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Taylor A, Burns L. Deep margin elevation in restorative dentistry: A scoping review. J Dent 2024; 146:105066. [PMID: 38740249 DOI: 10.1016/j.jdent.2024.105066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Deep margin elevation (DME) is a restorative approach offering the possibility of performing stepwise elevation of deep proximal cavities to create more favourable margins for direct or indirect restorations. The objectives of this scoping review were to explore what is known or unknown about DME by describing a wide ranging evidence base including peer reviewed literature and non-traditionally published information on the web. DATA Data were extracted from the included evidence in order to describe the following: the extent and nature of the evidence base; the situations which are appropriate for DME; the materials and techniques which are used; the outcomes which have been measured in empirical studies; the risks which have been reported; and the findings which have been reported in studies which compared DME to surgical crown lengthening. SOURCES This scoping review included a wide range of published evidence and extensive web searching for grey literature, including CPD, training and multimedia information. STUDY SELECTION The findings revealed a range of published literature as well as freely available, online information advising practitioners about DME. Most empirical evidence was based on in vitro studies, and there were few clinical studies comparing DME to crown lengthening. Online information included recent, multimedia sources. CONCLUSIONS DME is a technique that can be used with motivated patients with good oral hygiene if rubber dam isolation is achieved, if there is no invasion of the connective tissue space, and if a strict restorative protocol is adhered to. CLINICAL SIGNIFICANCE With phasing out of amalgam and adhesive dentistry increasing in popularity, DME addresses multiple clinical problems associated with sub-gingival margins prior to restoration.
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Affiliation(s)
- Anna Taylor
- The Treatment Centre, Tinner's Court, Back Quay, Truro, Cornwall TR1 2LL, UK
| | - Lorna Burns
- Peninsula Dental School, John Bull Building, Research Way, Plymouth, Devon PL6 8BU, UK.
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Ismail EH, Ghazal SS, Alshehri RD, Albisher HN, Albishri RS, Balhaddad AA. Navigating the practical-knowledge gap in deep margin elevation: A step towards a structured case selection - a review. Saudi Dent J 2024; 36:674-681. [PMID: 38766289 PMCID: PMC11096606 DOI: 10.1016/j.sdentj.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 05/22/2024] Open
Abstract
The deep margin elevation (DME) technique has gained popularity because of numerous supporting case reports. However, some clinicians are cautious regarding using this technique owing to the lack of clear case selection criteria for DME application. This review aimed to analyze case reports and a series of DME cases to determine pre-/post-operative evaluation methods that could be used to suggest a pre-operative case selection checklist for DME. An electronic database search was conducted in June 2021 and updated by June 2023 using selected terms from PubMed, Cochrane Library, Google Scholar, EBSCO, and Scopus. The search was limited to English-language publications and was not restricted to the date. The inclusion criteria were case reports/series addressing periodontal and restorative outcomes of DME. The search identified 217 articles, 76 of which were pertinent. However, only six case reports and one case series satisfied the inclusion criteria. None of the selected studies followed any reporting guidelines, which led to significant information gaps. While the reviewed studies reported favorable outcomes, standardized protocols for evaluating pre-/post-operative restorative and periodontal status were lacking. The post-operative follow-up period varied from 3 months to 6 years. Designing and implementing pre-/post-operative guidelines hold the potential for ensuring the safe application of the DME technique. This may enhance our understanding of the suitability and efficacy of such non-invasive technique in future clinical trials. Clinical significance Handling deep cavities and preparing crowns are challenging. However, a lack of understanding of when to perform DME can lead to missed opportunities for conservative treatment, thereby a disservice to the patient. Provision of safe guidelines should be employed by clinicians until further evidence either supports or contradicts this treatment method.
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Affiliation(s)
- Eman H. Ismail
- Department of Clinical Dental Science, College of Dentistry, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Saba S. Ghazal
- Department of Periodontics, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rahaf D. Alshehri
- Department of Orthodontics, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Hajar N. Albisher
- Department of Prosthodontics, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rana S. Albishri
- Department of Restorative Dentistry, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Abdulrahman A. Balhaddad
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Ismail HS, Ali AI, El Mehesen R, Garcia-Godoy F, Mahmoud SH. Clinical evaluation of subgingival open sandwich restorations: 3-year results of a randomized double-blind trial. J ESTHET RESTOR DENT 2024; 36:573-587. [PMID: 37902283 DOI: 10.1111/jerd.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/21/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVES To provide a 3-year follow-up of previously treated patients to assess and compare the periodontal responses and clinical performance of proximal subgingival open sandwich restorations. MATERIALS AND METHODS Ninety-five adults participated in the study, with a combined total of 120 compound Class II cavities. These cavities had gingival margins located below the CEJ. Four different restorative materials were used to elevate the dentin/cementum gingival margins of the cavities: resin-modified glass ionomer, glass hybrid, flowable bulk-fill composite, or ion-releasing material, which were then completed with the same overlaying composite. Different periodontal and clinical evaluations, based on the criteria set by the World Dental Federation (FDI) criteria, were performed at different time intervals, including baseline, 6 months, 1, 2, and 3 years. RESULTS The type of base material did not affect the periodontal evaluations. There were no statistically significant differences between different time intervals or base material groups in any of the evaluated FDI parameters. However, the ion-releasing material scored significantly worse in the radiographic evaluation than any of the other groups. CONCLUSIONS All tested materials are suitable for proximal subgingival open sandwich restorations, as long as the restoration/tooth margin is at least 2-mm away from the bone crest. CLINICAL SIGNIFICANCE Clinicians can confidently choose any of the tested materials for proximal subgingival open sandwich restorations, as they have shown good outcomes from both periodontal and clinical perspectives.
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Affiliation(s)
- Hoda S Ismail
- Conservative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ashraf I Ali
- Conservative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Rabab El Mehesen
- Conservative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Franklin Garcia-Godoy
- Professor, Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Adjunct Faculty, The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Salah H Mahmoud
- Conservative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Fichera G, Mazzitelli C, Picciariello V, Maravic T, Josic U, Mazzoni A, Breschi L. Structurally compromised teeth. Part I: Clinical considerations and novel classification proposal. J ESTHET RESTOR DENT 2024; 36:7-19. [PMID: 37615505 DOI: 10.1111/jerd.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE A comprehensive classification of structurally compromised teeth (SCT) was introduced. CLINICAL CONSIDERATIONS Dental injuries or operative mismanagement undermine the structural integrity of the tooth abutment, reducing its biomechanical strength and rendering restorative procedures challenging. To standardize the overall pre-operative evaluations and determine the biological and mechanical features, a classification of the coronal and cervical tooth defects, as well as an attentive analysis of the most apical location of the residual cervical tooth structure along the whole perimeter and the most coronal location of the bucco/lingual residual structure was presented. Considering the residual cervical structure, five possible clinical scenarios were individuated with respect to the gingival margin, gingival sulcus, supracrestal tissue attachment and bone crest (BC). The latter prevents the isolation procedures rendering the adhesive restorations unfeasible. Instead, the location of the most apical portion of residual cervical structure within subgingival/intrasulcular depth (>1.5 mm above BC) can be considered restorable. CONCLUSIONS This classification is threefold: to enclose all the possible clinically encountered tooth defects, to identify the apical problems of SCT to appropriately manage the perio-restorative interfaces, and to evaluate the tooth resistance capacity of SCT, as to plan and perform the most adequate biomechanical restorative approach. CLINICAL SIGNIFICANCE The present classification is proposed to provide a complete perspective of structurally compromised teeth to standardize the biologic and biomechanical evaluations during planning of restorative procedures.
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Affiliation(s)
| | - Claudia Mazzitelli
- Department of Biomedical and Neuromotor Science (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Tatjana Maravic
- Department of Biomedical and Neuromotor Science (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Uros Josic
- Department of Biomedical and Neuromotor Science (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Annalisa Mazzoni
- Department of Biomedical and Neuromotor Science (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Science (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Felemban MF, Khattak O, Alsharari T, Alzahrani AH, Ganji KK, Iqbal A. Relationship between Deep Marginal Elevation and Periodontal Parameters: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1948. [PMID: 38003997 PMCID: PMC10673413 DOI: 10.3390/medicina59111948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/07/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: This review focuses on reviewing studies from the literature regarding the effects of deep margin elevation on the surrounding periodontium. Materials and Methods: A review of the literature was carried out using the following online databases: Embase, The Cochrane Library, MEDLINE-PubMed and Google Scholar. Our search was limited to articles from 2010 to 2023. The search terms consisted of keywords and MeSH terms, which were 'deep margin elevation', 'coronal margin relocation', 'periodontium' and 'periodontal tissues'. The literature was searched thoroughly by two reviewers. Initially, the titles of the articles were extracted. After removing irrelevant and duplicate articles, abstracts were assessed for relevant articles. Finally, the reviewers analyzed full-text articles. Results: A total of twelve articles, including one randomized clinical trial, three systematic reviews, two prospective cohort, three case series, one a clinical study, one pilot study and one a retrospective study, were selected and analyzed. Conclusions: The review suggests potential benefits of Deep Margin Elevation (DME) over surgical crown lengthening due to reduced invasiveness, yet conclusive effects on periodontal tissue remain unclear, warranting further studies on clinical parameters and inflammatory biomarkers.
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Affiliation(s)
- Mohammed Fareed Felemban
- Department of Maxillofacial Surgery and Diagnostic Sciences, Faculty of Dentistry, Taif University, Taif 21944, Saudi Arabia;
| | - Osama Khattak
- Department of Restorative Dental Sciences, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Thani Alsharari
- Department of Restorative and Dental Science, Faculty of Dentistry, Taif University, Taif 21944, Saudi Arabia;
| | | | - Kiran Kumar Ganji
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
- Department of Periodontology & Oral Implantology, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education & Research, Sawangi (Meghe), Wardha 442107, India
| | - Azhar Iqbal
- Department of Restorative Dental Sciences, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia;
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Magne P. M-i-M for DME: matrix-in-a-matrix technique for deep margin elevation. J Prosthet Dent 2023; 130:434-438. [PMID: 34961611 DOI: 10.1016/j.prosdent.2021.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Deep margin elevation is a solution to the problem of localized subgingival margins when preparing a tooth for direct, semidirect, or indirect restorations. The technique focuses on the local isolation of the deep margin by using a modified circumferential matrix. An evolution of the technique is presented, the matrix-in-a-matrix technique, to facilitate the isolation and fit of the subgingival matrix by adding a sectional band inside the circumferential matrix and packing Teflon tape between the 2 bands. Resective surgeries, invasive restorative procedures, and even sometimes extractions can all potentially be avoided by this modified deep margin elevation, allowing ideal conditions for scanning or impression making.
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Affiliation(s)
- Pascal Magne
- The Don & Sybil Harrington Professor of Esthetic Dentistry, Herman Ostrow School of Dentistry of USC, University of Southern California, Los Angeles, Calif.
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Şenol AA, Karabulut Gençer B, Tarçın B, Kahramanoğlu E, Yılmaz Atalı P. Microleakage and Marginal Integrity of Ormocer/Methacrylate-Based Bulk-Fill Resin Restorations in MOD Cavities: SEM and Stereomicroscopic Evaluation. Polymers (Basel) 2023; 15:polym15071716. [PMID: 37050330 PMCID: PMC10096632 DOI: 10.3390/polym15071716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
This in vitro study aimed to compare the microleakage and marginal integrity of methacrylate/ormocer-based bulk-fill composite (BFC) restorations used in cervical marginal relocation with two different layering thicknesses in mesio-occlusal-distal (MOD) cavities exposed to thermo-mechanical loading. Standard MOD cavities were prepared in 60 mandibular molars and assigned into three groups: x-tra fil/AF + x-tra base/XB, Tetric N-Ceram Bulk Fill/TNB + Tetric N-Flow Bulk Fill/TFB, and Admira Fusion x-tra/AFX + Admira Fusion x-base/AFB. Each group was further divided into two subgroups (2 mm and 4 mm) based on the thickness of flowable BFCs (n = 10). The specimens were subjected to thermo-mechanical loading (240,000 cycles) and immersed in 0.2% methylene blue. Following mesiodistal sectioning, the specimens were examined under stereomicroscope (×25) and scored (0-3) for microleakage. Marginal integrity was examined using a scanning electron microscope (SEM). Descriptive statistical methods and the chi-square test were used to evaluate the data (p < 0.05). While there was no statistically significant difference in gingival cement microleakage in the XB and AFB specimens with a 4 mm thickness, microleakage was significantly increased in the TFB specimen (p = 0.604, 0.481, 0.018 respectively). A significantly higher amount of score 0 coronal microleakage was detected in the AFX2 mm + AFB4 mm compared to the TNB2 mm + TFB4 mm (p = 0.039). The SEM examination demonstrated better marginal integrity in groups with 2 mm thick flowable BFCs. Ormocer and methacrylate-based materials can be used in marginal relocation with thin layers.
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Affiliation(s)
- Aslı A Şenol
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, Istanbul 34854, Turkey
| | - Büşra Karabulut Gençer
- Department of Restorative Dentistry, Faculty of Dentistry, Nişantaşı University, Istanbul 34398, Turkey
| | - Bilge Tarçın
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, Istanbul 34854, Turkey
| | - Erkut Kahramanoğlu
- Department of Prosthodontic Dentistry, Faculty of Dentistry, Marmara University, Istanbul 34854, Turkey
| | - Pınar Yılmaz Atalı
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, Istanbul 34854, Turkey
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Robaian A, Alqahtani A, Alanazi K, Alanazi A, Almalki M, Aljarad A, Albaijan R, Maawadh A, Sufyan A, Mirza MB. Different Designs of Deep Marginal Elevation and Its Influence on Fracture Resistance of Teeth with Monolith Zirconia Full-Contour Crowns. Medicina (B Aires) 2023; 59:medicina59040661. [PMID: 37109619 PMCID: PMC10144512 DOI: 10.3390/medicina59040661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background and objectives: Even with the demand for high esthetics, the strength of the material for esthetic applications continues to be important. In this study, monolith zirconia (MZi) crowns fabricated using CAD/CAM were tested for fracture resistance (FR) in teeth with class II cavity designs with varying proximal depths, restored through a deep marginal elevation technique (DME). Materials and Methods: Forty premolars were randomly divided into four groups of ten teeth. In Group A, tooth preparation was conducted and MZi crowns were fabricated. In Group B, mesio-occluso-distal (MOD) cavities were prepared and restored with microhybrid composites before tooth preparation and the fabrication of MZi crowns. In Groups C and D, MOD cavities were prepared, differentiated by the depth of the gingival seat, 2 mm and 4 mm below the cemento-enamel junction (CEJ). Microhybrid composite resin was used for DME on the CEJ and for the restoration of the MOD cavities; beforehand, tooth preparations were conducted and MZi crowns were and cemented using resin cement. The maximum load to fracture (in newtons (N)) and FR (in megapascals (MPa)) were measured using the universal testing machine. Results: The average scores indicate a gradual decrease in the load required to fracture the samples from Groups A to D, with mean values of 3415.61 N, 2494.11 N, 2108.25 N and 1891.95 N, respectively. ANOVA revealed highly significant differences between the groups. Multiple group comparisons using the Tukey HSD post hoc test revealed that Group D had greater DME depths and showed significant differences compared with Group B. Conclusions: FR in teeth decreased when more tooth structure was involved, even with MZi crowns. However, DME up to 2 mm below the CEJ did not negatively influence the FR. Strengthening the DME-treated teeth with MZi crowns could be a reasonable clinical option, as the force required to fracture the samples far exceeded the maximum recorded biting force for posterior teeth.
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Lee HB, Bea EJ, Lee WS, Kim JH. Trueness of stereolithography ZrO 2 crowns with different build directions. Dent Mater J 2023; 42:42-48. [PMID: 36288942 DOI: 10.4012/dmj.2022-041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study aims to measure the trueness of zirconia crowns with different build directions of materials fabricated using the stereolithography (SLA) method. The anatomic contour crown of prepped maxillary right first molar was designed using CAD software to obtain the standard tessellation language (STL) file. Two different build directions were set for the crowns using Materialize Magics software. One group was built with a margin base platform, while the other group was built in the direction opposite to the occlusal surface base platform. The 20 crown-shaped parts were printed. The STL files of scanned printing zirconia crowns were superimposed each segment by the 3D analysis software. The two groups were statistically analyzed using t-tests. Significant differences were found in the marginal and internal discrepancies between the groups. The build direction had a significant influence on the accuracy of the zirconia crown. The results indicate the most effective build direction for manufacturing SLA 3D-printed crowns.
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Affiliation(s)
- Ha-Bin Lee
- Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University
| | | | - Wan-Sun Lee
- Department Of Dental Technology, Bucheon University
| | - Ji-Hwan Kim
- Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University
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Eggmann F, Ayub JM, Conejo J, Blatz MB. Deep margin elevation-Present status and future directions. J ESTHET RESTOR DENT 2023; 35:26-47. [PMID: 36602272 DOI: 10.1111/jerd.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Deep margin elevation (DME) is a treatment approach to relocate the cervical margin of teeth with subgingival defects to a supragingival position with a direct restoration to facilitate rubber dam isolation, impression taking, and bonding of indirect restorations. This article provides an overview of the current scientific evidence on DME and future directions for research. OVERVIEW The review included 38 studies on DME, most conducted in vitro. These studies indicate that DME has no detrimental effect on the fracture resistance of restored teeth. Evidence on the impact of DME on marginal quality is conflicting, but most in vitro studies observed no negative effect. Clinical studies, most comprising small patient cohorts, demonstrated favorable restorative outcomes and suggest that DME restorations made with scrupulous care are compatible with periodontal health. Bleeding on probing may occur more frequently at sites with DME, though evidence on this is not unequivocal. CONCLUSIONS Current evidence, based largely on laboratory studies and limited clinical data, supports DME as a viable approach to restore teeth with localized subgingival defects. However, further clinical studies with long-term follow-ups are required to provide corroborative evidence. CLINICAL SIGNIFICANCE Current evidence suggests that DME is a viable approach to restore teeth with localized subgingival defects as a possible alternative to surgical crown lengthening. Proper working field isolation, meticulous care in the bonding and buildup procedure, and biofilm removal through patient-performed oral hygiene and professional maintenance care are crucial. As scant clinical trial-based evidence is available today, further research is needed to evaluate the long-term performance of DME restorations and their impact on periodontal health.
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Affiliation(s)
- Florin Eggmann
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Jose M Ayub
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julián Conejo
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Markus B Blatz
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Chiu S, Lee Y, Liu M, Chen H, Ye H, Liu Y. Evaluation of the marginal adaptation and gingival status of full-crown restorations using an intraoral camera. BMC Oral Health 2022; 22:517. [PMID: 36403015 PMCID: PMC9675266 DOI: 10.1186/s12903-022-02587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Objective The purpose of this study was to compare the usefulness of intraoral photographs, acquired with a household intraoral camera operating in conventional, calibrated, and polarized modes, with clinical examinations for assessing the marginal adaptation and gingival status of full-crown restorations. Methods Clinical examinations were performed by a prosthodontist who classified the marginal adaptation of full-crown restorations according to FDI World Dental Federation criteria, and a periodontal expert who classified gingival status according to the Modified Gingival Index (MGI). The margins and gingival status of the conventional, calibration, and polarization groups of full-crown restorations were independently assessed by three evaluators who obtained photographs using an intraoral camera. Cases where at least two of three assessors were in agreement were analyzed using Cohen’s kappa coefficient and the chi-square test, and the sensitivity and specificity were calculated. Results The conventional, calibration, and polarization groups differed significantly in marginal and gingival status of full-crown restorations. In the calibration group, there was good agreement between the camera-based and oral clinical examinations in terms of the gingival status of full-crown restorations (kappa = 0.945), with 100% sensitivity and 91.67% specificity; this was also the case in the polarization group with respect to the margins of full-crown restorations (kappa = 0.917, sensitivity = 97.22%, specificity = 94.44%). Conclusions An intraoral camera with black and white calibrated images is useful to assess the gingival status of full-crown restorations. Polarization mode can be used to assess the marginal adaptation of full-crown restorations. The camera is a feasible and valid diagnostic aid.
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Affiliation(s)
- Shuting Chiu
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Yeh Lee
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Min Liu
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Hu Chen
- grid.11135.370000 0001 2256 9319Center of Digital Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Hongqiang Ye
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Yunsong Liu
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
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Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101482. [PMID: 36295642 PMCID: PMC9610387 DOI: 10.3390/medicina58101482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently trending. Materials and Methods: a search was performed through PubMed, Scopus, and Google Scholar search engines to obtain relevant articles with no time restriction. Results: With biological width taken into consideration, well-defined and polished sub-gingival restorations are compatible with periodontal health. Marginal integrity in the DME technique seems to be affected by the type of adhesive, restoration, and incremental layering of the restoration. Regarding fracture resistance, DME has no significant effects. Conclusion: The DME technique seems to be a minimally invasive alternative to surgical crown lengthening (SCL) and orthodontic extrusion (OE) with respect to biological width. Well-controlled clinical trials are limited in this field; further long-term follow-up studies emphasizing the periodontal outcomes and prevention of complications are needed.
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Mannocci F, Bitter K, Sauro S, Ferrari P, Austin R, Bhuva B. Present status and future directions: The restoration of root filled teeth. Int Endod J 2022; 55 Suppl 4:1059-1084. [PMID: 35808836 PMCID: PMC9796050 DOI: 10.1111/iej.13796] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 12/30/2022]
Abstract
This narrative review will focus on a number of contemporary considerations relating to the restoration of root filled teeth and future directions for research. Clinicians are now more than ever, aware of the interdependence of the endodontic and restorative aspects of managing root filled teeth, and how these aspects of treatment are fundamental to obtaining the best long-term survival. To obtain the optimal outcomes for patients, clinicians carrying out endodontic treatment should have a vested interest in the restorative phase of the treatment process, as well as an appreciation for the structural and biomechanical effects of endodontic-restorative procedures on restoration and tooth longevity. Furthermore, the currently available research, largely lacks appreciation of occlusal factors in the longevity of root filled teeth, despite surrogate outcomes demonstrating the considerable influence this variable has. Controversies regarding the clinical relevance of minimally invasive endodontic and restorative concepts are largely unanswered with respect to clinical data, and it is therefore, all too easy to dismiss these ideas due to the lack of scientific evidence. However, conceptually, minimally invasive endodontic-restorative philosophies appear to be valid, and therefore, in the pursuit of improved clinical outcomes, it is important that the efficacies of these treatment protocols are determined. Alongside an increased awareness of the preservation of tooth structure, developments in adhesive bonding, ceramic materials and the inevitable integration of digital dentistry, there is also a need to evaluate the efficacy of new treatment philosophies and techniques with well-designed prospective clinical studies.
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Affiliation(s)
- Francesco Mannocci
- Department of EndodonticsFaculty of Dentistry, Oral and Craniofacial SciencesKing's College LondonLondonUK
| | - Kerstin Bitter
- Department of Operative and Preventive DentistryCharité ‐ University Medicine BerlinBerlinGermany
| | - Salvatore Sauro
- Departamento de Odontología, Facultad de Ciencias de la SaludUniversidad CEU‐Cardenal Herrera ValenciaAlfara del PatriarcaSpain
| | - Paolo Ferrari
- Department of Operative DentistryUniversity of ParmaParmaItaly
| | - Rupert Austin
- Department of ProsthodonticsFaculty of Dentistry, Oral and Craniofacial SciencesKing's College LondonLondonUK
| | - Bhavin Bhuva
- Department of EndodonticsFaculty of Dentistry, Oral and Craniofacial SciencesKing's College LondonLondonUK
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Ismail HS, Ali AI, Mehesen RE, Juloski J, Garcia-Godoy F, Mahmoud SH. Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength. Restor Dent Endod 2022; 47:e15. [PMID: 35692223 PMCID: PMC9160765 DOI: 10.5395/rde.2022.47.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/25/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022] Open
Abstract
This review aimed to characterize the effect of direct restorative material types and adhesive protocols on marginal adaptation and the bond strength of the interface between the material and the proximal dentin/cementum. An electronic search of 3 databases (the National Library of Medicine [MEDLINE/PubMed], Scopus, and ScienceDirect) was conducted. Studies were included if they evaluated marginal adaptation or bond strength tests for proximal restorations under the cementoenamel junction. Only 16 studies met the inclusion criteria and were included in this review. These studies presented a high degree of heterogeneity in terms of the materials used and the methodologies and evaluation criteria of each test; therefore, only a descriptive analysis could be conducted. The included studies were individually evaluated for the risk of bias following predetermined criteria. To summarize the results of the included studies, the type of restorative material affected the test results, whereas the use of different adhesive protocols had an insignificant effect on the results. It could be concluded that various categories of resin-based composites could be a suitable choice for clinicians to elevate proximal dentin/cementum margins, rather than the open sandwich technique with resin-modified glass ionomers. Despite challenges in bonding to proximal dentin/cementum margins, different adhesive protocols provided comparable outcomes.
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Affiliation(s)
- Hoda S. Ismail
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Ashraf I. Ali
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Rabab El. Mehesen
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Jelena Juloski
- Clinic for Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Serbia
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
- The Forsyth Institute, Cambridge, MA, USA
| | - Salah H. Mahmoud
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
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Deep Margin Elevation: A Literature Review. Dent J (Basel) 2022; 10:dj10030048. [PMID: 35323250 PMCID: PMC8947734 DOI: 10.3390/dj10030048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
A conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called “deep margin elevation” (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width.
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Ismail HS, Morrow BR, Ali AI, Mehesen RE, Garcia-Godoy F, Mahmoud SH. Correlation between different methodologies used to evaluate the marginal adaptation of proximal dentin gingival margins elevated using a glass hybrid. RESTORATIVE DENTISTRY & ENDODONTICS 2022; 47:e36. [DOI: 10.5395/rde.2022.47.e36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Hoda S. Ismail
- Department of Operative Dentistry Faculty of Dentistry, Mansoura University, Mansoura, Egypt
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brian R. Morrow
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ashraf I. Ali
- Department of Operative Dentistry Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Rabab El. Mehesen
- Department of Operative Dentistry Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
- Adjunct Faculty, The Forsyth Institute, Cambridge, MA, USA
| | - Salah H. Mahmoud
- Department of Operative Dentistry Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Grassi EDA, de Andrade GS, Tribst JPM, Machry RV, Valandro LF, Ramos NDC, Bresciani E, Saavedra GDSFA. Fatigue behavior and stress distribution of molars restored with MOD inlays with and without deep margin elevation. Clin Oral Investig 2021; 26:2513-2526. [PMID: 34643807 DOI: 10.1007/s00784-021-04219-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated the effect of deep margin elevation (DME) and restorative materials (leucite-reinforced glass-ceramics [C] vs. indirect resin composite [R]) on the fatigue behavior and stress distribution of maxillary molars with 2-mm deep proximal margins restored with MOD inlay. METHODS Fifty-two extracted human third molars were randomly assigned into four groups (n = 13): C; DME + C; R; and DME + R. Inlays were fabricated in CAD-CAM and bonded to all teeth. The fatigue behavior was assessed with the stepwise stress test (10,000 cycles/step; step = 50 N; 20 Hz; initial load = 200 N). Fatigue failure loads and the number of cycles were analyzed with 2-way ANOVA and Tukey's test (p < 0.05) and Kaplan-Meier survival plots. The stress distribution was assessed with finite element analysis. The models were considered isotropic, linear, and homogeneous, and presented bonded contacts. A tripod axial load (400 N) was applied to the occlusal surface. The stress distribution was analyzed with the maximum principal stress criterion. RESULTS For fatigue, there was no difference for DME factor (p > 0.05). For the material factor, the load and number of cycles for failure were statistically higher in the R groups (p < 0.05). The finite element analysis showed that resin composite inlays concentrated more stress in the tooth structure, while ceramic inlays concentrated more stress in the restoration. Non-reparable failures were more frequent in the resin composite inlays groups. CONCLUSIONS DME was not negative for fatigue and biomechanical behaviors. Resin composite inlays were more resistant to the fatigue test, although the failure mode was more aggressive. CLINICAL SIGNIFICANCE DME does not impair mechanical behavior. Resin composite inlays failed at higher loads but with a more aggressive failure mode.
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Affiliation(s)
- Elisa Donaria Aboucauch Grassi
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - Guilherme Schmitt de Andrade
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - João Paulo Mendes Tribst
- Post-Graduate Program in Dentistry, University of Taubaté (UNITAU), 09th Rua Dos Operários St., Taubaté, SP, 12020-340, Brazil
| | - Renan Vaz Machry
- Graduate Program of Oral Science, Prosthodontics Unit, School of Dentistry, Federal University of Santa Maria (UFSM), Roraima Av, Santa Maria, RS, 100097105-340, Brazil
| | - Luiz Felipe Valandro
- Graduate Program of Oral Science, Prosthodontics Unit, School of Dentistry, Federal University of Santa Maria (UFSM), Roraima Av, Santa Maria, RS, 100097105-340, Brazil
| | - Nathalia de Carvalho Ramos
- School of Dentistry, São Francisco University (USF), 218th São Francisco de Assis Av., Bragança Paulista, SP, 12916-900, Brazil
| | - Eduardo Bresciani
- Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - Guilherme de Siqueira Ferreira Anzaloni Saavedra
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil.
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Da Silva D, Ceballos L, Fuentes MV. Influence of the adhesive strategy in the sealing ability of resin composite inlays after deep margin elevation. J Clin Exp Dent 2021; 13:e886-e893. [PMID: 34603617 PMCID: PMC8464384 DOI: 10.4317/jced.58689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/05/2021] [Indexed: 01/18/2023] Open
Abstract
Background The aim of this study was to determine the influence of the gingival margin position and the adhesive strategy selected to perform deep margin elevation (DME) in marginal sealing of resin composite inlays by a nanoleakage test. Material and Methods 12 sound third molars were selected and expulsive MOD cavities for inlays were prepared. Experimental groups were established according to gingival margin location (enamel: 1 mm above cemento-enamel junction (CEJ), dentin: 1 mm below CEJ, or DME, and the adhesive strategy used to lute inlays and elevate the gingival margin. Therefore, the six experimental groups were: 1) Enamel + etch-and-rinse adhesive (ERA) Adper Scotchbond 1XT (SB1XT); 2) Dentin + SB1XT; 3) DME + SB1XT; 4) Enamel + self-etching adhesive (SEA) with enamel selective etching Clearfil SE Bond (CSE); 5) Dentin + CSE; 6) DME + CSE. Resin composite inlays were constructed (Gradia Indirect) and all luted with the same resin cement (RelyX ARC). Specimens were submitted to nanoleakage test. Results were analyzed by Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction (p<0.05). Results A perfect sealing ability was evidenced for experimental groups with gingival margins on enamel. Similar nanoleakage values were determined when CSE adhesive was applied regardless the gingival margin position. The highest silver nitrate infiltration was detected for elevated margins with the ERA SB1XT. Conclusions The SEA Clearfil SE Bond showed higher sealing ability than the ERA Adper Scotchbond 1XT when margins were located on dentin, regardless margin elevation. Gingival margins on enamel together with enamel acid etching provided an excellent sealing with both adhesive systems. Key words:Adhesion, composite inlays, gingival margin, deep margin elevation, marginal seal, nanoleakage test.
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Affiliation(s)
- Dayana Da Silva
- DDS, PhD, Assistant Professor, IDIBO Research Group, Nursing and Stomatology Department, Health Sciences Faculty, Rey Juan Carlos University. Av. de Atenas, S/N, 28922. Alcorcón, Madrid, Spain
| | - Laura Ceballos
- DDS, PhD, Professor, IDIBO Research Group, Nursing and Stomatology Department, Health Sciences Faculty, Rey Juan Carlos University. Av. de Atenas, S/N, 28922. Alcorcón, Madrid, Spain
| | - María-Victoria Fuentes
- DDS, PhD, Associate Professor, IDIBO Research Group, Nursing and Stomatology Department, Health Sciences Faculty, Rey Juan Carlos University. Av. de Atenas, S/N, 28922. Alcorcón, Madrid, Spain
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19
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Pre-endodontic restoration of structurally compromised teeth: current concepts. Br Dent J 2021; 231:343-349. [PMID: 34561585 PMCID: PMC8463293 DOI: 10.1038/s41415-021-3467-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
Teeth that require endodontic treatment are often structurally compromised and this considerably complicates endodontic procedures. Therefore, pre-endodontic restoration is a key approach that dentists should consider for such teeth. This article discusses current concepts of pre-endodontic restoration, with a focus on adhesive restorative methods and surgical/orthodontic techniques, and provides a relevant decision-making flowchart. Highlights the importance of pre-endodontic restoration for the predictability of endodontic treatment. Discusses restorability aspects for structurally compromised teeth. Reviews current restorative and surgical/orthodontic techniques for pre-endodontic restoration and provides a decision-making flowchart.
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20
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Nicola D, Crystal M, Francesco S, Raffaele M, Fiorino F, Donata M, Gianni P, Marco F, Simone G. Impact of interproximal composite restorations on periodontal tissue health: Clinical and cytokine profiles from a pre-post quasi-experimental study. J Periodontol 2021; 93:911-923. [PMID: 34453748 DOI: 10.1002/jper.21-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of this study is to clinically and molecularly evaluate the effect of an interproximal iuxta/subgingival direct composite restoration on periodontal tissue healing. METHODS Individuals in need of a posterior iuxta/subgingival interproximal restoration were consecutively enrolled. After enrollment, a test (site with tooth decay) and a control site (intact contralateral tooth) were identified. After a periodontal examination (probing depth [PD], clinical attachment level, recession, plaque, and bleeding on probing [BOP]) and a sampling of gingival crevicular fluid, the composite restoration was performed (T0 ). Clinical and molecular assessments were repeated at 3 (T3 ), 6 (T6 ), and 12 (T12 ) months after the restoration. Intragroup pre-post comparisons for quantitative variables were performed either through one-way ANOVA or Kruskal-Wallis test. A multivariate linear regression analysis was then modeled. With α = 0.05, a power of 80% will be reached with the inclusion of 41 individuals. RESULTS Biometric parameters demonstrated an increased mean PD (ΔPDT0 -T12 = -0.83 mm; P = 0.001) and loss of attachment (AL) (ΔCALT0 -T12 = -0.91 mm; P = 0.005) in the test site at 12 months. Accordingly, in the final multivariate regression model the radiographic distance between the bone crest and the restorative margin at baseline accounted for the dependent variable "attachment loss (AL)" (ΔCALT0 -T12 ) (P <0.05). CONCLUSIONS Iuxta/subgingival interproximal restorative margins jeopardized clinically and molecularly the periodontal tissue healing at least up to 1 year of follow-up.
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Affiliation(s)
- Discepoli Nicola
- Unit of Periodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Marruganti Crystal
- Unit of Periodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Unit of Endodontics and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Santoro Francesco
- Department of Medical Biotechnologies, Laboratory of Molecular Microbiology and Biotechnology (LAMMB), University of Siena, Siena, Italy
| | - Mirra Raffaele
- Unit of Periodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Fabio Fiorino
- Department of Medical Biotechnologies, Laboratory of Molecular Microbiology and Biotechnology (LAMMB), University of Siena, Siena, Italy
| | - Medaglini Donata
- Department of Medical Biotechnologies, Laboratory of Molecular Microbiology and Biotechnology (LAMMB), University of Siena, Siena, Italy
| | - Pozzi Gianni
- Department of Medical Biotechnologies, Laboratory of Molecular Microbiology and Biotechnology (LAMMB), University of Siena, Siena, Italy
| | - Ferrari Marco
- Unit of Dental Materials and Fixed Prosthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Grandini Simone
- Unit of Endodontics and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Ercoli C, Tarnow D, Poggio CE, Tsigarida A, Ferrari M, Caton JG, Chochlidakis K. The Relationships Between Tooth-Supported Fixed Dental Prostheses and Restorations and the Periodontium. J Prosthodont 2020; 30:305-317. [PMID: 33210761 DOI: 10.1111/jopr.13292] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To search the literature and to critically evaluate the findings on the periodontal outcomes of restorations and tooth-supported fixed prostheses. MATERIALS AND METHODS PubMed was searched according to a systematic methodology, previously reported, but updated to include a larger database. Filters applied were: Case reports, clinical trial, review, guideline, randomized controlled trial, meta-analysis, systematic reviews, and English. A narrative review was then synthesized to discuss periodontal outcomes related to restorations and tooth-supported fixed prostheses. Relevant data was organized into four sections: Direct restorations, indirect restorations, biologic width or supracrestal tissue attachment and tooth preparation/finish line design. RESULTS While increased gingival index, bleeding on probing, probing depth and clinical attachment loss have been associated with subgingival restorations, intracrevicular margins do not cause periodontal diseases. Inflammation and bone loss occur, for both direct and indirect restorations, only with large overhangs. Different restorative materials are associated with different clinical responses when placed in the gingival sulcus or within the epithelial and connective tissue attachments. When the connective tissue attachment is removed, histological changes occur causing its apical shift and subsequent re-establishment. Gingival displacement during impression procedures can cause gingival recession. Emergence profile can have a range of values, not associated with periodontal diseases. Periodontal response appears to be clinically not different when compared among different finish line designs. CONCLUSIONS Contemporary procedures and materials used for the placement and fabrication of tooth-supported restorations and fixed prostheses are compatible with periodontal health when adequate patient education and motivation in self-performed oral hygiene are present. Periodontal diagnostic criteria should be thoroughly reviewed before fixed restorative treatments are planned and executed.
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Affiliation(s)
- Carlo Ercoli
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Dennis Tarnow
- Department of Periodontics, Columbia University College of Dentistry, New York, NY
| | - Carlo E Poggio
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Alexandra Tsigarida
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Marco Ferrari
- Department of Medical Biotechnologies, Division of Fixed Prosthodontics, Dean, University of Siena, Siena, Italy
| | - Jack G Caton
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Konstantinos Chochlidakis
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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22
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Juloski J, KÖken S, Ferrari M. No correlation between two methodological approaches applied to evaluate cervical margin relocation. Dent Mater J 2020; 39:624-632. [PMID: 32295986 DOI: 10.4012/dmj.2018-410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The study evaluated the quality of gingival margins created by cervical margin relocation (CMR) technique using different materials and assessed the consistency of the results obtained by two in vitro methods: microleakage test and scanning electron microscopy (SEM). Mesio-occlusal-distal cavities with subgingival proximal margins were prepared. Mesial margins were elevated supragingivally with total-etch adhesive and flowable composite (Group 1) or with universal adhesive and bulk-fill flowable composite (Group 2). Distal margins were not elevated. Teeth were restored with CAD/CAM overlays. Marginal quality was evaluated by microleakage test and SEM observation of epoxy resin replicas. Statistical analyses showed no significant correlations between microleakage scores and percentage of marginal integrity observed under SEM at CMR margins, lower microleakage scores at margins without CMR compared to CMR margins, lower microleakage scores in Group 2 than in Group 1 and no difference in SEM integrity between groups at CMR margins.
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Affiliation(s)
- Jelena Juloski
- Department of Medical Biotechnologies, University of Siena.,Clinic for Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade
| | - Serhat KÖken
- Department of Medical Biotechnologies, University of Siena
| | - Marco Ferrari
- Department of Medical Biotechnologies, University of Siena
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Bresser R, Gerdolle D, van den Heijkant I, Sluiter-Pouwels L, Cune M, Gresnigt M. Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. J Dent 2019; 91:103227. [DOI: 10.1016/j.jdent.2019.103227] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022] Open
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Bertoldi C, Monari E, Cortellini P, Generali L, Lucchi A, Spinato S, Zaffe D. Clinical and histological reaction of periodontal tissues to subgingival resin composite restorations. Clin Oral Investig 2019; 24:1001-1011. [PMID: 31286261 DOI: 10.1007/s00784-019-02998-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the clinical and histological response of supracrestal periodontal tissues to subgingival composite restorations versus natural root surfaces MATERIAL AND METHODS: In 29 subjects with a single tooth requiring subgingival restorations, a deep margin elevation (DME) procedure with composite resin was applied. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and focal probing depth (PD) were measured at baseline, before DME, and after 3 months. The distance between the coronal marked (CM) point to the apical margin of the composite reconstruction (AMR), at baseline, and to the tip of the periodontal probe inserted to reach the bottom of the sulcus (APP), 3 months later, was measured. An all-around secondary flap, harvested to ensure the subsequent single-crown prosthetic rehabilitation was histologically processed. The histological inflammation degree was evaluated in areas of gingival tissues adjacent to the composite (group B) and adjacent to the natural surface of each single tooth (group A). RESULTS Significant FMPS, FMBS, and PD decreases were observed (p < 0.05). CM-AMR and CM-APP were significantly different (p < 0.05), suggesting an attachment gain after 3-months. The inflammation level of gingival tissue was similar in groups A and B (p > 0.05). CONCLUSIONS For the first time, this topic was clinically and histologically studied in humans. Subgingival restorations resulted compatible with gingival health, with levels similar to that of untreated root surfaces. CLINICAL RELEVANCE Deep margin elevation procedure produces favorable clinical and histological outcomes allowing a routine utilization in reconstructive dentistry.
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Affiliation(s)
- Carlo Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy
| | - Emanuela Monari
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy
| | | | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy.
| | - Andrea Lucchi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy
| | | | - Davide Zaffe
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Grubbs TD, Vargas M, Kolker J, Teixeira EC. Efficacy of Direct Restorative Materials in Proximal Box Elevation on the Margin Quality and Fracture Resistance of Molars Restored With CAD/CAM Onlays. Oper Dent 2019; 45:52-61. [PMID: 31084532 DOI: 10.2341/18-098-l] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effect of four direct restorative materials that can be used in the proximal box elevation (PBE) technique. METHODS AND MATERIALS Seventy-five molar teeth were randomly assigned to one of five groups (n=15): type II glass ionomer (GI), type II resin-modified glass ionomer (RMGI), resin-based composite (RBC), bulk-fill (BF) resin-based composite, and a control with no box elevation procedure. Specimens were prepared for a standard mesio-occlusal-distal, computer-aided design/computer-aided manufactured (CAD-CAM) resin, nanoceramic onlay with mesial cervical margins located 1 mm above the cementoenamel junction (CEJ) and distal cervical margins located 2 mm below the CEJ. PBE was used to elevate the distal margins to 1 mm above the CEJ in all groups except the control group. For the control group the onlay margin was placed directly on the prepared distal tooth structure without PBE. A Lava Ultimate CAD/CAM resin, nanoceramic onlay restorative was manufactured and bonded on all specimens with RelyX Ultimate adhesive resin cement. The quality of the tooth-PBE material and PBE material-onlay interface was evaluated with scanning electron microscopy using epoxy resin replicas before and after cyclic loading (100,000 cycles, 1.2 Hz at 65N and 37°C). In addition to margin quality, the fracture resistance of each group was measured using a universal testing machine. Fracture pattern was recorded by visual examination. The Levene test for homogeneity and the Welch analysis of variance were completed for fracture resistance and margin quality. A χ2 test was completed for break mode. RESULTS For dentin margins, a statistically significant difference was detected between the RMGI and control groups at baseline (p=0.0442). All other groups-GI, RBC, and BF-showed no difference from the control at baseline (p>0.05). No statistical significance was observed among groups for post-cyclic fatigue (p=0.8735). For onlay margins, no statistical significance was observed among groups for pre-cyclic fatigue, post-cyclic fatigue, or change (p=0.9713, p=0.528, p=0.4385, respectively). No significant difference was observed for the fracture resistance among groups or for the type of break by material used (p=0.1593, p=0.77, respectively). CONCLUSION Within the parameters of this study, after mechanical fatigue, the materials used for PBE: RMGI, RBC, and BF, did not influence results in terms of margin quality and fracture resistance. Therefore, collective findings suggest that these materials might be suitable for PBE procedures. Nevertheless, clinical caution is recommended with any PBE procedure and further testing of GI materials is needed.
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Ferrari M, Ferrari Cagidiaco E, Goracci C, Sorrentino R, Zarone F, Grandini S, Joda T. Posterior partial crowns out of lithium disilicate (LS2) with or without posts: A randomized controlled prospective clinical trial with a 3-year follow up. J Dent 2019; 83:12-17. [DOI: 10.1016/j.jdent.2019.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/30/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022] Open
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