Shade management using a new zirconia-reinforced lithium disilicate press ceramic system and leucite-reinforced glass-ceramic veneering system.

The adhesive bonding technique together with tooth-colored ceramic material in fabricating veneers is considered one of the greatest achievements in modern prosthodontics. There is a wide range of indications for veneers, but they are most commonly used to establish adequate function and mask tooth discolorations and inappropriate tooth shape, size or position. A large variety of all-ceramic materials with excellent properties is available on the market today. It is challenging to select the material that will provide the best esthetics and function. The present article explains the principles of a modern, individual treatment approach for a young adult patient with multiple diastemata and shade disharmonies in the maxillary anterior teeth. The treatment plan was based on the selection of the appropriate ceramic material and technical procedures to achieve the best esthetic results using veneers. This included analyzing the specific case; defining the treatment goal; determining the precise shade; and selecting the most suitable and appropriate ceramic material, preparation design, fabrication technique, and adhesive concept. It was decided to use the new VITA zirconia-reinforced lithium disilicate press ceramic system and leucite-reinforced glass-ceramic veneering system to fabricate indirect ceramic veneers for all the maxillary anterior teeth. The size, shape, position, and shade of the natural teeth were changed and the diastemata were closed to achieve a more proportional dental relationship. The esthetic and functional goals were achieved and the patient was extremely satisfied with the final outcome.

Patients' Assessments of Tooth Sensitivity Increase One Day Following Different Whitening Treatments.

OBJECTIVES: The aim of this clinical study was to compare tooth sensitivity scores and color change values before and 1 day following whitening treatments using different concentrations of whitening agents for in-office and at-home procedures. MATERIALS AND METHODS: A total of 60 participants divided into 3 groups were included in this study. A whitening procedure was carried out in groups using 40% hydrogen peroxide (HP) in in-office treatment, 16% and 10% carbamide peroxide (CP), respectively. Participants rated their tooth sensitivity at the baseline and 1 day following the treatment. The CIElab values were recorded and color differences were calculated. RESULTS: Within each of the whitening treatments, the tooth sensitivity scores significantly increased following the procedure (p<0.05). The largest significant increase in scores was noted in 40% HP in-office whitening treatment, while the lowest increase was noted in 10% CP at-home whitening treatments (p<0.05). The highest color change 1 day following the procedure was found in the 40% HP in-office whitening treatment group (3.3) and it significantly differed from both 16% CP and 10% CP at-home whitening treatments whose color difference was both 2.0, respectively (p<0.05). CONCLUSION: 1 day following the procedure, a low concentrate CP agent for at-home whitening causes the least tooth sensitivity compared to higher concentrate CP for at-home and HP for in-office agents, with the same color change efficacy as higher concentrate CP agent. In case with slight tooth sensitivity reported at the baseline, a 10% CP whitening treatment should be recommended.

A clinical study assessing the short-term efficacy of combined in-office/at-home whitening treatment.

OBJECTIVE: The purpose of this randomized clinical trial was to assess the efficacy of color change in combined in-office/at-home whitening. MATERIALS AND METHODS: Thirty participants were randomly divided into two groups: 15 received combined treatment in-office whitening (6% hydrogen peroxide + 2 weeks at-home whitening with 16% carbamide peroxide [CP]); 15 were assigned to control group. Instrumental color measurements were obtained before whitening (t0 ), immediately after in-office whitening (tin-office ), after 1 week of active treatments (t1 ), and at the completion of the whitening treatment (t2 ). CIE L*a*b* values were recorded and CIE L*a*b* and CIEDE2000 color differences were calculated. RESULTS: The color change at tin-office was ΔEab = 4.7 and ΔE00 = 3.2 and overall color change of combined method at t2 was ΔEab = 8.2 and ΔE00 = 5.3 (P < 0.05). A statistically significant effect for the mean CIE L*a*b* and CIEDE2000 values was detected within time with the mean a*, b* and C' values decreasing and mean h' values increasing significantly (P < 0.05). CONCLUSIONS: Combined in-office/at-home whitening was effective. Whitening efficacy increased upon application of 16% CP in combined in-office/at-home treatment (P < 0.05). CLINICAL SIGNIFICANCE: The statistically significant increase in color change recommends clinical application of combined in-office/at-home whitening treatment.

Salivary Oxidant/Antioxidant Status in Chronic Temporomandibular Disorders Is Dependent on Source and Intensity of Pain - A Pilot Study.

Temporomandibular disorders (TMD) have been associated with altered salivary oxidative status, but the relation with pain source and pain severity isn't clarified. With the aim to assess their interaction with TMD, we compared levels of selected salivary oxidative stress (OS) markers (glutathione peroxidase, superoxide dismutase, total antioxidant capacity (TAC), uric acid, 8-hydroxydeoxyguanosine, malondialdehyde) and salivary cortisol (SC) as a stress indicator, between 20 TMD patients and 15 healthy control subjects. In order to record differences relating to pain source and severity, patients were respectively classified according to specific diagnoses (myofascial pain or disc displacement (DD)), and pain intensity (high or low). TAC was significantly higher in TMD patients than in controls (morning p = 0.015; afternoon p = 0.005). Significant differences were also observed when TAC levels between high-intensity pain patients and controls were compared, as well as between DD patients and controls. In logistic regression analysis, higher levels of TAC were related to DD (morning OR: 1.66, 95%CI: 1.05-2.64, p = 0.029; afternoon OR: 2.10, 95%CI: 1.11-3.98, p = 0.021) and to high-intensity pain (morning OR: 1.81, 95%CI: 1.04-3.15, p = 0.037; afternoon OR: 1.79, 95%CI: 1.02-3.14, p = 0.043). We also found that morning SC was positively correlated with antioxidant parameters in TMD patients. Our data suggest compensatory mechanism as response to higher level of stress. This stress could be extrinsic and lead toward TMD, or intrinsic, emerging from established TMD, or could be both. The intensity and the source of pain should be considered important factors in future investigations evaluating salivary OS markers in TMD patients.

Effect of Clinical Experience on the Shade Matching Accuracy in Different Dental Occupational Groups.

OBJECTIVES: The aim of this study was to evaluate the effect of clinical experience level on the shade matching accuracy in different dental occupational groups. MATERIALS AND METHODS: A total of 80 participants, assigned to one of four groups depending on the level of their clinical experience in shade matching: dental technicians (DTs), residents in prosthodontics (RPs), specialists in prosthodontics (SPs) and dental students (DSs) took part in the study. They were asked to use Tooth guide Training Box (TTB) and determine 15 standardized shade tabs using VITA 3D-Master shade guide. The number of mistakes in final test for each participant was recorded and accuracy was calculated. Color difference (ΔE) values for each shade were calculated from L*, a* and b* values. Differences in accuracy, mean ΔE values and mean error ΔE values between four different groups were examined. RESULTS: No statistically significant differences were found between the groups regarding accuracy and mean ΔE values (p>0.05). The accuracy rate in four groups was 0.51±0.20 (DTs), 0,54±0.18 (RPs), 0.49±0.16 (SPs) and 0.55±0.14 (DSs), respectively. Mean ΔE values were 2.10±0.98 (DTs), 2.18±0.97 (RPs), 2.51±0.97 (SPs) and 2.08±0.86 (DSs), respectively. Regarding mean error ΔE values, DTs made errors with significantly less deviations compared to other groups (p<0.05). CONCLUSIONS: This study has shown that clinical experience is not found to be a significant factor to the shade matching accuracy. With regard to the mean error ΔE values, DTs were more successful in shade matching than other participants.

Within-Subject Reliability and between-Subject Variability of Oxidative Stress Markers in Saliva of Healthy Subjects: A Longitudinal Pilot Study.

The present study evaluated diurnal variations and day-to-day fluctuations of salivary oxidative stress (OS) markers in healthy adult individuals. Whole unstimulated saliva was collected at 2 time intervals over 3 consecutive days. Glutathione peroxidase (GPX), superoxide dismutase (SOD), total antioxidant capacity (TAC), and uric acid (UA) were analyzed using spectrophotometric methods, while 8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) were determined using immunoassays. No significant differences for salivary OS markers between men and women were observed. For all examined OS markers, no significant day-to-day variations were demonstrated. Significant diurnal variations were found in salivary GPX, TAC and MDA levels. For SOD, TAC, GPX, and UA, good-to-moderate intraindividual coefficients of variations (CVs) were observed in more than 75% of the subjects. For MDA and 8-OHdG, intraindividual CVs > 35% were observed in 60% and 40% of the subjects, respectively. Between-subject variance was wide for all examined OS markers (CV% 30.08%-85.70%). Due to high intraindividual variability in the salivary concentrations of MDA and 8-OHdG, those markers cannot be reliably verified based on single measurements and multiple measurements over several days would provide more reliable information. Salivary SOD, TAC, GPX, and UA proved stable across three days of measurement. Trial Registration. ClinicalTrials.gov NCT03029494. Registered on 2017-01-19.

Radiomorphometric indices of mandibular bones in an 18th century population.

OBJECTIVE: To estimate four radiomorphometric indices of mandibular bones in an 18th century population sample, and possibly associate the findings with bone mass loss related to sex, age, nutritional habits and pathologies reflecting on the bone. DESIGN: Thirty-six sculls (31 males, 5 females), recovered from the crypt of Pozega Cathedral in Croatia were analyzed. Age estimation was based on tooth wear, and Eichner class was determined according to the number of occlusal supporting zones. The parameters in recording analogue orthopantomographs were set to constant current of 16 mA, exposure time of 14.1s, and voltage between 62-78 kV. Films were processed in an automatic dark chamber processor for 12 min, and digitized at 8-bit, 300 dpi. The thickness of the mandibular cortex was assessed below the mental foramen (MI), at antegonion (AI), at gonion (GI). Qualitative mandibular cortical index (MCI) was assessed. RESULTS: Average values of MI, AI and GI were 3.97 ± 0.94 mm, 2.98 ± 0.56 mm, and 1.99 ± 0.55 mm, respectively. Statistically significant differences between males and females were found for AI right (p=0.014), GI left (p=0.010) and GI average (p=0.006), and were in all cases higher in males. There were no statistically significant differences between age groups for either index (p>0.05). Considering Eichner classification the differences were not significant for MI (p=0.422), AI (p=0.516), and GI (p=0.443), but in Eichner classes II, MCI was significantly higher (p=0.02). CONCLUSION: The obtained data does not suggest generalized malnutrition or calcium, phosphorus and vitamin D deprivation in the historic population studied.

Residual ridge atrophy in complete denture wearers and relationship with densitometric values of a cervical spine: a hierarchical regression analysis.

BACKGROUND: The rate of residual ridge atrophy (RRR) and its association with mineral density of other bones have not yet been fully explained. OBJECTIVE: To measure RRR over a 5-year period in complete denture wearers and relate it to the density of a cervical spine (CSBD). MATERIALS AND METHODS: Sixty-two patients (different gender, age, body mass index, duration of edentulousness (DE) and different denture-wearing habits) participated. A copper stepwedge was attached to the cassette, and 50 lateral radiograms met the criteria to be included. RESULTS: A significant decrease in vertical height was observed in all measured sites. The amount of RRR was highest in frontal areas of both jaws and decreased gradually towards lateral regions. Hierarchical regression analysis revealed that the amount of RRR in the maxillary frontal area could be explained up to 48.4% by the variable DE and only up to 6.1% by the CSBD, while gender had almost no influence (1%). Similar results were obtained for the lateral maxillary RRR (33.9%; 7%; 2%), frontal mandibular RRR (40; 8.4; 0.4%) and lateral mandibular RRR (31.5%; 3.4%; 7.7%). CONCLUSION: Skeletal bone density, reflecting systemic and hereditary factors, is weakly related to RRR (3.4-8.4%).

Influence of esthetic dental and facial measurements on the Caucasian patients' satisfaction.

PURPOSE: The purpose of the present study was to investigate how some esthetic dental and facial measurements may correlate the variability of patients' ratings of their satisfaction with the maxillary anterior teeth appearance in different gender groups. MATERIALS AND METHODS: The following measurements were made on 78 Caucasian subjects: width and length of each maxillary anterior tooth, their distal gingival zenith displacements, the upper lip height, intercommisural width, maximum maxillary central incisal, and gingival display at rest and smile. All the patients rated their satisfaction with the dental appearance on the visual-analogue scale (0 meaning absolute dissatisfaction, whereas 4 indicated complete satisfaction). All the parameters have been analyzed with respect to gender. RESULTS: The majority of the esthetic dental and facial measurements were larger in men (p<0.05). The great majority of the participants were completely satisfied with their dental appearance (75% of men and 89% of women; p>0.05). In the men, the two factors of maximal maxillary incisal display at rest and intercommisural width at smile paralleled the variability of the patients' satisfaction with dental appearance by 99% (p>0.05). In women, the combination of central incisor width/length ratio, intercommisural width at rest, central incisor gingival zenith displacement, intercommisural width at smile, upper lip height, and maximum maxillary incisal display at rest paralleled the variability of the patients' satisfaction with dental appearance by 99% (p>0.05). CONCLUSIONS: Within the population tested, the results suggest that the use of esthetic dental and facial measurements may serve as an esthetic guideline and should be considered in esthetic anterior oral rehabilitation. CLINICAL SIGNIFICANCE: The information presented in this article may be useful in helping to create dental restorations with an acceptable esthetic appearance to the patient. Prior to the treatment the dentist should consider not only the size of maxillary anterior teeth but also their gingival architecture and the soft tissue surrounding the teeth.

A quantitative evaluation of the distal displacement of the gingival zenith in the maxillary anterior teeth.

The aim of this study was to quantify the specific distal displacement of the gingival zenith in the maxillary anterior dentition. Bilateral measurements, taken with a digital caliper in maxillary stone casts were recorded in six maxillary anterior teeth to evaluate distal displacement of the gingival zenith in relation to the long axis of the crowns. The gingival zenith was distally displaced between 0.45 and 1.01 mm in 90%, 85% and 60% of the central incisors, lateral incisors and canines, respectively. Contralateral comparisons between the tooth groups revealed significantly larger distal displacement of the zenith in left canine (p < 0.05). Ipsilateral comparisons revealed that the lateral displacement of the zenith was significantly larger in central than in lateral incisors (p < 0.05). Similarly, the zenith of lateral incisors was displaced significantly more distal than that of canine teeth (p < 0.05). Comparisons of the frequency of coincidence of the position of the gingival zenith with the long axis of the tooth revealed that it was significantly greater in canines than in lateral and central incisors (p < 0.05). The frequency and magnitude of distal displacement is tooth-dependent and larger in central than in lateral incisors, which in turn, is larger than in canines. These data could be used as reference points during esthetic anterior oral rehabilitation, especially in case of porcelain laminate veneers.

Surgical treatment of pathologic fractures in patients with metastatic tumors.

The study presents results in treatment of pathologic fractures of long bones of all patients who underwent surgery in the last 10 years in our hospital. The study cohort comprised 133 consecutive patients divided in two groups who underwent surgery of long bone fractures caused by metastatic tumor or trauma. We used resection, open reduction and plating with bone cement application for pathologic fracture and some cases of femoral shaft fractures were stabilized with intramedullary nailing. Proximal femoral fractures were treated with hip arthroplasty or dynamic hip screw. There were 2 amputations performed: one case of pathologic fracture of tibia and one case of humeral fracture. The present study compares results between two group of patients. We noted: age, gender, fracture site, choice of the surgical procedure, hospital stay, need for analgesia after surgery, postoperative complications, and reached level of physical activity after surgery. The mean survival rate was 8.1 months. Seventeen patients experienced postoperative complications. We also found statistically significant improvement in functional scores (MSTS and TESS) in surgically treated patients with pathologic fractures. There are many different techniques of surgical treatment of pathologic fractures caused by skeletal metastases including arthroplasty or a combination of internal fixation combined with polymethyl methacrylate (PMMA) that provides immediate fixation and stability. The present study showed that surgical treatment of pathologic fractures caused by skeletal metastases in vast majority of cases provides bone healing after pathologic fracture, with significant improvement of physical activity and rehabilitation in the investigated group.

[Assessment tools in early detection of osteoporosis in dentistry]. / Dijagnosticke metode za rano otkrivanje osteoporoze u stomatologiji.

Osteoporosis, one of the major skeletal diseases in older age, is characterised by low bone mass and microarchitectural deterioration with a resulting increase in bone fragility and hence susceptibility to fracture. In this review we analyse the systemic and local factors associated with oral bone mass loss. Systemic factors most often correlated with the oral bone mass loss include osteoporosis, renal diseases, hormonal disorders, diet and the impact of different drugs on the bony structure. Chronic periodontal disease, early loss of teeth or the effect of inadequate prosthodontic appliance on the residual ridge are the local factors associated with mandibular bone loss. Different assessment tools for the assessment of mandibular oral bone loss have been proposed, such as DXA absorptiometry, quantitative computed tomography, intraoral microdensitometry, SCORE index and the assessment of the thickness and quality of the mandibular inferior cortical border. Qualitative and quantitative assessment of the mandibular bony structure is of great importance in all fields of dentistry - from periodontology to endodontics and prosthodontics, especially in dental implantology. It is important to make the correct indication prior to dental implant therapy, and taking into account the systemic and local factors mentioned above, assess both the actual quality and quantity of the mandible.

Relationship of slightly limited mandibular movements to temporomandibular disorders.

Mandibular movements have been analyzed extensively in the past for prosthodontic reasons, and more recently to study the function of the masticatory system. This study investigated the range of mandibular movements in a young male population, and analyzed the difference in range of mouth opening, right and left lateral movements, and protrusive movement between asymptomatic subjects (control group) and patients with clinical diagnoses of temporomandibular disorders. A total of 180 subjects, aged 19-28 years, were included in the study. The TMD sample comprised 90 patients (30 patients with muscle disorders; 30 patients with disc displacement with reduction; 30 patients with muscle disorders and disc displacement with reduction) and was compared with 90 healthy control subjects. All participants were evaluated by the attending dentist at baseline with a complete physical examination and history questionnaire, which included the Research Diagnostic Criteria for Temporomandibular Disorders Axis I measures. Analysis of variance (ANOVA) showed significant differences in ranges of mandibular movements between and within the groups of healthy control subjects and patients with muscle and temporomandibular joint disorders. It is suggested that there are differences in the range of mandibular movements that clearly separate asymptomatic subjects and patients with temporomandibular disorders in this young male population.

Factors related to patient satisfaction with complete denture therapy.

BACKGROUND: Except for denture quality, many other factors are related to a patient's satisfaction with complete dentures (CDs). METHODS: A total of 222 patients with CDs took a part in this study. A questionnaire divided into 3 parts was completed by both the patients and the dentist, independently. The patients rated their dentures using a scale ranging from 1 to 5 (1 = dissatisfaction to 5 = excellent), and a dentist rated the quality of the denture and the denture-bearing area. RESULTS: Patients were mostly satisfied with the quality of their CDs. Only 7.2% of the patients were absolutely not satisfied with their dentures. Patients with a low level of education were more satisfied in general with their aesthetic appearance. Patients with better self-perception of their affective status and quality of life showed higher levels of general satisfaction. Patients with better self-perception of their economic status showed lower levels of satisfaction. Younger patients wearing dentures for the first time, with short periods of being edentulous, and with better quality maxillary denture-bearing areas were more satisfied with the retention of maxillary CDs. In contrast, younger patients with first-time dentures, a short period of being edentulous, and with better quality mandibular denture-bearing areas gave lower ratings to the retention and comfort of wearing mandibular dentures. CONCLUSIONS: Level of education, self-perception of affective and economic status, and quality of life are all related to patient satisfaction. However, the quality of dentures shows the strongest correlation with patient satisfaction. Not only the quality of the denture-bearing area but the denture-wearing experience itself seems to be more important in determining patient satisfaction with mandibular CDs.

Measurement of mandibular movements in patients with temporomandibular disorders and in asymptomatic subjects.

The aim of the study was to investigate the range of mandibular movements and to analyze the difference in range of mouth opening, right and left lateral movements, and protrusive movement between patients with clinical diagnoses of temporomandibular disorders and asymptomatic subjects (control group) in a young male population. A total of 240 subjects, aged 19-28, were included in the study. The TMD sample comprised 180 patients (60 patients with muscle disorders; 60 patients with disc displacement with reduction; and 60 patients with muscle disorders and disc displacement with reduction) and was compared with 60 healthy control subjects. All participants were evaluated by the attending dentists at baseline by means of a physical examination of the masticatory system and a history questionnaire which included the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I measures. Analysis of variance (ANOVA) with the post hoc Bonferroni criteria showed significant difference in ranges of mandibular movements between and within the groups of asymptomatic subjects and TMD patients for active mouth opening (p = 0.001), right lateral movement (p = 0.002), left lateral movement (p = 0.006), and protrusive movement (p = 0.05). It has been found that there are statistically significant differences in the range of mandibular movements that separate asymptomatic subjects and patients with muscle disorders and disc displacements with reduction in this young male population. However, we cannot conclude that measurements of active mandibular movements can discriminate one group (TMD patients) from the other (asymptomatic subjects), because the mean ranges of these active movements between the groups were measured in clinically "normal" values.

Influence of body mass index and the time of edentulousness on the residual alveolar ridge resorption in complete denture wearers.

Alveolar bone loss (RRR) is a continuous process following tooth extraction, more pronounced during the first few months after the tooth extraction than later. The RRR in the mandible is twice that of the maxilla during a 1-year period and the mandibular: maxillary resorption ratio increases further to 4:1. So far, the etiology of RRR has not been elucidated. It has been speculated that both systemic and local factors contribute. The aim of this study was to analyse the rate of RRR in five different regions of both jaws on lateral cephalograms of 100 complete denture wearers during a one-year period and to compare the rate of RRR between patients being edentulous over a different period of time and between patients with different body mass index. The height of residual ridges was measured on 5 different sites at the delivery of the dentures and a year later using a calibrated grid. The results revealed significant RRR in a one year period. Body mass index had no significant influence on the rate of RRR on any of the five examined sites of the maxilla or the mandible (p > 0.05), while the period of edentulousness had a significantly higher rate of resorption in first 3 sites of measurement (anteriorly) in patients being edentulous less than 1 year than in patients being edentulous for 1-10 years or for over 10 years (ANOVA, p < 0.05).

A comparison of patient's satisfaction between complete and partial removable denture wearers.

OBJECTIVES: The aim of this study was to compare satisfaction between complete denture (CD) and Kennedy Class I removable partial denture (RPD) wearers. MATERIALS AND METHODS: A total of 156 CD and 112 RPD wearers took a part in this study. From the primary group of the examined patients, only those whose RPDs and CDs were assessed as excellent or very good by the dentist, took a part in this study. Patients graded satisfaction of their dentures by using an analogue scale from 1 to 5 (1=unsatisfactory; 5=excellent). RESULTS: Both CD and RPD wearers were mostly satisfied with their dentures (the distribution of the scores of the patients' assessments was skewed towards the highest scores; more than half of the patients scored all the examined variables to the best score category). Complete Denture wearers were significantly more satisfied with chewing, speech and retention of maxillary denture than RPD wearers (P<0.05). Removable partial denture wearers were significantly more satisfied with the retention and the comfort of wearing mandibular denture (P<0.05). There was no significant difference between CD and RPD wearers for general satisfaction with their dentures, aesthetics and comfort of wearing maxillary denture (P>0.05; N.S.). CONCLUSIONS: A majority of CD and RPD wearers were satisfied with the dentures. CD wearers were more satisfied with speech, chewing and retention of maxillary denture, while RPD wearers were more satisfied with the retention and the comfort of wearing mandibular denture. Different groups of denture wearers have to make significant, but different adjustments to wear their dentures successfully.