The Resin Bond to High-Translucent Zirconia—A Systematic Review

Objectives: Several systematic literature reviews have assessed the scientific evidence on resin bonding protocols to conventional 3 mol% ytrria-stabilized zirconia (3Y-TZP) ceramics. It has been widely discussed, however, that the differing composition and physical properties of new high-translucent zirconia generations (4Y-TZP and 5Y-TZP) may require alternative bonding materials and procedures. This paper reviewed in vitro studies on the success and durability of bonding protocols to high-translucent zirconia. Material and methods: A systematic search of PubMed and Cochrane Library for in vitro studies on bonding to new zirconia generations published until November 2020 was conducted and complemented by a manual search. Studies selected for review fulfilled the applied inclusion and exclusion criteria. The quality of the included studies was assessed with the Cochrane risk-of-bias tool for randomized trials. Results: Of 629 screened articles, 18 were included in this review. They investigated different surface pretreatment methods, primers, resin cements, aging procedures, and bond strength test protocols. The limited number of the identified studies and the heterogeneity of the extracted data did not allow to conduct a meta-analysis. Conclusions: The available evidence suggests that resin bonding protocols successfully applied to conventional zirconia are also the most successful for high-translucent zirconia. Airborne particle abrasion and special phosphate monomer-containing primers or composite resin cements provide long-term durable resin bonds. Clinical significance: Durable bonds can be established between high-translucent zirconia and resin cements. The bonding materials and procedures applied do not compromise their physical properties. © 2022 Wiley Periodicals LLC

Digital and Microscopic Tools for Ultimate Esthetics and Precision

Objective: This clinical report describes and illustrates step-by-step protocols for interdisciplinary esthetic treatment with current digital and microscopic tools. Clinical Considerations: Digital dentistry is no longer limited to impression making and restoration fabrication but starts already in the diagnostic and treatment planning phase. In particular, digital smile design tools have significantly improved clinical and laboratory workflows, allowing for natural and facially driven smiles, based on the patient\u27s specific needs and preferences. Digital technologies also facilitate high precision and accuracy in the laboratory, which are interconnected with the quality of the clinical care. Precision and minimally invasive dentistry require visual magnification aids through high-power loupes or, even better, surgical microscopes. For optimal clinical success, however, these tools must be integrated into efficient workflows and made part of a comprehensive clinical and laboratory concept. Conclusions: Digital and high-magnification tools in clinics and dental laboratories facilitate highly esthetic and precise outcomes when integrated into a comprehensive treatment concept. Clinical Significance: While a plethora of new tools and technologies is available for the dental laboratory and clinical practice, they can be daunting. Clear step-by-step workflows and protocols must be followed to apply them in a most efficient and effective manner for optimal outcomes. © 2022 Wiley Periodicals LLC

Predictable Immediate Implant Placement and Restoration in the Esthetic Zone

This article describes a comprehensive step-by-step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate implant placement into fresh extraction sockets and immediate restoration have become widely accepted, demonstrating long-term success rates that are comparable with traditional delayed implant protocols. However, they are technique sensitive and require proper treatment planning as well as meticulous execution to be predictable and successful in the long term. This is particularly important in the esthetic zone, where even minor aberrations and mistakes can have devastating consequences, and especially in younger patients, where esthetic and functional outcomes should remain stable for years and possibly decades to come. The eight critical steps for predictable immediate implant placement include: provisional restoration of the failing tooth and presurgical phase, atraumatic tooth extraction, initial implant osteotomy, 3D bone graft packing, guided implant placement with a surgical guide, customized abutment insertion, provisional crown relining, and placement of a connective tissue graft from tuberosity. Immediate implant protocols in the esthetic zone require thorough planning and execution in the proper sequence. Each one of the critical steps discussed in this article has its own importance and challenges, which are critically assessed based on current scientific evidence. © 2021 Wiley Periodicals LL

Dental Software Classification and Dento-Facial Interdisciplinary Planning Platform

Objective: Despite all advantages provided by the digital workflow, its application in clinical practice is still more focused on device manufacturing and clinical execution than on treatment planning and communication. The most challenging phases of treatment, comprehensive planning, diagnosis, risk assessment, and decision-making, are still performed without significant assistance from digital technologies. This article proposes a new dental software classification based on the digital workflow timeline, considering the moment of patient\u27s case acceptance as key in this classification, and presents the ideal software tools for each phase. Clinical Considerations: The proposed classification will help clinicians and dental laboratories to choose the most appropriate software during the treatment planning phase and integrate virtual plans with other software platforms for digitally guided execution. A dento-facial interdisciplinary planning platform virtually simulates interdisciplinary clinical procedures and assists in the decision-making process. Conclusions: The suggested classification assists professionals in different phases of the digital workflow and provides guidelines for improvement and development of digital technologies before treatment plan acceptance by the patient. Clinical Significance: Three-dimensional interdisciplinary simulations allow clinicians to visualize how each dental procedure influences further treatments. With this treatment planning approach, predictability of different procedures in restorative dentistry, orthodontics, implant dentistry, periodontal, and oral maxillofacial surgery is improved. © 2021 Wiley Periodicals LL

Relationship Between Air-Blowing Duration and Bond Strengths of Three Adhesive Systems to Dentin After Thermal Aging

The purpose was to evaluate the effect of air-blowing duration of three different adhesive systems on immediate or thermal aged resin-dentin shear bond strength (SBS). Human dentin surfaces were bonded with: one-step (Bond Force, BF), two-step (FL-Bond II, FLB) and three-step (Scotch Bond Multi-Purpose, SBMP) adhesive systems. Bonded surfaces from each group were air-blown for 0, 5, or 10 s and cured. Composite cylinders were built on the treated surfaces and cured. Half of the specimens from each group were tested immediately and the other halves were tested after thermal aging. Statistical analysis showed signifcant decrease in SBS after thermal aging compared to immediate testing in all groups, except BF after 5 s air-blowing or FLB and SBMP with no air-blowing (p\u3e0.05). The results suggested that 5 s air-blowing is necessary to obtain a stable SBS for BF. However, extended airblowing duration of FLB and SBMP decreased the SBS significantly after thermal aging

Diagnosis of Biofilm-Associated Peri-Implant Disease Using a Fluorescence-Based Approach

Dental implants have become a routine component of daily dental practice and the demand for dental implants is expected to increase significantly in the future. Despite the high success rates of dental implants, failures do occur, resulting in discomfort, rampant destruction of the oral health, or painful and costly surgical replacement of a failed implant. Peri-implant diseases are inflammatory conditions affecting the soft/hard tissues surrounding a functional dental implant. Plenty of experimental evidence indicates that the accumulation of dental plaque at the soft tissue– implant interface and the subsequent local inflammatory response seems to be key in the pathogenesis of the peri-implant mucositis. Such peri-implant–soft tissue interface is less effective than natural teeth in resisting bacterial invasion, enhancing vulnerability to subsequent peri-implant disease. Furthermore, in certain individuals, it will progress to peri-implantitis, resulting in alveolar bone loss and implant failure. Although early diagnosis and accurate identification of risk factors are extremely important to effectively prevent peri-implant diseases, current systematic reviews revealed that a uniform classification and diagnostic methodology for peri-implantitis are lacking. Recent progress on fluorescence-based technology enabled rapid diagnosis of the disease and effective removal of plaques. Here, we briefly review biofilm-associated peri-implant diseases and propose a fluorescence-based approach for more accurate and objective diagnoses. A fluorescence-based diagnosis tool through headlights combined with special-filtered dental loupes may serve as a hands-free solution for both precise diagnosis and effective removal of plaque-biofilms. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

3D Printed Complete Removable Dental Prostheses: a Narrative Review

Background: The purpose of this paper is to review the available literature on three-dimensionally printed complete dentures in terms of novel biomaterials, fabrication techniques and workflow, clinical performance and patient satisfaction. Methods: The methodology included applying a search strategy, defining inclusion and exclusion criteria, selecting studies and forming tables to summarize the results. Searches of PubMed, Scopus, and Embase databases were performed independently by two reviewers to gather literature published between 2010 and 2020. Results: A total of 126 titles were obtained from the electronic database, and the application of exclusion criteria resulted in the identification of 21 articles pertaining to printed technology for complete dentures. Current innovations and developments in digital dentistry have successfully led to the fabrication of removable dental prostheses using CAD/CAM technologies. Milled dentures have been studied more than 3D printed ones in the currently available literature. The limited number of clinical studies, mainly case reports, suggest current indications of 3D printing in denture fabrication process to be custom tray, record bases, trial, interim or immediate dentures but not definitive prostheses fabrication. Limitations include poor esthetics and retention, inability to balance occlusion and low printer resolution. Conclusions: Initial studies on digital dentures have shown promising short-term clinical performance, positive patient-related results and reasonable cost-effectiveness. 3D printing has potential to modernize and streamline the denture fabrication techniques, materials and workflows. However, more research is required on the existing and developing materials and printers to allow for advancement and increase its application in removable prosthodontics. © 2020, The Author(s)

Bond Strengths of Various Resin Cements to Different Ceramics

This study evaluates the shear bond strength (SBS) of various resin cements to different ceramics. Composite resin cylinders of Z100 were fabricated and cemented to disks of feldspathic ceramic (Creation), leucite-reinforced feldspathic ceramic (Empress I), and densely sintered aluminum oxide ceramic (Procera AllCeram) using five resin cements: Panavia F (PAN), RelyX ARC (ARC), RelyX Unicem (RXU), RelyX Veneer, and Variolink II. SBS was measured after three days of water storage (baseline) and after artificial aging (180 days of water storage along with 12,000 thermal cycles). Failure mode of fractured specimens also was evaluated. Data were analyzed with Kruskal-Wallis and Mann-Whitney tests (α=0.05). RXU showed 1) the lowest baseline median SBS to feldspathic ceramic, which was not statistically different from PAN; 2) the lowest median baseline SBS to leucite-reinforced feldspathic and densely sintered aluminum-oxide ceramics. All cements performed similarly after aging, except for ARC (median 0.0 MPa) and PAN (median 16.2 MPa) in the densely sintered aluminum-oxide ceramic group. Resin cements perform differently when bonded to different ceramic substrates. While all test resin cements worked similarly in the long-term to feldspathic and leucite-reinforced feldspathic ceramics, only the MDP-containing resin cement provided durable bonds to densely sintered aluminum-oxide ceramic. © Sociedade Brasileira de Hematologia e Hemoterapia

Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study

OBJECTIVES To assess the impact of the age of resin-based composite (RBC) restorations used for deep margin elevation (DME) on the marginal quality and fracture resistance of inlays. MATERIALS AND METHODS Permanent human molars with direct RBC restorations, involving the mesial, occlusal, and distal surface (MOD), were allocated to four groups (each n = 12). Half of the teeth underwent thermomechanical loading including 240,000 occlusal load cycles and 534 thermal cycles (TML, 5 °C/55 °C; 49 N, 1.7 Hz). With RBC left in one proximal box as DME, all teeth received MOD inlays, made from lithium disilicate (LDS) or a polymer-infiltrated ceramic network material (PICN). The restored teeth underwent TML including 1.2 million occlusal cyclic loadings and 2673 thermal cycles. The marginal quality was assessed at baseline and after both runs of TML. Load-to-fracture tests were performed. The statistical analysis comprised multiple linear regressions (α = 0.05). RESULTS Simulated aging of RBC restorations had no significant effect on the marginal quality at the interface between the RBC and the tooth and the RBC and the inlay (p ≥ 0.247). Across time points, higher percentages of non-continuous margin were observed between the inlay and the tooth than between the tooth and the RBC (p ≤ 0.039). The age of the DME did not significantly affect the fracture resistance (p ≥ 0.052). CONCLUSIONS Artificial aging of RBC restorations used for DME had no detrimental effect on the marginal quality and fracture resistance of LDS and PICN inlays. CLINICAL RELEVANCE This laboratory study suggests that-in select cases-intact, direct RBC restorations not placed immediately before the delivery of an indirect restoration may be used for DME