The effect of different implant-abutment types and heights on screw loosening in cases with increased crown height space.

OBJECTIVES: The stability of the abutment screw is pivotal for successful implant-supported restorations, yet screw loosening remains a common complication, leading to compromised function and potential implant failure. This study aims to evaluate the effect of different implant-abutment types and heights on screw loosening in cases with increased crown height space (CHS). MATERIALS AND METHODS: In this in vitro study, a total of 64 abutments in eight distinct groups based on their type and height were evaluated. These groups included stock, cast, and milled abutments with heights of 4 mm (groups S4, C4, and M4), 7 mm (groups S7, C7, and M7), and 10 mm (groups C10 and M10). Removal torque loss (RTL) was assessed both before and after subjecting the abutments to dynamic cyclic loading. Additionally, the differences between initial RTL and RTL following cyclic loading were analyzed for each group (p < .05). RESULTS: The C10 group demonstrated the highest RTL, whereas the S4 group exhibited the lowest initial RTL percentage (p < .05). Furthermore, the study established significant variations in RTL percentages and the discrepancies between initial and postcyclic loading RTL across different abutment groups (p < .05). Additionally, both abutment types and heights were found to significantly influence the RTL percentage (p < .05). CONCLUSION: The type and height of the implant abutment affected screw loosening, and in an increased CHS of 12 mm, using a stock abutment with a postheight of 4 mm can be effective in minimizing screw loosening.

Comparison of mechanical properties, surface roughness, and color stability of 3D-printed and conventional heat-polymerizing denture base materials.

STATEMENT OF PROBLEM: Studies on the mechanical, optical, and surface properties of 3-dimensionally (3D) printed denture base materials are scarce, and those available have reported conflicting results. PURPOSE: The purpose of this in vitro study was to compare the mechanical properties, surface roughness, and color stability of 3D-printed and conventional heat-polymerizing denture base materials. MATERIAL AND METHODS: A total of 34 rectangular specimens (64×10×3.3 mm) were fabricated from each of the conventional (SR Triplex Hot; Ivoclar AG) and 3D-printed (Denta base; Asiga) denture base materials. All specimens underwent coffee thermocycling for 5000 cycles, and half in each group (n=17) were evaluated in terms of color parameters, color change (ΔE00), and surface roughness (Ra) before and after coffee thermocycling. The specimens then underwent a 3-point bend test. The remaining specimens in each group (n=17) underwent impact strength and Vickers hardness testing. Data were analyzed by the paired samples, independent samples, and Wilcoxon signed rank tests (α=.05). RESULTS: The color change caused by coffee thermocycling in the 3D-printed group was higher than that in the conventional group (P<.001). Surface roughness significantly increased in both groups after coffee thermocycling (P<.001). The conventional group had higher surface roughness before coffee thermocycling, while the 3D-printed group had higher surface roughness after coffee thermocycling (P<.001). The flexural strength, flexural modulus, and surface hardness in the conventional group were significantly higher than those in the 3D-printed group (P<.001). However, the impact strength of the conventional group was lower than that of the 3D-printed group (P<.001). CONCLUSIONS: The 3D-printed denture base material showed higher impact strength and surface roughness than the conventional heat-polymerizing acrylic resin. However, flexural strength and modulus, surface hardness, and color stability were lower in the 3D-printed group.

Fracture resistance and failure mode of endodontically treated premolars reconstructed by different preparation approaches: Cervical margin relocation and crown lengthening with complete and partial ferrule with three different post and core systems.

PURPOSE: To assess the fracture resistance and failure mode of endodontically treated premolars reconstructed by different preparation approaches: cervical margin relocation (CMR) and crown lengthening (CL) with complete ferrule (CLF) and partial ferrule (CLPF) with three different post and core systems. MATERIALS AND METHODS: In this in vitro study, 100 maxillary premolars were assigned to the following 10 groups according to their preparation approach and type of post and core system (n = 10): (I) control (intact teeth), (II) prefabricated fiber post (PFP) and composite core with CMR (PFP-CMR), (III) polyethylene fiber-reinforced composite (PEFRC) with CMR (PEFRC-CMR), (IV) casting post (CP) and core with CMR (CP-CMR), (V) PFP-CLPF, (VI) PEFRC-CLPF, (VII) CP-CLPF, (VIII) PFP-CLF, (IX) PEFRC-CLF, and (X) CP-CLF. After thermomechanical loading, the fracture resistance and failure mode were assessed. Data were analyzed statistically (α = 0.05). RESULTS: In all post and core systems, the CLPF approach had lower fracture resistance than CMR (p < 0.05); CLF showed higher fracture resistance than CLPF only in the PFP system (p = 0.038). In PEFRC and CP systems, the difference between CLF and CLPF was not significant (p > 0.05). No significant difference was found in fracture resistance of different post and core systems with the same preparation approach (p > 0.05). CLPF showed the highest frequency of favorable, and CLF showed the highest frequency of unfavorable fractures. CONCLUSION: CLPF yielded lower fracture resistance than CMR. The difference in fracture resistance was not significant between CLF and CMR but the frequency of unfavorable fractures was higher in CLF than in other groups.

Effect of orthodontic bonding with different surface treatments on color stability and translucency of full cubic stabilized zirconia after coffee thermocycling.

Objective: To assess the color stability and translucency of full cubic stabilized zirconia (FSZ) following orthodontic bonding with different surface treatments and coffee thermocycling (CTC). Methods: This in vitro study was conducted on 120 disc-shaped specimens of FSZ. Thirty specimens were selected as the control group and remained intact. The remaining specimens were randomly divided into three groups based on the type of surface treatment (n = 30): airborne particle abrasion (APA), silica-coating (CoJet), and carbon dioxide (CO2) laser. After metal bracket bonding in the test groups, debonding and polishing were performed. Subsequently, all specimens underwent CTC (10,000 cycles). Color parameters, color difference (ΔE00), and translucency parameter (TP) were measured three times at baseline (t0), after debonding and polishing (t1), and after CTC (t2). Data were statistically analyzed (α = 0.05). Results: Significant difference existed among the groups regarding ΔE00t0t2 (p < 0.001). The APA group showed minimum (ΔE00 = 1.15 ± 0.53) and the control group showed maximum (ΔE00 = 0.19 ± 0.02) color stability, with no significant difference between the laser and CoJet groups (p = 0.511). The four groups were significantly different regarding ΔTPt0t2 (p < 0.001). Maximal increases in TP were noted in the CoJet (1.00 ± 0.18) and APA (1.04 ± 0.38) groups while minimal increase was recorded in the control group (0.1 ± 0.02). Conclusions: Orthodontic treatment makes zirconia restorations susceptible to discoloration and increased translucency. Nonetheless, the recorded ΔE00 and ΔTP did not exceed the acceptability threshold.

Comparison of marginal leakage and retentive strength of implant-supported milled zirconia and cobalt-chromium copings cemented with different temporary cements.

Background: Few studies assessed the effect of coping material (particularly milled metal copings) on the retentive strength of cements and reported contradictory results. Thus, this study aims to assess the marginal leakage and retentive strength of implant-supported milled zirconia and cobalt-chromium (Co-Cr) copings cemented with different temporary cements. Materials and Methods: In this in vitro study, Zirconia and Co-Cr copings were fabricated on 100 straight titanium abutments. Each group of copings was divided into five subgroups (n = 10) for the use of different cements: permanent zinc-phosphate (ZP) cement, temporary zinc oxide eugenol cement (temp bond [TB]), calcium hydroxide-based temporary cement (Dycal [DC]), polymer-based eugenol-free acrylic-urethane temporary cement (Dentotemp [DT]), and methacrylate-based temporary cement (Implantlink [IL]). The retentive strength and marginal leakage of restorations were assessed. Data were analyzed by one-way ANOVA, Tukey, and Fisher's exact tests (α = 0.05). Results: In the Co-Cr group, the retentive strength values (in Newtons) were as follows: ZP (411.40 ± 5.19) >DC (248.80 ± 5.01) >IL (200.10 ± 5.06) >DT (157.90 ± 5.19) >TB (98.50 ± 6.88). This order was as follows in the zirconia group: ZP (388.70 ± 5.35) >DC (226.60 ± 5.08) >IL (179.00 ± 3.71) >DT (136.00 ± 4.88) >TB (78.60 ± 3.50). All pairwise comparisons were statistically significant (P < 0.001). The difference in marginal leakage was not significant among the groups (P = 0.480). Conclusion: The type of coping material and cement type significantly affected retentive strength, but not marginal leakage, of implant restorations. Milled Co-Cr copings showed higher retentive strength than zirconia copings, and ZP cement followed by DC yielded the highest retention.

Effect of different mechanical surface treatments on flexural strength of repaired denture base / Efecto de diferentes tratamientos superficiales mecánicos sobre la resistencia a la flexión de la base de la dentadura reparada

Aim: To assess the effect of different mechanical surface treatments on flexural strength of repaired denture base. Material and Methods: Sixty bar-shaped specimens of heat-polymerized acrylic resin were fabricated, and divided into six groups (n=10). All specimens, except the positive control group (group PC), were sectioned into halves to create a 1-mm clearance. A negative control group with no surface treatment (group NC) was also considered. Other groups underwent different surface treatments: group Laser; treated with erbium: yttrium-aluminum-garnet (Er:YAG) laser, group APA; airborne-particle abrasion (APA), group APA plus Laser; a combination of laser and APA, and group Bur; bur grinding. After measuring surface roughness (Ra) with a profilometer, all sectioned specimens were repaired by auto-polymerizing acrylic resin, and thermocycled afterward. Three-point bending test was performed by a universal testing machine. Data were statistically analyzed (α=0.05). Results: The mean surface roughness of all experimental groups were significantly higher than that of group NC (p<0.05). The mean flexural strength of all groups was significantly lower than that of group PC (p<0.05). Group B had significantly higher flexural strength than the other surface-treated groups (p<0.05). Group Laser had significantly higher flexural strength than groups APA (p=0.043) and APA plus Laser (p=0.023). No significant difference was found between groups APA and APA plus Laser (p=0.684). Conclusion: All surface treatments increased the surface roughness and flexural strength compared with the untreated group. The highest flexural strength was observed in specimens treated by bur grinding and then laser, however, it was still significantly lower than intact specimens.

Objetivo: Evaluar el efecto de diferentes tratamientos superficiales mecánicos sobre la resistencia a la flexión de la base de la prótesis reparada. Material y Métodos: Se fabricaron sesenta especímenes en forma de barra de resina acrílica termo-polimerizada y se dividieron en seis grupos (n=10). Todas las muestras, excepto el grupo de control positivo (grupo PC), se seccionaron en mitades para crear un espacio libre de 1 mm. También se consideró un grupo de control negativo sin tratamiento superficial (grupo NC). Otros grupos se sometieron a diferentes tratamientos superficiales: grupo Láser; tratados con láser de erbio: itrio-aluminio-granate (Er:YAG), grupo APA; abrasión por partículas en el aire (APA), grupo APA más láser; una combinación de láser y APA, y grupo Bur; molienda de fresas. Después de medir la rugosidad de la superficie (Ra) con un perfilómetro, todas las muestras seccionadas se repararon con resina acrílica de autopolimerización y se sometieron a termociclado. La prueba de flexión de tres puntos se realizó con una máquina de prueba universal. Los datos se analizaron estadísticamente (α=0,05). Resultados: La rugosidad superficial media de todos los grupos experimentales fue significativamente mayor que la del grupo NC (p<0,05). La resistencia media a la flexión de todos los grupos fue significativamente menor que la del grupo PC (p<0,05). El grupo B tenía una resistencia a la flexión significativamente mayor que los otros grupos tratados en la superficie (p<0,05). El grupo Láser tuvo una resistencia a la flexión significativamente mayor que los grupos APA (p=0,043) y APA más Láser (p=0,023). No se encontró diferencia significativa entre los grupos APA y APA más Láser (p=0,684). Conclusión: Todos los tratamientos superficiales aumentan la rugosidad de la superficie y la resistencia a la flexión en comparación con el grupo sin tratar. La resistencia a la flexión más alta se observó en las muestras tratadas con fresado y luego con láser; sin embargo, aún era significativamente más baja que las muestras intactas.

Shear bond strength of different luting agents to polyether ether ketone.

Background: Polyether ether ketone (PEEK) was recently introduced to dentistry. However, difficulty in provision of a strong durable bond is its main drawback. Thus, precise surface treatment and use of a suitable luting agent are imperative for bonding of PEEK restorations. This study aimed to assess the effect of type of luting agent on shear bond strength (SBS) of PEEK. Materials and Methods: In this in vitro study, 60 square-shaped PEEK samples were fabricated and sandblasted with 110 µm Al2O3 particles. The samples were then divided into four groups based on the type of cement used (n = 15): zinc phosphate cement, Panavia F2, Panavia V5, and resin-modified glass-ionomer (RMGI) cement. After bonding, the samples were thermocycled for 5000 cycles. The SBS was measured by a universal testing machine. The surface of samples was inspected under a video measuring machine to determine the mode of failure. Data were analyzed using the Kruskal-Wallis test via SPSS version 24 (α = 0.05). and Methods: In this in vitro study, 60 square-shaped PEEK samples were fabricated and sandblasted with 110 µm Al2O3 particles. The samples were then divided into four groups based on the type of cement used (n = 15): zinc phosphate cement, Panavia F2, Panavia V5, and resin-modified glass-ionomer (RMGI) cement. After bonding, the samples were thermocycled for 5000 cycles. The SBS was measured by a universal testing machine. The surface of samples was inspected under a video measuring machine to determine the mode of failure. Data were analyzed using the Kruskal-Wallis test via SPSS version 24 (α = 0.05). Results: RMGI did not bond to PEEK. The SBS values were 4.02 ± 2.87 megapascals (MPa) for Panavia V5, 10.84 ± 6.05 MPa for Panavia F2, and 10.50 ± 2.88 MPa for zinc phosphate. The SBS in the Panavia V5 group was significantly lower than that in the Panavia F2 (P = 0.001) and zinc phosphate (P < 0.001) groups. No significant difference existed between the Panavia F2 and zinc phosphate groups in this respect (P > 0.05). Conclusion: Panavia F2 resin cement and zinc phosphate conventional cement provided the highest bond strength to PEEK, while RMGI did not bond to PEEK.

Eating- and oral health-related quality of life in patients under fixed orthodontic treatment.

OBJECTIVE: The eating problems and changes in the diet and dietary intake of patients under orthodontic treatment are of great importance, and the available studies on this topic are mostly qualitative. Thus, this study aimed to assess the oral health-related quality of life (OHRQoL) and the eating-related quality of life (ERQoL) of patients under fixed orthodontic treatment. MATERIALS AND METHODS: This prospective study evaluated 105 patients (65 males, 40 females) with a mean age of 26 ± 1.1 years, who required fixed orthodontic treatment. All participants filled out the Oral Health Impact Profile-14 (OHIP-14) questionnaire before treatment (T0), and at 1 (T1), 3 (T2), and 6 (T3) months after treatment, and the ERQoL questionnaire at 1 (T1), 3 (T2), and 6 (T3) months after treatment. Data were analyzed using repeated measures analysis of variance with Greenhouse-Geisser and Huynh-Feldt corrections and Bonferroni test for pairwise comparisons (α = .05). RESULTS: The OHIP-14 total score increased at T1 and decreased at T2 and T3, with significant differences between all four time points (p < .001). The ERQoL total score decreased over time, and significant differences were noted between all three time points (p < .001). No significant difference existed in OHRQoL or ERQoL with regard to gender at any time point (p > .05). CONCLUSION: The reduction in OHRQoL due to fixed orthodontic treatment was temporary and improved over time. The eating problems also decreased with time.

Marginal and internal fit and fracture resistance of three-unit provisional restorations fabricated by additive, subtractive, and conventional methods.

OBJECTIVES: To compare the marginal and internal fit and fracture resistance of three-unit provisional fixed dental prostheses (FDPs) fabricated by additive, subtractive, and conventional methods. MATERIAL AND METHODS: Eighty 3-unit FDPs were fabricated on metal dies of the maxillary right second premolar and second molar by four different techniques (n = 20): The direct method by using autopolymerizing polymethyl methacrylate (PMMA), indirect method by the compression molding technique, subtractive manufacturing by using PMMA blocks, and additive manufacturing by using digital light processing technology. The adaptation of restorations at the marginal, axial, cuspal, and fossa areas was assessed by using the silicone replica technique. After thermocycling and cyclic loading, the fracture resistance was measured by a universal testing machine. Data were analyzed by a two-way analysis of variance (ANOVA), ANOVA, and Tukey test (α = .05). RESULTS: The mean gap measured in the additive group was lower than that in all other groups at all points (p < .05); however, the difference in the marginal gap with the subtractive group was not significant (p = .995). The mean marginal and axial gaps in the subtractive group were significantly lower than the corresponding values in both conventional groups (p < .05). A significant difference existed between all groups regarding the mean cuspal and fossa gaps (p < .05). The mean fracture resistance of the additive group was significantly higher than that of indirect (p = .018) and direct (p < .001) groups, and the fracture resistance of the subtractive group was significantly higher than that of the direct group (p = .020). CONCLUSION: The digitally fabricated provisional FDPs showed superior marginal and internal fit and higher fracture resistance than the conventionally fabricated FDPs. Between the digital methods, the additive technique yielded superior internal fit.

Comparative effects of tungsten, diamond burs and laser for residual adhesive removal after orthodontic debonding on flexural strength, surface roughness and phase transformation of high-translucent zirconia: An in vitro study.

OBJECTIVES: Information regarding the effects of orthodontic bracket debonding on zirconia restorations, and the preferred method for residual adhesive removal from the zirconia restoration surface is lacking. Thus, this study aimed to assess the effects of different methods of residual adhesive removal after orthodontic bracket debonding on flexural strength, surface roughness, and phase transformation of high-translucent (HT) zirconia. MATERIALS AND METHODS: This in vitro study evaluated 72 bar-shaped HT zirconia specimens; 18 specimens were assigned to the control group. Metal brackets were bonded to the remaining specimens by resin cement. After bracket debonding, the residual adhesive on the surface of specimens was removed by three methods (n=18): a 30-flute tungsten-carbide (TC) bur at low speed, an ultrafine diamond bur at high speed, and Er:YAG laser irradiation. The surface roughness (Ra and Rz) was measured. X-ray diffraction (XRD) analysis was carried out, and the flexural strength was measured as well. Data were statistically analyzed (α=0.05). RESULTS: Before polishing, all methods increased the Ra and Rz values (P<0.05) except for the diamond bur yielding a Rz value comparable to that of the control group. The Ra values of the test groups were comparable after polishing, and still higher than that of the control group (P<0.05). The flexural strength of all three test groups was comparable (P>0.05), and significantly lower than that of the control group (P<0.001). The monoclinic phase was not observed in any group. CONCLUSIONS: Orthodontic bracket debonding adversely affects the surface roughness and flexural strength of zirconia despite polishing.

Effect of Different Surface Treatments and Orthodontic Bracket Type on Shear Bond Strength of High-Translucent Zirconia: An In Vitro Study.

Objective: Considering the increasing number of adults seeking orthodontic treatment, and the possible need for bracket bonding to monolithic zirconia restorations, knowledge about the preferred type of bracket (metal/ceramic) and the most efficient surface treatment is imperative to achieve acceptable shear bond strength (SBS). This study aimed to assess the effect of different surface treatments and orthodontic bracket types on SBS of high-translucent zirconia. Materials and Methods: Totally, 248 disc-shaped zirconia specimens were assigned to two groups for bonding to metal and ceramic brackets. Each group was divided into four subgroups (n = 31) for the following surface treatments: no surface treatment (control group), airborne-particle abrasion (APA), tribochemical silica coating with CoJet, and CO2 laser irradiation. The mean surface roughness (Ra value) was measured. The SBS was measured after bracket bonding and thermocycling. Data were analyzed by two-way ANOVA, Tukey, Kruskal-Wallis, Mann-Whitney, and Fisher exact tests, and Bonferroni correction (α=0.05). Results: The mean Ra value was significantly different among the surface treatment subgroups (P < 0.001). The APA and CoJet subgroups were not significantly different regarding Ra (P=0.754). All other pairwise comparisons yielded significant differences (P < 0.001). Bracket type, surface treatment, and their interaction significantly affected the SBS (P < 0.001). Ceramic brackets bonded to zirconia surfaces treated with CoJet yielded the maximum SBS while ceramic brackets bonded to control and lased surfaces resulted in minimum SBS. No significant difference was noted in the SBS of different surface treatment groups when metal brackets were used (P > 0.05). Conclusions: The use of ceramic brackets and CoJet surface treatment would be the most appropriate combination to achieve optimal bonding to high-translucent zirconia restorations.

Clinical and Laboratory Outcomes of Angled Screw Channel Implant Prostheses: A Systematic Review.

The purpose of this systematic review was to evaluate the clinical and laboratory outcomes of angled screw channel (ASC) restorations and to summarize the influencing factors. An electronic search of the English language literature was performed in four databases and enriched by manual searches. Retrieved studies were screened against the predefined exclusion and inclusion criteria. Eight clinical and seven laboratory studies were eligible for the analysis. The risk of bias for included observational studies was performed using the Newcastle-Ottawa quality assessment scale. Laboratory studies quality assessment method was adapted from previous published systematic reviews. Two clinical studies focused on technical outcomes and the rest reported the biological outcomes of the ASC restorations. Out of the seven laboratory studies, two studies investigated the fracture resistance of ASC restorations, four studies evaluated the reverse torque value of the nonaxially tightened screws, and one study evaluated both variables. The present review revealed that while the performance of ASC restorations is promising in short-term clinical studies, the evidence of their long-term reliability is still lacking. The laboratory studies indicated comparable fracture resistance results of the ASC restorations with the straight screw channel restorations. In addition, factors, such as initial torque value, configuration of the screw driver, screw design, abutment system, and the angulation of screw channel, were shown to influence the screw resistance to loosening.

Analyzing the relationship between learning styles (Kolb and VARK) and creativity with the academic achievement of dental students.

BACKGROUND: One of the influential factors in students' learning is their learning styles which have the capacity to change. Furthermore, creativity is considered one of the essential cognitive features of humans. Thus, this study aimed to analyze the relationship between learning styles (Kolb and VARK) and emotional creativity with the academic achievement of dental students. MATERIALS AND METHODS: In this descriptive-analytical study, the statistical population included dental students of the third semester and above (250 persons). The data collection tools included Kolb and VARK learning style questionnaires, Averill emotional creativity questionnaire, the total Grade Point Average (GPA), and the GPA over the past two semesters of students to measure academic achievement. The data were analyzed using the measures of the descriptive (mean and standard deviation) and the inferential statistics tests including one-sample t-test, independent t-test, correlation coefficients of Pearson, and Eta squared. RESULTS: Based on Kolb and VARK learning styles, the majority of the students had accommodating learning style (64%) and read-write style (31.6%) and also were single-styled (80.4%). No significant relationship was found between the learning styles (Kolb and VARK) and creativity with academic achievement. The students scored higher than average in emotional creativity and all of its three elements. Moreover, there was a significant relationship between emotional creativity and the gender of the students (P = 0.01). Female students showed higher emotional creativity (97.26 ± 10.34) compared to the male students (94.24 ± 8.96). CONCLUSION: There was no significant relationship between learning styles and emotional creativity of the students with their academic achievement. The accommodating and read-write learning styles were more prevalent among students and they showed high emotional creativity.

Effect of different surface treatments on surface roughness and flexural strength of repaired 3D-printed denture base: An in vitro study.

STATEMENT OF PROBLEM: Information regarding three-dimensional-printed (3D-printed) dentures, especially when using the additive manufacturing technique, and the repair strength of this type of denture is sparse. PURPOSE: The purpose of this in vitro study was to assess the effect of different surface treatments on the surface roughness and flexural strength of repaired 3D-printed denture base. MATERIAL AND METHODS: One hundred and twenty 3D-printed bar-shaped specimens were fabricated from acrylic resin and divided into 6 groups (n=20). The positive control group consisted of intact specimens. The other specimens were sectioned in half with a 1-mm gap. Except for the specimens in the negative control group, the remaining specimens were treated with erbium: yttrium-aluminum-garnet (Er:YAG) laser, airborne-particle abrasion, a combination of laser and airborne-particle abrasion, and bur grinding. All sectioned specimens were repaired by autopolymerizing acrylic resin and thermocycled after measuring their surface roughness with a profilometer. The flexural strength test was performed with a universal testing machine. One specimen of each group was inspected under a scanning electron microscope. The data were analyzed with ANOVA, followed by the Games-Howell post hoc test or the Kruskal-Wallis test followed by the Mann-Whitney test with Bonferroni adjustment. RESULTS: The mean flexural strength of the PC group was significantly higher than that of all repaired groups (P<.001). All surface-treated groups showed significantly higher flexural strength (P<.05) and surface roughness (P<.004) than the negative control group. Bur grinding provided significantly higher flexural strength than other surface treatments (P<.001) and higher surface roughness than laser and airborne-particle abrasion plus laser (P<.001). CONCLUSIONS: All surface treatments significantly increased the surface roughness and flexural strength, but none of them yielded a strength comparable with that of the intact group. Bur grinding provided the highest flexural strength.

Three-dimensional accuracy of innovative implant-level impression techniques with plastic snap-on impression copings.

BACKGROUND: Several studies have assessed the accuracy of the indirect snap-on impression technique. However, some impression techniques that utilize plastic snap-on impression copings have not yet been investigated. OBJECTIVES: This study aimed to assess the three-dimensional (3D) accuracy of innovative implant-level impression techniques with plastic impression copings and the splinted open-tray technique with metal impression copings. MATERIAL AND METHODS: This in vitro study used a reference model of the mandible with 4 parallel dental implants. Forty impressions were made with polyether impression material, using the splinted opentray technique with metal impression copings (SOM group), the non-splinted closed-tray technique with snap-on impression copings (NCS group), the non-splinted open-tray technique with snap-on impression copings (NOS group), or the splinted open-tray technique with snap-on impression copings (SOS group); n = 10 per group. Linear discrepancies in the inter-implant distances on the obtained casts were determined in the X, Y and Z axes with the use of a coordinate measuring machine. Subsequently, the 3D accuracy of each impression technique was calculated. Data was analyzed by means of the one-way analysis of variance (ANOVA) followed by Tukey's post-hoc tests. RESULTS: Among different impression techniques, the amount of linear discrepancy was significant only for the Z axis. The SOM, NOS and SOS groups showed less discrepancy in this axis as compared to the NCS group (p < 0.001). A significant difference was also noted in 3D discrepancy (p = 0.022), with the SOM group showing a significantly higher discrepancy as compared to the SOS group (p = 0.016). CONCLUSIONS: The 3D accuracy of the implant-level splinted open-tray impression technique with plastic snap-on impression copings was significantly higher than that of the splinted open-tray technique with metal impression copings.

Marginal adaptation of three-unit interim restorations fabricated by the CAD-CA systems and the direct method before and after thermocycling.

BACKGROUND: Limited information is available regarding the marginal adaptation of three-unit interim restorations fabricated by different techniques from different materials. Also, the efficacy of computer-aided design/computer-aided manufacturing (CAD-CAM) systems for their fabrication is still questionable. This study aimed to assess the marginal adaptation of three-unit interim restorations fabricated by the CAD-CAM systems and the direct method from different materials before and after thermocycling. MATERIAL AND METHODS: A sound mandibular second premolar and a second molar were prepared for a three-unit all-ceramic restoration. Metal dies were fabricated to simulate a case of mandibular first molar missing, and were mounted in an acrylic block. Seventy-two three-unit interim restorations were fabricated by different techniques from different materials in six groups (n=12). In the first four groups, restorations were fabricated from Tempron, Visalys Temp, Unifast III, and Acropars by the direct technique, while the Amann Girrbach and Arum CAD-CAM systems and Ceramill Temp blocks were used in the last two groups. Marginal gap in each group was measured under a stereomicroscope at ×100 magnification. The specimens then underwent 5000 thermal cycles (5-55°C), and the marginal gap was measured again afterwards. ANCOVA and Bonferroni test (for pairwise comparisons) were applied for statistical analyses (α=0.05). RESULTS: Amann Girrbach and Arum CAD-CAM systems were not significantly different regarding the marginal gap of restorations (P=0.999). Among the traditional interim materials, Acropars showed significantly higher marginal gap than others (P<0.001). No significant difference was noted between other traditional materials. CAD-CAM interim materials showed significantly smaller marginal gap than traditional materials (P<0.001). CONCLUSIONS: The CAD-CAM interim materials yielded superior marginal adaptation in three-unit interim restorations compared with traditional interim materials. The type of CAD-CAM system had no significant effect on the final marginal adaptation of restorations. Key words:Dental marginal adaptation, interim dental prosthesis, CAD-CAM.

Marginal gap of monolithic zirconia endocrowns fabricated by using digital scanning and conventional impressions.

STATEMENT OF PROBLEM: The digital scanning technique has been introduced as an alternative to the conventional impression technique for the fabrication of fixed restorations. However, adequate information is not available on the efficacy of digital scanning for the fabrication of endocrowns regarding their marginal accuracy. PURPOSE: The purpose of this in vitro study was to compare the marginal gap of endocrowns fabricated by computer-aided design and computer-aided manufacturing (CAD-CAM) technology and digital scanning and conventional impression techniques. MATERIAL AND METHODS: An endodontically treated mandibular molar tooth was prepared to receive an endocrown. The impressions were made by using the conventional impression technique with polyvinyl siloxane material (n=11) and digital scanning by using an intraoral scanner (n=11). Endocrowns were fabricated from monolithic zirconia blocks by using a milling machine. Each restoration was seated on the prepared tooth, and the marginal gap was measured by using a video measuring machine at 8 points under magnification. The mean marginal gap for each restoration and the overall mean marginal gap for each group were calculated. Data were analyzed by using a statistical software program. Marginal gaps were compared with the Mann-Whitney U test (α=.05). RESULTS: The mean marginal gap was 74 µm for the conventional impression group. A similar mean marginal gap (70 µm) was found for the digital scanning group. No statistically significant difference was found between the groups (P=.375). CONCLUSIONS: The digital scanning technique and the conventional impression technique yielded crowns with comparable marginal adaptation.

Dental care management during the COVID-19 outbreak.

AIM: The level of preparedness of the healthcare system plays an important role in management of coronavirus disease 2019 (COVID-19). This study attempted to devise a comprehensive protocol regarding dental care during the COVID-19 outbreak. METHODS AND RESULT: Embase, PubMed, and Google Scholar were searched until March 2020 for relevant papers. Sixteen English papers were enrolled to answer questions about procedures that are allowed to perform during the COVID-19 outbreak, patients who are in priority to receive dental care services, the conditions and necessities for patient admission, waiting room and operatory room, and personal protective equipment (PPE) that is necessary for dental clinicians and the office staff. CONCLUSION: Dental treatment should be limited to patients with urgent or emergency situation. By screening questionnaires for COVID-19, patients are divided into three groups of (a) apparently healthy, (b) suspected for COVID-19, and (c) confirmed for COVID-19. Separate waiting and operating rooms should be assigned to each group of patients to minimize the risk of disease transmission. All groups should be treated with the same protective measures with regard to PPE for the dental clinicians and staff.

Marginal adaptation of zirconia-reinforced lithium silicate overlays with different preparation designs.

OBJECTIVE: Following the advent of strong adhesive bonding, the conservative tooth preparation designs without a retentive form gained increasing popularity. This study aimed to evaluate the marginal adaptation of zirconia-reinforced lithium silicate (ZLS) overlays with different preparation designs. MATERIALS AND METHODS: Forty sound human maxillary first molars were collected and divided into four groups (n = 10) according to their preparation design for the fabrication of ZLS overlays: (O) anatomical occlusal reduction, (OS) anatomical occlusal reduction with rounded shoulder, (OG) anatomical occlusal reduction with a central groove, and (OSG) anatomical occlusal reduction with rounded shoulder and central groove. A video measuring machine (VMM) was used to measure the marginal gap. Statistical analysis was carried out using one-way ANOVA followed by paired t test and Tukey's test (α = .05). RESULTS: The gap size was significantly different between the groups both before (P = .004) and after (P = .008) cementation, and it was significantly smaller in group O than group OSG (P = .002 before and P = .004 after cementation). Marginal gap increased in all groups following cementation (P < .001). CONCLUSIONS: Group O showed comparable marginal adaptation with groups OS and OG while group OSG with the most complex design showed the lowest marginal adaptation for ZLS overlays. CLINICAL SIGNIFICANCE: According to the results of this in vitro study, it may be stated that for defect-free teeth requiring occlusal restoration, the occlusal surface preparation alone would suffice to achieve optimal marginal adaptation, and retentive and more invasive preparation designs are not required.

Effect of Surface Treatment With Er:YAG and CO2 Lasers on Shear Bond Strength of Polyether Ether Ketone to Composite Resin Veneers.

Introduction: Polyether ether ketone (PEEK) has low surface energy and high resistance to chemical surface treatments. Therefore, different surface treatments such as laser conditioning should be investigated. There is a gap of information regarding the efficacy of laser irradiation in the surface treatment of PEEK, and the efficacy of several laser types needs to be evaluated for this purpose. This study aimed to assess the effect of surface treatment with erbium-doped yttrium aluminum garnet (Er:YAG) and carbon dioxide (CO2) lasers on shear bond strength (SBS) of PEEK to composite resin veneers. Methods: In this experimental study, 60 rectangular-shaped PEEK samples (7 x 7 x 2 mm) were used. The samples were mounted in auto-polymerizing acrylic resin in such a way that only one surface measuring 7x7 mm remained exposed. The samples were then randomly divided into 3 groups (n=20) of control, Er:YAG laser surface treatment (Power=1.5 W, energy density=119.42 J/cm2 , irradiation time=20 s) and CO2 laser surface treatment (Power=4 W, energy density=159.22 J/cm2 , irradiation time=50 s). The bonding agent and PEEK opaque were applied on the surface of samples and they were veneered with a composite resin using a hollow plastic cylinder with an internal diameter of 4 mm. The SBS was then measured and the data were analyzed using one-way ANOVA, Tukey HSD test and Dunnett's test at 0.05 level of significance. Results: The SBS of the 3 groups was significantly different (P<0.001). The Tukey HSD test revealed that the Er:YAG laser had higher SBS than the CO2 laser group (P<0.001). The Dunnett's test showed that both Er:YAG and CO2 laser groups yielded higher SBS than the control group (P<0.001). Conclusion: The Er:YAG and CO2 laser treatments can increase the SBS of PEEK to composite resin veneers, although the Er:YAG laser seems to be more effective for this purpose.