Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline

Background: The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it describes not only disease severity and extent but also the degree of complexity and an individual's risk. There is, therefore, a need for evidence-based clinical guidelines providing recommendations to treat periodontitis. Aim: The objective of the current project was to develop a S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I–III periodontitis. Material and Methods: This S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP), following the methodological guidance of the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The rigorous and transparent process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and consensus, on those recommendations, by leading experts and a broad base of stakeholders. Results: The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time. Conclusion: This S3 guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication

All-ceramic and porcelain-fused-to-metal fixed partial dentures: a comparative study by 2D finite element analyses

All-ceramic fixed partial dentures (FPDs) have an esthetic approach for oral rehabilitation. However, metal-ceramic FPDs are best indicated in the posterior area where the follow-up studies found a lower failure rate. This 2D finite element study compared the stress distribution on 3-unit all-ceramic and metal-ceramic FPDs and identified the areas of major risk of failure. Three FPD models were designed: (1) metal-ceramic FPD; (2) All-ceramic FPD with the veneering porcelain on the occlusal and cervical surface of the abutment tooth; (3) All-ceramic FPD with the veneering porcelain only on the occlusal surface. A 100 N load was applied in an area of 0.5 mm² on the working cusps, following these simulations: (1) on the abutment teeth and the pontic; (2) only on the abutment teeth; and (3) only on the pontic. Relative to the maximum stress values found for the physiological load, all-ceramic FPD with only occlusal veneering porcelain produced the lowest stress value (220 MPa), followed by all-ceramic FPD with cervical veneering porcelain (322 MPa) and metal-ceramic FPD (387 MPa). The stress distribution of the load applied on the abutments was significantly better compared to the other two load simulations. The highest principal stress values were low and limited in a small area for the three types of models under this load. When the load was applied on the pontic, the highest stress values appeared on the connector areas between the abutments and pontic. In conclusion, the best stress values and distribution were found for the all-ceramic FPD with the veneering porcelain only on the occlusal surface. However, in under clinical conditions, fatigue conditions and restoration defects must be considered

Presentation of Two Cases of Immediate Restoration of Implants in the Esthetic Region, Using Facilitate Software and Guides with Stereolithographic Model Surgery Prior to Patient Surgery

Improvements in both implant microsurfaces and placement techniques have reduced healing time and increased survival rates. CAD/CAM technology and improved ceramic materials allow for achievement of improved esthetics at the implant restoration level. Two clinical procedures have the capacity to decrease patient postoperative discomfort and improve esthetics. Flapless surgery reduces surgical trauma and postoperative problems. Placement of the final prosthetic abutment at the time of implant placement stabilizes soft tissue adhesion and position to the implant. Both results require careful presurgical planning with precise implant and abutment placement. This is a clinical report of two cases that are part of a larger ongoing clinical trial of 20 patients. The inclusion criterion was that patients should be missing a single tooth in the esthetic zone. Facilitate™ software was used in conjunction with dicom files transferred from CT scans for diagnosis. Stereolithographic models and surgical guides were fabricated from the digital information. Surgical guides were used preoperatively so implant replicas could be placed in stereolithographic models as simulated surgery. A ZirDesign™ ceramic abutment was adapted on the model, and a provisional crown was fabricated. At the time of actual implant surgery, the same surgical guide was used with a flapless approach. The previously modified ceramic abutment was screw-retained and torqued to place into the implant. The provisional crown was then cemented after blocking out the screw access hole. A final restoration was fabricated from all-ceramic material after several months. Success requires careful patient selection and attention to each step of the technique. Preliminary outcomes from the ongoing clinical trial are promising. © 2011 by The American College of Prosthodontists

The Effect of Surface Pretreatment and Water Storage on the Bonding Strength of a Resin Composite Cement to Modified PEEK

The bonding quality of bonding to polyether ether ketone (PEEK) after different surface treatments and adhesive regimens was assessed through shear bond strength. MATERIALS AND METHODS: Sixty modified PEEK disks were cut out of BioHPP round blanks using CAD-CAM procedures. Disks were subjected to the following surface pretreatments: (A) Sandblasting with alumina (Rocatec) and application of adhesive bonding agent visiolink (control group) (B) Sandblasting with silica-modified alumina (Cojet), application of silane agent Espe Sil, followed by application of adhesive bonding agent Visio-Bond (C) Sandblasting with silica-modified alumina (Cojet), application of silane containing primer-adhesive Clearfil Ceramic Primer, followed by application of adhesive bonding agent visiolink. A dual-curing resin composite cement (combolign) was luted to all treated surfaces. Each group was further divided to subgroups of 10 specimens which were stored in distilled water at 37°C for 150 days without further thermocycling. Specimens were then submitted to shear bond strength testing. RESULTS: Group (B) was statistically significant different from group (A) (control group). Water storage condition had no significant influence on final bond strength. CONCLUSIONS: Use of different conditioning protocols had a significant effect on the final bond strength of composite resin cement to PEEK surface. Water storage did not significantly influence bonding. Copyright© 2020 Dennis Barber Ltd

Effect of Staining Solutions on Color Stability, Gloss and Surface Roughness of Removable Partial Dental Prosthetic Polymers

Purpose: To assess the effect of commonly used solutions on color stability, gloss, and surface roughness of removable partial dental prostheses polymers. Materials and methods: Discs (n = 112) were made of a poly(etheretherketone) (PEEK) polymer, a polyamide, an acetal resin and a heat-cured poly(methylmethacrylate) PMMA acrylic resin polished according to manufacturers’ instructions. Seven specimens of each material were immersed in coffee, red wine, coca cola and distilled water for 30 days at 37οC. Changes of color (ΔΕ*) and color coordinates L*α*b* after immersion were calculated with a colorimeter. Changes in the values of gloss and surface roughness parameters (Sa, Sz, Str, Sdr, Sci, Svi) were also measured. Two-way ANOVA and pairwise comparisons were used to evaluate the effect of material and staining solution on parameter value alterations (α = 0.05). Results: The two-way ANOVA revealed that the interaction between material and staining solution significantly affected color changes after immersion [F(9,96) = 44.67, p < 0.001]. PEEK presented the lowest color change (ΔΕ* = 3.83 ± 2) while polyamide had the highest color change overall (ΔΕ* = 14.59 ± 8.65) (p < 0.001). Coffee caused the highest color (ΔΕ* = 13.08 ± 6.98) and gloss changes (ΔG = –6.36 ± 19.2 GU) among different solutions (p < 0.001). PEEK showed the highest alteration of gloss (ΔG = –11.31 ± 15.49 GU), with significant difference with the other three materials (p < 0.001). Insignificant interaction of material and immersing solution was found for surface roughness parameters (p > 0.05). Conclusions: Among the materials tested, PEEK seemed to be the most stable material when subjected to common, everyday staining solutions. Therefore, PEEK could be a viable solution for an RPDP framework fabrication, expanding the material list of prosthetic options. Further research and clinical trials are required to confirm the above statement. © 2021 by the American College of Prosthodontist

The current state of computer assisted orthognathic surgery: A narrative review

Objectives: Since cone beam computed tomography (CBCT) became available, research in the field of computer assisted orthognathic surgery (CAOS) is constantly on the rising. It is the purpose of the present paper to describe the use of the available digital technology in the workflow of CAOS and to provide insight on the advantages and limitations arising from the use of both hardware and software. Study selection, data and sources: Systematic reviews, randomised controlled trials, prospective and retrospective clinical studies, case series and reports were consulted with search terms having been entered into PubMed, Google Scholar and the Cochrane database. Results: There is evidence that supports the use of CAOS, which is based on the lack of time-consuming preparatory steps, more accurate treatment planning and overall, better surgical results. On the contrary, there is also evidence of increased need for training and of higher costs. Conclusions: The workflow of CAOS involves the acquisition of data which are manipulated to provide the virtual patient, the treatment planning with the appropriate software and the actual preparations for surgery. In case of a non-dynamically guided procedure, it also includes the 3d printing of surgical wafers, osteotomy guides and templates. Even though the native environment for any given surgical treatment planning is three-dimensional, several hurdles seem to impede the universal acceptance of CAOS amongst clinicians. Clinical significance: CAOS is a much desired yet sparsely employed practice for the correction of congenital, developmental or acquired pathologies in the dentomaxillofacial region. This paper addresses the small details in CAOS workflow towards an effective practice, and describes the advantages and limitations of the software and hardware currently in use. © 2022 Elsevier Lt

The use of PEEK in digital prosthodontics: A narrative review

Background: Advanced computer-aided design and computer-aided manufacturing (CAD-CAM) technology led to the introduction of an increasing number of machinable materials suitable for dental prostheses. One of these materials is polyetheretherketone (PEEK), a high performance polymer recently used in dentistry with favorable physical, mechanical and chemical properties. The purpose of this study was to review the current published literature on the use of PEEK for the fabrication of dental prostheses with CAD-CAM techniques. Methods: Electronic database searches were performed using the terms "PEEK", "CAD-CAM", "dental", "dentistry"to identify studies related to the use of PEEK for the fabrication of CAD-CAM prostheses. The search period spanned from January 1990 through February 2020. Both in vivo and in vitro studies in English were eligible. Review articles and the references of the included publications were searched to identify relevant articles. Results: A great number of in vitro studies are available in the current literature pointing out the noticeable properties of PEEK. The use of PEEK has been recommended for a wide range of CAD-CAM fabricated fixed and removable dental prostheses. PEEK was additionally recommended for occlusal splints, intra-radicular posts, implant abutments, customized healing abutments and provisional restorations. However, only a few clinical studies were identified. Conclusions: PEEK could be considered as a viable alternative for CAD-CAM fixed and removable dental prostheses to well-established dental materials. Due to the scarcity of clinical data, clinical trials are needed to assess the long-term performance of PEEK prostheses. © 2020 The Author(s)

Intrasurgical implant position transfer and interim restoration placement

In the esthetic zone, the placement of an interim prosthesis is an important stage in implant treatment for gingival contouring. This article presents a simple procedure for making an intraoperative implant position transfer to construct an interim prosthesis with optimal shape and emergence profile. This prosthesis, inserted at stage II surgery, guides soft tissue healing and aids in the fabrication of a definitive prosthesis with optimal gingival contours. © 2008 by The American College of Prosthodontists

Clinical and Patient-Reported Outcomes of Single Posterior Implant-Supported Restorations Completed by Predoctoral Students: A Retrospective Study with Up to 10 Years of Follow Up

Purpose: To assess clinical outcomes of screw-retained implant-supported restorations as well as patient satisfaction and Oral Health-related Quality of Life (OHQoL), when treatment is performed in an academic setting by supervised predoctoral students. Materials and methods: Ninety patients (n = 129 restorations) consented to participate in the study. The mean follow-up period was 4.2 years (range: 4 months to 10.6 years) after crown insertion. All patients filled out a modified Oral Health Impact Profile questionnaire, consisting of 14 questions (OHIP-14). A comprehensive examination of the implant-supported restoration was completed and restorative complications were recorded. Statistical analysis was performed using SPSS (IBM SPSS Statistics, v25; IBM Corp). Restoration survival rates were calculated using Kaplan-Meier survival analysis. Results: The most frequent complication was loss of the mesial interproximal contact (32.2%). The overall restoration survival and success rates were 93.8% and 74.4%, respectively. The majority of patients (95.6%) reported high satisfaction with their decision to get implant treatment in the predoctoral clinic. Conclusions: In the context of this study, clinical and patient-based outcomes of implant treatment rendered in an academic setting are favorable and comparable to those reported in the literature for restorations completed by experienced dentists. © 2020 by the American College of Prosthodontist