Clinical Behavior of the Gingival Margin following Conservative "Coronally Dynamic" Restorations in the Presence of Non-Carious Cervical Lesions Associated with Gingival Recession: A Pilot Study.

Gingival recessions (GR) are often associated with the presence of non-carious cervical lesions (NCCL). The latter result in the disappearance of the cement-enamel junction (CEJ), with consequent difficulties both in measuring the recession itself and in performing root coverage techniques. The restoration of cervical lesions is consequently an important aspect in the treatment of GR, with the re-establishment of a "new" CEJ. This pilot study aimed to verify whether restorative therapy alone, with the execution of a restoration that mimics the convexity of the natural CEJ and thanks to a slight horizontal over-contour, can stabilize a clot in the intrasulcular site and consequently is able to change the position of the gingival margin in a coronal direction. In periodontally healthy patients, with a non-thin gingival phenotype, 10 GR-associated NCCL restorations were performed using a protocol inspired by concepts of prosthetic conditioning, with a progressively reduced convexity ("coronally dynamic restoration") and de-epithelialization of the gingival sulcus. We observed that 70% of the treated teeth showed a reduction in crown length after 15 days (-0.267 mm), without an increase in probing depth. While considering the limitations of the sample and the need to evaluate the different parameters that can affect the result, the coronally dynamic restoration of NCCL with GR was able to influence the position of the gingival margin in a coronal direction.

Effectiveness of low-level diode laser therapy on pain during cavity preparation on permanent teeth.

PURPOSE: To evaluate the effectiveness of low-level laser therapy (LLLT) on dental pain felt during cavity preparation of carious lesions in permanent teeth of adults. METHODS: The study was carried out on 88 teeth with dental caries requiring class I restorations in 24 subjects with a pain score ≥ 7 but < 10 measured using a 0-10 visual analogue scale (VAS) in a preliminary test of pain threshold (PTPT) for each subject receiving a class I cavity preparation on another tooth without local anesthesia. The 88 teeth included were randomly allocated to test and control groups, each with 44 teeth. All teeth were treated with LLLT prior to the mechanical preparation of the cavity without local anesthesia, except that the laser device was kept in idle mode in the control group. After cavity preparation, subjects scored pain intensity using the VAS. The Wilcoxon test was used to analyze data and the values with P< 0.05 were considered significant. RESULTS: All subjects scored a pain reduction in the test group compared with the control group (P< 0.0001), with a reduction of 42% and 16%, respectively, compared to pain felt during the PTPT. The use of LLLT prior to mechanical preparation of a cavity by lowering pain intensity might reduce the quantity of drugs used for pain control required during restorative procedures. CLINICAL SIGNIFICANCE: Dental treatments could be more comfortable by using a preliminary phase of low-power lasers, limiting or eliminating pharmacological agents for pain control.

Class I restoration margin quality in direct resin composites: A double-blind randomized controlled clinical trial.

PURPOSE: To evaluate the margin quality of direct resin composite restorations comparing the enamel-dentin adhesive standard procedure with additional use of adhesive layer at the external outline. METHODS: A total of 648 teeth with Class I occlusal lesions in molars and premolars were randomly selected and distributed into two groups of 324 each in order to compare the margin quality with two restoration strategies. Lesions were sealed with the standard adhesion procedure for direct resin composite restorations (Group 1) and with an additional procedure of enamel adhesive on the outer boundary of the finished restoration (Group 2). Evaluation of marginal quality at 6, 12, 24, 36 and 48 months was performed and described as good marginal adaption or as poor quality defined as Inadequacy A (IA): overhanging resin or change of color; Inadequacy B (IB): the presence of a gap at the enamel-composite interface that retained the probe tip; or Inadequacy C (IC) presence of gap at the enamel-composite interface with explorer tip penetration of more than 1 mm. RESULTS: Data showed a higher number of Inadequacy A for restorations with the additional technique for marginal seal (Group 2): 16 of 24 total (57%) at 6 months; 28 of 37 total (76%) at 12 months; 36 of 44 total (82%) at 18 months; 22 of 33 total (67%) at 24 months; 14 of 21 total (70%) at 36 months and 16 of 25 total (64%) at 48 months. The Inadequacy B and C of marginal seal were more prevalent for restorations without the additional marginal seal (Group 1): 18 of 28 total (64%) at 12 months with inadequacy B; 19 of 25 total (76%) with inadequacy B and 16 total (100%) with inadequacy C at 18 months; 9 of 17 total (53%) with Inadequacy B and 13 total (100%) with Inadequacy C at 24 months; 12 of 17 total (70%) with Inadequacy B and 9 of 13 total (73%) with Inadequacy C at 36 months; 14 of 24 total (58%) with Inadequacy B and 7 of 11 total (63%) with Inadequacy C at 48 months.