Use of auxiliary devices during retreatment of direct resin composite veneers

A Narrative Review and Clinical Study on Er:YAG Laser Debonding of Ceramic and Composite Veneers

BACKGROUND

Composite resin veneers have gained popularity due to their affordability and minimally invasive application as biomimetic restorations. However, long-term clinical challenges, such as discoloration, wear, and reduced fracture resistance, necessitate their replacement over time. Ceramic veneers, particularly feldspathic and lithium disilicate, offer superior esthetics and durability, as demonstrated by studies showing their high survival rates and enamel-preserving preparation designs. However, while ceramic veneers survive longer than composite resin veneers, ceramic veneers may need to be removed and replaced. Reports vary for using Er:YAG (erbium-doped yttrium aluminum garnet) lasers for the removal of existing veneers.

METHODS

A review was conducted to evaluate the effectiveness of removing restorative materials with an Er:YAG laser. A clinical study was included, highlighting the conservative removal of aged composite resin veneers using the Er:YAG laser. This method minimizes enamel damage and facilitates efficient debonding. Following laser application, minimally invasive tooth preparation was performed, and feldspathic porcelain veneers were bonded.

RESULTS

The review showed positive outcomes whenever the Er:YAG laser was used. In the case study, after a 3-year follow-up, the restorations exhibited optimal function and esthetics.

CONCLUSIONS

Laser-assisted debonding provides a safe and predictable method for replacing failing composite veneers with ceramic alternatives, aligning with contemporary biomimetic principles.

Fluorescence intensity of composite resin for direct veneer removal using a fluorescence-aided identification technique

OBJECTIVES

This laboratory study evaluated the influence of the fluorescence intensity of composite resins on additional tooth wear and the presence of restorative material in different dental thirds during the retreatment of direct veneers.

MATERIALS AND METHODS

The crown dimensions of 60 bovine incisors were reduced to 10 × 8 mm. The teeth were classified according to the fluorescence intensity of the composites: low (LOW) (TPH Spectra), medium (MED) (Opallis), and high (HIGH) (Essentia) groups. The teeth were divided according to the removal methods: conventional (CON) and fluorescence-aided identification technique (FIT). The specimens were scanned (T0), received veneer preparation, and scanned again (T1). After restorations, the composites were removed and the teeth were scanned (T2). Measurement assessments between T1 and T2 were performed to determine additional wear, presence of residual areas, and the average between additional wear and the presence of residual areas. Kruskal Wallis, Mann-Whitney, Friedman, 2-way ANOVA, and post-Tukey tests were performed (α < 0.05).

RESULTS

The comparison of composite resins indicated a smaller area of additional wear and greater residue presence in the HIGH group than the LOW group for both techniques in the cervical third. Regarding removal methods, the FIT produced greater additional wear than the CON method for the LOW and MED groups in the middle and cervical thirds. The incisal third exhibited greater additional wear than the other thirds.

CONCLUSIONS

Composite resins with high fluorescence intensity removed using FIT had less tooth wear. The incisal third was the most affected area for direct veneer removal procedures.

CLINICAL SIGNIFICANCE

A FIT has been proposed for composite resin removal; however, the different fluorescence intensities of composite resins can influence tooth wear caused during this procedure.

The Effect of Various Preparation and Cementation Techniques of Dental Veneers on Periodontal Status: A Systematic Review and Meta-Analysis

Dental veneers are widely used to restore or/and enhance dental aesthetics. However, it is not well understood how various veneer preparation and cementation methods affect periodontal health. To provide a quantitative estimate of the overall effect size of the intervention, this study was conducted to synthesize the available evidence on the impact of various dental veneer preparation and cementation methods on periodontal status. A thorough search strategy was implemented using Medical Subject Headings keywords and Boolean operators across various major databases, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Nine papers were ultimately selected for inclusion in the review. Seven studies demonstrated a positive impact of dental veneers on overall periodontal health, while two studies reported a slight worsening. The forest plot analyses showed a somewhat protective effect of dental veneers on periodontal health, with odds ratio of 0.18 and relative risk of 0.34, suggesting that dental veneers may have a positive impact on overall periodontal health. The current study, with considerable heterogeneity among the studies, indicates that dental veneers are associated with an overall positive effect on the periodontal health. However, given the variations in study designs, sample sizes, and follow-up times, additional research may be required to confirm and generalize these results.

Impact of using magnifying dental loupes on clinical performance during tooth preparation: A systematic review

Background

To assess whether using magnification loupes affects tooth preparation working posture performed by undergraduate students and dentistry professionals and whether it influences the quality of the preparation, operator satisfaction and procedure time.

Material and Methods

This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered in the International Prospective Register of Systematic Review (CRD42023482377). Electronic searches were conducted in PubMed/Medline, Cochrane Library, Web of Science, and Scopus databases for relevant articles published up to August 2023. Clinical or laboratory studies evaluating cavities or dental preparations performed with and without magnification loupes were considered eligible. The outcomes were operator working posture, dental preparation quality, operator satisfaction, and procedure time. The quality of the studies was evaluated using the JBI Critical Appraisal tools for Quasi-Experimental Studies.

Results

The searches retrieved 1493 articles. Based on the eligibility criteria, 11 laboratory studies were included, where 410 undergraduate and graduate dental students conducted dental preparations in 1851 dental specimens. Of the 11 selected studies, 6 evaluated the working posture, 6 assessed the quality of the dental preparations, 5 reported operator satisfaction, and 2 assessed procedure time. The results showed that magnifying loupes significantly improved operator working posture, but did not influence the quality of tooth preparations. Although satisfaction reports about experiences with magnifying loupes were favorable, no significant difference was found.

Conclusions

Magnification loupes improved operator working posture. However, clinical studies with more scientific evidence are needed for steady conclusions regarding operator satisfaction and procedural time. Key words:Magnification, dental loupes, tooth preparation, cavity preparation, dental education.

Utilization of a 3D Printed Orthodontic Distalizer for Tooth-Borne Hybrid Treatment in Class II Unilateral Malocclusions

This paper introduces a novel method of 3D designing and 3D printing of a hybrid orthodontic tooth-borne personalized distalizer for treatment of unilateral Class II malocclusion. Research objectives were to clinically utilize 3D printed distalizers, appraise feasibility of this technique and compare two different biocompatible photopolymers (white and transparent). Frequency of distalizers’ debonding and patients’ aesthetical perception was evaluated on the set of 12 complete orthodontic treatments. The mean duration of treatment period with a bonded distalizer was 6.4 months. All cases were adults with unilateral Class II malocclusion managed with a hybrid approach as a part of Invisalign® comprehensive treatment. Results showed that such perspective practice is feasible for 3D design and in-office 3D printing of a personalized distalizer. Results also showed no clinically significant differences between both studied biopolymers. The paper discusses an evaluation of such personalized distalizer functionality with regard to the current state of the art and compares to conventional prefabricated alternatives like a Carriere® Distalizer™ appliance. Research showed a preference of patients towards transparent biocompatible photopolymer instead of the white A2 shade. The paper concludes that additive manufacturing from dental resins is a viable method in personalization and in-office 3D printing of orthodontic auxiliaries, particularly distalizers. New materials for orthodontic 3D printing endow enhanced individualization, thus more efficient treatment.