Aesthetic treatment planning simplified using digital smile design: A case report

Digital smile design (DSD) plays an essential role in the planning of aesthetic treatments. However, most digital smile designing software programmes are expensive and require specialised training and skill for effective implementation. This paper illustrates the use of Adobe Photoshop and Microsoft PowerPoint, which are economical and user friendly for planning aesthetics in a clinical case.

An in vitro study to compare the influence of two different primers on the peel bond strength between a maxillofacial silicone material and an acrylic resin material versus a composite resin material

Aim:

The aim of this study was to evaluate and compare the peel bond strength of an autopolymerizing acrylic resin and a fiberreinforced composite (FRC) resin to a heat temperature vulcanizing maxillofacial silicone (M511) using two different primers.

Settings and Design:

In vitro - comparative study.

Materials and Methods:

Autopolymerizing acrylic resin and FRC resin specimens with a dimension of 75 mm (length) ×10 mm (width) × 3 mm (height) were fabricated. A total of 60 samples were split into six categories based on the substructure material and primers (A330G primer and Sofreliner tough primer) used to bond the maxillofacial silicone to the FRC and acrylic resin specimens. In a universal testing machine, the peel bond strength was conducted at a 10 mm/min crosshead speed until bonding failure occurred.

Statistical Analysis Used:

The t-test, one-way analysis of variance, and the Tukey's honest significant difference (post hoc test) tests were used to statistically assess the values.

Results:

The Sofreliner tough primer produced the greatest peel bond strength in both the acrylic resin (0.89690 N/mm) and the FRC resin groups (3.19860 N/mm). Adhesive failures predominated in the acrylic resin group regardless of the primer used. The FRC group showed predominantly cohesive failures with both the A330G primer and Sofreliner tough primer.

Conclusion:

This study suggests that FRC resin combined with Sofreliner tough primer can significantly enhance the peel bond strength.

Survival rates of axial and tilted implants in the rehabilitation of edentulous jaws using the All-on-four™ concept: A systematic review

Aim:

The aim of this review was to evaluate the survival rate of axial and tilted implants in rehabilitation of edentulous jaws using all on four concept.

Setting and Design:

Systematic Review.

Materials and Methods:

A literature review was performed in MEDLINE, PubMed Central (PMC), Google scholar, Embase, Cochrane Central Register of Controlled Trials. Hand searches were conducted of the bibliographic of related journals and systematic reviews. A total of 380 articles were obtained from the intial screening process. Of these articles, 25 articles fulfilled the inclusion criteria. The authors performed evaluation of articles independently as well as data extraction and quality assessment.

Statistical Analysis Used:

Qualitative analysis.

Results:

The major prosthetic complication was the fracture of the acrylic prosthesis. The mean cumulative survival rate of implants (72-132 months) were 94% to 98%. The prosthesis survival rate (12 months) was between 99% to 100%. The averaged bone loss was 1.3 ±0.4 mm (12-60 months). No Significant difference was found between survival rates of axial and tilted implants nor between maxilla and mandible.

Conclusion:

All on four concept can be employed successfully in the edentulous patients with resorbed ridges while improving their quality of life and reducing morbidity. However,randomized clinical trials with large sampling size and long term follow up should be incorporated.

An in vitro study to compare the surface roughness of glazed and chairside polished dental monolithic zirconia using two polishing systems

Aim:

To evaluate the efficiency of two commercially available polishing systems in reducing surface roughness of a monolithic zirconia after clinical adjustment and to compare them to glazed zirconia.

Setting and Design:

In vitro study.

Material and Methods:

This in vitro study was conducted on 25 discs (10mm in diameter and 2mm in thickness) using monolithic zirconia (Ceramill Zolid). From 25 specimens, 5 specimens were randomly selected as the positive control. The remaining discs were abraded for 15 secs with a red band diamond finishing bur using an air rotor handpiece. Then the specimens were randomly divided into 5 equal groups of 5 specimens each. Group 1: Roughened, unpolished and unglazed. Group 2 (Positive Control): Glazed without prior roughening,Group 3: Roughened and polished with eZr polishing kit, Group 4: Roughened and polished with Optra fine ceramic polishing kit and Group 5: Roughened and glazed. The surface roughness (Ra) values (μm) were measured quantitatively by a surface analyzer. The mean values were compared using one-way ANOVA and Post Hoc Test. One specimen of each group was evaluated qualitatively under a scanning electron microscope(SEM) for surface topography.

Statistical Analysis Used:

One-way ANOVA and Post Hoc Test.

Results:

The lowest Ra value was found in Group 4-Roughened and polished with Optrafine ceramic polishing kit (Ra=0.47μm) as compared to Group 3-Roughened and polished with eZr polishing kit (Ra=0.49μm) and Group 5-Roughened and glazed (Ra=0.59μm). There was no stastistically significant difference between two polishing systems. SEM analysis of surfaces polished with Optrafine polishing kit revealed smoother and regular morphology as compared to surfaces polished with eZr polishing kit.

Conclusion:

The Optrafine polishing kit created more smoother and uniform surfaces as compared to surfaces polished with eZr polishing kit both quantitatively and qualitatively. Also, lowest surface roughness values were produced by optrafine ceramic polishing kit on monolithic zirconia as compared to glazed monolithic zirconia after their clinical adjustments.Thus Optrafine ceramic polishing kit can be used as alternative to glazing.

A simple method for fabricating custom sectional impression trays for making definitive impressions in patients with microstomia

Objectives: A maximum mouth opening that is smaller than the size of a complete denture can make prosthetic treatment challenging. This article describes a simple technique used to fabricate maxillary and mandibular custom sectional impression trays for making definitive impressions in patients with microstomia. (Eur J Dent 2012;6:244-247)

Iris Positioning Using a Grid Attached to a Spring Bow for a Custom Ocular Prosthesis

Eyes are among the first features of the face to be noticed. Loss of an eye due to congenital, traumatic or pathologic aetiologies causes disfigurement and loss of sensory feedback. It leaves a psychological impact on the patient, thus prosthesis should be provided at the earliest to raise the spirits of the afflicted. Iris positioning is one of the important steps in fabricating customized ocular prosthesis. In facial asymmetry cases, comparison of both irises together can be a major disadvantage. This case report illustrates the use of a unique customized frame spring bow assembly to position the iris disk using the established parallelism between inter pupillary line to the horizontal plane.

Surgical excision and contoured custom made splint to treat helical keloid

Helical keloids are difficult to treat as surgical excision requires effective compression of the operative scar to prevent recurrence while retaining the contour and elasticity of the helix. The authors fabricated a conforming custom made post-operative splint from a commonly used dental material. Splints could be fabricated in both pre-operative and post-operative stage.

Shade Guide for the Fabrication of Acrylic Denture Based on Mucosal Colour

This article highlights the use of a simple and convenient shade guide system which not only helps in choosing the shade tab that matches with the colour of the mucosa, but, also helps in the fabrication of the precise shade of acrylic resin for making the denture. The shade guide is fabricated by mixing specified quantities of various colours of acrylic polymer in order to obtain various shade tabs. The method for fabrication of the shade guide and the clinical procedure has been discussed.

Ocular prosthesis incorporating IPS e-max press scleral veneer and a literature review on non-integrated ocular prosthesis

The article highlights a new method for the fabrication of an ocular prosthesis by the incorporation of a ceramic scleral veneer. The steps of fabrication include impression making, wax try-in, performing a "cut-back" on a selected stock eye, insertion of the IPS e-max press scleral veneer, finishing and insertion. It also includes a detailed review on non-integrated ocular prostheses.

An innovative and simple approach to fabricate a hollow ocular prosthesis with functional lubricant reservoir: A solution to artificial eye comfort

The loss of an eye is an emotional and psychological setback to the patient. An ocular prosthesis is created to restore the lost anatomical structure and to correct the cosmetic defect. The tear reflexes do not function at optimal levels in anophthalmic sockets which make prosthesis wear uncomfortable. This case report presents an innovative hollow ocular prosthesis with functional lubricant reservoir which upon normal blinking would draw the lubricant from the reservoir through an exit hole which spreads over the prosthesis allowing a comfortable and long duration of prosthesis wear.

Three-dimensional finite element analysis of the stress distribution pattern in a mandibular first molar tooth restored with five different restorative materials

Introduction:

Badly broken or structurally compromised posterior teeth are frequently associated with crown/root fracture. Numerous restorative materials have been used to fabricate indirect full-coverage restorations for such teeth. This study aims to evaluate and compare the effect of restorative materials on the stress distribution pattern in a mandibular first molar tooth, under varying loading conditions and to compare the stress distribution pattern in five commonly used indirect restorative materials.

Materials and Methods:

Five three-dimensional finite element models representing a mandibular first molar tooth restored with crowns of gold, porcelain fused to metal, composite (Artglass), alumina-based zirconia (In-Ceram Zirconia [ICZ]), and double-layered zirconia-based materials (zirconia core veneered with porcelain, Lava) were constructed, using a Finite Element Analysis Software (ANSYS version 10; ANSYS Inc., Canonsburg, PA, USA). Two loading conditions were applied, simulating maximum bite force of 600 N axially and normal masticatory bite force of 225 N axially and nonaxially.

Results:

Both all-ceramic crowns allowed the least amount of stress distribution to the surrounding tooth structure. In maximum bite force-simulation test, alumina-based all-ceramic crown displayed the highest von Mises stresses (123.745 MPa). In the masticatory bite force-simulation test, both all-ceramic crowns (122.503–133.13 MPa) displayed the highest von Mises stresses.

Conclusions:

ICZ crown displayed the highest peak von Mises stress values under maximum and masticatory bite forces. ICZ and Lava crowns also allowed the least amount of stress distribution to the surrounding tooth structure, which is indicative of a favorable response of the underlying tooth structure to the overlying full-coverage indirect restorative material. These results suggest that ICZ and Lava crowns can be recommended for clinical use in cases of badly damaged teeth.

Comparative evaluation of border molding using two different techniques in maxillary edentulous arches: A clinical study

Purpose:

The aim of this in vivo study was to compare the single-step border molding technique using injectable heavy viscosity addition silicone with sectional border molding technique using low fusing impression compound by evaluating the retention of heat cure trial denture bases.

Materials and Methods:

Ten completely edentulous patients in need of prostheses were included in this study. Two border molding techniques, single-step (Group 1) and sectional (Group 2), were compared for retention. Both border molding techniques were performed in each patient. In both techniques, definitive wash impression was made with light viscosity addition silicone. The final results were analyzed using paired t-test to determine whether significant differences existed between the groups.

Results:

The t-value (3.031) infers that there was a significant difference between Group 1 and Group 2 (P = 0.014). The retention obtained in Group 2 (mean = 9.05 kgf) was significantly higher than that of Group 1 (mean = 8.26 kgf).

Conclusion:

Sectional border molding technique proved to be more retentive as compared to single-step border molding although clinically the retention appeared comparable.

Immediate dentin sealing for indirect bonded restorations

PURPOSE

The aim of this article is to review available literature on the clinical procedure of immediate dentine sealing for indirect bonded restorations.

STUDY SELECTION

More than 40 articles reporting the technique, studies, outcomes, etc. were reviewed after PUBMED/MEDLINE search, most of them addressing the specific situation of dentin bonding for indirect restorations.

RESULTS

It is known that tooth preparation for indirect bonded restorations can result in significant dentin exposures. Immediate application and polymerization of the dentin bonding agent to the freshly cut dentin, prior to impression making is therefore recommended by some authors. Literature indicates that this procedure, immediate dentine sealing (IDS), appears to achieve improved bond strength, fewer gap formations, decreased bacterial leakage, and reduces post-cementation sensitivity. This rational approach to adhesion is also reported to have a positive influence on tooth structure preservation, patient comfort, and long term survival of indirect bonded restorations.

CONCLUSION

In the extensive literature regarding advantages of using IDS technique significant differences have been shown when compared to Delayed Dentine Sealing. Although more research is required in this field, presently there are NO scientific reasons not to recommend IDS in routine practice.

The Ocular Prosthesis: A Novel Technique Using Digital Photography

Loss of an eye can cause a significant psychological and emotional disturbance to any patient. An ocular prosthesis helps to re-establish the physical and mental well-being of the patient. This article describes a novel technique along with a case report for fabricating a predictable, esthetic and well-fitting custom-made ocular prosthesis in an attempt to avoid costly and time consuming procedures that may be required in other methods.

A comparative evaluation of the marginal accuracy of crowns fabricated from four commercially available provisional materials: An in vitro study

Purpose:

The purpose of this in vitro study was to evaluate and compare the primary marginal accuracy of four commercially available provisional materials (Protemp 4, Luxatemp Star, Visalys Temp and DPI tooth moulding powder and liquid) at 2 time intervals (10 and 30 min).

Materials and Methods:

A customized stainless steel master model containing two interchangeable dies was used for fabrication of provisional crowns. Forty crowns (n = 10) were fabricated, and each crown was evaluated under a stereomicroscope. Vertical marginal discrepancies were noted and compared at 10 min since the start of mixing and then at 30 min.

Observations and Results:

Protemp 4 showed the least vertical marginal discrepancy (71.59 μ), followed by Luxatemp Star (91.93 μ) at 10 min. DPI showed a marginal discrepancy of 95.94 μ while Visalys Temp crowns had vertical marginal discrepancy of 106.81 μ. There was a significant difference in the marginal discrepancy values of Protemp 4 and Visalys Temp. At 30 min, there was a significant difference between the marginal discrepancy of Protemp 4 crowns (83.11 μ) and Visalys Temp crowns (128.97 μ) and between Protemp 4 and DPI (118.88 μ). No significant differences were observed between Protemp 4 and Luxatemp Star.

Conclusion:

The vertical marginal discrepancy of temporary crowns fabricated from the four commercially available provisional materials ranged from 71 to 106 μ immediately after fabrication (at 10 min from the start of mix) to 83–128 μ (30 min from the start of mix). The time elapsed after mixing had a significant influence on the marginal accuracy of the crowns.

Preoperative intraoral evaluation of planned fixed partial denture pontics using silicone putty

A preoperative visualization and evaluation of fixed partial denture (FPD) pontics in the anterior dentition is necessary for both the patient and the dentist. Such an evaluation allows patients to decide whether the esthetic and functional parameters of the restoration meet their requirements and expectations. To facilitate such an assessment, a method that allows stable intraoral positioning of the pontics is required. This article describes a technique to achieve this in a simple and effective way before the abutments are prepared. In addition, it also allows the operator to modify the pontics intraorally for esthetics and later incorporate the same pontics into the interim prosthesis. The integration of this pretreatment pontic evaluation procedure into FPD restorations assures better results and patient satisfaction.

Types of Implant Surgical Guides in Dentistry: A Review

Various techniques have been proposed for the fabrication of surgical guide templates in implant dentistry. The objective of this paper is to review the associated literature and recent advancements in this field, based on design concept. An electronic and hand search of the literature revealed 3 categories, namely, nonlimiting, partially limiting, and completely limiting design. Most clinicians still adopt the partially limiting design due to its cost-effectiveness and credibility. Moreover, clinicians use cross-sectional imaging during the preimplant assessment of surgical sites.

Hollow dentures: treatment option for atrophic ridges. a clinical report

Severely atrophic ridges provide decreased retention, support, and stability and pose a clinical challenge to the success of complete denture prostheses. Extreme ridge resorption also increases the interridge distance. Restoration of the vertical dimension and esthetics thus demands increased height of the prosthesis and in turn leads to an increase in prosthesis weight. Reducing the weight of the denture enhances stability and retention and reduces further resorption of the jaw, thereby favoring the prognosis of the denture. This report describes the rehabilitation of an edentulous patient with resorbed maxillary and mandibular ridges and an increased interridge distance using simplified techniques of fabricating hollow dentures.

A simple method for fabricating custom sectional impression trays for making definitive impressions in patients with microstomia

OBJECTIVE

A maximum mouth opening that is smaller than the size of a complete denture can make prosthetic treatment challenging. This article describes a simple technique used to fabricate maxillary and mandibular custom sectional impression trays for making definitive impressions in patients with microstomia.

The effect of ceramic thickness and number of firings on the color of a zirconium oxide based all ceramic system fabricated using CAD/CAM technology

PURPOSE

Ceramics have a long history in fixed prosthodontics for achieving optimal esthetics and various materials have been used to improve ceramic core strength. However, there is a lack of information on how color is affected by fabrication procedure. The purpose of this study was to evaluate the effects of various dentin ceramic thicknesses and repeated firings on the color of zirconium oxide all-ceramic system (Lava™) fabricated using CAD/CAM technology.

MATERIALS AND METHODS

Thirty disc-shaped cores, 12 mm in diameter with a 1 mm thickness were fabricated from zirconium oxide based all ceramic systems (Lava™, 3M ESPE, St Paul, MN, USA) and divided into three groups (n = 10) according to veneering with dentin ceramic thicknesses: as 0.5, 1, or 1.5 mm. Repeated firings (3, 5, 7, or 9) were performed, and the color of the specimens was compared with the color after the initial firing. Color differences among ceramic specimens were measured using a spectrophotometer (VITA Easyshade, VITA Zahnfabrik, Bad Säckingen, Germany) and data were expressed in CIELAB system coordinates. A repeated measures ANOVA and Bonferroni post hoc test were used to analyze the data (n = 10, α=.05).

RESULTS

L*a*b* values of the ceramic systems were affected by the number of firings (3, 5, 7, or 9 firings) (P<.001) and ceramic thickness (0.5, 1, or 1.5 mm) (P<.001). Significant interactions were present in L*a*b* values between the number of firings and ceramic thickness (P<.001). An increase in number of firings resulted in significant increase in L* values for both 0.5 mm and 1.5 mm thicknesses (P<.01, P=.013); however it decreased for 1 mm thickness (P<.01). The a* values increased for 1 mm and 1.5 mm thicknesses (P<.01), while it decreased for 0.5 mm specimens. The b* values increased significantly for all thicknesses (P<.01, P=.022). As the dentin ceramic thickness increased, significant reductions in L* values (P<.01) were recorded. There were significant increases in both a* and b* values (P<.01) as the dentin ceramic thickness increased.

CONCLUSION

The number of firings and dentin ceramic thickness have a definite effect on the final color of all ceramic system tested. The mean ΔE value increased as the dentin ceramic thicknesses increased for zirconium-oxide based all ceramic specimens tested. However, the mean ΔE values were less than 3.7ΔE units which is rated as a match in the oral environment.

Management of flabby ridges using liquid supported denture: a case report

Flabby ridges commonly occur in edentulous patients. Inadequate retention and stability of a complete denture are the often encountered problems in these patients. A liquid supported denture due to its flexible tissue surface allows better distribution of stress and hence provides an alternate treatment modality in such cases. This case report presents the use of a liquid supported denture in a patient with completely edentulous maxillary arch with flabby tissue in anterior region opposing a partially edentulous mandibular arch.

Zirconia-based fixed partial dentures: a clinical review

Ceramics have a long history in fixed prosthodontics of achieving optimal esthetics. Yttrium tetragonal zirconia polycrystal (Y-TZP)-based systems are a recent addition to the high-strength, all-ceramic systems used for crowns and fixed partial dentures. CAD/CAM-produced, Y-TZP-based systems are in considerable demand in esthetic and stress-bearing regions. The highly esthetic nature of zirconia coupled with its superior physical properties and biocompatibility have resulted in restorative systems that meet the demands of today's patients. Undoubtedly, these systems are considered to be prospective replacements for metal-ceramic restorations. This article reviews relevant contemporary literature regarding all-ceramic materials and systems and discusses their material properties, biocompatibility, advances in cementation, and more with special emphasis on clinical survival. The article also aims to provide recommendations for their use.