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Objective@#To explore an accurate method to obtain an intraoral model of patients with specific limited mouth opening (microstomia) due to systemic scleroderma.@*Methods@#This study followed medical ethics, and informed consent has been obtained from patients. A case of Ken's Type I mandibular dentition defect scleroderma with limited mouth opening was addressed with digital technology as the leading method combined with the traditional impression method of segmental impression. Individual trays were made based on the patient's left and right mandibular dentition, and segmented molds were obtained. Simultaneously, intraoral scanning was performed to obtain the morphological data of both the soft and hard tissues of the upper and lower mandibles. After each part of the model was obtained, the mandibular model was scanned and digitally aligned to form the final denture model, and the final removable partial denture was designed and made by computer aided design/computer aided manufacturing (CAD/CAM) technology. At the same time, combined with the literature, the diagnosis and treatment of removable partial denture in patients with limited mouth opening were retrospectively analyzed.@*Results@#The denture was well retained and achieved a good repair effect. The patients expressed satisfaction with the mastication efficiency and other functions of the denture. The findings of the literature review show that the integration of digital technology with the traditional impression method, along with computer fitting, can accurately obtain the patient's oral model and facilitate successful follow-up repairs. However, when the anterior mandibular dentition of the patient is absent, the margin of error is increased in this procedure, which deserves further exploration.@*Conclusion@#Utilizing digital technology as the leading method, combined with the traditional impression method of segmental impression, for the repair of dental defects in patients with limited mouth opening, has proven to be effective. Thus, patients report a positive medical experience with high satisfaction, indicating that this approach is worthy of clinical promotion.
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Objective@#To investigate the effect of the socket-shield technique (SST) concurrent with immediate implant placement and provisionalization (IIPP) in the aesthetic restoration of anterior teeth.@*Methods@#A case of maxillary anterior tooth stumps with a thin labial bone wall was treated with SST for preservation of labial soft and hard tissue fullness, combined with an immediate implant placement and immediate provisional crown for restoring the shape of the tooth and gingival molding@*Results@#Immediate implant placement and provisionalization restored the morphology and function of the affected tooth in the shortest possible time. The patient's labial soft and hard tissue contours in the affected tooth area were well preserved in the 18-month follow-up after the application of the SST, which presented a better aesthetic result. The literature review indicates that the indications for SST are unrestorable maxillary anterior teeth, whose dental, periodontal and periapical tissues are healthy and intact. In the esthetic zone, root shielding is effective in maintaining the soft and hard tissue contour on the labial side of the implant. However, there is no consensus on the technical details of SST, such as the ideal coronal height and thickness of the shield, and the management of the gap between the shield and the implant. Thus, more clinical studies and histologic evidence are needed to provide a reference for clinical decision-making. In addition, digital technology can improve the accuracy of implant placement and shield preparation.@*Conclusion@#The correct application of SST combined with IIPP in the esthetic zone can ensure esthetic results. However, more high-quality evidence-based medical evidence is needed for its long-term efficacy, and indications should be strictly controlled during clinical application.
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Objective@# To investigate the adverse reactions of resin cement used for dentin bonding and its influencing factors.@*Methods@# Patients with dental defects treated with resin cement dentin adhesive for direct composite resin repair or full crown indirect repair were selected as the research objects. The occurrence and causes of adverse reactions, such as dental pulp lesions, soft tissue adverse reactions, and restoration loosening and falling off 7 days, 1 month, 3 months, 6 months, and 1 year after treatment, were analyzed retrospectively.@*Results @# Among the 14 776 teeth of 5 971 patients who used resin cement dentin adhesive, 580 cases (3.93%) had adverse reactions. Univariate analysis showed that the incidence of adverse events was highest in teeth with the "full crowns (fixed partial dentures)" restoration type at 7 days, 1 month, and 12 months after treatment. At 7 days after treatment, the incidence of adverse events was the highest in teeth with a preparation depth of "near pulp after preparation". At 7 days and 3 months after treatment, the incidence of adverse events was the highest in teeth with " dentin conditioner-adhesive-resin" treatment of the bonding surface. Multivariate analysis indicated that pulp perforation and pulp capping after tooth preparation were risk factors for adverse events 7 days after treatment (OR=2.610), and the “dentin primer-adhesive-resin” bonding surface treatment method was a protective factor for adverse events 7 days and 3 months after treatment (OR<1). @*Conclusion@#affect the occurrence of adverse events. pulp perforation, and pulp capping after tooth preparation, and self-etching bonding may contribute to adverse reactions.
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Objective@#To explore the application effect of a four-dimensional smile design as the leading and facial streamline as the reference system in the aesthetic restoration of anterior teeth.@*Methods@# A case of scattered space in anterior teeth was treated with a four-dimensional smile design and digital aesthetic restoration with ultrathin porcelain veneer. The digital information of the patients was obtained through oral and facial scanning, and a four-dimensional smile design and prediction were carried out. After the treatment plan was jointly determined by doctors and patients, minimally invasive abutment preparation was carried out, and ultrathin porcelain veneer was made and bonded in place. After the operation, the esthetic degree and marginal fit were observed and reexamined one year after the repair.@* Results @#The edges of the ultrathin ceramic veneers were naturally tight, and the color was coordinated, with satisfying pink and white esthetics. The face was more harmonious and natural when smiling. One year after the restoration, the facial aesthetics were wonderful, the abutment teeth and periodontal tissues were healthy, and the patients were satisfied. The results of the literature review showed that the fitting of temporal facial scanning and intraoral scanning data can accurately predict four-dimensional smile aesthetics, simulate the real state of the dynamic smile and pronunciation process, and combine it with facial streamlines to design a natural and coordinated personalized smile for patients with asymmetric faces. However, for patients with occlusal changes, unstable occlusion or temporomandibular joint disorder, it is necessary to add data fitting, such as electronic facial arch and cone beam CT, to more accurately simulate postoperative mandibular movement.@*Conclusion@# With a four-dimensional smile design as the leading and facial streamline as the reference system, the whole process digital design assisted the restoration of asymmetric anterior teeth with ultrathin porcelain veneer and had a good effect. The postoperative smiling of patients is harmonious and beautiful, which is in line with the expected effect. Patient participation and satisfaction are high; thus, this method is worthy of clinical promotion.
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Objective@#To investigate the changes and significance of human beta-defensin-2 (HBD-2) and LL-37 in the gingival crevicular fluid of patients with periodontitis and type 2 diabetes mellitus (T2DM).@*Methods@#This study was conducted among 45- to 85-year-old patients in the Department of Stomatology and Internal Medicine of Shenzhen Center for Chronic Disease Control, including a healthy control group of 22 people, a systemically healthy control group of 19 people with periodontitis, a T2DM periodontal health group of 15 people, and a T2DM group of 21 people with periodontitis. The Florida periodontal probe was used for periodontal examination, and the clinical indexes, including probing depth (PD), clinical attachment level (CAL) and probing on bleeding (BOP), were recorded. The concentrations of HBD-2 and Ll-37 in gingival crevicular fluid were determined by ELISA. The differences in HBD-2, LL-37 and periodontal clinical indexes between the groups were compared, and correlation analysis was conducted.@*Results@#The PD values in T2DM with the periodontitis group were higher than those of the systemically healthy controls with periodontitis group (P < 0.05); the levels of HBD-2 and LL-37 in gingival crevicular fluid in systemically healthy controls with periodontitis group were significantly higher than those in the healthy control group (P < 0.05), the level of HBD-2 in gingival crevicular fluid in systemically healthy controls with periodontitis group was significantly higher than that in T2DM with periodontitis group (P < 0.05); and the antimicrobial peptides HBD-2 and LL-37 in gingival crevicular fluid were significantly positively correlated with the PD and CAL in systemically healthy controls with periodontitis group (P < 0.05), and there was no significant correlation between the antimicrobial peptides HBD-2, LL-37 in gingival crevicular fluid and PD, CAL in T2DM with periodontitis group (P > 0.05).@*Conclusion@#The levels of antimicrobial peptides HBD-2 and LL-37 in gingival crevicular fluid of middle-aged and elderly patients with T2DM periodontitis were lower, and there was no significant correlation with PD and CAL in periodontal clinical indicators.