Prophylactic third molar removal: are oral surgeons and orthodontists aligned in preventive approaches?

BACKGROUND: There is a general consensus among dental professionals regarding the extraction of impacted third molars in the presence of clinical symptoms. However, there is less agreement on the management of asymptomatic third molars. The objective of this study is to compare the perspectives of oral surgeons and orthodontists regarding the indications for the extraction of asymptomatic third molars. It is possible that healthcare professionals from different specialties may approach the extraction of these teeth in different ways. METHODS: In this cross-sectional study, a web-based questionnaire has been employed to collect data by inquiring about the reasons why participants prefer the extraction of asymptomatic third molars. Descriptive statistics were employed to evaluate the data obtained. The level of significance was set at P < 0.05. RESULTS: Prophylactic extraction of partially impacted molars was more favored among the participants (P < 0.05). The orthodontists preferred prophylactic extraction due to the risk of late anterior dental crowding (LADC); however, the oral surgeons preferred pre-pregnancy extractions (P < 0.05). The extraction decision for partial impaction was higher in females when the risk of distal caries was considered. For fully impacted ones, it was higher in males when the risk of caries and pericoronitis were considered (P < 0.05). CONCLUSIONS: Orthodontists preferred extraction because of the risk of LADC and caries, while oral surgeons focused on preventing pericoronitis, pathology, focal infection, and symptoms during pregnancy. This divergence between the participants may inform the guidelines for prophylactic management of third molars. These findings may be pertinent in gender medicine. CLINICAL RELEVANCE: This study has been enlightening for departments to consult each other before the extraction of a patient's asymptomatic third molar.

Increase in Oral Streptococcal Endocarditis Among Moderate-Risk Patients: Impact of Guideline Changes on Endocarditis Prevention.

Background: The well-established connection between oral bacteria and infective endocarditis (IE) has prompted discussions about using antibiotic prophylaxis (AP) before invasive dental procedures. In 2007/2008, guidelines restricted AP from moderate and high-risk to exclusively high-risk patients. Objectives: The authors aimed to assess whether the proportion of oral streptococcal IE increased in moderate-risk patients using University Hospital Zurich data from 2000 to 2022. Methods: Adult IE patients were categorized into risk groups based on European Society of Cardiology and Swiss guidelines. The investigation focused on analyzing the proportion of oral streptococcal IE across different risk groups in two distinct periods (1: 2000-2008; 2: 2009-2022). Logistic regression models, adjusted for various factors, were employed. Results: Of 752 IE cases, 163 occurred in period 1, and 589 in period 2. Oral streptococci caused 22% of cases. Proportions of streptococcal IE in period 1 versus period 2 were 24% versus 16% in high-risk, 24% versus 39% in moderate-risk, 33% versus 7% in low-/unknown-risk, and 18% versus 14% in no-risk patients. Compared to the other risk groups, the moderate-risk group had a 22% higher chance of oral streptococcal IE in period 2. After multivariable adjustment, moderate-risk patients had twice the risk of oral streptococcal IE compared to period 1 (OR: 2.59 [95% CI: 1.16-5.81]). Among moderate-risk conditions, congenital valve anomalies were associated with oral streptococcal IE (unadjusted OR: 2.52 [95% CI: 1.71-3.71]). Conclusions: Oral streptococcal IEs increased in the moderate-risk group of patients after the AP guideline change. Exploring the potential necessity for expanding AP indications to certain patient groups with congenital valve anomalies may be warranted.

Effect of adding ytterbium trifluoride filler particles on the mechanical, physicochemical and biological properties of methacrylate-based experimental resins for 3D printing.

OBJECTIVE: To formulate an experimental methacrylate-based photo-polymerizable resin for 3D printing with ytterbium trifluoride as filler and to evaluate the mechanical, physicochemical, and biological properties. METHODS: Resin matrix was formulated with 60 wt% UDMA, 40 wt% TEGDMA, 1 wt% TPO, and 0.01 wt% BHT. Ytterbium Trifluoride was added in concentrations of 1 (G1 %), 2 (G2 %), 3 (G3 %), 4 (G4 %), and 5 (G5 %) wt%. One group remained without filler addition as control (GC). The samples were designed in 3D builder software and printed using a UV-DLP 3D printer. The samples were ultrasonicated with isopropanol and UV cured for 60 min. The resins were tested for degree of conversion (DC), flexural strength, Knoop microhardness, softening in solvent, radiopacity, colorimetric analysis, and cytotoxicity (MTT and SRB). RESULTS: Post-polymerization increased the degree of conversion of all groups (p < 0.05). G2 % showed the highest DC after post-polymerization. G2 % showed no differences in flexural strength from the G1 % and GC (p > 0.05). All groups showed a hardness reduction after solvent immersion. No statistical difference was found in radiopacity, softening in solvent (ΔKHN%), colorimetric spectrophotometry, and cytotoxicity (MTT) (p > 0.05). G1 % showed reduced cell viability for SRB assay (p < 0.05). SIGNIFICANCE: It was possible to produce an experimental photo-polymerizable 3D printable resin with the addition of 2 % ytterbium trifluoride as filler without compromising the mechanical, physicochemical, and biological properties, comparable to the current provisional materials.

Effect of Stearyl Methacrylate Comonomer on the Mechanical and Physical Properties of Dimethacrylate-Based Dental Resins.

This study evaluated the effect of stearyl methacrylate addition on the physical and mechanical properties of bisphenol A glycidyl methacrylate- and triethylene glycol dimethacrylate-based polymers, which are traditionally used in dental applications. Methacrylate-based monomer compositions are polymerized under the visible blue light spectrum. An analysis of double bond conversion, surface microhardness test, three-point bending test and water sorption and water solubility were tested to determine the physical and mechanical properties of the dental polymers. The results indicated that stearyl methacrylate addition up to 25 wt% reduced the water sorption of the polymers. At amounts of stearyl methacrylate higher than 25 wt%, the solubility of the polymer in water increases due to the monofunctional structure. Mechanical properties are negatively affected by the increasing stearyl methacrylate ratio. Further, the addition of stearyl methacrylate slightly increased thermal stability. As such, the amount of stearyl methacrylate in a polymer composition is critical for the optimization of its mechanical and physical properties. According to the results, the amount of stearyl methacrylate has to be between 12.5-25 wt%.

Clinical outcome of non-surgical root canal treatment using different sealers and techniques of obturation in 237 patients: A retrospective study.

OBJECTIVES: The aim of this retrospective study was to compare the clinical results of two root canal sealers and three obturation techniques used for non-surgical root canal treatment. MATERIALS AND METHODS: A total of two hundred eighty-three root canal treated teeth in two hundred thirty-seven patients with minimum a 6-month follow-up was included for this study. The canals were filled with three different modes: 1) cold lateral condensation (CLC) and AH Plus Sealer; 2) continuous wave condensation technique (CWC) and AH Plus Sealer, and 3) sealer-based obturation technique (SBO) and AH Plus Bioceramic Sealer. The treatment outcome was analysed based on clinical signs and symptoms, and periapical radiograph (periapical index, PAI). RESULTS: There were no significant differences in treatment outcome between various sealers and filling techniques applied. The sealer extrusion was found most frequently in the CWC group (60.67%), followed by SBO (59.21%) and CLC (21.19%) with statistically significant differences (p < .05). The initial diagnosis, previous treatment and sealer extrusion (p < .05) were prognostic factors that affected treatment outcome. CONCLUSIONS: Based on the findings of this study, neither the sealer type nor the filling technique affected the treatment success while preoperative diagnosis, previous treatment and sealer extrusion had significant effect on the outcome. CLINICAL RELEVANCE: A bioceramic sealant applied along with the single-cone technique might be considered as an alternative method in root canal obturation.

The impact of inorganic fillers, organic content, and polymerization mode on the degree of conversion of monomers in resin-matrix cements for restorative dentistry: a scoping review.

PURPOSE: The main aim of the present study was to carry out a scoping review on the differences in degree of conversion of monomers regarding several types resin cements, indirect restorative materials, and light-curing procedures used in dentistry. METHOD: A bibliographic review was performed on PubMed using the following search items: "degree of conversion" OR "filler" AND "resin cement" OR "inorganic cement" AND "organic" OR "radiopacity" OR "refractive" OR "transmittance" OR "type" AND "resin composite." The search involved articles published in English language within the last thirteen years. A research question has been formulated following the PICO approach as follow: "How different is the degree of conversion of monomers comparing several types of resin-matrix cements?". RESULTS: Within the 15 selected studies, 8 studies reported a high degree of conversion (DC) of the organic matrix ranging from 70 up to 90% while 7 studies showed lower DC values. Dual-cured resin-matrix cements revealed the highest mean values of DC, flexural strength, and hardness when compared with light- and self-polymerized ones. DC mean values of resin-matrix cements light-cured through a ceramic veneer with 0.4 mm thickness were higher (~ 83%) than those recorded for resin-matrix cements light-cured through a thicker ceramic layer of 1.5 mm (~ 77%). CONCLUSIONS: The highest percentage of degree of conversion of monomers was reported for dual-cured resin-matrix cements and therefore both chemical and light-induced pathways promoted an enhanced polymerization of the material. Similar degree of conversion of the same resin-matrix cement were recorded when the prosthetic structure showed a low thickness. On thick prosthetic structures, translucent materials are required to allow the light transmission achieving the resin-matrix cement. CLINICAL RELEVANCE: The chemical composition of resin-matrix cements and the light-curing mode can affect the polymerization of the organic matrix. Thus, physical properties of the materials can vary leading to early clinical failures at restorative interfaces. Thus, the analysis of the polymerization pathways of resin-matrix cements is significantly beneficial for the clinical performance of the restorative interfaces.

Effect of Different Adhesive Resin and Composite Veneering Materials on Adhesion to Polyetheretherketone.

OBJECTIVE: To evaluate the effect of different adhesives and veneering resins on the shear bond strength (SBS) of polyetheretherketone (PEEK). METHODS: A total of 138 PEEK specimens were randomly divided into 6 groups according to adhesive material application: Control (C, no application), Adhese Universal (A) (Ivoclar Vivadent, Schaan, Liechtenstein), Gluma Bond Universal (G) (Heraeus Kulzer, South Bend, IN, USA), G-PremioBOND (P) (GC Corporation, Tokyo, Japan), Single Bond Universal (S) (3M, Saint Paul, MN, USA) and visio.link (V) (Bredent, Senden, Germany). Each adhesive group was divided into two subgroups according to the type of veneering material: Estenia direct composite (D) and Gradia Plus indirect composite (IN) (both GC Corporation). After the veneering process, the specimens were aged by thermal cycling. Kruskal-Wallis and Mann-Whitney U tests were used for SBS analysis (P < 0.05). RESULTS: The highest SBS results were obtained in the VIN group, followed by the VD, PD, GIN, AIN, AD, SIN, SD, PIN, GD, CIN and CD groups, respectively (P = 0.001). There were no significant differences in terms of the type of veneering composite when the same adhesive was applied (P > 0.05), except for Gluma Bond Universal (P = 0.009). All the adhesives tested showed clinically acceptable SBS results. CONCLUSION: Visio.link offered the highest adhesion to PEEK, whereas the tested universal adhesives may be used as an alternative to visio.link in clinical settings. It was determined that changing the veneer type has no statistical difference when the same adhesive material is used.

Load-bearing capacity, internal accuracy and time-efficiency of heat-pressed, milled and 3D-printed lithium disilicate ultra-thin occlusal veneers.

OBJECTIVES: The primary aim of this in vitro study was to compare the load-bearing capacity of lithium disilicate occlusal veneers, fabricated via different manufacturing processes. Secondary objectives included assessing internal accuracy and production time-efficiency. METHODS: Four fabrication methods for ultra-thin lithium disilicate occlusal veneers on extracted human molars with simulated erosive defects were compared (n = 20/group): CAM: milled lithium disilicate (IPS e.max CAD); HPR: heat-pressed lithium disilicate (IPS e.max Press) out of a milled PMMA template (Ddpmma CAST); 3DP: 3D-printed lithium disilicate (experimental lithium disilicate); PTE: heat-pressed lithium disilicate (IPS e.max Press) out of a 3D-printed template (SilaPrint cast). Internal accuracy was measured prior to thermo-mechanical aging, followed by static loading to measure the load-bearing capacity (Fmax). Fabrication time (time-efficiency) was also recorded. Statistical analysis was performed using the Kruskal-Wallis (KW) test. RESULTS: No statistically significant differences were found in median load-bearing capacities (Fmax) between the groups (KW p = 0.5902): CAM 1821 N, HPR 1896 N, 3DP 2003 N, PTE 1687 N. Significant differences were found in internal accuracy between the groups that employed printing processes (3DP, PTE) and all other groups in margins (p < 0.001), cusps (p < 0.0018), and fossae (p < 0.0346). The time-efficiency measurements indicated an increase in fabrication time, starting from CAM 67.2 ± 5.8 min, followed by HPR 200.8 ± 33.0 min, PTE 289.2 ± 38.7 min, and peaking with the highest duration observed for 3DP 701.6 ± 8.1 min. SIGNIFICANCE: The fabrication method of ultra-thin lithium disilicate occlusal veneers does not significantly impact their load-bearing capacity, but affects the clinical fit and adaptation of the veneers.

Fitting of Different Intraradicular Composite Posts to Oval Tooth Root Canals: A Preliminary Assessment.

The purpose of the present study was to perform a preliminary analysis of the fitting of different fiber-reinforced composite (GFRC) posts to tooth root canals and determine the resin cement layer thickness. The following GFRC posts were assessed: bundle posts (Rebilda GTTM, VOCO, Germany), sleeve system (SAPTM, Angelus Ind, Brazil), and accessory posts (ReforpinTM, Angelus, Brazil). Twenty-four freshly extracted mandibular single-rooted pre-molars were endodontically treated and divided into six groups, according to the type of GFRC post and resin cement (self-adhesive or conventional dual-cured). Then, specimens were cross-sectioned and inspected by optical microscopy regarding the cement layer thickness and presence of defects such as pores, voids, or fissures were assessed. Bundle and accessory posts revealed a regular distribution of resin cement with a lower number of voids than found with sleeve systems. The sleeve system posts showed poor fitting at the apical portion of the root canals. The type of resin cement did not affect the thickness of the interface, although both bundle and accessory posts allow a better distribution of resin cement and fibers. The present preliminary study reveals interesting insights on the fitting of bundle and accessory posts to root dentin and resin cement layer thickness in oval-shape root canals. The sleeve system posts showed adequate fitting only at the coronal portion of the canals.

Evaluating mechanical and surface properties of zirconia-containing composites: 3D printing, subtractive, and layering techniques.

This study assessed the monotonic and fatigue flexural strength (FS), elastic modulus (E), and surface characteristics of a 3D printed zirconia-containing resin composite compared to subtractive and conventional layering methods. Specimens, including discs (n = 15; Ø = 15 mm × 1.2 mm) and bars (n = 15; 14 × 4 × 1.2 mm), were prepared and categorized into three groups: 3D printing (3D printing - PriZma 3D Bio Crown, Makertech), Subtractive (Lava Ultimate blocks, 3M), and Layering (Filtek Z350 XT, 3M). Monotonic tests were performed on the discs using a piston-on-three-balls setup, while fatigue tests employed similar parameters with a frequency of 10 Hz, initial stress at 20 MPa, and stress increments every 5000 cycles. The E was determined through three-point-bending test using bars. Surface roughness, fractographic, and topographic analyses were conducted. Statistical analyses included One-way ANOVA for monotonic FS and roughness, Kruskal-Wallis for E, and Kaplan-Meier with post-hoc Mantel-Cox and Weibull analysis for fatigue strength. Results revealed higher monotonic strength in the Subtractive group compared to 3D printing (p = 0.02) and Layering (p = 0.04), while 3D Printing and Layering exhibited similarities (p = 0.88). Fatigue data indicated significant differences across all groups (3D Printing < Layering < Subtractive; p = 0.00 and p = 0.04, respectively). Mechanical reliability was comparable across groups. 3D printing and Subtractive demonstrated similar E, both surpassing Layering. Moreover, 3D printing exhibited higher surface roughness than Subtractive and Layering (p < 0.05). Fractographic analysis indicated that fractures initiated at surface defects located in the area subjected to tensile stress concentration. A porous surface was observed in the 3D Printing group and a more compact surface in Subtractive and Layering methods. This study distinguishes the unique properties of 3D printed resin when compared to conventional layering and subtractive methods for resin-based materials. 3D printed shows comparable monotonic strength to layering but lags behind in fatigue strength, with subtractive resin demonstrating superior performance. Both 3D printed and subtractive exhibit similar elastic moduli, surpassing layering. However, 3D printed resin displays higher surface roughness compared to subtractive and layering methods. The study suggests a need for improvement in the mechanical performance of 3D printed material.

Effect of 3D printer, implant analog and angulation on the accuracy of analog position in implant casts.

OBJECTIVES: To evaluate the accumulative effect of 3D printer, implant analog systems, and implant angulation on the accuracy of analog position in implant casts. METHODS: A reference cast, presenting a case of a three-unit implant-supported prosthesis, was scanned with a coordinate measurement machine, producing the first reference data set (CMM, n = 1). The second reference data set (n = 10) was prepared using an intraoral scanner (IOS) (Trios4). Test quadrant casts were produced using three DLP type 3D printers, Max (MAX UV385), Pro (PRO 4K65 UV), and Nex (NextDent 5100), and three implant analog systems, El (Elos), Nt (Nt-trading), and St (Straumann) (n = 90). Stone casts were also produced via analog impressions (Stone, n = 10). After digitization, the accuracy of 3D distance, local angulation (angle between implants) and global angulation (angle between the implant center axis and an axis perpendicular to the global plane) was evaluated by comparing the reference (CMM, IOS), test (3D print), and control (Stone) groups using metrology software. Data were statistically analyzed using three-way ANOVA and Tukey`s tests (α = 0.05). RESULTS: IOS was truer in 3D implant distance and more precise in capturing local angulation than Stone (p ≤ 0.05). Other measurements were similar between both groups (p > 0.05). The amount of error introduced in the workflow by IOS and 3D printing was mostly similar (p > 0.05). 3D printed casts had similar or even higher accuracy than Stone group (p > 0.05). In most cases, higher trueness was achieved when using PRO 4K65 UV 3D printer and Elos implant analog system (p ≤ 0.05). CONCLUSION: 3D printer, implant analog system, and implant angulation have a significant effect on the accuracy of analog position in implant casts. Limited-span implant-supported cases could be reproduced digitally with similar accuracy as conventional methods. CLINICAL SIGNIFICANCE: A fully digital workflow with a carefully selected 3D printer and implant analog system can increase the accuracy of digitally produced implant casts with comparable accuracy to conventional workflow.

Adhesive Cementation of CAD/CAM Silica-based Ceramics: Effect of Adhesive Type and Long-term Aging on the Bond Strength to Composite Cement.

PURPOSE: To investigate the effect of adhesive type and long-term aging on the shear bond strength (SBS) between silica-based ceramics and composite cement (CC). MATERIALS AND METHODS: Lithium-silicate (LS), feldspathic (FD) and polymer-infiltrated ceramic (PIC) blocks were sectioned (10 x 12 x 2 mm) and divided into 24 groups considering the factors: "ceramics" (LS, FD, and PIC), "adhesive" (Ctrl: without adhesive; 2SC: 2-step conventional; 3SC: 3-step conventional; 1SU: 1-step universal), and "aging" (non-aged or aged [A]). After the surface treatments, CC cylinders (n = 15, Ø = 2 mm; height = 2 mm) were made and half of the samples were subjected to thermocycling (10,000) and stored in water at 37°C for 18 months. The samples were submitted to SBS testing (100 kgf, 1 mm/min) and failure analysis. Extra samples were prepared for microscopic analysis of the adhesive interface. SBS (MPa) data was analyzed by 3-way ANOVA and Tukey's test (5%). Weibull analysis was performed on the SBS data. RESULTS: All factors and interactions were significant for SBS (p<0.05). Before aging, there was no significant difference between the tested groups and the respective control groups. After aging, the LS_1SU (22.18 ± 7.74) and LS_2SC (17.32 ± 5.86) groups exhibited significantly lower SBS than did the LS_Ctrl (30.30 ± 6.11). Only the LS_1SU group showed a significant decrease in SBS after aging vs without aging. The LS_1SU (12.20) group showed the highest Weibull modulus, which was significantly higher than LS_2SC_A (2.82) and LS_1SU_A (3.15) groups. CONCLUSION: No type of adhesive applied after silane benefitted the long-term adhesion of silica-based ceramics to CC in comparison to the groups without adhesive.

Influence of different printing orientations and post-polymerization time on the translucency of three-dimensional (3D) printed denture base resins.

PURPOSE: To evaluate the effect of different printing orientations and post-polymerization time with thermal cycling on the translucency of 3D-printed denture base resins. METHODS: Heat-polymerized (HP) acrylic resin specimens were fabricated and 3D-printed denture base materials (NextDent, ASIGA, FormLabs) were printed with different printing orientations (0, 45, 90 degrees) and subjected to different post-polymerization times (15-, 30-, 60-, and 90-min). All specimens were polished and immersed in distilled water for 1 day at 37°C. CIEDE2000 was used to measure the translucency parameters (TP00) before and after thermal cycling (5000 cycles) recording the color parameters (L*, a*, b*) against a black and white background using a spectrophotometer. k-factors ANOVA followed by post hoc Tukey's test (α = .05) was performed for statistical analysis. RESULTS: The k-factors ANOVA test showed a significant effect of resin material, post-polymerization time, and printing orientation on translucency (p < 0.001). In comparison to HP, all 3D-printed resins showed lower translucency with all post-polymerization times and printing orientation (p < 0.001) except FormLabs resin (p > 0.05). For all 3D-printed resins, the translucency increased, with increasing the post-polymerization time (p < 0.001) and 60- and 90-min showed the highest translucency. For printing orientation, 90 and 45 degrees significantly showed high translucency in comparison to 0 degrees (p < 0.001). FormLabs showed significantly higher translucency when compared with NextDent and ASIGA per respective printing orientation and post-polymerization time. The translucency significantly decreased after thermal cycling for all tested resins (p < 0.001). CONCLUSION: The findings of this study demonstrated that the translucency of 3D-printed resins is influenced by the printing orientation, post-polymerization time, and resin type. As a result, choosing a resin type, and printing orientation, with a longer post-polymerization time should be considered since it may improve the esthetic appearance of the 3D-printed resins.

An evaluation of dental paste-like bulk-fill composite wear using intra-oral scanner.

This study evaluates the wear resistance of dental paste-like bulk-fill composites compared to conventional paste-like composite resins using an intraoral scanner and 3-D analyzing software. Six different dental composite materials, including five bulk-fill composites and one conventional composite, were tested alongside natural human enamel as a control group. A computer-controlled chewing simulator for wear testing. A one-way ANOVA test was used to identify any significant differences between the means of the tested dental composite materials α=0.05. The results showed variability among bulk-fill composites, with some demonstrating wear resistance similar to conventional composites (p<0.05). Human enamel displayed the lowest wear values, but some bulk-fill composites matched this resistance(p>0.05). Significant variability was observed among bulk-fill composites but the results were comparable to those of conventional composites. The enamel control group demonstrated the lowest wear values, with some bulk-fill composites showing similar wear resistance. This study provides valuable information about the wear resistance of contemporary bulk-fill composite materials, commonly used in current clinical practice, contributing to enhancing clinical procedures.

Effect of Different Intraoral Scanners on the Accuracy of Bite Registration in Edentulous Maxillary and Mandibular Arches.

OBJECTIVES: The objective of this study was to use in vitro models to examine the bite registration accuracy of four different intraoral scanners (IOS) for edentulous maxillary and mandibular arches. The objective was to assess the trueness and precision of the IOS and determine if there were significant differences between them. METHODS: An Asiga Max UV 3D printer was used to print maxillary and mandibular edentulous models based on the shape of Frasaco models (artificial dental arch models). Four dental implants were placed symmetrically in both models using Straumann BLT RC implants. Digital impressions were taken with Primescan, Trios 3, Trios 4, and Medit i500 intraoral scanners (n = 10 for each IOS). Digital bite registrations were made, and scanning data was exported in STL format. The accuracy of the interarch distance (the distance between the metrological spheres attached to the mandibular and maxillary models) was estimated for each IOS. RESULTS: The results showed significant differences in trueness and precision between different IOS (p <.05), except Medit i500 and Trios 3 (p >.05). Primescan provided the most accurate results, followed by Medit i500, Trios 3, and Trios 4, respectively. CONCLUSIONS: within the limitations of this study, the IOS type affects the accuracy of interocclusal bite registration in in vitro design. Only Primescan achieved clinically acceptable accuracy for the interocclusal recording of edentulous arches. CLINICAL RELEVANCE: The comparison of the accuracy of bite registration between different intraoral scanners will help increase the efficiency of the clinical application of digitalized interarch registration.

Accuracy, adaptation and margin quality of monolithic zirconia crowns fabricated by 3D printing versus subtractive manufacturing technique: A systematic review and meta-analysis of in vitro studies.

OBJECTIVE: The purpose of this systematic review and meta-analysis was to evaluate the accuracy (trueness and precision), marginal and internal adaptation, and margin quality of zirconia crowns made by additive manufacturing compared to subtractive manufacturing technology. METHODS: The investigation adhered to the PRISMA-ScR guidelines for systematic reviews and was registered at the Prospero database (n°CRD42023452927). Four electronic databases, including PubMed, Scopus, Embase, and Web of Science and manual search was conducted to find relevant studies published until September 2023. In vitro studies that assessed the trueness and precision, marginal and internal adaptation, and margin quality of printed crowns compared to milled ones were included. Studies on crowns over implants, pontics, temporary restorations, laminates, or exclusively experimental materials were excluded. RESULTS: A total of 9 studies were included in the descriptive reporting and 7 for meta-analysis. The global meta-analysis of the trueness (P<0.74,I2=90 %) and the margin quality (P<0.61,I2=0 %) indicated no significant difference between the root mean square of printed and milled zirconia crowns. The subgroup analysis for the printing system showed a significant effect (P<0.01). The meta-analysis of the crown areas indicated no significant difference in most of the areas, except for the marginal (favoring milled crowns) and axial (favoring printed crowns) areas. For precision and adaptation, both methods showed a clinically acceptable level. CONCLUSIONS: Additive manufacturing technology produces crowns with trueness and margin quality comparable to subtractive manufacturing. Both techniques have demonstrated the ability to produce crowns with precision levels, internal discrepancy, and marginal fit within clinically acceptable limits. CLINICAL SIGNIFICANCE: 3D printing emerges as a promising and potentially applicable alternative method for manufacturing zirconia crowns, as it shows trueness and margin quality comparable to restorations produced by the subtractive method.

A Review on Enhancing the Life of Teeth by Toothpaste Containing Bioactive Glass Particles.

Purpose of Review: Dental caries or tooth decay is one of the communal problems in the world which can affect not only the oral health but also the general health conditions. The main objective of this systematic review is to explore the efficacy of bioactive glass-based toothpastes against cariogenic bacteria. Recent Findings: Bioactive glass particulates containing toothpaste show better remineralization potential on demineralized enamel and dentin when compared with toothpaste containing various bioactive constituents such as fluoride and potassium chloride. These constituents in conventional toothpaste can rapidly streak off due to acidic impact in the oral environment as the bioactive glass provides minerals for demineralized enamel and dentin by forming a strong hydroxyapatite (HAp) layer on its surface. Further, the therapeutic ions present in the bioglass can resist plaque formation by raising the pH of the surrounding environment or saliva and create amicable media for healthier teeth. Summary: Toothpaste containing bioactive glass particles undoubtedly displayed the remineralizing potentiality of the dental hard tissues. Dynamics of the mineralization through different bioactive glass materials needs further investigations. In order to prevent dental cavities and improve oral health, it is important to identify and study different effective bioglass particles in toothpaste.

Evaluation of the Color Stability of Three Resin-Ceramic Materials Using a Spectrophotometer and a Digital Photography Software.

Background: Computer-aided design/computer-aided manufacturing (CAD/CAM) resin ceramics allow easier milling than glass ceramics but are suspected to be more stainable. Although Photoshop® is widely used for picture analysis, its potential for shade selection has not been properly assessed. Aim: Purpose primary: To evaluate the color stability of three CAD/CAM resin ceramics and Lithium Disilicate. Secondary: to compare the color evaluation between a spectrophotometer (Vita Easyshade compact) and Photoshop software. Materials and Methods: Three CAD/CAM resin ceramic materials (n = 10) and a fourth group of lithium disilicate were used. Half of each group were thermocycled (5°C and 55°C; 3000 cycles). All samples were immersed in colored beverages (coffee, tea and red wine) for 30 days. Values were obtained by spectrophotometry and photographs analyzed using Photoshop software. The parameters measured were CIEL*a*b, and the color difference (ΔE) was analyzed. A mixed model test was used to compare the results through time and materials (α = 0.05). The comparison between the spectrophotometer and Photoshop results was performed using the bivariate Pearson's correlation test. Results: Lithium disilicate glass ceramic exhibited less color change (ΔE = 14) than resin ceramics (15.7 < ΔE < 18.7). The least change was noted with GC Cerasmart (ΔE = 15.7) followed by Vita Enamic (ΔE = 17*) and Brilliant Crios (ΔE = 18.7*). Spectrophotometer and Photoshop values showed low correlations. Conclusions: Resin ceramics may suffer from color change in clinical use. Photoshop is technique sensitive; pictures are easily affected by the light conditions and camera settings.

Partial glass-ceramic posterior restorations with margins beyond or above the cemento-enamel junction: An observational retrospective clinical study.

PURPOSE: This observational retrospective clinical study aimed to investigate the survival and success rates of partial indirect lithium disilicate restorations with margins extending above or beyond the cementoenamel junction (CEJ). METHODS: The study included patients who underwent partial indirect lithium disilicate restorations with immediate dentin sealing (IDS) between January 2008 and October 2018. All the restorations were placed in a single general dental practice following a standardized protocol. The impact of various predictive variables on the survival rates was assessed. Moreover, modified United States Public Health Service (USPHS) criteria were used to evaluate the survival quality. RESULTS: Totally 1146 partial indirect lithium disilicate restorations in 260 patients were evaluated over an average period of 7.5 years. The cumulative survival and success rates were 97.3% and 95.3%, respectively. Margins extending beyond the cemento-enamel junction did not increase the risk of success or survival failure (P > 0.05). Patients with a high risk of caries, male sex, or non-vital teeth had a significantly higher risk of restoration failure (P < 0.05). Restorations with longer clinical service times exhibited marginally lower clinical quality (P < 0.001). CONCLUSIONS: Partial indirect glass-ceramic restorations demonstrated survival and success rates of 97.3% and 95.3%, respectively, over an extended period. However, a higher risk of restoration failure existed in patients with a high caries risk for (pre)molars that had undergone endodontic treatment and in males. In terms of the risk of success or survival failure, comparable results were obtained for the positions of the restoration margin in relation to the cemento-enamel junction.

3D printed, subtractive, and conventional acrylic resins: Evaluation of monotonic versus fatigue behavior and surface characteristics.

This study assessed the mechanical properties and surface characteristics of dental prosthetic acrylic resin fabricated by 3D printing, comparing it with subtractive, pressing, and molding techniques. Bar-shaped specimens (N= 90; 65 × 10 × 3.3 mm; ISO:207951) were prepared and assigned into six groups: PRINT (3D printing vis stereolithography with PriZma 3D Bio Denture, Makertech Labs); SUB (subtractive manufacturing with Vipiblock Trilux, Vipi); PRESS Base (pressing using muffle with Thermo Vipi Wave, Vipi for base); PRESS Tooth (pressing with Onda-cryl, Clássico for tooth); MOLD Base (molding using addition silicone with Vipi Flash, Vipi for base); and MOLD Tooth (molding with Dencor, Clássico for tooth). Monotonic flexural strength (FS) and elastic modulus (E) were measured using a three-point bending approach (n= 5) on a universal testing machine at a crosshead speed of 5 mm/min. Fatigue testing (n= 10) followed similar geometry and settings, with a frequency of 2 Hz, initial stress level at 20 MPa, and stress increments of 5 MPa every 2,500 cycles. Surface roughness (n= 10) was assessed through profilometry, and fractographic and topographic analyses were conducted. Statistical analyses included One-Way ANOVA for monotonic FS, roughness, and E, along with Kaplan-Meier with Mantel-Cox post-hoc and Weibull analysis for fatigue strength. PRINT showed lower monotonic FS than the SUB and PRESS Tooth but comparable fatigue strength to these groups and superior to PRESS Base and MOLD (Base and Tooth) groups. All groups had similar Weibull moduli. Surface roughness of the PRINT group was comparable to most techniques but higher than the PRESS Tooth group. Fractographic analysis revealed fractures originating from surface defects under tensile stress, with SEM showing scratch patterns in all groups except PRINT, which had a more uniform surface. Despite its lower monotonic strength, 3D printed resin demonstrated comparable fatigue strength to subtractive and pressing methods and similar surface roughness to most methods, indicating its potential as a viable option for dental prosthesis.