FitJaw Mobile, a virtual reality device applied to dentistry: An analysis based on two patient treatments.

STATEMENT OF PROBLEM: Virtual reality (VR) has improved significantly in the last decade and has been applied to different fields, including medicine, dentistry, and physiotherapy. VR has been used for the innovative treatment of painful conditions, especially when traditional exercise therapies were unsuccessful because of patient noncompliance. PURPOSE: The purpose of this study was to analyze the use of VR as an aid when using exercises to manage temporomandibular disorders (TMDs). MATERIAL AND METHODS: Two White women diagnosed with TMDs of muscular origin (one with muscular pain and the other with reduced mouth opening) were referred to the Department of Prosthodontics of the University of Seville, where they were enrolled in an exercise program using the VR software program FitJaw Mobile. Both had been treated the previous year with an occlusal device for TMD of muscular origin, but their symptoms had not improved. RESULTS: For both patients, the functional movement limitation and the chronic pain improved noticeably. CONCLUSIONS: The use of VR when doing jaw exercises can improve outcomes and compliance.

Comparative analysis of smile esthetics between top celebrity smile and a Southern European population.

STATEMENT OF PROBLEM: The analysis of different parameters involved in the esthetic perception of the smile is important for the correct planning of cosmetic dental treatments. PURPOSE: The purpose of this study was to analyze the differences in the main parameters of smile esthetics among celebrities identified as having the best esthetic smiles and a young Southern European population. MATERIAL AND METHODS: The study consisted of a control group of 144 dental students from the University of Seville (69.4% women; 30.6% men) with a mean ±standard deviation age of 23.19 ±0.5 years and photographs of 58 celebrities identified as having the best esthetic smiles (74.1% women; 25.9% men) with a mean ±standard deviation age of 42.09 ±2.25 years. Photographs of the celebrities were obtained from the Internet, and standardized photographs were made of the control group. The variables measured were smile line, smile arc, incisal edges and lower lip relationship, smile width, dental midline deviation and tilting, buccal corridor widths, and angulation discrepancy between interpupillary line and commissural line and between interpupillary line and occlusal plane. The data obtained were processed in a statistical software program for a descriptive statistical analysis and for inferential analysis parametric statistical tests by applying the Wilcoxon, chi-square, Student t, and kappa index tests (α=.05). RESULTS: Statistically significant differences (P<.01) were found between the groups in terms of smile width, smile arc, midline deviation and tilting, and angulation discrepancy between the interpupillary line and the commissural line. Smile arc was the only variable found to be different (P<.01) in relation to sex. CONCLUSIONS: Characteristics of the most esthetic smiles were no deviation or tilting of the maxillary midline, showing a greater number of teeth in the smile, displaying incisal edges parallel to the lower lip (particularly in women), and displaying occlusal and commissural planes parallel to the interpupillary line.

A comparison of the passive fit of a 3-unit implant-supported fixed partial denture fabricated by lost-wax casting, milling soft metal blocks, or direct metal laser sintering: An in vitro study.

STATEMENT OF PROBLEM: Stresses induced by implant-supported prostheses are related to mechanical complications. However, how the manufacturing method affects the generated stresses is unclear. PURPOSE: The purpose of this in vitro study was to compare the passive fit of 3-unit cobalt-chromium partial prostheses fabricated by using 3 different methods: conventional casting (milled resin with lost-wax method), machined (milling soft metal blocks), or sintered (direct metal laser sintering). MATERIAL AND METHODS: Thirty 3-unit implant-supported cobalt-chromium fixed prostheses were fabricated, 10 with each method. Four strain gauges were placed over an in vitro resin model with 2 implants in it; 2 gauges were placed above and 2 on the sides to measure the microdeformations caused by placing the structures above the implants in longitudinal flexion, vertical flexion, or torsion, before and after tightening the screws. An inferential analysis was carried out by using a statistical software program, and the Wilcoxon and Kruskal-Wallis tests were applied and then complemented with the Mann-Whitney test for multiple comparisons with the Bonferroni correction (α=.01). RESULTS: The mean longitudinal deformation, vertical flexion, and torsional deformation values increased after tightening the screws with each of the 3 fabrication methods. Significant differences (P<.01) were found for all 3 methods before and after screw tightening. After screw tightening, the machined structures, followed by sintered structures, and the cast structures (P<.05) had smaller deformations in the X, Y, and Z dimensions. The longitudinal deformation was less in machined structures, and vertical flexion deformation was less in machined and sintered structures than in cast structures (P<.05). CONCLUSIONS: The deformations registered in the in vitro model increase considerably after screw tightening, which indicates the lack of passive fit. Machined structures provide a better passive fit, followed by sintered structures, and the cast structures had the poorest fit.

How the geometry of the scan body affects the accuracy of digital impressions in implant supported prosthesis. In vitro study.

Background: To determine and compare how three-dimensionally accurate scan bodies of different geometric shapes are placed over 6 implants (platform or crestal module). Material and Methods: A master plaster model was made with 6 INHEX STD implant analogs made by Mozo-Grau S.A and 4 scan body types were compared. Several groups were made: a control group using a DS101 85G20 contact scanner (Renishaw, Gavá, Spain) and 2 experimental groups using optical scanners: Cerec Omnicam (Sirona, Bensheim, Germany) and Trios 3 (3Shape, Copenhagen, Denmark). 3 parameters were measured on the implants: dis-tance between the axial axes, height difference and angulation difference. Two experienced op-erators scanned 10 times using each of the 2 scanners. The STL files were compared using the "Best-Fit" technique and the data was then extrapolated and processed statistically. Results: The scan bodies PRMG (SB3) and TALL (SB4) lead to smaller errors in distance, projected height and angulation than ELOS (SB1) and MG (SB2). Conclusions: Despite the results obtained in PRMG (SB3) and TALL (SB4), the scanning errors may still be too large to achieve a good fit in large rehabilitations over implants. Any marginal discrepancy may lead to the failure of the rehabilitation or the implant due to the associated biomechanical problems. Key words:IOS, CAD/CAM, SCAN Bodies.

Esthetic assessment of celebrity smiles.

STATEMENT OF PROBLEM: Guidelines for planning esthetic outcomes are sparse. The present study evaluated the most noticeable characteristics of the celebrities with the most esthetic smiles. PURPOSE: The purpose of this observational study was to assess the smiles of celebrities based on descriptive esthetic smile criteria and to compare male and female celebrity smiles based on dentally esthetic smiles. MATERIAL AND METHODS: An internet search for the "most beautiful celebrity smile ranking" was conducted in 2019, resulting in 50 celebrities that had been voted for having the most beautiful smiles. A second search was conducted to locate images of the identified individuals with the whole face and a broad smile. RESULTS: The most frequent characteristics of the studied variables were a normal smile line (70.7%), incisal edges parallel to the lower lip (56.1%), maxillary anterior incisal edges touching the lower lip (48.8%), a smile width of 10 teeth (53.7%), a facial midline coincident with the maxillary dental midline (51.2%), and average buccal corridors (78%). Statistically significant differences between men and women were only found in the smile arch (P<.01). CONCLUSIONS: Celebrities voted as having the most beautiful smiles comply with most of the characteristics described as esthetically pleasing, except for midline deviations. The general population is influenced by factors other than the individual's smile.

Width/Length Ratio in Maxillary Anterior Teeth. Comparative Study of Esthetic Preferences among Professionals and Laypersons.

PURPOSE: Many studies have examined the esthetic preferences of professionals in the maxillary anterior region; however, only a few have taken into account the ratios that are more frequent within the population or other ratios suggested in the literature as ideal. Previous studies also failed to compare them with the esthetic preferences of the lay population with regards to the smile. The purpose of this study is to highlight the differences when perceiving the esthetics of smiles between general dentists and laypersons, and linking them with the width/length of the maxillary anterior teeth. MATERIALS AND METHODS: Photographs of the full face of a female subject were modified with Photoshop CS regarding the length/width relationships of the 6 maxillary anterior teeth. The three modifications made were: (a) 80% length/width, (b) 85%, length/width, and (c) 85% length/width in central incisors, 80% length/width in lateral incisors and canines. Three sequences of photograph pairs were created with different ratios and presented in PowerPoint to a sample of 100 general dentists and 100 laypersons. RESULTS: The ratio considered as the most esthetic by the majority of the judges was 85% for central incisors and 80% for lateral incisors and canines, with a statistically significant difference (p < 0.01). There was no statistically significant difference in the esthetic preferences of the studied populations either due to gender or professional experience of the dentists (p > 0.01). CONCLUSIONS: According to the results obtained in this study, professionals and laypersons considered a width/length ratio of 85% for maxillary central incisors and 80% for lateral incisors and canines as the most esthetic for maxillary anterior teeth. These results do not support findings from other studies previously published with similar ratios in central incisors, lateral incisors, and canines. CLINICAL IMPLICATION: Today clinicians practice in a treatment environment where not only function and utility but also esthetics is demanded in almost every procedure. Restoring/maintaining function is considered essential in any restorative dentistry treatment, but the esthetic aspects of any treatment should never be forgotten. This study was motivated by the increasing importance of obtaining a better appreciation of the perception of smile beauty, and of the role of maxillary teeth width/length ratio on the perception of dental esthetics.

Satisfaction in complete denture wearers with and without adhesives: A randomized, crossover, double-blind clinical trial.

BACKGROUND: The purpose of this study was to compare the satisfaction of patients regarding retention, stability and accumulation of particles with a randomized, double-blind crossed method in users with complete dentures with and without adhesive. MATERIAL AND METHODS: Seventeen edentulous individuals were randomized and received new upper and lower complete dentures. After a period of adaptation, they participated in some masticatory tests and clinical revisions, after use the protheses with and without the use of two denture adhesives: Adhesive A (Fittydent, Fittydent International GmbH) and adhesive B (Corega, GlaxoSmithKline) at 0, 7 and 14 days. Satisfaction was measured immediately after each test through a survey using a VAS scale (0-10) and data were analyzed with McNemar's test with Bonferroni correction. RESULTS: The results showed significant differences (p<.01) between the study groups with adhesive A - B and the group without adhesive, but no significant differences were found between the two stickers for any of the variables studied. CONCLUSIONS: Complete denture adhesives significantly improved the satisfaction of patients because a better retention, stability and less accumulation of particles of the food substitute between the denture and the mucosa is obtained compared with non-use of complete denture adhesives. Key words:Complete dentures, patient satisfaction, denture adhesives, clinical trials.

Layperson's perception of axial midline angulation in asymmetric faces.

OBJECTIVE: Asymmetric facial features such as a deviated nose and chin are common and known to affect smile esthetics. When presented with these asymmetries, the clinician must consider the impact they will have on the smile design parameters-especially the placement and angulation of the dental midline, which is a common starting point for a case involving smile design. The purpose of this article is to determine if the nose and chin deviations affect the perception of dental midline angulation. MATERIALS AND METHODS: An asymmetric facial model (AFM) was created from a digital symmetric facial model, used in a previous study by digitally deviating the nose and chin to the same side. Eight different pictures of this AFM were created, each with different degrees of maxillary midline angulation (both in and against the direction of the deviated nose and chin). Using a visual Likert scaled delivered via Websurvey in the private practice setting, one hundred and ninety-six randomly selected laypersons were asked to evaluate each image according to their own notions of beauty. RESULTS: A minor axial dental midline angulation of 3.5° can be perceived independently of the direction of the cant. All pictures where the midline was canted pointing in the opposite direction of nose and chin deviations presented lower rating mean values. CONCLUSIONS: Off-center noses and chins can influence the perceived attractiveness of a smile with a canted dental midline. The degree and direction of a canted midline can influence the harmony between the smile and overall face, with canting in the same direction of the asymmetric features being rated as more attractive. CLINICAL SIGNIFICANCE: The dental midline should be as vertically straight as possible. If a midline cant is present, however, it is more favorable to have a dental midline angulation which points in the same direction as nose and chin deviations, rather than in the opposite direction.

Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: A randomized, crossover, double-blind clinical trial.

STATEMENT OF PROBLEM: The masticatory efficacy between dentate and edentulous individuals with and without the use of dental adhesives has been little studied. A comparative study of the addition of various agents of synthetic adhesion (vinyl methyl ether versus polyvinyl acetate) to these adhesives is needed. PURPOSE: The purpose of this randomized, crossover, double-blind clinical trial was to compare the masticatory efficacy of wearers of complete dentures with and without dental adhesives of 2 different compositions and that of dentate controls. MATERIAL AND METHODS: Seventeen participants with edentulism (edentulous control and 2 experimental groups) received new maxillary and mandibular complete dentures. After an adjustment period, they participated in masticatory tests with and without the use of 2 denture adhesives (Fittydent; Fittydent International GmbH and Corega; GlaxoSmithKline). The participants with edentulism were compared with 17 dentate controls. Masticatory efficacy was evaluated while the participants were masticating a substitute for irreversible hydrocolloid (20 g) and performing a single test of mastication (with 20 masticatory strokes) at 0, 7, and 14 days. Masticatory efficiency was measured immediately after each test with the sieving method and was calculated according to the weight of the particles of the substitute in each of the sieve filters. Data were analyzed using 1-way ANOVA for simple pairs, and a multiple comparison was made using the Wilcoxon test with Bonferroni correction (α=.05). RESULTS: Significant differences were found between the 2 adhesives (P<.05) in the masticatory efficacy for filters 2 and 3, and nonsignificant differences occurred for filter 1. Compared with the edentulous control group, significant differences between the use or nonuse of adhesives were found in the edentulous group for the 3 filters (P<.05). Compared with the dentate control group, significant differences were found in masticatory efficiency between the dentate control group and the other groups for all comparisons (P<.05). CONCLUSIONS: Masticatory efficacy was higher with the use of Corega denture adhesive. The masticatory efficacy was significantly higher in dentate participants compared with participants with edentulism who had complete dentures, with or without denture adhesives. A significant increase of masticatory efficacy was observed among edentulous participants with denture adhesives in relation to those not using denture adhesives.

Layperson's preference regarding orientation of the transverse occlusal plane and commissure line from the frontal perspective.

STATEMENT OF PROBLEM: Facial asymmetries in features such as lip commissure and interpupillary plane canting have been described as common conditions affecting smile esthetics. When presented with these asymmetries, the clinician must choose the reference line with which to orient the transverse occlusal plane of the planned dental restorations. PURPOSE: The purpose of the online survey described in this study was to determine lay preferences regarding the transverse occlusal plane orientation in faces that display a cant of the commissure line viewed from the frontal perspective. MATERIAL AND METHODS: From a digitally created symmetrical facial model with the transverse occlusal plane and commissure line parallel to the interpupillary line (horizontal) and a model constructed in a previous study (control), a new facial model was created with 3 degrees of cant of the commissure line. Three digital tooth mountings were designed with different transverse occlusal plane orientations: parallel to the interpupillary line (A), parallel to the commissure line (B), and the mean angulation plane formed between the interpupillary and commissure line (C), resulting in a total of 4 images. All images, including the control, were organized into 6 pairs and evaluated by 247 selected laypersons through an online Web site survey. Each participant was asked to choose the more attractive face from each of the 6 pairs of images. RESULTS: The control image was preferred by 72.9% to 74.5% of the participants compared with the other 3 images, all of which represented a commissure line cant. Among the 3 pairs which represent a commissure line cant, 59.1% to 61.1% preferred a transverse plane of occlusion cant (B and C) compared with a plane of occlusion parallel to the interpupillary, line and 61.1% preferred a plane of occlusion parallel to the commissure line (B) compared with the mean angulation plane (C). CONCLUSIONS: Laypeople prefer faces with a commissure line and transverse occlusal plane parallel to the horizontal plane or horizon. When faces present a commissure line cant, laypeople prefer a transverse occlusal plane with a similar and coincident cant.

Fibromyalgia syndrome and temporomandibular disorders with muscular pain. A review.

OBJECTIVES: Temporomandibular disorders (TMD) refer to a group of clinical picture affecting the masticatory muscles and temporomandibular joint that are characterized by muscular or joint pain, dysfunction (limited or altered functions) and joint noises, as well as other associated symptoms, such as tension headaches, otalgia, dizziness, tinnitus, and others. Fibromyalgia (FM) is a syndrome of unknown etiology involving generalized chronic pain accompanied, in a high percentage of cases, by other symptoms such as asthenia, anxiety, depression, sleep disturbances, and other less frequent symptoms, such as temporomandibular disorders (TMD). DATA: Data were compiled by two experienced examiners following a specific form. SOURCES: An electronic search was carried out in the Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, and SCOPUS electronic databases (up to April 2016, unrestricted by date or language). STUDY SELECTION: Comparative clinical studies with patients with both clinical pictures involving the study of pathogenic processes. CONCLUSIONS: Fibromyalgia and temporomandibular disorders with muscle pain both have profiles that affect the muscular system and therefore share many epidemiological, clinical, and physiopathological symptoms. Because of this, we are led to think that there is, if not a common etiology, at least a common pathogenesis. This article revises the physiopathological processes of both clinical pictures in an attempt to determine their similarities and likenesses. This would undoubtedly help in providing a better therapeutic approach.

Tooth Fractures in Fixed Full-Arch Implant-Supported Acrylic Resin Prostheses: A Retrospective Clinical Study.

PURPOSE: The aim of this study was to assess the influence of several variables in the frequency of prosthetic teeth fractures in fixed full-arch implant-supported acrylic resin prostheses. MATERIALS AND METHODS: The influence of each variable was determined after analyzing the results obtained from 161 prostheses after a mean follow-up period of 39.69 months. All patients were treated with standard Nobel Biocare and Biomet 3i implants, and followed a strict prosthodontic protocol. RESULTS: A total of 155 fractures were recorded, all of which took place in 60 prostheses (40% of the total). Statistically significant differences were found among several variables: the arch the prosthesis was on, patient sex, opposing arch characteristics, length of the cantilevers, and whether the structure had mechanical retention. The prostheses that suffered a greater number of fractures were those that had been placed in men, opposing a natural arch, with cantilevers shorter than 10 mm and without mechanical retention. Patient age and presence or absence of a cantilever were not determinants. CONCLUSION: Tooth fractures in fixed full-arch implant-supported metal-acrylic prostheses are a common complication. Several factors are linked more directly with the need for mechanical maintenance. The design and indications of this type of prosthesis should be carefully considered.

Prevalence of alterations in the characteristics of smile symmetry in an adult population from southern Europe.

STATEMENT OF PROBLEM: Deviation from the facial midline and inclination of the dental midline or occlusal plane has been described as extremely influential in the layperson's perceptions of the overall esthetics of the smile. PURPOSE: The purpose of this study was to determine the prevalence of deviation from the facial midline and inclination of the dental midline or occlusal plane in a selected sample. MATERIAL AND METHODS: White participants from a European population (N=158; 93 women, 65 men) who met specific inclusion criteria were selected for the present study. Standardized 1:1 scale frontal photographs were made, and 3 variables of all participants were measured: midline deviation, midline inclination, and inclination of the occlusal plane. Software was used to measure midline deviation and inclination, taking the bipupillary line and the facial midline as references. Tests for normality of the sample were explored and descriptive statistics (means ±SD) were calculated. The chi-square test was used to evaluate differences in midline deviation, midline inclination, and occlusion plane (α=.05) RESULTS: Frequencies of midline deviation (>2 mm), midline inclination (>3.5 degrees), and occlusal plane inclination (>2 degrees) were 31.64% (mean 2.7±1.23 mm), 10.75% (mean 7.9 degrees ±3.57), and 25.9% (mean 9.07 degrees ±3.16), respectively. No statistically significant differences (P>.05) were found between sex and any of the esthetic smile values. CONCLUSIONS: The incidence of alterations with at least 1 altered parameter that affected smile esthetics was 51.9% in a population from southern Europe.

Biometric analysis of the clinical crown and the width/length ratio in the maxillary anterior region.

STATEMENT OF PROBLEM: Restorative dentistry often involves correcting tooth size discrepancies. Therefore, dental biometrics should play an important role in the planning of an esthetic restoration. PURPOSE: The purpose of this study was to analyze the clinical crown width, length, and width/length ratio of maxillary central incisors, lateral incisors, and canines in an adult population. The study also aimed to determine whether a correlation exists between natural tooth dimensions and the optimal tooth dimension guidelines suggested for planning esthetic restorations. MATERIAL AND METHODS: Stone casts were poured from irreversible hydrocolloid impressions of 412 healthy adult participants. These casts were used to measure the maximum mesiodistal width and maximum crown-root length of the maxillary central incisors, lateral incisors, and canines with a digital precision caliper (0.01 mm). The width/length ratio was calculated for each tooth, and 40 casts were selected to test the reliability of the measuring method. RESULTS: The mean age of the participants in the sample was 33.94 years; 60.7% were women and 39.3% were men. The mean width value was 8.71 mm for central incisors, 6.75 mm for lateral incisors, and 7.81 mm for canines. The mean length was 10.23 mm for central incisors, 8.59 mm for lateral incisors, and 9.93 mm for canines. The average width/length ratio was 85% for central incisors and 79% for lateral incisors and canines. CONCLUSION: The data obtained from the population studied are similar to those from previous research studies with similar methodology. However, great discrepancies in the absolute values were found when compared with other studies of ideal tooth dimension guidelines on the personal preferences and the esthetic perception of dentists. The perception of what is considered natural seems to differ from what is considered esthetically perfect.

Perception of maxillary dental midline shift in asymmetric faces.

PURPOSE: The purpose of this article is to determine whether certain facial asymmetries (nose and chin) have an impact on the perception of the maxillary dental midline shift. MATERIALS AND METHODS: From a digitally created symmetric facial model (SFM) constructed in a previous study, a new asymmetric facial model (AFM) was created, with nose and chin deviated to the same side. Modifications were made on the AFM for shifts in the maxillary dental midline in both directions, resulting in a total of eight different images. Through a web survey, 112 randomly selected laypersons were asked to evaluate each image according to their own personal beauty and esthetic criteria using a visual Likert scale. RESULTS: 1 mm of dental midline shift to the left of the AFM was not noticed; 1 mm of dental midline shift to the right of the AFM had a negative impact on perception of facial attractiveness; 2 and 3 mm of dental midline shift to left or right of the AFM had a negative impact on perception of facial attractiveness. CONCLUSIONS: Facial asymmetries such as nose and chin inclinations have an impact on the perception of maxillary dental midline shift. Direction of dental midline shift can be a major factor in this perception.

Maxillomandibular osteomyelitis associated with osteopetrosis.

Osteopetrosis is a heterogeneous disorder characterized by abnormal bone remodeling and increased bone density primarily due to defective osteoclast resorption. The diagnosis is based on a history of numerous fractures and radiological findings indicative of osteosclerosis, usually sufficient for a definitive diagnosis. We present a quite rare case of osteopetrosis complicated by recurrent episodes of maxillomandibular osteomyelitis associated with cutaneous fistulization and purulent nasal discharge. We used intravenous antibiotic therapy and necrotic bone debridement that prevented the appearance of acute infections over a 3-year follow-up, but the complete healing of the case was not achieved.

Laypersons' perception of facial and dental asymmetries.

The purpose of this article was to determine the individual visual perception thresholds of certain facial and dental discrepancies for a symmetric face model (SFM). A facial photograph of a female subject's smile was digitally manipulated into an artificially symmetric picture. Modifications were made on the SFM for shifts in the dental midline, nose, and chin (group 1) and cants of dental midline and incisal plane (group 2), resulting in a total of 24 different images divided into two groups. One-hundred randomly selected laypersons divided into two groups were used to evaluate each image according to their own personal beauty and esthetic criteria using a visual analog scale. The visual perception thresholds found for the SFM were 2 mm for a dental midline shift, 4 mm for nose deviation, 5 degrees for dental midline cant, and 3 degrees for frontal incisal plane cant. Chin deviations of 6 mm or less were not noticed. Dental midline shift, nose deviation, dental midline cant, and incisal plane cant relative to an SFM have an impact on the perception of facial attractiveness. Chin deviations did not have a statistically significant impact.

Myxofibroma of the maxilla. Reconstruction with iliac crest graft and dental implants after tumor resection.

Odontogenic fibromyxomas are benign odontogenic tumors of mesenchymal origin of rare presentation in the oral cavity, which exhibit locally aggressive behavior and are prone to local recurrence. The controversy has mainly been on therapeutic management with recommendations varying, depending on the clinical cases, from simple curettage of lesion to segmental bone resection. We present a case report describing the reconstruction of an osseous defect in the maxilla and the restoration with dental implants in a 32 year old female patient after radical surgical excision due to an odontogenic fibromyxoma with locally aggressive behavior. The primary reconstruction of maxillary discontinuity defect was carried out by an immediate non-vascularized cortico-cancellous iliac crest graft. Using a computer-guided system for the implant treatment-planning, three dental implants were secondary placed in the bone graft by means of flapless implant surgery. The patient was subsequently restored with an implant-supported fixed prosthesis that has remained in continuous function for a period of three years. The surgical, reconstructive and restorative treatment sequence and techniques are discussed.

Effect of tooth type and ferrule on the survival of pulpless teeth restored with fiber posts: a 3-year clinical study.

PURPOSE: To determine, in a 3-year clinical trial, whether tooth type and ferrule significantly affect the survival of pulpless teeth restored with fiber posts. METHODS: A sample of 87 teeth in 87 patients (32 men and 55 women, age ranged from 23 to 78) were restored using Snowpost: 34 incisors, 12 canines, 25 premolars and 16 molars. The posts were cemented with RelyXUnicem and the core was made with a resin composite (Dentocore Automix). Every tooth was covered with a metal-ceramic or all ceramic crown. Two experimental groups, according to the presence or absence of ferrule, were defined: A) 45 teeth with ferrule (>2 mm height); and B) 42 teeth without ferrule (<2 mm height). Patients were reevaluated every 6 months. RESULTS: 14 of the total restorations failed (16.1%). The failure modes were caries (n=4), post fracture (n=4), root fracture (n=2), and marginal gap, post cement failure, crown cement failure, and periapical lesion (n= 1 respectively). In Group A the failure observed was 6.67% and in Group B it was 26.20%. The log-rank test showed statistically significant differences between both groups. According to the type of tooth, the incisors were the teeth with the highest failure rate (73.52%), but Chi-square test showed no statistically significant differences among the four tooth types, perhaps because of the low number of the sample.