diferencia en la capacidad del IOS independientemente de la posición vertical de la finish line preparada.Material y métodos: En este estudio, se reclutaron 60 pacientes (28 mujeres y 32 hombres) con una edad media de 45 (± 20,5) años (rango 18-69) que necesitaban una corona dentaria en los sitios posteriores. El presente ensayo clínico prospectivo fue aprobado por el Comité de Ética de la Universidad de Siena. Para cada individuo incluido, se obtuvo un consentimiento por escrito firmado después de información clara sobre el estudio. Se siguieron las pautas de la declaración CONSORT (http://www.consortsttement.org) (Fig. 1)

Particulate Filler and Discontinuous Fiber Filler Resin Composite's Adaptation and Bonding to Intra-Radicular Dentin

The aim of this study was to assess adaptation and bonding to root canal dentin of discontinuous (short) glass fiber-reinforced composite to intra-radicular dentin (DSGFRC). Methods: Seventy virgin human teeth were extracted and then endodontically treated; then samples were randomly divided into 7 groups (n = 10), based on the materials' combinations as follows: Group 1, a two-bottle universal adhesive + DSGFRC; Group 2, a single-component universal adhesive + DSGFRC; Groups 3 and 4, the same materials of Goups 1 and 2 were used but after cleaning of the canal walls with 17% EDTA and final irrigation with 5.25% NaOCl Ultrasound Activated (UA); Group 5, traditional prefabricated fiber posts were luted after being silanized with G-Multi Primer; Groups 6 and 7, like Group 5 but after ultrasonic irrigation (UA). All sample roots were cut 1 mm thick (n = 10) to be evaluated regarding root canal adaptation using a light microscope and scanning electron microscope (SEM) and push-out bond strength. These results were statistically analyzed by Kruskal-Wallis analysis of variance by ranks. The level of significance was set at p < 0.05. Results: Bond strength forces varied between 6.66 and 8.37 MPa and no statistically significant differences were recorded among the groups. By microscopic examination, it was noted that ultrasonic irrigation increased the adaptation of the materials to the dentin surface. Conclusions: Within the limitations of this in vitro study, it may be concluded that when DSGFRC was used for intracanal anchorage in the post-endodontic reconstruction, similar push-out retentive force and strength to those of traditional fiber posts cemented with particulate filler resin composite cements were achieved

Multiplicative effect of stress and poor sleep quality on periodontitis: A university-based cross-sectional study

BackgroundThe aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals. MethodsA total of 235 individuals were included in this cross-sectional study. Perceived stress and sleep quality were evaluated through validated questionnaires, while periodontitis was identified with a full-mouth periodontal examination protocol using both European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) and Centers for Disease Control and Prevention (CDC)/AAP case definitions. Simple and multiple linear and ordinal logistic regression analyses were performed to evaluate the association between perceived stress and sleep quality with periodontitis prevalence and severity. ResultsStage III/IV periodontitis resulted associated with both moderate/high perceived stress (odds ratio [OR] = 5.4; 95% confidence interval [CI]: 2.2-13.5; p < 0.001) and poor sleep quality (OR = 3.0; 95% CI: 1.2-7.4; p < 0.05). The interaction between moderate/high perceived stress and poor sleep quality presented a multiplicative association with stage III/IV periodontitis (EFP/AAP; OR = 5.8; 95% CI: 1.6-21.3; p < 0.001). Multiple linear regression analyses indicated a similar trend of association also with linear periodontal parameters, that is, mean clinical attachment level (CAL) and mean probing pocket depth (PPD). ConclusionsThe findings from the present study suggest that stress and poor sleep quality may exert a multiplicative effect on periodontitis prevalence and severity

Healthy lifestyles are associated with a better response to periodontal therapy: A prospective cohort study

Aim: To evaluate the association between lifestyle behaviours and clinical periodontal outcomes following Steps 1/2 of periodontal therapy.Methods: A total of 120 subjects with untreated Stage II/III periodontitis participated in this study. At baseline, questionnaires were administered to assess the following lifestyle behaviours: adherence to Mediterranean diet (MD), physical activity (PA) and stress levels, sleep quality, smoking and alcohol use. Participants received Steps 1/2 of periodontal therapy and were re-evaluated after 3 months. A composite outcome of the endpoint of therapy (i.e., no sites with probing pocket depth [PPD] >= 4 mm with bleeding on probing, and no sites with PPD >= 6 mm) was regarded as the primary outcome. Simple and multiple regression analyses were used to evaluate the association between lifestyle behaviours and clinical periodontal outcomes. Disease severity at baseline, body mass index, diabetes, household disposable income and plaque control were considered as confounders.Results: Multiple regression analyses showed significantly lower odds of achieving the endpoint of therapy in subjects with poor sleep quality (odds ratio [OR] = 0.13; 95% confidence interval [CI]: 0.03-0.47; p <.01), smoking (OR = 0.18; 95% CI: 0.06-0.52; p <.05) and alcohol use above the suggested intake (OR = 0.21; 95% CI: 0.07-0.63; p <.01). Subjects with a combination of `unhealthy lifestyles' (low adherence to MD and low PA levels and high levels of stress and poor sleep quality) showed higher proportions of residual PPD >= 6 mm (MD = 1.51; 95% CI: 0.23-2.80; p <.05) and lower odds of achieving the endpoint of therapy (OR = 0.85; 95% CI: 0.33-0.99; p <.05) at re-evaluation.Conclusions: Subjects with unhealthy lifestyle behaviours showed worse clinical outcomes 3 months after Steps 1/2 of periodontal therapy

Periodontal evaluation of restorative and prosthodontic margins

Prosthodontic and periodontal correlation on teeth In the daily dental practice 3 fundamental/empiric/clinical parameters have a role to establish the clinical success of prosthodontic treatment: function, aesthetic and longevity of the restorations. But, from a scientific point of view, how do we rate the success of the restorations? When analyzing the existing literature, it can be noted that many authors focus their attention on the precision of the margin, to pursuit a small gap between the abutment and the crown, and to achieve the clinical success. Christensen et al.1 and Mc Lean & Von Fraunhofer2 investigated the margins’ clinical acceptability by dentists and asked to measure the gap between the abutment and the crown to a number of practitioners: it was shown that a clinician can clinically appreciate a gap not lower than 120 microns using a sharp explorer. This result may end in a not sure and sufficient seal between the crown and abutment, and consequently leakage at the margins. This finding is not in agreement with the existing data coming from an in vitro study in which the acceptable marginal gap is lower than 50 microns3 Sorensen3 reported that small defects less or equal then 0,050 mm were associated with significantly less fluid flow and bone loss than defects exceeding this value. Martignoni4-5 reported that there are variable definitions regarding what constitutes a margin that cab ne clinically acceptable, and there is no definite threshold for the maximum marginal discrepancy that is clinically acceptable. Many authors accept the criteria established by McLean and Von Fraunhofer2, they completed a 5-year examination of 1000 restorations and concluded that 120 microns should be considered the maximum marginal gap. The adaptation, the precision and the quality of the restoration margin can be of greater significance in terms of gingival health, than the position of the margin6. According to Lang et al. 7 following the placement of restorations with overhanging margins, a subgingival flora was detected which closely resembled that of chronic periodontitis. Following the placement of the restorations with clinically perfect margins, a microflora characteristic for gingival health or initial gingivitis was observed. In patients with suitable oral hygiene, tooth-supported and implant-supported crowns with intra-sulcular margins were not predisposed to unfavorable gingival and microbial responses8. Even among patients receiving regular preventive dental care, subgingival margins are associated with unfavorable periodontal reactions9. Ercoli and Caton10, in a systematic review, describe how placement of restoration margins within the junctional epithelium and supracrestal connective tissue attachment can be associated with gingival inflammation and, potentially, recession or periodontal pocket. The presence of fixed prostheses finish line within the gingival sulcus or wearing of partial, removable dental prostheses does not cause gingivitis if the patients are complaint with self-performed plaque control and periodic maintenance. Procedures adopted for the fabrication of dental restorations and fixed prostheses have the potential to cause traumatic loss of the periodontal supporting tissue. They concluded that restoration margins located within the gingival sulcus do not cause gingivitis if the patients are complaint with self-performed plaque control and periodic maintenance. Tooth-supported and/or tooth-retained restorations and their design, fabrication, delivery, and materials, have often been associated with plaque retention and loss of attachment. Restoration margins placed within the junctional epithelium and supracrestal connective tissue attachment can be associated with inflammation and, potentially, recession. Factors related to the presence, design, fabrication, delivery and materials of tooth-supported prostheses seem to influence the periodontium, generally related to localized increase in plaque accumulation and, less often, to traumatic and allergic reactions to dental materials10. Jansson showd that the influence of a marginal overhang on pocket depth and radiographic attachment decrease with increasing loss of periodontal attachment in periodontitis-prone patients, and the effect on pocket depth of a marginal overhang may act synergistically, potentiating the effect of poor oral hygiene11. Subgingival restorations with their apical borders still located subgingivally after periodontal treatment should be regarded as a risk factor in the progression of periodontitis12. Consequently, placement of the restoration margin supragingivally is recommended, especially in periodontitis-prone patients with an insufficient plaque control12. Dental restorations may be suggested as a risk indicator for periodontal disease and tooth loss. Routine SPT (Supportive Periodontal Therapy) was found to be associated with decrease in the prevalence of deep PPD over time, and it is of the utmost importance in maintaining periodontal health, especially adjacent to teeth with restorations. Finally, these findings may support the treatment of caries lesions and faulty restorations as part of a comprehensive cause-related therapy and should be followed by a regular maintenance program13. The relationship between dental restorations and periodontal status has been examined for some time. Research has shown that overhanging dental restorations and subgingival margin placement play an important role providing an ecologic niche for periodontal pathogens14. An overhanging dental restoration is primarily found in the class II restoration, since access for interdental finishing and polishing of the restoration, and cleansing is often difficult in these areas, even for patients with good oral hygiene. Many studies have shown that there is more periodontal attachment loss and inflammation associated with teeth with overhangs than those without. Presences of overhangs may cause an increase in plaque formation15-21 and a shift in the microbial composition from healthy flora to one characteristic of periodontal disease14. The location of the gingival margin of a restoration is directly related to the health status of the adjacent periodontium8. Numerous studies8-12-25 have shown that subgingival margins are associated with more plaque, more severe gingival inflammation and deeper periodontal pockets than supragingival ones. In a 26-year prospective cohort study, Schatzle et al. 25 followed middle class Scandinavian men for a period of 26 years. Gingival index, and attachment level were compared between those who did and those who did not have restorative margins greater than 1mm from the gingival margin. After 10 years, the cumulative mean loss of attachment was 0.5 mm more for the group with subgingival margins. This was statistically significant. At each examination during 26 years of the study, the degree of inflammation in the gingival tissue adjacent to subgingival restorations was much greater than in the gingiva adjacent to supragingival margins. This is the first study to document a time sequence between the placement of subgingival margins and periodontal attachment loss, confirming that the subgingival placement of margins is detrimental to gingival and periodontal health. Plaque at apical margin of a subgingival restoration will cause periodontal inflammation that may in turn destroy connective tissue and bone approximately, 1-2 mm away from inflamed area14. Determination of the distance between the restorative margin and the alveolar crest is often done with bitewing radiographs; however, it is important to remember that a radiograph is a 2-dimensional representation of 3-dimensional anatomy and structure. Thus, clinical assessment and judgment are important adjuncts in determining if, and how much, bone should be removed to maintain adequate room for the dento-gingival supra crestal connective tissue height attachment14. Although surface textures of restorative materials differ in their capacity to retain plaque26, all of them can be adequately maintained if they are correctly polished and accessible to patient care27. This includes underside of pontics. Composite resins are difficult to finish interproximally and may be more likely to show marginal defects than other materials28. As a result, they are more likely to harbor bacterial plaque29. Intra-subject comparisons of unilateral direct compositive “veneers” showed a statistically significant increase in plaque and gingival indices adjacent to the composites, 5-6 years after placement28. In addition, when a diastema is closed with composite, the restorations are often overcontoured in the cervical-interproximal area, leading to increased plaque retention28. As more plaque is retained, this could pose a significant problem for a patient with moderate to poor oral hygiene14. For that, in absence of more specific prosthodontic parameters to evaluate the integration of crowns in to the periodontal environment, another way to determine the success and health of the restoration is to use the periodontal parameters such as: PPD (Periodontal Probing Depth) that is the measurement of the periodontal sulcus/pocket between the gingival margin and the bottom of the sulcus/pocket; REC (Recession) is the apical migration of the gingival margin measured with the distance between the gingival margin and the CEJ (Cement-Enamel Junction); PI (Plaque Index) the index records the presence of supragingival plaque; BOP (Bleeding On Probing) the presence or not of bleeding on surfaces of the teeth during the probing. The aim of this study/thesis was to propose a clinical procedure to evaluate single unit restorations and their relations with periodontal tissues by a new clinical score: the FIT ( Functional Index for Teeth). FIT, that is a novel index for the assessment of the prosthetic results of lithium disilicate crowns, based on seven restorative-periodontal parameters, that evaluate crowns placed on natural abutments, and want to be a reliable and objective instrument in assessing single partial crown success and periodontal outcome as perceived by patients and dentists

Repeatability of Teethan® indexes analysis of the masseter and anterior temporalis muscles during maximum clenching: a pilot study

ObjectivesThe aim of this study is to assess the repeatability of a surface electromyographic (EMG) device (Teethan & REG;, Teethan S.p.A., Milan, Italy), designed for the analysis of the masseter and anterior temporalis muscles.Materials and methodsTests were performed on a sample of 30 healthy fully dentate TMD-free individuals randomly selected. Each test consisted of two distinct recordings performed at 5-min intervals: (i) the patient is asked to clench with maximum voluntary contraction (MVC), with two cotton rolls interposed between the dental arches; (ii) the patient is asked to repeat the same clenching activity without the cotton rolls. The outcomes of the study were the EMG indices conceptualized by the manufacturing company, based on the differences between the two test conditions (i.e., clenching on cotton rolls and on dentition). Pairwise correlation analysis and ANOVA test were performed to assess the strength of correlation and the significance of differences between the results of the three trials.ResultsThirty TMD-free healthy individuals (20 females and 10 males; mean age 44 years, range 16-60 years) took part in the study. ANOVA test did not show any statistically significant difference between the three trials. The Global Index, which is the mean of the other EMG indices, showed the highest correlation values between the three trials, while some other indices showed a weak-to-medium correlation level. One out of five participants showed a coefficient of variation higher than 10%.ConclusionsThe statistical analysis showed that the indices provided by the device are quite repeatable. However, this does not necessarily imply a specific clinical application of the device, which was here used in fully controlled experimental conditions

A randomized controlled clinical trial of two types of lithium disilicate partial crowns

Purpose: This randomized controlled clinical trial evaluated the behavior of lithium disilicate partial crowns by means of a novel Functional Index for Teeth (FIT). Methods: 105 subjects in need of at least a single prosthetic restoration in posterior areas were treated with adhesive partial crowns (for a total of 170 restorations) onto natural vital abutment teeth and followed-up annually for 4 years. Subjects were randomly divided into two experimental groups: Group 1, e.max Press and Group 2, Initial LiSi Press. FIT was used for the objective assessment of outcomes including clinical and radiographic examinations. A dropout rate of 4.25% in Group 1 and 3.4% in Group 2 was recorded. FIT is made up of seven variables (interproximal, occlusion, design, mucosa, bone, biology and margins); each of them to be evaluated using a 0-1-2 score. The Mann-Whitney U test was applied for statistical analysis and the level of significance was set at P< 0.05. Results: In Group 1, five complications were recorded, and four in Group 2, with a failure rate of 6.25% and 6.17%, respectively. No statistically significant difference was found between the experimental groups in any of the assessed variables. The tested lithium disilicate material brands showed comparable clinical performances after 4 years of clinical service. Clinical significance: Clinicians can use either of the tested lithium disilicate materials to make adhesively luted partial crowns

A pilot trial on lithium disilicate partial crowns using a novel prosthodontic functional index for teeth (FIT)

BACKGROUND: Lithium disilicate is now a well accepted material for indirect restorations. The aim of this trial was to evaluate two lithium disilicate systems using a novel prosthodontic Functional Index for Teeth (FIT). METHODS: Partial adhesive crowns on natural abutment posterior teeth were made on sixty patients. Patients were divided into two groups: Group 1 IPS e.max press (Ivoclar-Vivadent, Schaan, Liecthestein), and Group 2 Initial LiSi press (GC Co., Tokyo, Japan). The restorations were followed-up for 3 years, and the FIT evaluation was performed at last recall. The FIT is composed of seven variables (Interproximal, Occlusion, Design, Mucosa, Bone, Biology and Margins), each of them are evaluated using a 0-1-2 scoring scheme, and is investigated by an oral radiograph and occlusal and buccal pictures. More in details, three variables have the three scores made on the presence or not of major, minor or no discrepancy (for 'Interproximal', 'Occlusion' and 'Design'), presence or not of keratinized and attached gingiva ('Mucosa'), presence of bone loss &gt; 1.5 mm, &lt; 1.5 mm or not detectable ('Bone'), presence or not of Bleeding on Probing and or Plaque Index ('Biology'), presence of detectable gap and marginal stain or not ('Margins'). The Mann-Whitney 'U' test was used and the level of significance was set at p &lt; 0.05. Also, "success" of the crowns (restoration in place without any biological or technical complication) and "survival" (restoration still in place with biological or technical complication) were evaluated. RESULTS: Regarding FIT scores, all partial crowns showed a stable level of the alveolar crest without detectable signs of bone loss in the radiographic analysis. All other evaluated parameters showed a high score, between 1.73 and 2. No statistically significant difference emerged between the two groups in any of the assessed variables (p &gt; 0.05). All FIT scores were compatible with the outcome of clinical success and no one restoration was replaced or repaired and the success rate was 100%. CONCLUSIONS: The results showed that it is possible to evaluate the clinical performance of partial crowns using FIT. The FIT proved to be an effective tool to monitor the performance of the restorations and their compatibility with periodontal tissues at the recall. The FIT can be really helpful for a standardized evaluation of the quality of the therapy in prosthodontic dentistry. The two lithium disilicate materials showed similar results after 3 years of clinical service. TRIAL REGISTRATION: The study protocol was approved by the Ethical Committee of University of Siena (clinicaltrial.gov # NCT01835821), 'retrospectively registered'

Survival Rates of Endodontically Treated Posterior Teeth Restored with All-Ceramic Partial-Coverage Crowns: When Systematic Review Fails

Background: To determine the survival rates of endodontically treated posterior teeth (EDPT) restored with partial coverage all-ceramic crowns with or without the use of fiber posts. Methods: MEDLINE and Cochrane searches were conducted in order to identify Randomized Clinical Trials (RCTs) related to endodontically treated posterior teeth restored with partial coverage crowns. The search period was extended until February 2020 and only in vivo, human, and studies in the English language were included. A manual search was also conducted and additional articles, if found, were included in the database. Results: The initial search for the selected databases identified 495 studies, which were all screened for inclusion through titles, abstracts and full-text reading. Out of these 495 studies, only one article met the eligibility criteria and was included in this systematic review. Statistical analysis could not be performed. Conclusions: Only one RCT was identified in this systematic review. More clinical evidence is necessary to assess the survival rate of EDPT with partial-coverage crowns. This systematic review failed because it did not find scientific evidence to support the use of indirect bonded restorations on EDPT