Multidisciplinary Therapeutic Approach of a Patient With Sjogren's Syndrome: A Three-Year Follow-Up Study

Sjögren's syndrome is a chronic, inflammatory autoimmune disorder characterized by lymphocyte infiltration of the exocrine glands. Notably, the rehabilitation of partially edentulous patients with Sjögren's syndrome is limited by the scarce availability of studies that could inform therapeutic modalities and potential challenges during clinical procedures. This case report aimed to present the oral rehabilitation of a patient with Sjögren's syndrome who received fixed partial dentures (FPDs). A 28-year-old female patient sought treatment to restore her missing teeth. She was diagnosed with Sjögren's syndrome by a rheumatologist adhering to the revised version of the European criteria proposed by the American-European Consensus Group and was on a medication regimen including prednisolone, hydroxychloroquine, pantoprazole, pilocarpine, and tear substitutes to manage her condition. The final treatment plan consisted of extractions, management of gingivitis, post-and-core restorations, and a 2 mm vertical dimension increase with the placement of 15 porcelain-fused-to-metal (PFM) crowns and 4 short-span bridges. The patient underwent regular clinical and radiographic evaluations every 3 months since June 2020. Throughout this period, the fixed prostheses, teeth, and periodontal tissues demonstrated remarkable stability and exhibited no complications. This three-year case study provides evidence that meticulous planning and clinical execution can facilitate successful oral rehabilitation in young edentulous patients with Sjögren's syndrome. Tooth-supported fixed prostheses can effectively restore oral function and aesthetic appeal in these individuals, provided they undergo more frequent dental examinations than the general population and maintain a cooperative attitude throughout the treatment process.

The cantilever contact-point resin bonded bridge; adhesion 2.0

AIM

When young patients are congenitally missing anterior teeth, different treatment modalities can be used to complement the dental arch. This article proposes a new treatment modality for the replacement of anterior teeth, the cantilever contact-point resin bonded bridge (CCP-RBB).

MATERIALS AND METHODS

In this proof of principle study, CCP-RBB's delivered by one operator were clinically assessed. Patients who were missing maxillary incisors and had suitable intra-oral conditions for a contact-point cantilever RBB were included. Three cases are presented to describe all adhesive steps. This proof of principle clinical study is presented with up to 60 months follow-up of the cantilever contact resin bonded bridges.

RESULTS

A total of 19 CCP-RBB's were evaluated after a mean period of 29.8 months. None of the restorations exhibited failure, carious lesions or fractures during the follow-up periods, demonstrating an absence of restoration debonding or the need for repair.

CONCLUSION

The new cantilever contact-point resin bonded bridge exhibited an excellent treatment modality without failure or debonding up to 5 years. More and extended duration in vivo studies are needed to evaluate this new treatment modality.

CLINICAL SIGNIFICANCE

In this proof of principle the new cantilever contact-point resin bonded bridge obtained excellent results up to 5 years of clinical follow-up.

Clinical Outcomes of CAD/CAM (Lithium disilicate and Zirconia) Based and Conventional Full Crowns and Fixed Partial Dentures: A Systematic Review and Meta-Analysis

Although CAD/CAM (computer-aided design/computer-aided manufacturing) restorations act as a favorable alternative to conventional metal-ceramic restorations for fixed dental prostheses, little is known about their intermediate and persistent clinical performance. This systematic review and meta-analysis aimed to assess the clinical performance in terms of biological, technical, and esthetic aspects and the survival and success ratios for single full crowns (SFCs) and fixed partial dentures (FPDs) fabricated by CAD/CAM and conventional techniques and according to the materials used (zirconia {ZC} and lithium disilicate {LD}). The population, intervention, control, outcome, and study design (PICOS) strategy was used to electronically search key terms in the PubMed, Cochrane Library, Embase, and Wiley Online databases for randomized control trials (RCTs) and cohort studies. The bias risks for RCTs and cohort studies were assessed using the Cochrane collaboration tool and the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using Rev5 from Cochrane. A total of 13 studies reporting on 1598 restorations in 1161 patients with a mean observation period of 3.6 years (minimum-maximum: 1-9.3 years) met the inclusion criteria. Meta-analysis of the included studies indicated that CAD/CAM manufacturing resulted in 1.17, 1.14, and 16.88 (95% CI: 0.64-2.17, 0.86-1.52, 7.59-37.56) higher biological, technical, and esthetic complications than conventional manufacturing of restorations. However, the difference was significant for esthetic complications only (p<0.00001). A significant difference was observed for all biological, technical, and aesthetic aspects between SFCs and FPDs (odds ratio {OR} = 2.61 vs. 1.78, 95% CI: 1.92-3.56 vs. 1.33-2.38; p<0.00001). The survival ratio of SFCs was 2.69 (95% CI: 1.98-3.65), significantly higher compared to the 1.76 (95% CI: 1.31-2.36) of FPDs (p<0.00001). The success ratio of FPDs at 1.18 (95% CI: 0.83-1.69) was significantly lower compared to SFCs at 2.36 (95% CI: 1.68-3.33). The clinical performance of LD with 2.42 (CI: 1.16-5.03) was significantly higher compared to ZC with 2.22 (CI: 1.78-2.77) (p<0.00001). The biological, technical, and aesthetic behaviors showed similar clinical outcomes between the CAD/CAM and conventional groups. LD could be a good alternative to zirconia, but its intermediate or persistent clinical performance needs to be evaluated. Overall, zirconia and CAD/CAM techniques must evolve further to outclass the conventional techniques used in the fabrication of SFCs and FPDs.

Oral and Periodontal Risk Factors of Prosthetic Success for 3-Unit Natural Tooth-Supported Bridges versus Implant-Supported Fixed Dental Prostheses

The goals of this research are: (1) to compare the survival and prosthetic success of metal-ceramic 3-unit tooth- versus implant-supported fixed dental prostheses; (2) to evaluate the influence of several risk factors on the prosthetic success of tooth- and implant-supported fixed dental prostheses (FPDs). A total of 68 patients with posterior short edentulous spaces (mean age 61.00 ± 1.325 years), were divided into two groups: 3-unit tooth-supported FPDs (40 patients; 52 FPD; mean follow-up 10.27 ± 0.496 years) and 3-unit implant-supported FPDs (28 patients; 32 FPD; mean follow-up 8.656 ± 0.718 years). Pearson-chi tests were used to highlight the risk factors for the prosthetic success of tooth- and implant-supported FPDs and multivariate analysis was used to determine significant risk predictors for the prosthetic success of the tooth-supported FPDs. The survival rates of 3-unit tooth- versus implant-supported FPDs were 100% and 87.5%, respectively, while the prosthetic success was 69.25% and 68.75%, respectively. The prosthetic success of tooth-supported FPDs was significantly higher for patients older than 60 years (83.3%) vs. 40-60 years old (57.1%) (p = 0.041). Periodontal disease history decreased the prosthetic success of tooth- versus implant-supported FPDs when compared with the absence of periodontal history (45.5% vs. 86.7%, p = 0.001; 33.3% vs. 90%, p = 0.002). The prosthetic success of 3-unit tooth- vs. implant-supported FPDs was not significantly influenced by gender, location, smoking, or oral hygiene in our study. In conclusion, similar rates of prosthetic success were recorded for both types of FPDs. In our study, prosthetic success of tooth- versus implant-supported FPDs was not significantly influenced by gender, location, smoking, or oral hygiene; however, history of periodontal disease is a significant negative predictor of success in both groups when compared with patients without periodontal history.

Awareness of Fixed Partial Dentures and Implant Rehabilitation of Missing Teeth Among a Subset of Saudi Population

Background  Maintaining one's sense of self requires having healthy teeth. A person's physical well-being is greatly impacted by their dental health. They are intimately related, and the socioeconomic situation of the individual largely determines how teeth are maintained. As a result, tooth loss causes injury to the stomatognathic system as well as the masticatory function. Morale is negatively impacted by psychological discomfort as well as the reduction in general quality of life brought on by tooth loss. Objectives  The purpose of this study was to assess the awareness of patients about various dental prosthetic rehabilitative procedures in Saudi Arabia, their preference(s) regarding the choice of treatment, and the motivating factors that drive them to avail of dental prosthetic rehabilitative treatment. Methods  After randomly selecting 600 individuals for the purpose of our investigation, a nine-variable questionnaire was framed by investigators to record the responses of those who consented to participate in our study. Results  Only 68.3% of the respondents were found to be aware of the several prosthodontic replacement choices. As mentioned by the majority of the respondents, the cost element was the biggest drawback for replacement. The benefits of choosing fixed partial dentures (FPD) or dental implants were judged to be aesthetics (41.1%) and the feel of one's own teeth (40.1%). Conclusion Only 68.3% of respondents reported knowing about the several prosthodontic replacement choices. The cost aspect was cited by 348 respondents as the biggest drawback to replacement. The perceived benefits of choosing FPD or dental implants were deemed to be aesthetics (41.1%) and the feel of one's own teeth (40.1%). We believe that patients' health and quality of life can be improved by raising awareness about and changing patients' attitudes toward the most cutting-edge treatment options that are readily available. This can be done by educating people about the drawbacks of delaying the replacement of missing teeth and other treatment options.

Pulpal and Periapical Status of the Vital Teeth Used as Abutment for Fixed Prosthesis-A Systematic Review and Meta-Analysis

PURPOSE

This is a systematic review to identify the incidence of pulp necrosis and/or periapical changes among vital teeth which are used as an abutment for crown and fixed partial dentures (FPDs).

MATERIALS AND METHODS

Two reviewers independently searched two electronic databases, PubMed and Scopus. The search was complemented from references of included studies and published reviews. Studies published in the English language through January 2021 that had assessed and documented the clinical and radiographic failure of crown or FPD in vital permanent teeth due to pulpal or periapical pathology with a follow-up of at least 12 months were selected. Data screening, data collection and extraction of data was performed. Quality of studies involved was analyzed using the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Meta-analysis was done using random effects model. Publication bias was assessed using funnel plots.

RESULTS

Electronic searches provided 10,075 records among which 20 studies were selected for systematic review and 7 studies were selected for meta-analysis. With respect to quality assessment, all the studies involved were considered as high quality as the score in scale ranged between 6 and 9 as per the Newcastle-Ottawa Quality Assessment Scale for cohort studies. The meta-analyses showed that there was no statistically significant difference in the incidence of the loss of pulp vitality or pulp necrosis through clinical and radiographic examination with the follow up period of 5 years: p < 0.001, 95% CI: 0.96-1.00, I² = 77.84%; 10 years: p < 0.001, 95% CI: 0.88-0.95, I² = 93.59%; 15 years: p < 0.001, 95% CI: 0.92-0.96, I² = 94.83%; and 20 years: p < 0.001, 95% CI: 0.94-0.96, I² = 95.01%.

CONCLUSIONS

The meta-analysis revealed clinical and radiographic success rate ranging between 92% to 98% at different follow up periods ranging between 5 years and 20 years. Future high-quality randomized clinical controlled trials with a larger population are required to confirm the evidence as only observational studies were considered in this paper.

Fracture Load of Metal, Zirconia and Polyetheretherketone Posterior CAD-CAM Milled Fixed Partial Denture Frameworks

The aim of this study was to investigate the load to fracture and fracture pattern of prosthetic frameworks for tooth-supported fixed partial dentures (FPDs) fabricated with different subtractive computer-aided design and computer-aided manufacturing (CAD-CAM) materials. Materials and Methods: Thirty standardized specimens with two abutments were fabricated to receive three-unit posterior FDP frameworks with an intermediate pontic. Specimens were randomly divided into three groups (n = 10 each) according to the material: group 1 (MM)—milled metal; group 2 (L)—zirconia; and group 3 (P)—Polyetheretherketone (PEEK). The specimens were thermo-cycled and subjected to a three-point bending test until fracture using a universal testing machine (cross-head speed: 1 mm/min). Axial compressive loads were applied at the central fossa of the pontics. Data analysis was made using one-way analysis of variance, Tamhane post hoc test, and Weibull statistics (α = 0.05). Results: Significant differences were observed among the groups for the fracture load (p < 0.0001). MM frameworks showed the highest fracture load values. The PEEK group registered higher fracture load values than zirconia samples. The Weibull statistics corroborated these results. The fracture pattern was different among the groups. Conclusions: Milled metal provided the highest fracture load values, followed by PEEK, and zirconia. However, all tested groups demonstrated clinically acceptable fracture load values higher than 1000 N. PEEK might be considered a promising alternative for posterior FPDs.

Cytomorphometric Analysis of Inflammation Dynamics in the Periodontium Following the Use of Fixed Dental Prostheses

Cytomorphometry is used in the sampling of biological materials and diagnostic procedures. The use of cytological studies in periodontal diseases is not well described in the literature. Our study aimed to quantitatively assess the inflammation dynamics using cytomorphometric analysis of the periodontium before and after the use of fixed dental prostheses. Following ethics approval, a total of 105 subjects were divided in 3 groups as gingivitis (n = 23), periodontitis (n = 58), and healthy periodontium (control) (n = 24). The fixed dental prostheses (crowns and fixed partial dentures) were fabricated from cobalt-chrome metal-ceramic prostheses using the conventional method (C/M-CoCr), cobalt-chrome metal-ceramic prostheses by the computer-aided design and computer-aided manufacturing (CAD/CAM) technique (C/C-CoCr), and zirconia-based ceramic prostheses by the CAD/CAM technique (C/C-Zr) among subjects with gingivitis and periodontitis. The gingival crevicular fluid (GCF) was obtained from subjects before and after the use of the prostheses. The total count of epithelial cells and the connective tissue cells or polymorphonuclear neutrophils (PMNs) in GCF were studied using cytomorphometric analysis. The Statistical Package Tor the Social Sciences (SPSS), Version 20 (IBM Company, Chicago, IL, USA) was used to analyze the results and the significance level was set at p = 0.05. The data for before and after the use of the prostheses were compared using independent t-Tests. Similarly, the results after the use of prostheses in gingivitis, periodontitis, and control in each type of prostheses were compared using One-way ANOVA with post hoc using Scheffe. The total epithelial cells and the PMNs were determined along with the epithelium/leukocyte index. Regardless of the prostheses type used, no significant change in the parameters was identified among patients with a healthy periodontium, before and after prosthetic treatment. In all study groups, a statistically increase (p value < 0.05) was observed in the oral epithelial cell counts and a statistically decrease (p < 0.05) in the PMNs count following the use of the fixed prostheses. Data on cytomorphometric analysis could enable the selection of the most appropriate prostheses for use in patients with periodontal pathologies. When choosing prostheses, changes in the composition of GCF could be considered as a useful criterion for their use.

Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: A randomized controlled clinical trial reporting 10-year outcomes, survival analysis and mean cumulative cost of recurrence

Background

Periodontal regeneration can change tooth prognosis and represents an alternative to extraction in teeth compromised by severe intra‐bony defects. The aim of this study was to compare periodontal regeneration (PR) with tooth extraction and replacement (TER) in a population with attachment loss to or beyond the apex of the root in terms of professional, patient‐reported and economic outcomes.

Methods

This was a 10‐year randomized controlled clinical trial. 50 stage III or stage IV periodontitis subjects with a severely compromised tooth with attachment loss to or beyond the apex were randomized to PR or TER with either an implant‐ or a tooth‐supported fixed partial denture. Subjects were kept on a strict periodontal supportive care regimen every 3 months and examined yearly. Survival and recurrence analysis were performed.

Results

88% and 100% survival rates were observed in the PR and TER groups. Complication‐free survival was not significantly different: 6.7–9.1 years for PR and 7.3–9.1 years for TER (p = .788). In PR, the observed 10‐year attachment gain was 7.3 ± 2.3 mm and the residual probing depths were 3.4 ± 0.8 mm. Recurrence analysis showed that the 95% confidence interval of the costs was significantly lower for PR compared with TER throughout the whole 10‐year period. Patient‐reported outcomes and oral health‐related quality‐of‐life measurements improved in both groups.

Conclusions

Periodontal regeneration can change the prognosis of hopeless teeth and is a less costly alternative to tooth extraction and replacement. The complexity of the treatment limits widespread application to the most complex cases but provides powerful proof of principle for the benefits of PR in deep intra‐bony defect.

Dimensional Stability and Acuracy of Silicone - Based Impression Materials Using Different Impression Techniques - A Literature Review

A quality-made dental impression is a prerequisite for successful fixed-prosthodontic fabrication and is directly dependent on the dimensional stability, accuracy and flexibility of the elastomeric impression materials, as well as on the appropriately used impression techniques. The purpose of this paper is to provide a literature review of relevant scientific papers which discuss the use of various silicone impression materials, different impression techniques and to evaluate their impact on the dimensional stability and accuracy of the obtained impressions. Scientific papers and studies were selected according to the materials used, the sample size, impression technique, storage time, type of measurements and use of spacer for the period between 2002 and 2016. In the reviewed literature several factors that influence the dimensional stability and accuracy of silicone impression molds, including the choice of the type of viscosity, impression material thickness, impression technique, retention of the impression material on the tray, storage time before the casting, number of castings, hydrophilicity of the material, release of byproducts, contraction after polymerization, thermal contraction and incomplete elastic recovery were presented. The literature review confirmed the lack of standardization of methodologies applied in the research and their great diversity. All findings point to the superiority of the addition silicone compared to the condensation silicone.

Prosthetic dental restorations in Swedish samples: prevalence and agreement between self-report, clinical findings, and influence on quality of life

OBJECTIVE

To determine the prevalence of dental prosthetic restorations in an adult population, to study the agreement between self-reports and clinical findings of prosthetic restorations, and to study answers from a questionnaire in relation to the prevalence of prosthetic restorations.

MATERIAL AND METHODS

A questionnaire was sent to a sample of 10,000 adults. A further sample of 1000 individuals was invited to answer the questionnaire and also participate in a clinical study. The agreement between self-report and clinical findings was analyzed, as were the associations between prosthetic restorations and questionnaire responses, using the chi² test.

RESULTS

A total of 40% of the sample had fixed dental prostheses (FDP), 2.7% had removable dentures. The agreement between self-report and clinical findings was 93%. 34.7% of the individuals with no prosthetic restorations were university graduates and 4% of individuals with removable complete dentures. Oral health had the greatest impact on the quality of life of younger individuals with FDP, with an OHIP-14 (Oral Health Impact Profile) score of 7.3 for the age group 20-39 years compared to 4.9 for the age group 65-89 years.

CONCLUSION

The questionnaire method can be a cost-effective way to determine the prevalence of prosthetic restorations.

IPS e.max for All-Ceramic Restorations: Clinical Survival and Success Rates of Full-Coverage Crowns and Fixed Partial Dentures

The IPS e.max system by Ivoclar Vivadent, offering a variety of products and indications, is widely used for all-ceramic restorations. We analyzed the clinical track record of these products in daily clinical practice, associating their restorative survival rate with various parameters to define recommendations for long-term stability. A total of 1058 full-coverage crowns and fixed partial dentures (FPDs) were evaluated retrospectively over up to 66.48 (37.05 ± 18.4) months. All were made of IPS e.max Press, IPS e.max CAD, IPS e.max Ceram or IPS e.max ZirPress and had been delivered by a private dental practice within three years. Uses not recommended by the manufacturer were also deliberately included. The five-year cumulative survival was 94.22% (i.e., 94.69% or 90.58% for glass-ceramic crowns or FDPs and 100% or 90.06% for zirconia-based crowns or FDPs). Significantly superior outcomes emerged for conventional vs. adhesive cementation and for vital vs. non-vital abutment teeth, but not for recommended vs. non-recommended uses. Caution is required in restoring non-vital teeth, but the spectrum of recommended uses should generally be reconsidered and expanded, given our finding of high survival and success rates for IPS e.max ceramics, even for uses not currently recommended by the manufacturer.

Implant vs abutment level connection in implant supported screw-retained fixed partial dentures with cobalt-chrome framework: 1-year interim results of a randomized clinical study

BACKGROUND

Screw-retained fixed partial dentures (FPD) have shown a lower incidence of biologic complications and an easier retrievability compared with cemented FPD.

PURPOSE

To compare the marginal bone loss at conical connection implant restored with a screw retained cobalt-chrome FPD in an implant-level (IL) or an abutment-level (AL) setup.

MATERIALS AND METHODS

Patients with at least two adjacent missing teeth were randomly allocated to be restored with IL or AL FPD. Periapical radiographs and clinical examination were taken at implant placement, prosthetic connection, 6 and 12 months to evaluate marginal bone loss (MBL), and soft tissue conditions. Complications were used to calculate prognostic indexes.

RESULTS

Fifty patients were treated with 50 FPD supported by 119 implants. The difference of MBL between the IL and AL groups was statistically significant (P = 0.003). At 1 year, MBL was 0.086 ± 0.313 mm and 0.005 ± 0.222 mm in the IL and AL groups, respectively. The presence of BoP increased with time in IL, whereas it decreased in AL group (P < 0.001). A minor complication was encounted in one FPD.

CONCLUSIONS

A low grade of MBL was present after 1 year. IL showed greater amount of MBL and soft tissue inflammation indexes than AL. In FPD, AL may be a safer procedure than IL setup in order to preserve a healthy periimplant tissue.

Clinical outcome of tooth-supported fixed partial dentures in unilateral cleft lip and palate patients: A case series

INTRODUCTION

Cleft lip and palate (CLP) is the most frequent congenital facial abnormality and multidisciplinary treatment extending over many years is necessary to rehabilitate the affected individuals to normal function and esthetics.

OBJECTIVE

To evaluate the clinical treatment outcome for missing teeth with tooth supported fixed partial dentures in unilateral cleft lip and palate patients.

PATIENTS AND METHODS

Tooth supported fixed partial denture (T-FPD) was utilized for restoration of missing teeth in the cleft area for 9 non syndromic, unilateral cleft lip and palate patients (U-CLP). The mean age of the patients was 25±4 years. The edentulous sites were prepared to receive ovate pontic for best possible esthetic results. Survival and complications were recorded following various biologic, technical and esthetic parameters up to 10 years of follow up. A clinical comparison was also made with respect to the periodontal status and development of new carious lesion between the restored cleft side teeth and corresponding teeth of the normal side with in the same patient.

RESULTS

Three failures experienced with fixed partial dentures were a result of ceramic chipping after 10 years, functional fracture after 3 years, and fracture due to external trauma after 2 years.

DISCUSSION

CLP patients undergo a lot of treatment; therefore understanding their opinions, expectations, and perspectives towards the prosthodontic intervention was given due importance. The provisional phase was utilized to educate the patients on the achievable treatment outcome and its limitation. In the present case series, out of three failed FPDs, only one restoration failed relatively early due to functional factors. Re-treatment was successfully achieved without change in the original material and extent of the FPDs.

CONCLUSION

The outcome accomplished endorses the integral role of T-FPDs in the overall cleft care and it will remain a viable treatment alternative in select few patients in meeting their esthetic and functional desires.

Maximum bite force following unilateral fixed prosthetic treatment: a within-subject comparison to the dentate side

OBJECTIVES

We evaluated the maximum occlusal bite force (MBF) among individuals with fixed partial dentures compared to the opposite dentate side and determined the relationship between MBF and gender, age, and body mass index (BMI).

SUBJECTS AND METHODS

A total of 85 subjects (43 males and 42 females, age range 28-66 years) with fixed partial dentures on one side and dentate on the other side participated in the study. The MBF was measured at the first molar area on both sides using a digital hydraulic bite force gauge. The highest MBF value was recorded from three measurements of bite force at each side (with 45-second intervals between measurements).

RESULTS

The mean MBF was 596.2 ± 76.3 N at the dentate side and 580.9 ± 74.3 N at the fixed partial denture side. The difference was statistically significant (p < 0.05). The MBF values were greater in males as well as in taller and heavier participants. Nevertheless, the BMI had no relationship with MBF values (p >0.05).

CONCLUSIONS

Within the same subjects, the measured MBF values at the dentate side were higher than those at the fixed partial denture side. Females, lighter, and shorter participants had lower MBF values. Meanwhile, the BMI had no significant relationship to MBF values.

Effect of different design preparations on the flexural and fracture strength of fiber-reinforced composite fixed partial dentures: an in vitro study

PURPOSE

To determine and compare the flexural and fracture strength of three-unit fiber-reinforced composite (FRC) fixed partial dentures (FPDs) using three abutment design preparations.

MATERIAL AND METHODS

The flexural and fracture strength of three-unit FRC FPDs were evaluated using three design preparations of the abutments (conventional full crown [group A], box-shaped [group B], and tub-shaped [group C]). Thirty three-unit FRC FPDs were fabricated (10 specimens per group) for the replacement of missing mandibular first molars and were adhesively luted to extracted human teeth. The flexural and fracture strength were determined using a universal testing machine with a steel loading pin of 20 mm diameter with a 3-mm-diameter hardened circular tip. Each specimen was evaluated under SEM to determine mode of failure.

RESULTS

Mean fracture strength for group A was 820.00 ± 56.51 N, group B was 536.94 ± 65.62 N, and group C was 501.24 ± 66.71 N. The highest mean flexural strength was found in group A (68.33 ± 4.71 MPa), followed by group B (44.74 ± 5.46 MPa) and lowest in group C (41.77 ± 5.56 MPa). The SEM evaluation showed partial or complete debonding of veneering composite from fiber framework, leaving intact fiber frameworks in all the specimens.

CONCLUSION

Full-coverage design had significantly higher flexural and fracture strengths than box and tub-shaped designs. Since both values were noted to be in the order of masticatory stresses, the full coverage design is a good alternative for the replacement of missing molar teeth; however, the framework veneering composite interface was the weakest phase of FRC FPDs, thus indicating that further improvement in veneering composite or fiber framework is needed to improve the compatibility of veneering composite with that of fiber framework for long-term clinical implications.

An harmonic smile resulted from the use of ceramic prosthesis with zirconia structure: a case report

The rehabilitation of patients requiring an esthetic smile demands a multidisciplinary approach. This clinical report describes a treatment plan for recovery aesthetics' smile of anterior teeth using ceramic prosthesis with zirconia structure. Initially, a review of aesthetic parameters, diagnostic waxing, mock-up and provisional restorations was performed. A contextual assessment of aesthetic, proportion and shape of teeth was done to recreate a natural looking for teeth in consonance with the smile line. Subsequently, based on these parameters, fixed prostheses of the upper anterior teeth using ceramic restorations with zirconia infrastructures were performed. The use of ceramic restorations with zirconia structures associated with a careful treatment plan allows the professional to integrate esthetic and function for satisfactory clinical results. How to cite the article: Tavarez RR, Gonçalves LM, Dias AP, Dias AC, Malheiros AS, Silva AC, Bandeca MC. An harmonic smile resulted from the use of ceramic prosthesis with zirconia structure: A case report. J Int Oral Health 2014;6(3):90-2.

Dental Erosion in a Partially Edentulous Patient with Gastroesophageal Reflux Disease: A Case Report

Diseases such as gastroesophageal reflux disease (GERD), bulimia, anorexia, and extrinsic alimentary factors may cause dental erosion (DE). The minimally invasive therapeutic attitude preserves the remaining healthy tooth structure. In the earlier stages, the direct restoration of dental lesions is possible, using composite materials. In advanced stages of DE, prosthetic treatments are recommended for stable esthetic and functional results. We present a case of DE in a partially edentulous patient who benefited from a complex therapy. The prosthetic project of the case involves ceramic veneers associated with dental and implant supported fixed prosthesis for the restoration of esthetics, mastication, phonetics and their maintenance.

Oral rehabilitation of a patient with ectodermal dysplasia with prosthodontics treatment

Ectodermal dysplasia (ED) is a rare, congenital disease that involves the sweat glands, scalp hair, nails, skin pigmentation, and craniofacial structure. Oral symptoms of ED include multiple tooth abnormalities (such as hypodontia, anadontia, impacted teeth, and peg-shaped or conical anterior teeth) and lack of normal alveolar ridge development. A 12-year-old male patient, in the absence of any other systemic abnormalities, exhibited typical characteristics of ED, visited our department of pedodontics and preventive dentistry at Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre. In the clinical and radiographic evaluation, it was occurred that he had only maxillary and mandibular first molars in his mouth. A maxillary and mandibular denture with clasps for retention was fabricated for prosthodontic rehabilitation after considering his growth and the number and condition of his present teeth. At the 18-month follow-up no major complications occurred and further future treatment included implants retained fixed partial dentures.

Strength of zirconia fixed partial dentures: review of the literature

OBJECTIVE

The aim of this study is a systematic review of the literature on the strength and long-term behavior of zirconia FPDs.

METHODS

The literature search was performed using as the primary source the Medline database. Were also imposed a set of inclusion and exclusion criteria in order to narrow the search to differentiate the two distinct parts in which it was structured the review. In addition, MeSH terms were applied to further refine the choice of articles more relevant to the review. In the part of the review concerning the long-term behavior of zirconia fixed partial dentures were considered useful only those studies with a minimum follow-up of one year.

RESULTS

The search provided a total of 813 articles, but only 25 were considered for the review because they were the only ones who satisfied search criteria. In particular, 13 items relate to the mechanical strength of zirconia prostheses and 12 regarding the long term behavior of zirconia FPDs. The resistance values also exceed the 2000 N while the survival rate reaches to almost 94%.

CONCLUSIONS

Based on this review, Zirconia FPDs can be considered reliable products in both the anterior and posterior fields with survival rates comparable to traditional metal-ceramic prostheses.

Fiber-reinforced composites in fixed partial dentures

Fiber-reinforced composite resin (FRC) prostheses offer the advantages of good aesthetics, minimal invasive treatment, and an ability to bond to the abutment teeth, thereby compensating for less-than-optimal abutment tooth retention and resistance form. These prostheses are composed of two types of composite materials: fiber composites to build the framework and hybrid or microfill particulate composites to create the external veneer surface. This review concentrates on the use of fiber reinforcement in the fabrication of laboratory or chairsidemade composite-fixed partial dentures of conventional preparation. Other applications of FRC in dentistry are briefly mentioned. The possibilities fiber reinforcement technology offers must be emphasized to the dental community. Rather than limiting discussion to whether FRC prostheses will replace metal-ceramic or full-ceramic prostheses, attention should be focused on the additional treatment options brought by the use of fibers. However, more clinical experience is needed.