Cervical margin relocation in indirect adhesive restorations: A literature review

Purpose: The aim of this review was to summarize the existing scientific literature investigating on cervical margin relocation technique (CMR) performed prior to the adhesive cementation of the indirect restorations. Study selection: An electronic search with no date restriction was conducted in the MEDLINE database, accessed through PubMed. The following main keywords were used: "cervical margin relocation", "coronal margin relocation", "deep margin elevation" and "proximal box elevation". Results: Seven in vitro studies and 5 clinical reports investigating on CMR are taken into consideration for the present review. The most frequently investigated parameter in almost all of the in vitro studies was the marginal adaptation of the indirect restorations. One study additionally assessed the influence of CMR on the fracture behavior of the restored teeth and one study assessed the bond strength of the indirect composite restoration to the proximal box floor. Clinical reports provided documentation with a detailed description of the treatment protocol. In the current literature no randomized controlled clinical trials or prospective or retrospective clinical studies on CMR technique could be found. Conclusions: On the basis of the reviewed literature, it can be concluded that currently there is no strong scientific evidence that could either support or discourage the use of CMR technique prior to restoration of deep subgingival defects with indirect adhesive restorations. Randomized controlled clinical trials are necessary to provide the reliable evidence on the influence of CMR technique on the clinical performance, especially on the longevity of the restorations and the periodontal health

Teškoće u održavanju oralnog zdravlja kod dece i adolescenata sa poremećajima iz autističnog spektra - opažanja roditelja

Introduction/Objective Autism spectrum disorder (ASD) is characterized by features that have the potential to make oral hygiene and dental appointments challenging. The aim of this study was to investigate difficulties related to oral hygiene and dental appointments that may be encountered in children and adolescents with ASD, in comparison to their typically developing peers. Methods A 48-item questionnaire was prepared for the purpose of the study and distributed to parents of children and adolescents with ASD in three specialized daycare centers, as well as to parents of typically developing children and adolescents at the Clinic for Pediatric and Preventive Dentistry in Belgrade, Serbia. Ninety-two questionnaires were considered and statistically analyzed in the SPSS program, using χ2 and Mann-Whitney U-test. Results The following statistically significant differences were found between children and adolescents with ASD and their typically developing peers: general difficulties in everyday oral hygiene, need of help for basic oral hygiene tasks, tooth brushing frequency, sensory difficulties related to toothbrush and toothpaste, level of anxiety prior to dental appointment, cooperation during appointment, sensory difficulties related to touch, operatory light and sound of dental unit, number of treatments under general anesthesia, and the number of refused dental treatments. Conclusion Children and adolescents with ASD face significantly more difficulties concerning everyday oral hygiene and dental appointments in comparison to their typically developing peers. Dentists' awareness of issues that are specific to this population of patients is important in order to enable quality dental care.Uvod/Cilj Poremećaji autističnog spektra (PAS) mogu biti uzrok poteškoća vezanih za održavanje oralne higijene, kao i za posete stomatologu. Cilj rada je bio da se utvrde razlike između dece i adolescenata sa PAS i kontrolne grupe neurotipičnih vršnjaka sa aspekta održavanja oralne higijene i poseta stomatologu. Metode Upitnik od 48 pitanja distribuiran je roditeljima dece i adolescenata sa PAS u tri specijalizovana dnevna boravka, kao i roditeljima kontrolne grupe neurotipičnih vršnjaka. Devedeset dva upitnika je uzeto u obzir i statistički analizirano u programu SPSS. Rezultati Statistički značajne razlike između dece i adolescenata sa PAS i njihovih tipično razvijenih vršnjaka utvrđene su u sledećim kategorijama: teškoće u svakodnevnoj oralnoj higijeni, potreba za pomoći u održavanju oralne higijene, učestalost pranja zuba, senzorne teškoće vezane za četkicu i zubnu pastu, nivo anksioznosti pre posete stomatologu, saradnja tokom stomatološkog tretmana, senzorne teškoće vezane za dodir stomatologa, svetlo i zvuk stomatološkog uređaja, broj tretmana pod opštom anestezijom i broj odbijenih stomatoloških usluga. Zaključak Deca i adolescenti sa PAS suočavaju se sa znatno većim poteškoćama u pogledu svakodnevne oralne higijene i poseta stomatologu u poređenju sa tipično razvijenim vršnjacima. Svest stomatologa o pitanjima koja su specifična za ovu populaciju pacijenata je važna kako bi se deci i adolescentima sa PAS omogućila kvalitetna stomatološka nega

The influence of resin infiltration pretreatment on orthodontic bonding to demineralized human enamel

Prior research reveal that low-viscosity resin is able to significantly penetrate initial caries lesions, which leads to their stabilization. The objective of the present report is to assess the shear bond strength (SBS) of orthodontic brackets bonded with different adhesives to demineralized enamel treated with a low-viscosity resin infiltrant. It also aims to compare the achieved bond strengths to those achieved in relation to sound enamel (SE). A total of 48 newly extracted third molars were collected, distributed in four groups (n=12), covered with a nail varnish, with 4 x 4 mm of uncoated area, immersed in Buskes demineralizing solution (14 days, 37 °C) or remained untreated. Group I: SE + Transbond XT; Group II: demineralized enamel (DE) + ICON + Transbond XT; Group III: DE + ICON + Scotchbond Universal; Group IV: DE + ICON + Assure PLUS. SBS was quantified in megapascals (MPa) and statistically analyzed (ANOVA, p 0.05). The mode of failure was assessed microscopically (10 x magnification). The highest SBS detected was in Group IV, and the difference was statistically significant (F = 14.37; p = 0.000). Treatment with a resin infiltrant on DE does not impair the shear bond strength when compared to SE, although it does produce a significantly higher strength when combined with Assure PLUS

Prosthetics in paediatric dentistry

Premature loss of teeth in children may lead to both functional and esthetic problems. Missing teeth in both anterior and posterior regions may cause malfunctions in mastication and proper pronunciation. If the missing teeth are not replaced, further complications may occur, including adjacent tooth migration, loss of alveolar bone, and irregular occlusion. Considering the sensitive nature of children, loss of teeth may cause the development of insecurities and low self esteem problems. Due to dynamic nature of growth in children and adolescents, prosthetic appliances must not hinder development of orofacial system, and must meet adequate esthetic and functional standards. Dental prosthetic appliances in paediatrics must be planned with respect to the special conditions that led to tooth loss or damage. Multi-disciplinary approach is needed, under constant supervision of paediatric dentist and orthodontist, as well as regular checkups with clinical and radiographical examinations

Simultaneous sinus lift and implant placement using lateral approach in atrophic posterior maxilla with residual bone height of 5 mm or less. A systematic review

Aim To test both success and survival rate of implant placed simultaneously with sinus lift in atro-phic posterior maxilla with a residual bone height of less than 5 mm. Materials and methods A computer search strategy was developed for the following electronic databases: MEDLINE/ PubMed and EMBASE. All the relevant articles were screened involving controlled clinical trials, randomized clinical trials, prospective cohort studies. Results The selection process yielded 12 studies, published between 1999 and 2016, 6 of which were prospective, 1 was a randomized controlled trial, 5 were controlled studies. Conclusions Within the limitation of this systematic review, the qualitative data analysis revealed that the survival rate of implants placed in grafted sinus ranged from 61% to 100%; on the other hand, the success rate ranged between 75.3% to 94.8%. No significant differences were detected regarding different grafting materials used. In order to understand if the one-stage pro-cedure is an effective and predictable surgical alternative in critically resorbed maxillae, larger and well designed clinical trials are needed

Fracture resistance and failure pattern of endodontically treated teeth restored with computer-aided design/ computer-aided manufacturing post and cores: A pilot study

Aim: To evaluate the fracture resistance and failure pattern of custom made computer-aided design & computer-aided manufacturing (CAD/CAM) post and cores using a fiber reinforced composite material (FRC) and a high-density-polymer. Materials and methods: Thirty extracted mandibular second premolars were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three groups (n = 10) according to each material: group 1 (RXP): fiber posts (Rely X, 3M-ESPE) with composite core build-up (Filtek Bulk Fill Posterior, 3M-ESPE) as a control group; group 2 (BLC): one-piece milled post and core from fiber reinforced composite blocks (Trilor, Bioloren); and group 3 (AMC): one-piece milled post and core from hybrid ceramic disks (Ambarino, Creamed). All the posts were cemented using a self-adhesive resin cement (Rely X U200, 3M ESPE). Fracture resistance was tested using a universal testing machine, failure patterns were then observed visually and radiographically then evaluated under SEM. Data was analyzed using One-way analysis of variance (ANOVA) followed by Tamhane post-hoc test in order to determine significant differences among groups (α = 0.05). Results: The mean fracture resistance values were: 426.08 ± 128.26 N for group 1 (R X P), 367.06 ± 72.34N for group 2 (BLC), and 620.02 ± 5 4.29N f or g roup 3 ( AMC). S tatistical analysis revealed that group 3 (AMC) had the highest mean load to fracture in comparison to the other groups (p = 0.000). failures were cohesive in group 2 and 3 and mixed in group 1 with no catastrophic failures reported in all groups. Conclusion: All systems evaluated presented sufficient mean load-to-failure values for endodontically treated teeth restorations. CAD/CAM post and cores made from high-densitypolymer showed a better performance than prefabricated fiber posts

Oral and perioral soft tissue lesions and oral functions in patients with dystrophic epidermolysis bullosa

Background/Aim. Dystrophic epidermolysis bullosa (DEB) is characterized by distinct systemic and skin changes, as well as numerous oral manifestations. The aim of the study was to examine oral and perioral soft tissues and oral functions in DEB patients by monitoring changes over a period of one year. Methods. Twenty-four patients (1 month to 36 years old) were clinically examined initially (T0), after 6 months (T6), and after 12 months (T12). Appearance and localization of perioral and oral bullae and scars, maximum mouth opening, reduced vestibule depth, absence of lingual papillae and palatal rugae, and restricted tongue movement due to scarring were monitored. The values of maximum mouth opening at the initial examination were compared to those measured in the healthy con-trol group of the same age. The age of patients and differences between the dominant and recessive subtypes of DEB were analyzed. Results. The average maximum mouth opening was significantly lower in DEB patients compared to healthy individuals. Oral and perioral bullae and scars, microstomia, and reduced vestibule depth were very common, with no statistically significant difference among T0, T6, and T12. The prevalence of restricted tongue movement due to scarring and the absence of lingual papillae and palatal rugae increased significantly over one year. Patients with microstomia, vestibule depth, and restricted tongue movement due to scarring were significantly older than patients without these characteristics. Lingual papillae and palatal rugae were more frequently absent in recessive than dominant DEB. Conclusion. DEB causes significant changes in oral and perioral soft tissues and oral functions impairment

The effect of ferrule height on stress distribution within a tooth restored with fibre posts and ceramic crown: A finite element analysis

Objectives. To evaluate via finite element analysis the effect of different ferrule heights on stress distribution within each part of a maxillary first premolar (MFP) restored with adhesively luted glass fiber-reinforced resin (GFRR) posts and a ceramic crown. Methods. The solid models consisted of MFP, periodontal ligament and the corresponding alveolar bone process. Four models were created representing different degrees of coronal tissue loss (0 mm, 1 mm, 2 mm and 3 mm of ferrule height). First set of computing runs was performed for in vivo FE-model validation purposes. In the second part, a 200-N force was applied on the buccal cusp directed at 45° to the longitudinal axis of the tooth. Principal stresses values and distribution were recorded within root, abutment, posts, crown and related adhesive interfaces. Results. All FE-models showed similar stress distribution within roots, with highest stress present in the chamfer area. In composite abutments higher stress was observed when no ferrule was present compared to ferruled FE-models. Stress distribution within crown and GFRR posts did not differ among the models. Stress values at the adhesive interfaces decreased with increasing ferrule height. Significance. The stress state at abutment-crown and post-root interfaces was very close to their strength, when ferrule was not present. Similarly, higher ferrule produced more favorable stress distribution at post-abutment and abutment-root interfaces. Endodontically treated teeth with higher ferrule exhibit lower stress at adhesive interfaces that may be expected to lower the probability of clinical failur

Can Fiber-post Placement Reinforce Structurally Compromised Roots?

Purpose: Immature teeth are characterized by short roots, thin root canal walls, and open apices, which makes them prone to fracture. The aim was to investigate whether fiber-post placement had an influence on the fracture resistance of endodontically treated immature teeth. Materials and Methods: To simulate immature teeth, the apical third of 20 intact mandibular premolars was resected. After the access cavity was prepared, root canals and apices were enlarged. A 4-mm apical barrier was placed using calcium-silicate based material (Biodentine, Septodont). The teeth were then randomly assigned to two groups (n = 10). Root canals in group 1 were sealed using Acroseal (Septodont, France) and gutta-percha, followed by composite resin for the coronal restoration (Evetric, Ivoclar Vivadent). In group 2, fiber posts (FRC Postec Plus, Ivoclar Vivadent) were luted using self-adhesive composite cement (SpeedCEM Plus, Ivoclar Vivadent), followed by the same coronal restoration. The teeth were then subjected to fatigue and static load testing. Results: The average loads (+/- SD) that led to tooth fracture were: 401.40 +/- 296.83 N in group 1 and 636.20 +/- 204.95 N in group 2. Unfavorable fractures were noted in 9 specimens from group 1 and in 7 specimens in group 2. No statistically significant difference in fracture resistance or fracture mode was found between the groups. Conclusion: Fiber-post placement had no significant influence on the fracture resistance of endodontically treated immature teeth

Bracket Bonding to All-Ceramic Materials with Universal Adhesives

The need for bracket bonding to ceramic restorations is increasing. The aim of this study was to evaluate the effect of universal adhesives on bracket adhesion to polished or glazed lithium disilicate (LDS) and monolithic zirconia (MZ) surfaces. One hundred and twenty brackets (N = 10) were bonded to either polished or glazed LDS (e.max CAD B32, Ivoclar Vivadent, Schaan, Liechtenstein) and MZ (In-Ceram® YZ, VITA, Bad Sackingen, Germany) blocks using three different adhesives combined with Transbond™ XT Paste (3M Unitek, Monrovia, CA, USA). Tested universal adhesives were Scotchbond™ Universal Adhesive (SU, 3M St. Paul, MN, USA) and Assure Plus (AP, Reliance, Itasca, IL, USA). Transbond™ XT Primer (XTP, 3M Unitek, Monrovia, CA, USA) served as a control adhesive. Bracket bond strength was measured in shear mode (SBS). Failure type was determined by the Modified Adhesive Remnant Index (ARI). Data were statistically analyzed. On polished LDS, SU yielded bracket SBS significantly superior to those of AP and XTP. On polished MZ, the use of SU and AP significantly enhanced bracket retention as compared with XTP. Low SBS values, below the threshold of clinical acceptability, were reached by all tested adhesives on glazed LDS and MZ specimens. SBS measurements corresponded with failure type observations. Universal adhesives SU and AP could be considered for use on polished LDS and MZ surfaces