Effect of Bleaching on Color Change and Surface Topography of Composite Restorations

This study was conducted to determine the effect of 15% carbamide peroxide bleaching agent on color change and surface topography of different composite veneering materials (Filtek Z350 (3M ESPE), Esthet X (Dentsply India), and Admira (Voco, Germany). Methods. 30 samples were fabricated for evaluation of color change using CIELAB color system and Gonioreflectometer (GK 311/M, ZEISS). 45 disc-shaped specimens were made for evaluation of surface topography after bleaching (Nupro White Gold; Dentsply) using SEM. Statistical analysis. One way ANOVA and Multiple comparison tests were used to analyze the data. Statistical significance was declared if the P value was .05 or less. Results and conclusion. All the specimens showed significant discoloration (ΔE > 3.3) after their immersion in solutions representing food and beverages. The total color change after bleaching as compared to baseline color was significant in Filtek Z350 (P = .000) and Esthet X (P = .002), while it was insignificant for Admira (P = .18). Esthet X showed maximum surface roughness followed by Admira and Filtek Z350. Bleaching was effective in reducing the discoloration to a clinically acceptable value in all the three groups (ΔE < 3.3)

Prosthodontic rehabilitation of patient with marginal mandibular resection using attachment supported prostheses: A clinical report

Marginal mandibular resection to treat neoplasms leads to loss of alveolar bone and teeth at the affected side. Consequently patient suffers with poor masticatory performance and esthetic disfigurement, which we need to restore with the help of prosthodontic rehabilitation. The success of rehabilitation of these patients depends on strategic treatment planning and choice of most suitable treatment modality. In this article, case of a patient has been presented who underwent marginal mandibular resection and reported with many limiting factors like obliterated buccal and lingual sulci, attachment of lingual frenum and lower lip at the level of alveolar ridge and Macroglossia. Impression making and fabrication of a retentive prosthesis were the main challenges. Therefore, a modified impression technique was used to fabricate mandibular cast partial denture with extracoronal semi precision attachments to enhance the retention of the prosthesis

Prosthodontic rehabilitation of combined oronasal defect in patients with non-Hodgkin's lymphoma using two different attachments: Two case reports

Debridement of affected parts in patients with non-Hodgkin's lymphoma leads to large mid facial defects leading to poor quality of life due to cosmetic disfigurement and various functional comorbidities. Therefore, a surgeon should refer the patients to a prosthodontist for replacement of lost tissues to improve their function and esthetics. Two cases have been presented here with a history of non-Hodgkin's lymphoma having large, continuous defects involving nose, cheeks, and maxilla. Retaining large facial prosthesis and intraoral obturator was a challenge as supporting hard and soft tissues were less. Two-piece lightweight prostheses were fabricated and retained with the use of very economical titch buttons used (used in clothes) in case 1 due to financial constraints and slightly expensive iron boron neodymium magnets in case 2. Functional and esthetic rehabilitation was successfully achieved with intraoral and facial prostheses attached to each other

Use of Diode Lasers to Enhance Aesthetics of Anterior Implant Supported Prosthesis: A Report of Two Cases

Diode lasers have been used for multiple applications in dentistry; however, its use for soft tissue management around dental implants has not been reported much. The role of symmetrical gingival tissue with properly positioned zenith is paramount to achieving aesthetics. The gingival zenith can be described as the most apical point on the marginal gingiva; its ideal placement should be at the crest of the curvature of the gingival margin for the central incisors, canines, and premolars, this should be ideally located slightly distal to the middle of the long axis on these teeth. This produces a slight inclination of the distal root which plays a vital role in the foundation of a beautiful smile. If this gingival complex is malpositioned in maxillary anterior region, it may result in an unaesthetic appearance even if the artificial teeth are perfectly aligned. Here, authors are presenting two patients with missing anterior teeth, who were not satisfied with the final aesthetic outcome of their implant supported prostheses. Due to history of trauma and painful course of treatment, patients were not comfortable with one more exposure to injectable anaesthesia, use of scalpel, or long healing process when they were almost nearing completion of their treatment. So, Diode laser was used for soft tissue excision around implants followed by gingival contouring in pontic region to achieve the desired gingival zenith and contour. The procedure was painless, blood free, followed by quick healing and effective in achieving optimal aesthetic outcome for both the patients

Flapless versus open flap techniques of implant placement: A 15-month follow-up study

Aim: To evaluate and compare the effect of flapless and “open flap” techniques of implant placement on crestal bone height (CBH) around implants. Materials and Methods: This prospective study comprised of 32 implants placed in 16 subjects with a bilateral missing mandibular first molar. In each subject, one implant was placed with “flapless” and other using “open flap” technique. Radiographic assessment of CBH was carried out using standardized intraoral periapical radiograph of the site at baseline, 3 months, 9 months and 15 months after implant placement. Statistical Analysis: Data were analyzed using STATA 11.0 statistical software. To determine the changes in CBH from baseline, at 3-, 9-, and 15-month, repeated measures analysis of variance followed by post-hoc Bonferroni was used for each of the two techniques for mesial and distal aspects separately. For both techniques, changes in CBH from baseline to 15 months were compared using an independent t-test with a confidence interval of 95%. Results: For “flapless” technique, there was no statistically significant (P > 0.05) reduction of CBH in initial 9 months but was significant for the 9–15 months period while for “open flap” technique, statistically significant (P < 0.05) reduction was observed up to 15 months. Comparison of both techniques showed significantly lesser reduction with “flapless” than “open flap” technique. The overall average crestal bone loss was 0.046 ± 0.008 mm on mesial aspect, 0.043 ± 0.012 mm on distal aspect with “flapless” technique and 1.48 ± 0.085 mm on mesial aspect, 1.42 ± 0.077 on distal aspect “open flap” technique. Conclusions: Both techniques showed a reduction in CBH with time but the flapless technique showed a lesser reduction. Therefore, the flapless technique can be considered as a better treatment approach for placement of implants, especially where adequate width and height of available bone are present

Comparative evaluation of effects of bleaching on color stability and marginal adaptation of discolored direct and indirect composite laminate veneers under in vivo conditions

Statement of Problem: Change in color and loss of marginal adaptation of tooth colored restorative materials is not acceptable. Bleaching is commonly used for treating discolored teeth. However, the literature is scanty regarding its effect on color and marginal adaptation of direct and indirect composite laminate veneers (CLVs) under in vivo conditions. Purpose: Purpose of the study was to determine the effect of bleaching on color change and marginal adaptation of direct and indirect CLVs over a period of time when exposed to the oral environment. Materials and Methods: For this purpose, a total of 14 subjects irrespective of age and sex indicated for CLV restorations on maxillary anterior teeth were selected following the inclusion and exclusion criteria. For each subject, indirect CLVs were fabricated and looted in the first quadrant (Group 1) and direct CLV′s (Group 2), were given in the second quadrant. Color change was assessed clinically using intra-oral digital spectrophotometer and marginal adaptation was assessed on epoxy resin replica of the tooth-restoration interface under scanning electron microscope. After 6 months, the subjects underwent a home bleaching regimen for 14 days using 10% carbamide peroxide. The assessment of color change and marginal adaptation was done at 6 months after veneering (0-180 days), immediately after the bleaching regimen (0-194 days) and 3 months after the bleaching regimen (0-284 days). Results: The difference in median color change (ΔE) between the groups was tested using Wilcoxon rank sum test while the median color change with time within the groups was tested using Wilcoxon signed rank test. The difference in the rates of marginal adaptation was tested between the groups using Chi-square/Fisher′s exact test. Bleaching led to statistically significant color change at cervical (CE), middle and incisal (IE) regions when direct and indirect composites were compared (P < 0.05). During intra-group comparison, direct CLV′s showed significant color change at CE and IE regions when ΔE was compared at 180 days and 284 days (CE 10 vs. CE 30, P = 0.008, IE 10 vs. IE 30, P = 0.003). No significant differences were found when within group comparison was made for indirect laminates. Intergroup comparison between the groups showed significant difference in marginal adaptation at CE margin at all-time points (at baseline, P = 0.005; at 180 days, P = 0.007; 194 days, P = 0.025; at 284 days, P = 0.067). Conclusion: After bleaching, indirect CLVs performed better in terms of color stability whereas direct CLVs performed better in terms of marginal adaptation. Clinical Significance: Indirect composites should be preferred to direct composites as veneering materials as they have better color stability. Special attention should be given to their marginal adaptation especially in the CE region. Bleaching should be avoided in patients with composite restorations in the mouth

Effect of denture soft liner on mandibular ridge resorption in complete denture wearers after 6 and 12 months of denture insertion: A prospective randomized clinical study

Purpose: Soft liners act as a cushion between the denture base and the residual ridge. Hence, it is important to study their effect on resorption of mandibular denture bearing area. Therefore, the purpose of this study was to evaluate the influence of soft denture liner on mandibular ridge resorption after 1 year in completely denture wearers. Materials and Methods: Twenty-eight completely edentulous patients having age between 45 and 60 years with well-formed ridges in class I jaw relations were selected as per the inclusion and exclusion criterion. Randomization chart was used to enroll participants in experimental and control groups who were given mandibular dentures with and without soft denture liner, respectively. Vertical measurements were made on orthopantomograph and analyzed using Adobe Photoshop 7.0 software at five points, i.e., one at central incisor and two points at right and left first premolars and two in each first molar region. Results: On application of repeated measures analysis of variance, both groups showed a significant change in bone height after denture delivery (P < 0.05). Intergroup comparison (Wilcoxon rank sum test) of bone height in different regions at various time intervals showed statistically significant difference in bone levels (P < 0.05) from baseline to 6 months and baseline to 12months (P < 0.01), while the difference was statistically not significant during 6 and 12 months’ period. Conclusion: The use of soft denture liner significantly reduces the residual ridge resorption in complete denture wearers as compared to conventional denture wearers (without denture liner) over a period of 1 year