Prevention and treatment strategy for deviation of costal cartilage dorsal onlay graft in rhinoplasty / 中华医学美学美容杂志

Objective:To investigate the prevention and treatment for deviation of costal cartilage dorsal onlay grafts in rhinoplasty.Methods:From January 2010 to October 2020, a total of 588 patients (83 male cases, 505 female cases, age range from 25 years to 55 years, 32±4 years in average) accepted costal cartilage rhinoplasty in Shenzhen Mylike Medical Plastic Aesthetic Hospital. During the operation, various methods were used in the process of catilage selection, water bath, sculpture, treatment of nasal dorsal, graft fixation and fascial modification to prevent and treat the deformation and displacement of the costal cartilage dorsal onlay grafts.Results:The immediate postoperative photograph of 588 cases showed that costal cartilage dorsal onlay graft was put on the middle of dorsum. After a follow-up period of 396 cases from 6 to 60 months, the average follow-up period was 12.1 months, there were 44 cases happened with the deviation of dorsal onlay grafts, and deviation was managed after the second rhinoplasty surgery. There was no prolonged function sequela such as ventilation dysfunction, abnormal sensation, or hyposmia occured. 362 cases were satisfied with the aesthetic effect.Conclusions:It is particularly important to grasp the principles of managing costal cartilage in rhinoplasty and to learn how to prevent and treat postoperative complications of costal cartilage dorsal onlay graft.

Dentes gretados: o que clínicos e especialistas precisam saber / Cracked teeth: What clinicians and specialists need to know

A proposta da presente revisão de literatura foi estabelecer as evidências existentes sobre etiologia, sinais e sintomas, métodos de diagnóstico e tratamento de dentes gretados. Segundo a American Association of Endodontists (AAE), o termo dente gretado (DG) foi definido como uma fratura em um plano que quebra a continuidade do esmalte e da dentina, sem separação das partes, geralmente no sentido mesiodistal, passando pela superfície oclusal, podendo envolver uma ou ambas as cristas marginais. Essa fratura, por apresentar profundidade e direção desconhecidas, pode se estender até a polpa e/ou ligamento periodontal, levando a um quadro de pulpite reversível, pulpite irreversível, necrose pulpar ou, até mesmo, evoluir para uma fratura completa. Atualmente, os DGs estão relacionados à terceira maior causa de dentes perdidos, após cárie e doença periodontal. Estudos indicam uma falta de consenso entre profissionais sobre como tratar dentes gretados, uma questão clínica relevante, que precisa ser priorizada e esclarecida. Nesse contexto, essa revisão abordou a etiologia, sinais e sintomas, métodos de diagnósti- co e tratamento de dentes gretados (AU)

The purpose of this literature review is to examine the existing evidence regarding etiology, signs, symptoms, methods of diagnosis, and treatment of cracked teeth. According to the American Association of Endodontists (AAE), the term cracked tooth (CT) is defined as "a fracture in a plane that breaks the continuity of the enamel and dentin, without separation of the parts, usually in the mesiodistal direction, passing through the surface occlusal, which may involve one or both of the marginal ridges." Due to its unknown depth and direction, this fracture can extend to the pulp and periodontal ligament, leading to reversible pulpitis, irreversible pulpitis, pulp necrosis, or even progress to a complete fracture. Currently, cracked teeth are related to the third largest cause of missing teeth, after caries and periodontal disease. Studies indicate a lack of consensus among professionals about treating cracked teeth, a clinically relevant issue that needs to be prioritized and clarified. In this context, this review addressed the etiology, signs and symptoms, diagnostic methods, and treatment of cracked teeth (AU).

Comportamento clínico de restaurações onlay cad-cam chairside: estudo in silico e série de casos com medição de desgaste por software de metrologia após um ano de acompanhamento / Clinical behavior of onlay cad-cam chairside restorations: an in silico study and case series with wear measurement by metrology software after one year follow-up

O presente trabalho teve como objetivos: (1) relatar uma série de casos e apresentar uma metodologia para medição de desgaste usando software de metrologia comparando dois tipos de materiais em blocos CAD-CAM (dissilicato de lítio e resina composta) usados para restaurações onlay; (2) avaliar, in silico, a distribuição de tensões de dois materiais restauradores, IPS emax CAD e Grandio Blocs, em dois tipos de desenho de preparo dentário para onlay envolvendo cúspides funcionais ou não funcionais. (1) O estudo clínico foi registrado para avaliação do comitê de ética local e foi realizado com voluntários que necessitaram de procedimento restaurador indireto, seguindo os critérios de inclusão/exclusão. Quatro restaurações do tipo onlay (IPS emax CAD e GrandioBlocs) foram confeccionadas pelo método CAD-CAM chairside por um único operador treinado. A alocação dos tratamentos foi feita de forma aleatória. Após a cimentação das restaurações, a avaliação foi feita por examinador calibrado, não sendo o operador, nos períodos de 7 dias, 6 meses e 1 ano. Neste estudo foi analisada a quantidade de desgaste das restaurações por software de medição de dados (Gom Inspect) com acompanhamento de 6 meses e 1 ano com 4 pacientes avaliados sendo 2 restaurações de GrandioBlocs e 2 para IPS emax CAD. O resultado foi representado por um mapeamento de cores onde cada tonalidade representa uma quantidade de desgaste. O resultado obtido pelas imagens foi insignificante mostrando leve diferença nas imagens com restauração de GrandioBlocs. (2) Os molares foram modelados em quatro desenhos de preparação para restauração onlay: preparo tradicional com cobertura da cúspide funcional (TFC), preparo não retentivo com cobertura da cúspide funcional (NFC), preparo tradicional com cobertura da cúspide não funcional (TNFC), preparo não retentivo com cobertura de cúspide não funcional (NNFC). As restaurações foram simuladas com dois materiais restauradores CAD / CAM: LD - dissilicato de lítio (IPS emax CAD) e RC - resina composta (GrandioBlocs). Uma carga axial de 100 N foi aplicada à superfície oclusal simulando o ponto de contato cêntrico. As tensões de Von Mises (VM) e as tensões principais máximas (Pmax) foram avaliadas tanto para restaurações onlay, camada de cimento e substrato dentário. O desenho do preparo não retentivo melhorou a concentração de tensões na estrutura dentária em comparação com o desenho retentivo convencional. Para as onlays LD, a distribuição de tensões na superfície interna da restauração mostrou que o desenho da preparação influenciou a distribuição de tensões, bem como a opção de cúspide preparada. O desenho do preparo não retentivo proporcionou melhor distribuição de carga em ambos os materiais restauradores e mais vantajoso para a estrutura dentária. A restauração de resina composta em cúspides não funcionais é recomendada quando a cúspide funcional está preservada, para ser mais conservadora.

The aim of the present study was (1) to report a series of cases and to present a methodology for measurement of wear using metrology software comparing two types of CAD-CAM materials (lithium disilicate and composite resin) used for onlay restorations; (2) to evaluate, in silico, the stress distribution of two restorative materials, IPS emax CAD and Grandio Blocs, in two types of dental preparation design for onlay involving functional or non-functional cusps. (1) The clinical study was registered for evaluation by the local ethics committee and was carried out with volunteers who needed an indirect restorative procedure, following the inclusion / exclusion criteria. Four onlay restorations (IPS emax CAD and Grandio Blocs) were made using the chairside CAD-CAM method by a single trained operator. The allocation of treatments was done at random. After the cementation of the restorations, the assessment was made by a calibrated examiner, not being the operator, in the periods of 7 days, 6 months and 1 year. In this study, the amount of wear of the restorations was analyzed by data measurement software with 6-month and 1-year follow-up with 4 patients evaluated, 2 of which were GrandioBlocs and 2 for , IPS emax CAD restorations. The result is represented by a color mapping where each shade represents a quantity of wear. The result obtained by the images was insignificant, showing a slight difference in the images with restoration of GrandioBlocs. (2) Molars were modeled in four preparation designs for onlay restoration: traditional design with functional cusp coverage (TFC), non- retentive design with functional cusp coverage (NFC), traditional design with non-functional cusp coverage (TNFC), non-retentive design with non-functional cusp coverage (NNFC). Restorations were simulated with two CAD-CAM restorative materials: LD - lithium-disilicate (IPS emax CAD) and RC - resin composite (GrandioBloc). A 100 N axial load was applied to the occlusal surface simulating the centric contact point. Von Mises (VM) and maximum principal (Pmax) stresses were evaluated for onlay restorations, the cement layer and the dental substrate. The non-retentive preparation design improved the stress concentration in the tooth structure in comparison to the conventional retentive design. For LD onlays, the stress distribution on the restoration intaglio surface showed that the preparation design influenced the stress distribution as well as the prepared cusp option. The design of non-retentive preparation provided better load distribution in both restorative materials and more advantageous for tooth structure. The resin composite restoration on non- functional cusp is recommended when functional cusp is preserved, in order to be more conservative.

Re-recognition of endoscopic Sublay repair / 中华消化外科杂志

Repair of abdominal hernia is in dynamic evoluation.Laparoscopic intra-peritoneal onlay mesh (IPOM) and open Sublay repair are still the best methods for the repair of abdominal wall hernia. The application of component separation technique has further widened the indications of IPOM and Sublay repair for the treatment of large abdominal wall hernia. Endoscopic Sublay technique theoretically combines the advantages of open Sublay repair and laparoscopic IPOM repair, but it has the disadvantages of iatrogenic destruction of the tendon septum and normal mechanical deconstruction, which requires strict specification of indications and further research.

Dorsal onlay buccal mucosal graft or penile skin graft substitution urethroplasty in bulbar urethral stricture: compare the outcome and review

Background: Authors describe their experience with dorsal onlay urethroplasty using Buccal mucosal graft or penile skin graft through dorsal sagittal urethrotomy for bulbar urethral stricture.Methods: From 2014 to 2017, 29 male patients with bulbar urethral stricture have been treated by one stage dorsal onlay substitution urethroplasty using buccal mucosal graft and penile skin graft. Patients with balanitis xerotica obliterans, unhealthy penile skin, oral mucosa pathology or those who had undergone more than one urethral dilation/internal urethrotomy or urethroplasty were excluded from study. Results were analyzed at 6th and 12th month follow up with clinical history and uroflowmetry. Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilation or optical internal urethrotomy.Results: A total of 16 men age between 21 to 56 years for buccal mucosa graft (BMG) urethroplasty and 13 men age between 18 to 59 years underwent dorsal onlay substitution urethroplasty using BMG and penile skin graft (PSG). Mean stricture length was 4.2 cm (3.8-6) for BMG urethroplasty and 4.1 cm (3.2-5) for PSG urethroplasty. Mean length and width of graft were 4.2 cm and 2.6 cm respectively in BMG urethroplasty while 4.6 cm and 2.5 cm in PSAG urethroplasty. Average follow up months were 13.4 months with overall success rate 87.5% in BMG urethroplasty while average follow up months were 14.6 months with overall success rate 82.3% in PSG urethroplasty.Conclusions: On short term follow up substitution urethroplasty using both penile skin and buccal mucosa graft have comparable results.

Dorsal onlay versus dorsal inlay buccal mucosal graft urethroplasty for anterior urethral stricture: a single centre retrospective study

Background: Urethral stricture is a relatively common disease. The choice of surgery is based on the stricture location, length of the stricture and etiology. Buccal mucosal graft (BMG) urethroplasty with Asopa and Kulkarni techniques, revolutionized the approach to anterior urethral stricture repair. Objective of the study was to compare both the dorsal onlay BMG urethroplasty technique of Kulkarni and the dorsal inlay BMG urethroplasty technique of Asopa for the management of long anterior urethral stricture.
Methods: From January 2015 to October 2019, a total of 90 patients with long anterior urethral strictures were randomized into two groups. Group A (42 patients) managed by Kulkarni technique. Group B (48 patients) managed by Asopa technique. BMG urethroplasty was considered successful if no further procedure required postoperatively with maximum flow rate >15 ml/s during the follow-up period.Results: The success rate in group A and B were 80.9% and 87.5%, respectively. The mean operative time was significantly longer in group A (175±22.6 min) than in group B (102±18.14 min, p-value <0.001). The average blood loss was significantly higher in group A (154±15.65 ml) than in group B (112.76±12.62 ml, p-value <0.012).Conclusions: The dorsal onlay technique of Kulkarni and the dorsal inlay technique of Asopa buccal mucosal graft urethroplasty are reliable and satisfactory procedures with good success rates and minimum complications.

An audit of management of male urethral stricture and it’s outcome: a single centre retrospective review

Background: Anterior urethral stricture involves penile, bulbar or panurethra with varied aetiology. Direct vision internal urethrotomy (DVIU), stricture excision with primary end to end anastomosis, single stage or staged reconstruction with local flap or buccal mucosal graft (BMG) are surgical options.Methods: This single centre retrospective study was conducted from April 2017 to March 2019. Patient underwent DVIU, stricture excision with primary end to end anastomotic, staged urethroplasty, BMG urethroplasty (BMGU) dorsal inlay Asopa technique, dorsal onlay Kulkarni technique and ventral onlay technique depending on site and extent of strictures. Preoperative, intraoperative, post-operative data were reviewed.Results: Here, 51 patients underwent DVIU for single soft short segment bulbar urethral stricture with success rate 58.82%. 26 patients with post traumatic short segment bulbar urethral stricture underwent excision and primary end to end anastomosis with success rate 92.31%. Patients with long segment bulbar urethral stricture underwent either dorsal onlay (n=19) or ventral onlay (n=14) BMGU with success rate 89.47% and 85.71% respectively. Total 59 patients with long segment penile or pan urethral stricture underwent either single stage (n=27) or staged reconstruction (n=32) with success rate of 85.18% and 90.63% respectively. Patients with staged reconstruction had significantly longer hospital stay (p<0.0001) and poor quality of life due to laid opened urethra. Asopa’s dorsal inlay (n=15) and Kulkarni’s dorsal onlay (n=12) BMGU had equivalent success rate of 86.67% and 83.33% and comparable complications.Conclusions: Surgery for urethral stricture differs according to site and extent of stricture. Single stage BMG urethroplasty is preferred modality for long segment bulbar, penile and panurethral stricture.

A comparative study of closure versus non-closure of hernial defect in laparoscopic ventral hernia mesh repair

Background: Laparoscopic ventral hernia repair has better out comes when compared to open mesh repair. But closure of the hernial defect is still a contentious issue. This study is designed to compare the outcome of closure versus non-closure of hernia defect in laparoscopic ventral hernia repair.Methods: A 2 years prospective randomized controlled study was conducted on 60 patients undergoing elective laparoscopic ventral hernia repair in the Department of General Surgery (November 2016 to October 2018).Results: The patients in the two groups were analyzed using Chi-square, ANOVA, Fisher exact test, and results were formulated. The mean age of ventral hernia was 41 years and overall incidence more in females. Paraumbilical hernia is the commonest variety of ventral hernia and 63.3% hernias were reducible. Average post-operative length of hospital stay was 2 days with no difference in both the groups. Post-operative pain was more in intraperitoneal onlay mesh (IPOM) plus group. Seroma formation and Incidence of mesh bulge was found be more in IPOM group, but there was no difference in the incidence of chronic pain or recurrence rate between the two groups. All the above proved statistical significance.Conclusions: Primary defect closure in ventral hernia along with mesh placement in laparoscopy seems to have better outcome, with respect to less chance of seroma formation and mesh bulge.

Autologous cortical bone block for repair of implant-site jaw bone defects / 中国组织工程研究

BACKGROUND: Autologous bone with good biocompatibility possesses the characteristics of bone conduction, osteoinduction and osteogenesis. However, the healing process after autologous bone grafting is still controversial. The focus of controversy is whether the bone graft is completely absorbed and replaced or whether it can retain cell viability for a long time. OBJECTIVE: To observe the histological changes in bone remodeling and regeneration after cortical bone grafting. METHODS: Six healthy beagle dogs were selected as the research animals. The maxillary premolars of experimental dogs were extracted and the bone plates with width of 10 mm, length of 15 mm and thickness of 2 mm were removed from the buccal side. A bone defect model was established. The corresponding size of cortical bone block was cut on the buccal side of the bilateral mandibular body. Cortical bone grafts were fixed in the maxillary defect area. On one side pure cortical bone block was used as grafting material; on the other side the implant was placed simultaneously with the bone graft. Samples were harvested at 3 and 6 months after bone grafting. The cell survival and bone graft resorption of autologous cortical bone graft were analyzed by gross observation and histological observation. The study protocol was approved by the Animal Ethics Committee of Dalian Medical University, China. RESULTS AND CONCLUSION: The size of the grafted bone was gradually reduced, and the margin was blunt and firmly bonded to the base bone. All implants lost after 6 months. A newly formed connection between the graft and the base bone was shown by hard tissue ground sections. The porosity of bone lacuna in the grafted bone block at 6 months was significantly lower than that at 3 months (P < 0.05). The grafted bone resorption rate at 6 months was significantly higher than that at 3 months (P < 0.05). These findings indicate that osseointegration exists between grafted cortical bone block and the base bone of the recipient area. Osteocytes in the graft bone partially remain alive. With the prolongation of healing period, the proportion of new bone cells increases, and the volume of the grafted bone gradually decreases. Osseointegration of the concurrent implant is disturbed due to the absorption of cortical bone graft.

A CAD/CAM-based strategy for concurrent endodontic and restorative treatment

This case report describes a technique in which endodontic treatment and permanent indirect restoration were completed in the same clinical appointment with the aid of a computer-aided design/computer-aided manufacturing (CAD/CAM) system. Two patients were diagnosed with irreversible pulpitis of the mandibular first molar. After access preparation, root canals were located, irrigation was performed until bleeding ceased, and the coronal tooth structure was prepared for indirect restoration. Then, utilizing an interim 3-mm build-up of the endodontic access cavity, a hemi-arch digital scan was performed with an intraoral scanner. Subsequent to digital scanning, restoration design was performed simultaneously with the endodontic procedure. The root canals were shaped using the Race system under irrigation with 2.5% sodium hypochlorite followed by root canal filling. The pulp chamber was subsequently filled with a 3-mm-thick composite resin restoration mimicking the interim build-up previously utilized to facilitate block milling in the CAD/CAM system. Clinical try-in of the permanent onlay restoration was followed by acid etching, application of a 5th generation adhesive, and cementation of the indirect restoration. Once the restoration was cemented, rubber dam isolation was removed, followed by occlusal adjustment and polishing. After 2 years of follow-up, the restorations were esthetically and functionally satisfactory, without complications.

Effect analysis of ceramic onlay to repair serious dental defects in young permanent molars / 华西口腔医学杂志

OBJECTIVE@#To analyze the effect of ceramic onlay to repair serious defects in young permanent molars.@*METHODS@#Sixty patients with defects in young permanent molars were selected. The patients were randomly divided into two groups. One group was restored with ceramic onlay, and the other used resin composite to direct filling. Follow-up visit was conducted at 3, 6, 12, and 24 months after treatment. Modified USPHS/Ryge criteria were used to evaluate the effect of restoration. The occlusal courses were recorded by the T-Scan Ⅲ system in intercuspal position. Gingival and food impaction were recorded. The effect of the two restorative methods, the recovery of occlusal function, and the gingival and approximal conditions were analyzed.@*RESULTS@#At 12 months after restoration, the marginal fitness in the onlay group was significantly better than that in the resin group (P0.05). The gingival and approximal conditions also demon-strated no stati-stical differences (P>0.05).@*CONCLUSIONS@#The ceramic onlay repair method is better than resin composite filling in marginal fitness, surface smoothness, and recovery of the occlusal function when restoring young permanent molars with serious defects.

A comparative study between onlay and subway mesh repair in the treatment of ventral hernia

Background: More than 1 million ventral hernia surgeries are done annually in India. Suture repair techniques have dominated ventral and incisional hernia repair over a century. The most popular of these techniques was the Mayo duplication. In larger hernias, suture repair requires the application of tension to the fascia in order to close the orifice. The aim of the study: This study aimed to compare the duration of surgery and postoperative complications of subway and only meshplasty in the treatment of ventral hernias. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. Totally 50 cases were included in the study. Group A (25 Cases- Onlay meshplasty) Group B (25 cases - Sublay meshplasty). All subjects undergoing onlay and sub lay mesh repair for ventral hernias were evaluated intraoperatively for the duration of surgery and postoperatively for complications like surgical site infections, seroma formation, flap necrosis and duration of hospital stay. Results: The most common complication observed was seroma in 6 patients. 1(4%) were in preperitoneal and 4(20%) in the onlay mesh repair group. This complication was managed with seroma drainage. The only technique had more of seroma formation, due to the fact that onlay techniques require significant subcutaneous dissection to place the mesh, which can lead to devitalized tissue with seroma formation or infection. The superficial location of the mesh also puts it in danger of becoming infected if there is superficial wound infection. Wound infection was found in 5 cases. Out of these, 1(4%) were in a pre-peritoneal group and 4(16%) were in onlay group. These patients were Manimegalai, Avvait. A comparative study between onlay and subway mesh repair in the treatment of ventral hernia. IAIM, 2019; 6(3): 217-222. Page 218 treated with appropriate antibiotics and regular dressing. No patient required removal of mesh because the infection was superficial and responded well to antibiotics. Conclusion: Sublay mesh repair is a good alternative to onlay mesh repair that may be applicable to all forms of ventral hernia as the mesh related overall complication rate like a seroma, surgical site infections, flap necrosis, and hospital stay are less compared to onlay mesh plasty.

Clinical effect of resin hybrid ceramic onlay in repairing posterior tooth defects / 口腔疾病防治

Objective@#To investigate the clinical effect of restoration of posterior teeth with machinable CAD/CAM resin hybrid ceramic (VITA Enamic) onlays after root canal treatment. @* Methods @#136 posterior teeth restored after root canal treatment in our hospital were selected as the research subjects. The posterior teeth were restored chairside with CAD / CAM ceramic onlays to recover occlusion relation and protect residual dental tissues. With 68 teeth in each group, one group was restored with a machinable CAD / CAM resin hybrid ceramic (VITA Enamic) while the control group received zirconia-reinforced lithium silicate ceramic (VITA Suprinity). Before bonding, all the onlays were examined for good adjacency, fitness and occlusion, and then the adhesive surface was etched with hydrofluoric acids. After isolating the rubber dams in the mouths, the onlays were bonded with dual-cure resin cements. The patients were followed up for 24 months to compare the degree of prosthesis integrity, marginal fitness, gingival health, dental integrity, color matching and secondary caries. @* Results @#After restoration, all the onlays were in harmony with the surrounding teeth with good aesthetic effect and suitable marginal fit. Two years later, there were no significant differences in the marginal fitness, gingival health, dental integrity or secondary cavities between the two groups (P > 0.05). In terms of restoration integrity, the VITA Enamic onlays (100%) were intact and displayed good retention. The group that received VITA Suprinity had 6 onlay (9.23%) fractures and a success rate of 90.77%; however, the residual dental tissues did not break. The difference of prosthesis integrity between the two groups was statistically significant (χ2= 4.45, P < 0.05). @*Conclusion@#Chairside CAD/CAM resin hybrid ceramic (VITA Enamic) onlays can quickly restore posterior teeth after root canal therapy and better protect the residual dental tissue.

Minimally invasive restoration of endodontically treated teeth / 口腔疾病防治

@#The aims of tooth restoration of endodontically treated teeth are to protect the remaining dental tissue; restore coronal morphology, functions and aesthetics; prevent bacterial microleakage and ensure periodontal healthy; prevent fracture of the restorations and reduce the wear from antagonist teeth. This article reviews the preservation and minimally invasive restoration of endodontically treated teeth. The results of the literature review show that tooth fracture resistance decreases after root canal treatment, the amount of remaining tooth tissue is an important factor affecting the success of root canal treatment, and the neck is the stress concentration area of tooth tissue, the traditional full crown and postcore crown have a certain amount of abrasion on the healthy neck teeth tissue, which will further reduce the bending resistance of the teeth and may cause the teeth to fracture. With the development of bonding technology, composite resin materials and ceramic materials, there are fewer molar tissues removed when resin, inlay, onlay, overlay and inlay crown are used to repair tooth defects, which can better preserve the remaining tooth tissues, especially the neck tooth tissues. After root canal treatment, only the pulp cavity of the tooth can be directly repaired by resin. When the marginal ridge is absent, minimally invasive restoration methods, such as inlay, onlay, and inlay crown, can be selected according to the number of marginal ridges removed and the thickness of the remaining dental tissue.

Effect observation of onlays on the posterior teeth with subgingival defects after deep margin elevation / 口腔疾病防治

Objective@#Objective To evaluate the effect of repairing posterior teeth with subgingival defects with onlays after deep margin elevation and to provide a reference for clinical application.@*Methods @#Eighty-six cases of posterior teeth with subgingival defects were treated with resin filling to elevate the subgingival margin to the superior gingival margin and were then restored with onlays of cast porcelain. Patients were followed up at 1 week, 6 months and 12 months. The wear and tear of the restorations, fractures of the restorations, loss of the restorations, marginal closeness, marginal staining, secondary caries and gingival health were examined. Assessment of efficacy with reference to American public health service standards was conducted.@*Results @#One week after the operation, there was no loss of follow-up. Eighty-six cases of onlays had no prosthetic wear, prosthetic fracture, prolapse of the prosthesis, edge adhesion, edge coloration, secondary caries, etc., and the gums were healthy. At 6 months after surgery, 2 patients were lost to follow-up and 4 of the remaining 84 onlays were detached. After re-adhesion, there was no shedding. At 12 months after surgery, 5 cases were lost to follow-up and 81 cases of onlays demonstrated no further prosthetic wear, prosthetic fracture, prolapse of the prosthesis, edge adhesion, edge coloration, secondary caries, etc., and the gums were healthy. The success rate after 12 months of repair was 95.1% (77/81).Conclusion For posterior teeth with a subgingival defect, onlays of cast porcelain have the advantages of a high success rate, co@*Conclusion@# For posterior teeth with a subgingival defect, onlays of cast porcelain have the advantages of a high success rate, convenient clinical operation and no influence on periodontal health to restore posterior teeth after deep margin elevation.

Three-dimensional finite element analysis of cuspal-coverage thickness influence on the stress distribution of all-ceramic onlay-restored premolars / 华西口腔医学杂志

OBJECTIVE@#To investigate the influence of cuspal-coverage thickness on the stress distribution of all-ceramic onlay-restored premolars by using 3D finite element (FE) analysis and to provide references for the design of all-ceramic onlays for clinical application.@*METHODS@#3D FE models of all-ceramic onlays with three cuspal-coverage thicknesses (2, 3, and 4 mm) of endodontically treated maxillary premolar were constructed based on micro-CT images. Stress distributions in the onlay, adhesive resin cement layer, and dentin of models were analyzed under vertical load (600 N) and oblique load (200 N).@*RESULTS@#When the cuspal-coverage thickness increased, the peak maximum principal stress value decreased inside the onlay but increased in the margin of the adhesive resin cement layer. In addition, stress concentration areas increased in the coronal residual dentin on the palatal side under oblique load.@*CONCLUSIONS@#An increase in the cuspal-coverage thickness of all-ceramic onlays may reduce the risk of rupture of the restoration but may deteriorate the restoration and cause palatal dentin fracture.

Rehabilitating Form, Function and Natural Aesthetics with Onlay Ceramic IPS Empress Esthetic®: Evidence and Versatility / Rehabilitando forma, función y estética mediante el uso de un Onlay IPS Empress Esthetic®: Evidencia y Versatilidad

Abstract Clinical research and in vitro laboratory tests have enabled the development and improvement of dental ceramics. Comprehension of the physical and mechanical properties of this material is essential, in order to ensure a functional, aesthetic and long-lasting posterior ceramic restoration. The clinical protocol for onlay preparation involves important considerations in treatment planning, such as selection of the restorative material, biomechanical design, color selection, dental substrates conditioning and adhesive cementation. This article discusses a brief review on the topic and a case presentation in which a posterior tooth was rehabilitated with an IPS Empress Esthetic® ceramic onlay.

Resumen La investigación clínica y las pruebas de laboratorio in vitro han permitido el desarrollo de los materiales cerámicos en odontología. La comprensión de las propiedades físicas y mecánicas de este material es esencial para asegurar una restauración funcional, estética y duradera. El protocolo clínico para la preparación de un onlay implica consideraciones importantes en la planificación del tratamiento, tales como la selección del material restaurador, diseño biomecánico, selección de color, acondicionamiento de sustratos dentales y cementación adhesiva. Este artículo discute una breve revisión sobre el tema y una presentación de caso en la que un diente posterior fue rehabilitado con una restauración indirecta tipo Onlay.

Clinical observations of all-ceramic restorations of children’s first permanent molars with severe defects / 口腔疾病防治

Objective @#To explore the therapeutic efficacy of chairside CEREC all-ceramic restorations in children with first permanent molars with severe defects and to summarize the clinical methods and procedures.@*Methods@# Forty teeth of 7-15 years old thirty-four children with first permanent molars with severe defects were selected. After careful tooth preparation, a total of 40 all-ceramic restorations (8 inlays, 32 onlays) were designed and manufactured using the CEREC 3D system, and all prostheses were bonded with composite resin cement. Immediately after treatment and after 24 months, the subjective satisfaction of the patients was assessed. The clinical efficacy was analyzed using modified USPHS criteria at 12 months and 24 months. Evaluations included secondary caries, marginal adaptation, surface texture, color matching, fracture, anatomical form, adjacency relationship and gingival health.@*Results @# For the 40 all-ceramic restorations of the first permanent molars, after 24 months, 100% of the teeth were grade A for secondary caries, surface texture and fracture of the prosthesis, and 85% of the teeth were up to grade A for the other indexes at 12 and 24 months. There were no significant differences (P > 0.05) between 12 months and 24 months. Immediately after treatment and after 24 months, the subjective satisfaction of the patients was greater than 94%. @*Conclusion @#Application of the CEREC 3D system had a clear curative effect and resulted in high satisfaction in the repair of permanent molars with severe defects in children.

Stress distribution in premolars restored with inlays or onlays: 3D finite element analysis

PURPOSE: To analyze stress distribution in premolars restored with inlays or onlays using various materials. MATERIALS AND METHODS: Three-dimensional maxillary premolar models of abutments were designed to include the following: 1) inlay with O cavity (O group), 2) inlay with MO cavity (MO group), 3) inlay with MOD cavity (MOD group), and 4) onlay (ONLAY group). A restoration of each inlay or onlay cavity was simulated using gold alloy, e.max ceramic, or composite resin for restoration. To simulate masticatory forces, a total of 140 N static axial force was applied onto the tooth at the occlusal contact areas. A finite element analysis was performed to predict the magnitude and pattern of stresses generated by occlusal loading. RESULTS: Maximum von Mises stress values generated in the abutment teeth of the ONLAY group were ranged from 26.1 to 26.8 MPa, which were significantly lower than those of inlay groups (O group: 260.3–260.7 MPa; MO group: 252.1–262.4 MPa; MOD group: 281.4–298.8 MPa). Maximum von Mises stresses generated with ceramic, gold, and composite restorations were 280.1, 269.9, and 286.6 MPa, respectively, in the MOD group. They were 252.2, 248.0, 255.1 MPa, respectively, in the ONLAY group. CONCLUSION: The onlay design (ONLAY group) protected tooth structures more effectively than inlay designs (O, MO, and MOD groups). However, stress magnitudes in restorations with various dental materials exhibited no significant difference among groups (O, MO, MOD, ONLAY).

Three-year retrospective clinical evaluation of pulp-less molars with defects of varying degree repaired by cast ceramic onlays of three marginal types / 华西口腔医学杂志

OBJECTIVE@#This study aimed to evaluate the clinical effect of pulp-less molars with defects of different degrees repaired by cast ceramic onlays of three marginal types.@*METHODS@#A total of 165 endodontically treated molars of 105 patients were included in this study and were divided into three kinds of defect (mild, moderate, severe) according to the number of remaining axial walls. Each defect was divided into three groups according to the shape of edge to edge, bevel edge, and concave shoulder. After tooth preparation, the casting of ceramic onlays was performed. Treatment follow-up was done for the evaluation of the success and survival rates of three groups under the same defect.@*RESULTS@#The average follow-up was 925.44 days. Under the mild defect, the success and survival rates of the edge to edge onlays were respectively 100% and 100%; bevel edge onlays, 100% and 100%; and concave shoulder onlays, 94.4% and 100%. Under the moderate defect, the success and survival rates of the edge to edge onlays were respectively 96.0% and 100%; bevel edge onlays, 80.0% and 93.3%; and concave shoulder onlays, 95.2% and 95.2%. Under the severe defect, the success and survival rates of the edge to edge onlays were respectively 95.2% and 100%; bevel edge onlays, 73.7% and 89.5%; and concave shoulder onlays, 73.3% and 80.0%. Under different defects, the success or survival rates of the three kinds of onlays had no significant difference (P>0.05).@*CONCLUSIONS@#The edge to edge type is the most preferable way of onlay tooth preparation and can achieve good clinical results in the mild, middle, and severe tooth defection with root canal treatment.