Technique to Maintain the Correct Spatial Orientation of the Maxillary Diagnostic Cast to that of the Master Cast in a Full-Mouth Rehabilitation Case.

A common challenge in full-mouth rehabilitation is preserving the correct spatial orientation of the maxillary diagnostic, diagnostic wax-up and master casts within the dental articulator. Any malposition of the maxillary master cast will immediately invalidate the articulator settings that were programmed from the pantographic or axiographic tracing. This will subsequently affect the occlusal morphology of the restorations. The technique presented in this article helps to precisely relocate the maxillary master cast to the same spatial orientation as both the initial diagnostic, and diagnostic wax-up casts.

A Report of Three Cases from an Ongoing Prospective Clinical Study on a Novel Pink Biomimetic Implant System.

While, overall, dental implants are highly efficacious, consistently achieving predictable esthetic results can pose color-driven challenges at the implant/soft-tissue interface, particularly in the esthetic zone. An ongoing, 5-year, multicenter (eight sites) prospective study is following a total of 168 implants placed in 120 patients using a novel biomimetic (osteoconductive) implant system with pink collars and abutments that afford better gingival color matching, enhanced design variability, and streamlined fabrication and customization of the abutment/implant-tissue interface. The full results of this study will be published at the 3-year and 5-year timepoints; however, clinical analyses of the 18-month interim survival rates, marginal bone and soft-tissue level changes, and esthetics have been completed, showing an overall success rate among all of the implanted sites of 95.8%. For the three representative cases described in this article (two anterior, one posterior), all of the implant site probing depths were ≤ 3 mm at the final crown placement as well as at 6, 12, and 18 months after implant placement. Facial soft-tissue heights were stable or increased by ≥ 0.86 mm; lingual soft-tissue heights were reduced by ≤ 1.11 mm. Facial and lingual attached-gingiva widths were reduced by ≤ 1.20 mm and ≤ 0.63 mm, respectively. Interproximal marginal alveolar bone levels were stable (gain/loss range: +0.40 to -1.1 mm) from the start of the study through 18 months. Gingival inflammation, bleeding on probing, and plaque were infrequently observed, and esthetic results were uniformly excellent at the 18-month follow-up visit.

Biotype change for the esthetic rehabilitation of the smile.

UNLABELLED: An esthetic and natural appearing smile is the result of multiple important factors. There must be a harmonious relation between tooth size, shape, proportion, and the periodontium. Successful rehabilitation of a smile often requires an interdisciplinary approach which was applied in the case presented in this article to a patient with multiple esthetic challenges. Treatment included management of canines in the lateral incisor positions, proportionally small teeth, and excessive gingival display. Good communication and coordination of care between the surgical and restorative partners produced a pleasing outcome facilitated by periodontal surgery resulting in a modification of the gingival biotype. CLINICAL SIGNIFICANCE: Smile design including crown lengthening and biotype modification can be used to create an esthetic and natural appearing restorative result.

Titanium-zirconium implants: Case report. Immediate provisional and restoration using a small-diameter system.

This article presented the immediate provisional and definitive restoration at 6 weeks of a novel small-diameter titanium-zirconium implant, with a 6-month follow up. The manufacturer purports that the implant described herein has superior mechanical and biological properties that could expand treatment options for small-diameter implants, thus benefiting accelerated protocols by further shortening the total treatment time. Human studies are needed to validate these claims.

Esthetic rehabilitation of maxillary incisors in conjunction with flapless surgical techniques, an implant zirconia crown, and porcelain veneers.

ABSTRACT Esthetic replacement of a maxillary central incisor using a dental implant can be a challenging task. The hard and soft tissues must be managed in a way that minimizes the risk of tissue loss, while preserving and/or regenerating full interdental papillae. In order to achieve this, flapless surgical techniques have been developed. Advances in dental materials have led to the introduction of zirconia abutments and crowns that can be synergistically combined with other ceramic materials. This article describes a case in which a hopeless maxillary central incisor is replaced with an implant using flapless techniques, and restored with a customized zirconia abutment and crown. In addition, the remaining maxillary incisors were restored with feldspathic porcelain veneers to yield a highly esthetic result. CLINICAL SIGNIFICANCE This case demonstrates how a conservative multidisciplinary approach facilitates excellent results in an esthetically demanding area. Atraumatic surgical techniques can maintain the natural soft tissue architecture, while a detailed approach to provisional and final restorations allows for a highly esthetic smile. (J Esthet Restor Dent 21:294-303, 2009).

Full-mouth rehabilitation using a multidisciplinary approach: material and periodontal considerations.

The complete aesthetic rehabilitation of dentition can be a complicated task. A multidisciplinary approach is often necessary to achieve ideal results. Clinical crown lengthening surgery can develop an aesthetic soft tissue profile and sufficient tooth structure for preparation and restoration. In addition, the development of novel all-ceramic zirconia materials has resulted in the delivery of improved aesthetics, function, and longevity. This article discusses the use of zirconia crowns in multidisciplinary full-mouth rehabilitation and provides recommendations to enhance the performance of these restorations.

The aesthetic replacement of mandibular incisors using an implant-supported fixed partial denture with gingival-colored ceramics.

Restoration of the anterior dentition using dental implants can be technically demanding. Loss of the supporting hard and soft tissue structures diminishes the clinician's ability to obtain optimal results. The use of gingival-colored ceramics offers on effective method of developing aesthetics when reconstructive surgery is not an option. This article describes the use of gingival-colored porcelain in creating a natural-looking, implant-supported fixed partial denture to replace compromised mandibular incisors.

Restoration of maxillary incisors with a zirconia all-ceramic system: a case report.

The increase in patient demands for enhanced esthetics has prompted the development of several all-ceramic restorative systems. Despite their esthetic advantage, unsatisfactory mechanical properties have restricted the clinical indications of all-ceramic restorations. Recently, densely sintered zirconia-based restorations have become available. This material appears to have adequate strength and toughness to allow for the fabrication of anterior and posterior crowns and fixed partial dentures. This clinical report describes the procedures used for the restoration of maxillary incisors with the zirconia-based Lava system.

Materials design in the performance of all-ceramic crowns.

Results from a systematic study of damage in material structures representing the basic elements of dental crowns are reported. Tests are made on model flat-layer specimens fabricated from various dental ceramic combinations bonded to dentin-like polymer substrates, in bilayer (ceramic/polymer) and trilayer (ceramic/ceramic/polymer) configurations. The specimens are loaded at their top surfaces with spherical indenters, in simulation of occlusal function. The onset of fracture is observed in situ using a video camera system mounted beneath the transparent polymer substrate. Critical loads to induce fracture and deformation at the ceramic top and bottom surfaces are measured as functions of layer thickness and contact duration. Radial cracking at the ceramic undersurface occurs at relatively low loads, especially in thinner layers. Fracture mechanics relations are used to confirm the experimental data trends, and to provide explicit dependencies of critical loads in terms of key variables: material-elastic modulus, hardness, strength and toughness; geometric-layer thicknesses and contact radius. Tougher, harder and (especially) stronger materials show superior damage resistance. Critical loads depend strongly (quadratically) on crown net thickness. The analytic relations provide a sound basis for the materials design of next-generation dental crowns.

Simple method of fabricating an impression coping to reproduce peri-implant gingiva on the master cast.

This article describes a simple technique in which a custom impression coping is fabricated with flowable composite and used to reproduce peri-implant soft tissues on the master cast. This procedure is designed to generate an accurate reproduction of the gingival contours surrounding the implant, thus contributing to a final restoration with favorable esthetics.

Effect of water quality on the bonding of resin to moist dentin.

PURPOSE: To test the effect of different water samples, used for rinsing the dentin, following acid conditioning, on the bond strength of a resin-based composite (RBC) restorative material (Z100), to dentin using a one-bottle dentin adhesive (Single Bond). MATERIALS AND METHODS: In preliminary experiments two experimental shear bond strength methods were compared, and one was selected which was deemed to permit more uniform application of the adhesive and better light curing. In the definitive experiments there were five experimental groups, according to rinsing water used (1) distilled water as control, (2) water with 3.5 ppm iodine, (3) water 3.0 ppm sodium hypochlorite, (4) water with 2% ethanol, (5) water contaminated with 6 x 10(4) cfu/mL of E. coli BH5V. For each experimental group the shear bond strength to moist dentin from 10 human intact impacted third molars was measured. The dentin samples were etched, washed and gently blotted to leave the dentin moist. Following application of the adhesive and resin, specimens were stored at 37 degrees C for 24 hours prior to testing in an Instron testing machine at a rate of 0.5 mm/minute. RESULTS: Data (in MPa +/- standard deviation) were: Group 1: 21.2 +/- 4.1; Group 2: 20.8 +/- 5.6; Group 3: 21.8 +/- 6.2; Group 4: 22.9 +/- 5.9; Group 5: 19.6 +/- 5.5. These data support the null hypothesis that the water types used in this work had no significant effect on the bonding of a resin composite to dentin (P= 0.74, ANOVA).

Efecto de ácidos sobre esmalte y dentina: estudio con MEB / The effect of acids on enamel and dentin: a SEM study

Se observaron con MEB las superficies de preparaciones gingivales en caras libres de molares extraídos. Un grupo de ellas fue utilizado como control y otro sometido a tratamiento con ácidos fosfórico al 35 por ciento (3M). Las superficies adamantinas tratadas con ácido fosfórico presentaron excavaciones de diversas formas y profundidad y las tratadas con ácido maleico, zonas más resistentes a la penetración ácida. Casi todas las superficies dentinarias tratadas con ácido fosfórico presentaron los túbulos abiertos, mientras que la mayoría de las tratadas con ácido maleico mostraban su obliteración parcial. Las superficies adamantinas utilizadas como control presentaban un aspecto liso y en las dentinarias no fue posible distinguir las estructuras características de dicho tejido. Dentro de los límites de este estudio, podría concluirse que el ácido fosfórico sería más efectivo que el maleico para grabar el esmalte y remover el barro dentinario afectando más la matriz intertubular (AU)

Efecto de ácidos sobre esmalte y dentina: estudio con MEB / The effect of acids on enamel and dentin: a SEM study

Se observaron con MEB las superficies de preparaciones gingivales en caras libres de molares extraídos. Un grupo de ellas fue utilizado como control y otro sometido a tratamiento con ácidos fosfórico al 35 por ciento (3M). Las superficies adamantinas tratadas con ácido fosfórico presentaron excavaciones de diversas formas y profundidad y las tratadas con ácido maleico, zonas más resistentes a la penetración ácida. Casi todas las superficies dentinarias tratadas con ácido fosfórico presentaron los túbulos abiertos, mientras que la mayoría de las tratadas con ácido maleico mostraban su obliteración parcial. Las superficies adamantinas utilizadas como control presentaban un aspecto liso y en las dentinarias no fue posible distinguir las estructuras características de dicho tejido. Dentro de los límites de este estudio, podría concluirse que el ácido fosfórico sería más efectivo que el maleico para grabar el esmalte y remover el barro dentinario afectando más la matriz intertubular

Adhesión de composites a dentina tratada con láser de CO2 / Bonding of composite resins to CO2 laser-treated dentin

El objetivo del presente trabajo fue evaluar la resistencia de la unión adhesiva de composites a dentina sometida o no a tratamiento láser utilizando un sistema de adhesión. Superficies dentinarias de molares humanos fueron irradiadas o no con un láser de CO2 (Luxar). Sobre ellas se fijaron probetas de composite (Z100 - 3M) previa aplicación del adhesivo Scotchbond Multipropósito (SBMP - 3M). Como agentes para el tratamiento ácido de utilizaron geles de ácido fosfórico al 35 por ciento y ácido maleico al 10 por ciento. Los resultados obtenidos sobre dentina irradiada fueron 17,0 MPa y 17,3 MPa con ácidos fosfórico y maleico, respectivamente. Los valores testigo fueron 16,4 MPa 13,2 MPa con la misma secuencia de ácidos. Las diferencias no fueron encontradas significativas (P mayor 0.05). Puede concluirse que el tratameinto de la dentina con láser de CO2 no altera la interacción adhesiva entre composite (Z100 - 3M)-substrato utilizando el sistema adhesivo SBMP (3M) e independientemente del ácido empleado (fosfórico o maleico) (AU)

Adhesión de composites a dentina tratada con láser de CO2 / Bonding of composite resins to CO2 laser-treated dentin

El objetivo del presente trabajo fue evaluar la resistencia de la unión adhesiva de composites a dentina sometida o no a tratamiento láser utilizando un sistema de adhesión. Superficies dentinarias de molares humanos fueron irradiadas o no con un láser de CO2 (Luxar). Sobre ellas se fijaron probetas de composite (Z100 - 3M) previa aplicación del adhesivo Scotchbond Multipropósito (SBMP - 3M). Como agentes para el tratamiento ácido de utilizaron geles de ácido fosfórico al 35 por ciento y ácido maleico al 10 por ciento. Los resultados obtenidos sobre dentina irradiada fueron 17,0 MPa y 17,3 MPa con ácidos fosfórico y maleico, respectivamente. Los valores testigo fueron 16,4 MPa 13,2 MPa con la misma secuencia de ácidos. Las diferencias no fueron encontradas significativas (P mayor 0.05). Puede concluirse que el tratameinto de la dentina con láser de CO2 no altera la interacción adhesiva entre composite (Z100 - 3M)-substrato utilizando el sistema adhesivo SBMP (3M) e independientemente del ácido empleado (fosfórico o maleico)

Shear bond strenght of adhesive composite systems to human dentin

Este estudio fue llevado a cabo para evaluar diversos sistemas adhesivos bajo diferentes condiciones, desde el punto de vista de la resistencia adhesiva que es obtenida sobre dentina y la resistencia adhesiva fue determinada bajo corte. No se encontraron diferencias significativas entre productos utilizados con la desmineralización de la dentina como paso independiente considerados como un grupo y aquellos en los que este paso no está indicado o fue omitido. Puede concluirse que el uso del tratamiento ácido de la dentina como paso independiente no es necesariamente indispensable para lograr valores elevados de adhesión de resinas compuestas a dentina, aun cuando podría representar un paso clínico conveniente para preparar simultáneamente la superficie del esmalte (AU)