Laser systems for gingival retraction in fixed prosthodontics: a narrative review.

Aim The present narrative review aimed to shed light on the use of laser systems for gingival retraction procedures necessary for the exposure of iuxta- and sub-gingival finish lines before impression making in fixed prosthodontics. Methods An extensive search of the literature was made on the electronic databases of Pubmed (Medline), Scopus, Embase, Google Scholar, Dynamed, and Open Grey. No limitations were applied to the date of publication. The following keywords and MeSH terms were used: “gingiva”, “displacement”, “troughing”, “retraction”, and “laser”. Results Out of 344 studies found, 25 records were included for review. Laser systems are efficient in gingival retraction, allowing better intraoperative haemostasis control and postoperative patient comfort than other surgical troughing procedures. Laser- mediated gingival displacement seems to be safe particularly in the case of thick gingival biotype. Conclusions As regards laser-related issues in prosthodontics such as pre-setting protocols of laser devices, the best laser system in gingival retraction, their use around implants and effectiveness compared to other troughing systems, further in vitro, in vivo, and randomized controlled trial studies are needed

Interdisciplinary full digital restorative treatment of a young patient with severe open bite and amelogenesis imperfecta: a case report.

Background Amelogenesis Imperfecta (AI) is a syndromic entity comprising several clinical conditions, mostly genetic- based, affecting quality and quantity of enamel. The use of digital tools can be advantageous to enhance communication between the dental team and patients. Moreover, a full digital approach would allow to check each single clinical step according to the treatment plan with a backward approach. The aim of this case report is to describe a multidisciplinary treatment program of a young patient with severe open bite and amelogenesis imperfecta, whose restorative rehabilitation was planned in a full-digital workflow, from the initial communication phase up to the final prosthodontic rehabilitation. Case report An 8-year old female patient was diagnosed with a Class II division 1 malocclusion, severe open bite and AI. The treatment plan included 3 phases: the elimination of the tongue interposition habit and the anterior open bite, the orthodontic correction of dental deviation and leveling of both dental arches and a prosthetic rehabilitation. The extraction of the four first molars corrected the canine and molar Angle Class II relationships, deviation of the midline and repositioning of the maxillary incisors on the sagittal plane. Feldspathic ceramics was used in anterior sites to enhance the esthetic outcome. CAD/CAM hybrid ceramo-polymeric restorative material (PICN) was chosen for posterior regions. Conclusion The outcomes of the present case report proved that the planned objectives were satisfactorily obtained thanks to proper treatment planning, full digital workflow and the patient’s optimal compliance with the extraoral device

“Digitally Oriented Materials”: Focus on Lithium Disilicate Ceramics

The present paper was aimed at reporting the state of the art about lithium disilicate ceramics. The physical, mechanical, and optical properties of this material were reviewed as well as the manufacturing processes, the results of in vitro and in vivo investigations related to survival and success rates over time, and hints for the clinical indications in the light of the latest literature data. Due to excellent optical properties, high mechanical resistance, restorative versatility, and different manufacturing techniques, lithium disilicate can be considered to date one of the most promising dental materials in Digital Dentistry

Area accuracy gradient and artificial markers: a three-dimensional analysis of the accuracy of IOS scans on the completely edentulous upper jaw

Aim The present paper aimed to assess the accuracy gradient of scans made using an intraoral scanner (IOS) on a totally edentulous maxilla and the effectiveness of artificial markers. Materials and methods A reference scan was made by scanning a fully edentulous upper jaw cast (RC) with a dedicated metrological machine. On the RC, an IOS was used to make 10 scans then superimposed to detect their area accuracy gradient. Artificial markers with a diameter of 2 mm were placed in the less accurate areas following two approaches. In the first one, semispherical resin composite markers were used. In the second approach, a dermographic pen was used to draw circular flat markers. Three experimental groups (n = 10) were obtained: “no markers” for the control group without markers, “embossed markers” for resin composite markers, and “flat markers” for ink-drawn ones. The scans were processed into a specialized software, where trueness and precision were measured in millimeters. Descriptive statistics (95% C.I.) were conducted, also, the Games-Howell and Kruskal-Wallis tests (α = .05) were used to investigate differences between groups. Results Mean values for trueness were: no markers 48.8 (39.2- 58.3); embossed markers 39.2 (37.5-40.8); flat markers 60.5 (47.7-73.4), with statistically significant differences between embossed and flat markers (p = .011). Mean values for precision were: no markers 46.7 (29.7-63.7); embossed markers 41.4 (34.7- 48); flat markers 99.8 (69.3-130.3), with significant differences between embossed markers and flat ones (p = .008) and between the latter and the control group (p = .005). Minor accuracy was detected at both tuberosities, palate, posterior aspect of the papilla, and flattened areas of the ridges. Conclusions To improve IOS scans accuracy on the totally edentulous upper jaw, it is suggested to place embossed markers, rather than flat ones, in the areas of minor accuracy

Dentin Exposure after Tooth Preparation for Laminate Veneers: A Microscopical Analysis to Evaluate the Influence of Operators’ Expertise

Background: To assess the quantity of dentin exposure detected by 3 operators with different clinical expertise for 2 designs of tooth preparation for laminate veneers: window (WI) and butt joint (BJ). Methods: 20 intact maxillary central incisors were collected and then prepared for laminate veneers to a depth of 0.6 mm, with a cervical mini-chamfer finish line of 0.3 mm. Each prepared tooth was analyzed by 3 operators with different expertise: undergraduate student (ST), general practitioner (GP), and prosthodontist (PR), at sight under magnification. Besides descriptive statistics (CI 95%), 2-way ANOVA and Games–Howell tests were used to analyze differences among groups (α = 0.05). Results: The means of percentage and area of detected dentin exposure were WI = 30.48%, 21.57 mm2; BJ = 30.99%, 21.97 mm2; ST/WI = 22.82%, 16.44 mm2; GP/WI = 58.05%, 40.64 mm2; PR/WI = 10.55%, 7.63 mm2; ST/BJ = 28.99%, 20.83 mm2; GP/BJ = 40.56%, 28.32 mm2; PR/BJ = 23.42%, 16.75 mm2. Significant differences were found between ST/WI vs. GP/WI (p = 0.005) and GP/WI vs. PR/WI (p < 0.001). Conclusions: There was no difference in detection of exposed dentin among operators with different expertise for BJ preparation, whereas differences were found between the general practitioner and the other 2 operators in WI. Moreover, the quantity of exposed dentin was not related to different tooth preparation designs

Comparison of different intraoral scanning techniques on the completely edentulous maxilla: An in vitro 3-dimensional comparative analysis

Statement of problem: Information about the accuracy of intraoral scanners for the edentulous maxilla is lacking. Purpose: The purpose of this in vitro study was to compare the accuracy of 3 different intraoral scanner techniques on a completely edentulous maxilla typodont. Material and methods: Two completely edentulous maxillary typodonts with (wrinkled typodont) and without (smooth typodont) palatal rugae were used as reference and were scanned by using an industrial metrological machine to obtain 2 digital reference scans in standard tessellation language (STL) format (dWT and dST). Three different scanning techniques were investigated: in the buccopalatal technique, the buccal vestibule was scanned with a longitudinal movement ending on the palatal vault with a posteroanterior direction; the S-shaped technique was based on an alternate palatobuccal and buccopalatal scan along the ridge; in the palatobuccal technique, the palate was scanned with a circular movement and then with a longitudinal one along the buccal vestibule. Consecutively, 6 types of scans were obtained (n=10), namely wrinkled typodont/buccopalatal technique, wrinkled typodont/S-shaped technique, wrinkled typodont/palatobuccal technique (wrinkled typodont), smooth typodont/buccopalatal technique, smooth typodont/S-shaped technique, and smooth typodont/palatobuccal technique (smooth typodont). Scans in STL format were imported into a dedicated software program, and trueness and precision were evaluated in μm. In addition to descriptive statistics (95% confidence interval), a 2-factor ANOVA on the data ranks, the Kruskal-Wallis, and the Dunn tests were performed to analyze differences among groups (α=.05). Results: Mean values for trueness (95% confidence interval) were wrinkled typodont/buccopalatal technique=48.7 (37.8-59.5); wrinkled typodont/S-shaped technique=65.9 (54.9-77.4); wrinkled typodont/palatobuccal technique=109.7 (96.1-123.4); smooth typodont/buccopalatal technique=48.1 (42.4-53.7); smooth typodont/S-shaped technique=56.4 (43.9-68.9); smooth typodont/palatobuccal technique=61.1 (53.3-69), with statistically significant differences for wrinkled typodont/buccopalatal technique versus wrinkled typodont/palatobuccal technique (P<.001), buccopalatal technique versus palatobuccal technique (P<.001), and wrinkled typodont versus smooth typodont (P=.002). Mean values for precision (95% confidence interval) were wrinkled typodont/buccopalatal technique=46.7 (29.7-63.7); wrinkled typodont/S-shaped technique=53.6 (37.6-69.7); wrinkled typodont/palatobuccal technique=90 (59.1-120.9); smooth typodont/buccopalatal technique=46 (39.7-52.3); smooth typodont/S-shaped technique=76 (55.5-96.6); smooth typodont/palatobuccal technique=52.9 (41.9-63.8); with statistically significant differences for buccopalatal technique versus palatobuccal technique (P=.032) and wrinkled typodont/buccopalatal technique versus wrinkled typodont/palatobuccal technique (P=.012). Conclusions: Smooth typodont scans showed better trueness than wrinkled typodont scans. Buccopalatal technique showed better mean values for trueness and precision than palatobuccal technique only in the wrinkled typodont scenario, while the other scanning approaches did not show significant differences in either tested configuration

CAD/CAM Diagnostic Esthetic Functional Splint (DEFS) as a removable prototype to evaluate the final prosthetic rehabilitation: a narrative review.

The main objective of this narrative review was to provide an overview of DEFS (Diagnostic Esthetic Functional Splint), namely CAD/CAM manufactured, “snap-retained”, tooth-colored splints available by materials exhibiting a certain degree of elasticity (like polycarbonates or acetal resins) for restoring function, esthetics and occlusion in several clinical situations, before or as an intermediate alternative to undergoing the final treatment. The search strategy included all papers dealing with snap-retained prosthetic systems and was based on a literature review of papers available in electronic databases (Pubmed/Medline, Evidence-Based Dentistry, BMJ Evidence-Based Medicine, Dynamed, Embase, BMJ Clinical Evidence, Web of Science, Scientific reports); eligible papers were researched on Opengreyand a manual search was performed, as well. From the electronic databases emerged 13,199 records, many of which were duplicates. The grey literature and the manual research did not produce any eligible article. After duplicates removal, 7690 records were obtained. Titles, abstracts and keywords were analyzed. The studies concerning the topic of interest were examined by the reviewers and discussed. Although no evidence-based data were found in the literature, according to the authors’ clinical experience, the DEFS (Diagnostic Esthetic Functional Splint) is a very promising solution in multiple clinical situations, due to its diagnostic, therapeutical, functional and esthetic versatility

Accuracy of a chairside intraoral scanner compared with a laboratory scanner for the completely edentulous maxilla: An in vitro 3-dimensional comparative analysis

Statement of problem: Intraoral scanners are promising options for removable prosthodontics. However, analog aids, including occlusion rims, are still used, as a completely digital workflow is challenging and scientific evidence on the topic is scarce. Purpose: The purpose of this in vitro study was to assess and compare the trueness and precision of scans obtained from a reference typodont of a completely edentulous maxilla by using an intraoral scanner (TRIOS 3 Pod; 3Shape A/S) with scans obtained by using a laboratory scanner (DScan 3; EGS S.R.L.) from both Type IV stone casts and polysulfide impressions. Material and methods: The polyurethane resin reference typodont was replicated from a clinical cast and was scanned with a metrological machine to obtain a reference scan. Ten digital casts were obtained by applying standardized scanning strategies to the reference typodont with the intraoral scanner. A device was created to make 10 consistent polysulfide impressions, and a scan of each impression was made with the laboratory scanner and then digitally reversed to obtain 10 digital reversed casts. Ten Type IV stone casts were poured and then scanned with the laboratory scanner to obtain 10 digital extraoral scanner casts. The scans in standard tessellation language (STL) format were imported into a dedicated software program, and the trueness and precision were calculated in μm. In addition to descriptive statistics (confidence interval 95%), 1-way ANOVA followed by the Bonferroni test or the Kruskal-Wallis and the Dunn tests were used to analyze differences among groups (α=.05). Results: The trueness values (95% confidence interval) were digital intraoral scanner cast=48.7 (37.8-59.5), digital reversed cast=249.9 (121.3-378.5), and digital extraoral scanner cast=308.8 (186.6-430.9); significant differences were detected between digital intraoral scanner cast and digital reversed cast (P<.001) and between digital IOS casts and digital extraoral scanner cast (P<.001). The precision values (95% confidence interval) were digital intraoral scanner cast=46.7 (29.7-63.7), digital reversed cast=271.2 (94.6-447.8), and digital extraoral scanner cast=341.4 (175.5-507.3); significant differences were detected between digital intraoral scanner cast and digital reversed cast (P=.003) and between digital intraoral scanner cast and digital extraoral scanner cast (P=.001). Conclusions: Directly scanning a solid typodont of a completely edentulous maxilla with the intraoral scanner produced better trueness and precision than scanning the polysulfide impressions or the stone casts with a laboratory scanner

Zirconia-reinforced lithium silicate (ZLS) mechanical and biological properties: A literature review

Objectives: This paper aimed to provide a literature review of the mechanical and biological properties of zirconia-reinforced lithium silicate glass-ceramics (ZLS) in Computer-aided design / Computer-aided manufacturing (CAD/CAM) systems. Data/Sources: An extensive search of the literature for papers related to ZLS was made on the databases of PubMed/Medline, Scopus, Embase, Google Scholar, Dynamed, and Open Grey. The papers were selected by 3 independent calibrated reviewers. Study selection: The search strategy produced 937 records. After the removal of duplicates and the exclusion of papers that did not meet the inclusion criteria, 71 papers were included. Conclusions: After reviewing the included records, it was found that two types of ZLS (Vita Suprinity PC; Vita Zahnfabrik and Celtra Duo; Dentsply Sirona) are nowadays available on the market for CAD/CAM systems, similar in their chemical composition, microstructure, and biological-mechanical properties. ZLS is reported to be a biocompatible material, whose fracture resistance can withstand physiological chewing loads. The firing process influences the improvements of strength and fatigue failure load, with a volumetric shrinkage. To date, ZLS can be considered a viable alternative to other glass-ceramics for fixed single restorations. Clinical Significance:. As to biocompatibility and mechanical properties of ZLS, data are still scarce, often controversial and limited to short-term observational periods. These promising ceramics require further in vitro/in vivo studies to accurately define mechanical and biological properties, mainly in the long-term performance of restorations produced with such materials

Effects of finish line design and fatigue cyclic loading on phase transformation of zirconia dental ceramics: A qualitative micro-raman spectroscopic analysis

Objectives: Stresses produced during the fabrication of copings and by chewing activity can induce a tetragonal-to-monoclinic (t-m) transformation of zirconia. As a consequence, in the m-phase, the material is not able to hinder possible cracks by the favorable mechanism known as "transformation toughening". This study aimed at evaluating if different marginal preparations of zirconia copings can cause a premature phase transformation immediately after manufacturing milling and after chewing simulation. Methods: Ninety copings using three commercial zirconia ceramics (Nobel Procera Zirconia, Nobel Biocare Management AG; Lava Classic, 3M ESPE; Lava Plus, 3M ESPE) were prepared with deep-chamfer, slight-chamfer, or feather-edge finish lines (n = 10). Specimens were tested in a chewing simulator (CS-4.4, SD Mechatronik) under cyclic occlusal loads simulating one year of clinical service. Raman spectra were acquired and analyzed for each specimen along the finish lines and at the top of each coping before and after chewing simulation, respectively. Results: Raman analysis did not show any t-m transformation both before and after chewing simulation, as the typical monoclinic bands at 181 cm -1 and 192 cm -1 were not detected in any of the tested specimens. Conclusions: After a one-year simulation of chewing activity, irrespective of preparation geometry, zirconia copings did not show any sign of t-m transformation, either in the load application areas or at the margins. Consequently, manufacturing milling even in thin thickness did not cause any structural modification of zirconia ceramics "as received by manufacturers" both before and after chewing simulation