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Pilecco RO, da Rosa LS, Baldi A, Machry RV, Tribst JPM, Valandro LF, Kleverlaan CJ, Scotti N, Pereira GKR. How do different intraoral scanners and milling machines affect the fit and fatigue behavior of lithium disilicate and resin composite endocrowns? J Mech Behav Biomed Mater 2024; 155:106557. [PMID: 38657286 DOI: 10.1016/j.jmbbm.2024.106557] [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: 02/27/2024] [Revised: 04/03/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
The aim of this in vitro study was to evaluate the effect of the combinations of two different intraoral scanners (IOS), two milling machines, and two restorative materials on the marginal/internal fit and fatigue behavior of endocrowns produced by CAD-CAM. Eight groups (n= 10) were considered through the combination of TRIOS 3 (TR) or Primescan (PS) IOS; 4-axes (CR; CEREC MC XL) or 5-axes (PM; PrograMill PM7) milling machines; and lithium disilicate (LD; IPS e.max CAD) or resin composite (RC; Tetric CAD) restorative materials. Specific surface treatments were applied to each material, and the bonding to its corresponding Endocrown-shaped fiberglass-reinforced epoxy resin preparations was performed (Variolink Esthetic DC). Computed microtomography (μCT) was performed to assess the marginal/internal fit, as well as a mechanical fatigue test (20 Hz, initial load = 100 N/5000 cycles; step-size = 50 N/10,000 cycles until a threshold of 1500 N, then, the step-size was increased if needed to 100 N/10,000 cycles until failure or a threshold of 2800 N) to evaluate the restorations long-term behavior. Complementary analysis of the fracture features and surface topography in scanning electron microscopy was performed. Three-way ANOVA and Kaplan-Meier test (α = 0.05) were performed for marginal/internal fit, and fatigue behavior data, respectively. PS scanner, CR milling machine, and RC endocrowns resulted in a better marginal fit compared to their counterparts. Still, the PM machine resulted in a better pulpal space fit compared to the CR milling machine. Regardless of the scanner and milling machine, RC endocrowns exhibited superior fatigue behavior than LD ones. LD endocrowns presented margin chipping regardless of the milling machine used. Despite minor differences in terms of fit, the 'IOS' and 'milling machine' factors did not impair the fatigue behavior of endocrowns. Resin-composite restorations resulted in a higher survival rate compared to glass-ceramic ones, independently of the digital devices used in the workflow.
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Affiliation(s)
- Rafaela Oliveira Pilecco
- Post-Graduate Program in Oral Sciences (Prosthodontics Units), Faculty of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Lucas Saldanha da Rosa
- Post-Graduate Program in Oral Sciences (Prosthodontics Units), Faculty of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Andrea Baldi
- Department of Surgical Sciences, Dental School, University of Turin (UNITO), Turin, Piedmont, Italy.
| | - Renan Vaz Machry
- Post-Graduate Program in Oral Sciences (Prosthodontics Units), Faculty of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - João Paulo Mendes Tribst
- Department of Reconstructive Oral Care, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, North Holland, the Netherlands.
| | - Luiz Felipe Valandro
- Post-Graduate Program in Oral Sciences (Prosthodontics Units), Faculty of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Cornelis Johannes Kleverlaan
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, North Holland, the Netherlands.
| | - Nicola Scotti
- Department of Surgical Sciences, Dental School, University of Turin (UNITO), Turin, Piedmont, Italy.
| | - Gabriel Kalil Rocha Pereira
- Post-Graduate Program in Oral Sciences (Prosthodontics Units), Faculty of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
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2
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Casaponsa J, Vinothkumar TS, Dummer PMH, Nagendrababu V, Abella Sans F. Restoration of Teeth with Severely Compromised Tooth Structure using Digital Planning Combined with Orthodontic Magnetic Extrusion-A Report of 2 Cases. J Endod 2024; 50:852-858. [PMID: 38428807 DOI: 10.1016/j.joen.2024.02.017] [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: 12/29/2023] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
This report outlines 2 digitally planned cases in which the teeth underwent magnetic extrusion to preserve the supracrestal tissue attachment and regain the ferrule, followed by their restoration. Case 1: A 42-year-old man with the chief concern of a fractured right maxillary second premolar. Following the completion of root canal treatment, the remaining tooth structure was insufficient to create a ferrule for tooth restoration. For this scenario, a rapid magnetic extrusion technique was performed on tooth #4 to obtain an approximate 3-mm ferrule. The condition of both the dentition and the restorative margin was acceptable 18 months following treatment. Case 2: A 62-year-old man with the chief complaint of mobility on both sides of the maxillary arch in relation to a tooth-supported fixed partial denture (FPD). Following removal of the FPD, multiple extractions were carried out and tooth #6 was subjected to magnetic extrusion in 3 stages to a maximum of 4 mm to obtain a ferrule. At the 18-month and 3-year follow-up appointments, the tooth had no symptoms and the gingiva around the restorations had optimal architecture and margins. The 3-dimensional digital planning was helpful in precisely positioning the magnets within the tooth and the provisional restorations to facilitate axial extrusion. The extruded teeth were restored with zirconia crowns in both cases. The beneficial outcomes observed from these cases provides evidence that the integration of digital planning and magnetic extrusion holds promise as a method for reconstructing teeth with crowns that are significantly compromised.
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Affiliation(s)
- Jaume Casaponsa
- Department of Integrated Clinics for Adults, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Thilla Sekar Vinothkumar
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Francesc Abella Sans
- Department of Endodontics, School of Dentistry, Universitat International de Catalunya, Barcelona, Spain.
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Frankenberger R, Becker S, Beck-Broichsitter B, Albrecht-Hass S, Behrens CJ, Roggendorf MJ, Koch A. 40-Year Outcome of Old-School, Non-Surgical Endodontic Treatment: Practice-Based Retrospective Evaluation. Dent J (Basel) 2024; 12:90. [PMID: 38668002 PMCID: PMC11049336 DOI: 10.3390/dj12040090] [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: 12/25/2023] [Revised: 02/12/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Non-surgical endodontic treatment has been shown to be clinically successful; however, clinical long-term data are scarce. This practice-based retrospective clinical investigation evaluated endodontic outcomes over 40 years and identified relevant clinical co-factors. (2) Methods: Two experienced dental practitioners in two different private dental practices treated 174 patients with 245 teeth from 1969 to 1993. After root canal obturation, either a new direct restoration (amalgam, resin composite, or glass-ionomer cement) or the re-cementation of a pre-existing prosthetic restoration or renewal of prosthetic restoration followed. Metal posts (operator A) or metal screws (operator B) were inserted when coronal substance loss was significant. The primary outcome (i.e., tooth survival) was achieved when the endodontically treated tooth was, in situ, painless and had full function at the end of the observation period. A secondary outcome, the impact of different prognostic factors on survival rate, was evaluated. (3) Results: The overall mean survival was 56.1% of all treated teeth after 40 years of clinical service, resulting in an annual failure rate of 1.1%. Most investigated clinical co-factors (jaw, tooth position, intracanal dressings, post/screw placement, and gender) showed no significant influence on survival. (4) Conclusions: Even with materials and techniques from the 1970s and 1980s, successful root canal treatment was achievable. Except for post-endodontic restorations, most of the evaluated factors had no significant influence on the clinical long-term survival of root canal-treated teeth.
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Affiliation(s)
- Roland Frankenberger
- Department of Operative Dentistry, Endodontics, and Pediatric Dentistry, Medical Center for Dentistry, University Medical Center Giessen and Marburg, 35392 Marburg, Germany; (M.J.R.); (A.K.)
| | - Stephan Becker
- Prof. Becker & Kollegen, Kehdenstrasse 2-10, 47803 Kiel, Germany; (S.B.); (C.J.B.)
| | - Benedicta Beck-Broichsitter
- Clinic for Oral and Maxillofacial Surgery, Stuttgart City Clinic, Kriegsbergerstr. 60, 70174 Stuttgart, Germany;
| | | | - Charlotte J. Behrens
- Prof. Becker & Kollegen, Kehdenstrasse 2-10, 47803 Kiel, Germany; (S.B.); (C.J.B.)
| | - Matthias J. Roggendorf
- Department of Operative Dentistry, Endodontics, and Pediatric Dentistry, Medical Center for Dentistry, University Medical Center Giessen and Marburg, 35392 Marburg, Germany; (M.J.R.); (A.K.)
| | - Andreas Koch
- Department of Operative Dentistry, Endodontics, and Pediatric Dentistry, Medical Center for Dentistry, University Medical Center Giessen and Marburg, 35392 Marburg, Germany; (M.J.R.); (A.K.)
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Cocco F, Packaeser MG, Machry RV, Tribst JPM, Kleverlaan CJ, Pereira GKR, Valandro LF. Conventional-, bulk-fill- or flowable-resin composites as prosthetic core build-up: Influence on the load-bearing capacity under fatigue of bonded leucite-reinforced glass-ceramic. J Mech Behav Biomed Mater 2024; 151:106365. [PMID: 38183746 DOI: 10.1016/j.jmbbm.2023.106365] [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: 11/19/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
This study aimed to evaluate the fatigue performance of simplified ceramic restorations (leucite-reinforced glass ceramic) adhesively cemented onto substrates of different resin composites. Three options from the same commercial line were selected (Tetric N-Line, Ivoclar), classified as Conventional (CRC), Bulk-fill (BRC) and Flowable (FRC), which were used to make discs using a cylindrical metallic device (n = 19; Ø = 10 mm, thickness = 2.0 mm). A total of 57 discs (Ø = 10 mm, thickness = 1.0 mm) were made from CAD/CAM prefabricated blocks of a leucite reinforced glass-ceramic (Empress CAD, Ivoclar) to simulate a monolithic restoration, then were randomly distributed to be bonded on 19 discs of each three different resin composite substrates (CRC; BRC; or FRC) with a dual resin cement (Multilink N; Ivoclar). The samples were subjected to a compression test with a hemispherical stainless-steel piston (Ø = 40 mm) at a monotonic regimen (n = 4; 1 mm/min loading rate and 500 kgf loading cell until fracture). The cyclic fatigue test was performed underwater at a frequency of 20 Hz (n = 15). The first step was applied using 200N for 5000 cycles, followed by increments of 50N at each step of 10,000 until failure. The outcome considered for both tests was the occurrence of radial crack. Specific statistical tests (α = 0.05) were performed for monotonic (One-way ANOVA; Tukey's test) and fatigue data (Kaplan-Meier test; Log-rank test). Fractography of fractured samples were also performed. The FRC group had the lowest failure load in both test regimes (p < 0.05; monotonic: 726.64N; fatigue: 716.67N). There were no differences between the CRC and BRC groups (p > 0.05; monotonic: 989.30 and 990.11N; fatigue: 810.00 and 833.33N, respectively). The same result was obtained considering cycles for fatigue failure (FRC < CRC=BRC). Leucite glass-ceramic bonded to substrates made of flowable resin composite behaves worse mechanically than bonding to conventional or bulk-fill resin composite substrates.
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Affiliation(s)
- Fernanda Cocco
- Undergraduate Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Maria Gabriela Packaeser
- MSciD and PhD Post-Graduate Program in Oral Sciences (Prosthodontics Unit), Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Renan Vaz Machry
- MSciD and PhD Post-Graduate Program in Oral Sciences (Prosthodontics Unit), Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - João Paulo Mendes Tribst
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Oral Regenerative Medicine, University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands.
| | - Cornelis Johannes Kleverlaan
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Dental Material Sciences, University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands.
| | - Gabriel Kalil Rocha Pereira
- MSciD and PhD Post-Graduate Program in Oral Sciences (Prosthodontics Unit), Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Luiz Felipe Valandro
- MSciD and PhD Post-Graduate Program in Oral Sciences (Prosthodontics Unit), Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
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Ikemoto S, Komagata Y, Yoshii S, Masaki C, Hosokawa R, Ikeda H. Impact of CAD/CAM Material Thickness and Translucency on the Polymerization of Dual-Cure Resin Cement in Endocrowns. Polymers (Basel) 2024; 16:661. [PMID: 38475344 DOI: 10.3390/polym16050661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/18/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
The objective of this study is to evaluate the impact of the thickness and translucency of various computer-aided design/computer-aided manufacturing (CAD/CAM) materials on the polymerization of dual-cure resin cement in endocrown restorations. Three commercially available CAD/CAM materials-lithium disilicate glass (e.max CAD), resin composite (CERASMART), and a polymer-infiltrated ceramic network (ENAMIC)-were cut into plates with five different thicknesses (1.5, 3.5, 5.5, 7.5, and 9.5 mm) in both high-translucency (HT) and low-translucency (LT) grades. Panavia V5, a commercial dual-cure resin cement, was polymerized through each plate by light irradiation. Post-polymerization treatment was performed by aging at 37 °C for 24 h under light-shielding conditions. The degree of conversion and Vickers hardness measurements were used to characterize the polymerization of the cement. The findings revealed a significant decrease in both the degree of conversion and Vickers hardness with increasing thickness across all CAD/CAM materials. Notably, while the differences in the degree of conversion and Vickers hardness between the HT and LT grades of each material were significant immediately after photoirradiation, these differences became smaller after post-polymerization treatment. Significant differences were observed between samples with a 1.5 mm thickness (conventional crowns) and those with a 5.5 mm or greater thickness (endocrowns), even after post-polymerization treatment. These results suggest that dual-cure resin cement in endocrown restorations undergoes insufficient polymerization.
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Affiliation(s)
- Soshi Ikemoto
- Division of Biomaterials, Kyushu Dental University, Kitakyushu 803-8580, Japan
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Kitakyushu 803-8580, Japan
| | - Yuya Komagata
- Division of Biomaterials, Kyushu Dental University, Kitakyushu 803-8580, Japan
| | - Shinji Yoshii
- Division of Promoting Learning Design Education, Kyushu Dental University, Kitakyushu 803-8580, Japan
| | - Chihiro Masaki
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Kitakyushu 803-8580, Japan
| | - Ryuji Hosokawa
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Kitakyushu 803-8580, Japan
| | - Hiroshi Ikeda
- Division of Biomaterials, Kyushu Dental University, Kitakyushu 803-8580, Japan
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Intaraprasong N, Banomyong D, Chotvorrarak K, Ngoenwiwatkul Y, Pittayachawan P. Influence of Different Post-endodontic Restorations on the Survival Rate Against Fracture of Endodontically Treated Anterior Teeth Affected by Cervical Lesions with Pulpal Involvement: A Retrospective Clinical Study. Eur Endod J 2024; 9:44-56. [PMID: 37966965 PMCID: PMC10777090 DOI: 10.14744/eej.2023.15870] [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: 12/21/2022] [Revised: 04/03/2023] [Accepted: 07/12/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE To compare the survival rate against fracture of endodontically treated anterior teeth (ETT) affected by cervical (class V) lesions with pulpal involvement restored with resin composite or a post/core and crown, and to identify the prognostic factors for fracture. METHODS Dental records and radiographs of ETT affected by cervical lesions with pulpal involvement restored with resin composite or a post/core and crown during a recall period from 2009-2022 were selected according to the inclusion and exclusion criteria. The number of tooth fracture, the restorability after fracture and any possible risk factors were identified. The survival rate against ETT fracture were analyzed and com- pared between the two restoration groups by Kaplan-Meier survival analysis and the Tarone-Ware test. Non- proportional hazard models were used to identify the prognostic factors. The sub-analysis in each restoration group was also performed. RESULTS The study comprised 175 ETT restored with resin composite (n=125) or a crown (n=50). With a mean recall period of 32.9+-15.8 months, the survival rate against ETT fracture with resin composite (85.6%) was not significantly different from those with a crown (88%) (p≥0.05). The most frequent mode of fracture was crown-root fracture, which accounted for 78% and 83.30% of the fractures in the resin composite and crown groups, respectively. A significant prognostic factor for ETT fracture affected by cervical lesions with pulpal involve- ment was additional tooth structure loss from a class III, class IV or another class V lesion on the opposite side (p<0.05). The ETT affected by cervical lesions with pulpal involvement combined with additional tooth structure loss had a 7.25-fold higher risk of fracture than those with single-surface affected by cervical lesions with pulpal involvement (hazard ratio [HR] = 7.25; 95% confidence interval [CI], 1.68-31.30). The sub-analysis in the crown and resin composite groups revealed that the survival rates of ETT with single-surface affected by cervical lesions with pulpal involvement was 100% and 96.15%, respectively, which were significantly higher than those of ETT with additional tooth loss at 80.65% and 78.08%, respectively (p<0.05). CONCLUSION With a mean 33-month recall period, the survival rate against ETT fracture affected by cervical lesions with pulpal involvement restored with resin composite or crown were not significantly different. Additional tooth structure loss was a significant prognostic factor for fracture.
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Affiliation(s)
- Nitchnun Intaraprasong
- Department of Operative Dentistry and Endodontics, Mahidol University Faculty of Dentistry, Bangkok, Thailand
| | - Danuchit Banomyong
- Department of Operative Dentistry and Endodontics, Mahidol University Faculty of Dentistry, Bangkok, Thailand
| | - Kanet Chotvorrarak
- Department of Operative Dentistry and Endodontics, Mahidol University Faculty of Dentistry, Bangkok, Thailand
| | - Yaowaluk Ngoenwiwatkul
- Department of Community Dentistry, Mahidol University Faculty of Dentistry, Bangkok, Thailand
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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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Fichera G, Mazzitelli C, Picciariello V, Maravic T, Josic U, Mazzoni A, Breschi L. Structurally compromised teeth. Part II: A novel approach to peripheral build up procedures. J ESTHET RESTOR DENT 2024; 36:20-31. [PMID: 37565412 DOI: 10.1111/jerd.13118] [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: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To introduce the "Peripheral Build-Up technique - PBUt" as a foundation restoration strategy for structurally compromised teeth (SCT). CLINICAL CONSIDERATIONS Several strategies have been proposed over time (cervical marginal relocation, doughnut, and preformed ring techniques) to enable the management of restorative procedures in challenging situations such as the presence of deep subgingival defects. The PBUt is a versatile, completely additive direct technique that share some strategical concepts with these techniques to approach critical clinical situations while supplying a wider field of application thanks to distinct operative expedients. The clamp insertion modality, the extension of the proximal wall and the matrix customization/stabilization strategies adopted in PBUt endorse the possibility to manage the most apical and peripheral border of the residual tooth structure when located up to >1.5 mm above the bone crest. The periodontal response has to be then monitored over time. Moreover, thanks to the peripheral and apically-extended addictive approach, it allows a massive preservation of residual sound tooth structure and improves the resistance and retentive physical/geometrical features of the abutment tooth. The PBUt operative workflow is herein explained. CLINICAL SIGNIFICANCE The Peripheral-Build-Up technique (PBUt) advocates some innovative clinical restorative steps for the management of SCT with coronal and deep subgingival defects.
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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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9
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Zanza A, Reda R, Testarelli L. Endodontic Orthograde Retreatments: Challenges and Solutions. Clin Cosmet Investig Dent 2023; 15:245-265. [PMID: 37899987 PMCID: PMC10612510 DOI: 10.2147/ccide.s397835] [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: 05/03/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
Endodontic orthograde retreatments are considered one of the possible treatment options in case of post-treatment diseases considering the promising results present in the literature. Despite this, a plethora of articles have been published on this topic, and drawing conclusions could be challenging. For this reason, this review aims to summarize the crucial points on each aspect of non-surgical endodontic retreatments, discussing and comparing the current protocols, techniques, materials, and indications. Taking into consideration data from the literature, in terms of diagnosis, CBCT should be considered the first choice, since it can thoroughly affect the diagnosis and treatment plan. Regarding the procedural phases, some conclusions can be drawn: when present, coronal restoration materials such as crowns, partial prostheses, post, and core should be removed; the use of magnification devices, ultrasonic instruments, and an in-depth interpretation of radiographic images with both 2D and 3D images are strongly recommended during the orifice location; additional protocols such as irrigants activation, ultrasonic cleaning, and rotary or reciprocating instrumentation of treated canals are strongly recommended for filling materials removal and to achieve a high-quality chemo-mechanical disinfection; perforations should be treated as soon as possible, and the material of choice to treat them is the MTA or other calcium-silicate-based repair materials; the presence of ledges does not intrinsically reduce the success rate of RCRts if properly managed; in case of instrument fragments, their removal should be considered as the first treatment option, however many variables should be considered to select the proper technique or consider the option of bypassing.
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Affiliation(s)
- Alessio Zanza
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Rodolfo Reda
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Testarelli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
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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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Kharouf N, Sauro S, Hardan L, Jmal H, Bachagha G, Macaluso V, Addiego F, Inchingolo F, Haikel Y, Mancino D. Compressive Strength and Porosity Evaluation of Innovative Bidirectional Spiral Winding Fiber Reinforced Composites. J Clin Med 2022; 11:jcm11226754. [PMID: 36431231 PMCID: PMC9694289 DOI: 10.3390/jcm11226754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this in vitro study was to investigate the compressive strength and the bulk porosity of a bidirectional (bFRC) and an experimental bidirectional spiral winding reinforced fiber composite (bswFRC). Cylindrical-shape specimens were prepared for each material group and processed for the evaluation of compressive strength after different storage conditions (dry, 1 and 3 months) in distilled water at 37 °C. The specimens were also assessed for the degree of bulk porosity through X-ray tomography. A scanning electron microscope (SEM) was used to determine the fracture mode after a compressive strength test. Data were statistically analyzed using Two-Way Analysis of Variance (ANOVA). A significantly lower compressive strength was obtained in dry conditions, and after 1 month of water immersion, with the specimens created with bFRC compared to those made with bswFRC (p < 0.05). No significant difference (p > 0.05) was found between the two groups after 3 months of water immersion. However, the presence of water jeopardized significantly the compressive strength of bswFRC after water storage. The type of fracture was clearly different between the two groups; bswFRC showed a brutal fracture, whilst bFRC demonstrated a shear fracture. The bswFRC demonstrated higher pore volume density than bFRC. In conclusion, bswFRC is characterized by greater compressive strength compared to bFRC in dry conditions, but water-aging can significantly decrease the mechanical properties of such an innovative FRC. Therefore, both the novel bidirectional spiral winding reinforced fiber composites (bswFRC) and the bidirectional fiber reinforced composites (bFRC) might represent suitable materials for the production of post-and-core systems via CAD/CAM technology. These findings suggest that both FRC materials have the potential to strengthen the endodontically treated teeth.
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Affiliation(s)
- Naji Kharouf
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Correspondence: ; Tel.: +33-6675-22841
| | - Salvatore Sauro
- Dental Biomaterials and Minimally Invasive Dentistry, Department of Dentistry, University CEU Cardenal Herrera, CEU Universities, C/Santiago Ramón y Cajal, s/n, Alfara del Patriarca, 46115 Valencia, Spain
- Department Interdisciplinary of Bari, Università di Bari “Aldo Moro”, Giulio Cesare Square, 11, 70124 Bari, Italy
| | - Louis Hardan
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 11072180, Lebanon
| | - Hamdi Jmal
- ICube Laboratory, Mechanics Department, UMR 7357 CNRS, University of Strasbourg, 67000 Strasbourg, France
| | - Gulbahar Bachagha
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, 67000 Strasbourg, France
| | | | - Frédéric Addiego
- Luxembourg Institute of Science and Technology (LIST), Department Materials Research and Technology (MRT), ZAE Robert Steichen, 5 Rue Bommel, Hautcharage, L-4940 Luxembourg, Luxembourg
| | - Francesco Inchingolo
- Department Interdisciplinary of Bari, Università di Bari “Aldo Moro”, Giulio Cesare Square, 11, 70124 Bari, Italy
| | - Youssef Haikel
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Davide Mancino
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
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