Multidisciplinary Approach for Autotransplantation and Restoration of a Maxillary Premolar into an Area of an Avulsed Anterior Tooth: A Case Report with a 6-Year Follow-up.

The loss of an anterior tooth because of avulsion has been reported in up to 3% of dental injuries. Management alternatives, such as implant-supported restorations and a fixed partial denture, are contraindicated in growing patients because of the continuous growth of the alveolar process. At the same time, orthodontic treatment for gap closure will result in asymmetry and will require adjustment of the adjacent healthy teeth. Therefore, restoring a missing tooth imposes a treatment challenge, especially in children and young adults. Tooth autotransplantation is a treatment modality with high reported survival and success rates that overcome these mentioned limitations. It might also help to preserve the alveolar bone and the soft tissues. This case report describes a multidisciplinary approach for managing a 13-year-old boy who lost his right maxillary central incisor because of a fall. Management included autotransplantation of the left maxillary second premolar to the site of the lost right maxillary central incisor, management of external inflammatory resorption with an endodontic treatment, orthodontic treatment, and aesthetic restoration of the area with composite resin crowns that can be adapted to the expected changes of the jaws during the craniofacial growing period. At the 6-year follow-up, the teeth demonstrated a positive outcome.

Esthetic outcome for implant therapy of a maxillary lateral incisor using prefabricated titanium and customized zirconia abutments: 4-year clinical reports.

The reported clinical scenarios presented two patients, one managed with a prefabricated abutment and the other with a customized abutment, and both patients were pleased with the outcome. However, from a professional viewpoint, the esthetic outcome using the custom zirconia abutment was superior to that using the prefabricated titanium abutment.

Effect of thickness, translucency, and firing protocol on the masking ability of a CAD/CAM zirconia-reinforced lithium silicate for different backgrounds.

PURPOSE: To evaluate the masking ability of computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia-reinforced lithium silicate (ZLS) glass-ceramic under the different material configurations of thickness, translucency, and finishing protocol as well as significance of the color difference due to the manufacturer's one-firing protocol. MATERIALS AND METHODS: Ninety high-translucency (HT) and low-translucency (LT) ZLS glass-ceramic discs of different thicknesses (1.0, 1.5, and 2.0 mm) were evaluated as a monolithic structure with and without the use of a one-firing protocol. Disc samples were placed onto the substrates for measurement; a spectrophotometer measured the L*, a*, and b* color attributes of each specimen. ∆E value was calculated for determining color differences in tooth-colored substrate specimens (shade B1) compared with three darker backgrounds (shade C2, and two metal substrates - gold and silver). ∆E values were then compared against clinically acceptable (∆E = 5.5) and ideal (∆E = 2.6) thresholds. Color differences between the control and test groups were evaluated under different effects using a series of one-sided paired t tests (P < 0.01). The 99% confidence interval (CI) for the true ∆E mean and P values are reported and discussed. A complementary regression analysis depicts the effect size of translucency and firing protocol. RESULTS: Over C2, a 1-mm thickness demonstrated P < 0.01 for the clinically acceptable threshold, whereas the ideal threshold was ensured only with P < 0.01 under a 2-mm thickness. Over silver, only the clinically acceptable standard was met with P < 0.01 under a 2-mm thickness. Over gold, a 1-mm thickness was clinically acceptable with P < 0.01, and the ideal standard was met with P < 0.01 under a 1.5-mm thickness. These results remained valid regardless of the firing protocol or translucency; however, significant (P < 0.01) yet small-sized effects were found for translucency and firing protocol over gold, and for translucency over silver, through multiple regression analysis. CONCLUSIONS: To achieve ideal masking, the minimum thickness of CAD/CAM ZLS glass-ceramic should be 1.5 mm over a gold background, and 2 mm over a C2 background. The silver background did not achieve ideal masking in any situation. The one-firing protocol did not affect the final color and can be used to increase restoration strength.

Effect of MDP-Based Primers on the Luting Agent Bond to Y-TZP Ceramic and to Dentin.

PURPOSE: The aim of this study was to evaluate the influence of multimode MDP-based primers and different application protocols on the bond strength of a representative resin cement to an yttrium stabilized tetragonal zirconia (Y-TZP) ceramic. MATERIALS AND METHODS: The occlusal dentin from 60 human molars was exposed. The teeth and zirconia cylinders (N = 60) (3 mm of diameter; 4 mm of height) were divided into six groups (n = 10) according to the ceramic surface conditioning: (1) air abraded with SiO2 particles; (2) Z-Prime Plus; (3) air abraded with SiO2 particles + Z-Prime Plus; (4) air abraded with SiO2 particles + All-Bond Universal; (5) air abraded with SiO2 particles + ScotchBond Universal Adhesive; and (6) untreated zirconia. The luting agent (Duo-Link cement) was applied on the treated dentin surface. Specimens were stored in water (37°C, 24 h) and tested in shear bond strength. Data were statistically analyzed using 2-way ANOVA and Post hoc Tukey tests (α = 0.05). RESULTS: Significant effects of ceramic conditioning were found (p < 0.0001). The specimens sandblasted with silica particles followed by the application of Z-Prime Plus or All-Bond Universal presented greater bond strength values. For the untreated zirconia, several specimens failed prematurely prior to testing. CONCLUSIONS: Sandblasting with silica particles combined with Z-Prime Plus increased the bond strength.

Fracture strength of CAD/CAM posterior ceramic crowns after manual enhancement of occlusal morphology.

PURPOSE: The aim of this study was to investigate the fracture strength of computer-aided design/computer-aided manufacturing (CAD/CAM) posterior ceramic crowns with and without post-milling manual enhancement of occlusal morphology (MEOM), as indicated especially with early CAD/CAM restorations that have limited capacity to generate natural occlusal morphology. MATERIALS AND METHODS: A mandibular molar of an acrylic tooth model was prepared to receive a CAD/CAM all-ceramic crown and was used as a master die to fabricate 80 prepared tooth replicas using an epoxy resin with an elastic modulus (E) of 18 GPa. The crown was designed using Cerec software's Biogeneric Copy Design mode (Sirona). Eighty identical monolithic crowns were fabricated by milling four types of ceramic blocks. Forty monolithic crowns (10 of each ceramic system) were randomly selected as the control group, and MEOM was performed for each of the other 40 crowns by a certified dental technician. Restorations were crystallized and glazed according to the manufacturers' instructions and firing protocols. All crowns were cemented to their respective die using resin cement, and loaded to fracture at a crosshead speed of 0.5 mm/min. The resultant fractures were classified into three modes. Data were statistically analyzed using the nonparametric Mann-Whitney U test at α = 0.05. RESULTS: The MEOM treatment decreased the fracture load for all ceramic brands. CONCLUSION: The MEOM procedure should be considered detrimental for monolithic CAD/CAM-generated crowns and should thus be avoided.

Minimally Invasive Complete Mouth Reconstruction using Full-Contour Ceramic Veneers: A Clinical Report.

This case report illustrates a full-mouth rehabilitation for a patient that presented with severe non-carious tooth surface loss. The patient was restored following a minimally invasive tooth preparation, with 28 full-contour veneers. The patient was evaluated at baseline and at 2, 9, and 13 months following cementation to assess the integrity of the restorations, the proximal and occlusal contacts, pulp vitality, and tooth mobility. After 13 months, no postoperative sensitivity was reported. In addition, no secondary caries, loss of tooth vitality, or chipping or fractures of the veneers were detected. The clinical outcome of using a minimally invasive adhesive technique was an esthetic, mechanical, and biological success.

The effect of prolonged storage and disinfection on the dimensional stability of 5 vinyl polyether silicone impression materials.

PURPOSE: Vinyl polyether silicone (VPES) has a different composition from other elastomeric impression materials as it combines vinyl polysiloxane (VPS) and polyether (PE). Therefore, it is important to study its properties and behavior under different test conditions. This study investigated the dimensional stability of 5 VPES consistencies when stored for up to 2 weeks, with and without using a standard disinfection procedure. MATERIALS AND METHODS: 40 discs of each VPES consistency (total 200) were made using a stainless steel die and ring as described by ANSI /ADA specification No. 19. 20 discs of each material were immersed in a 2.5% buffered glutaraldehyde solution for 30 minutes. Dimensional stability measurements were calculated immediately after fabrication and repeated on the same discs after 7 and 14 days of storage. The data was analyzed using two-way ANOVA with a significance level set at α = 0.05. RESULTS: The discs mean contraction was below 0.5% at all test times ranging from 0.200 ± 0.014 to 0.325 ± 0.007. Repeated measures ANOVA showed a statistically significant difference after 2-week storage between the disinfected and non-disinfected groups (P < .001). Although there was no statistically significant difference between the materials at the time of fabrication, the contraction of the materials increased with storage for 1 and 2 weeks. CONCLUSION: The dimensional changes of VPES impression discs after disinfection and prolonged storage complied with ANSI/ADA standard. The tested VPES impression materials were dimensionally stable for clinical use after disinfection for 30 minutes in glutaraldehyde and storage for up to 2 weeks.

In vitro wear behavior of zirconia opposing enamel: a systematic review.

PURPOSE: The aim of this systematic review was to assess enamel wear on teeth opposing zirconia restorations and to evaluate factors related to the wear of natural teeth opposing zirconia restorations. MATERIALS AND METHODS: Five electronic databases were searched through May 2013 without limitations. The terms "antagonist*," "enamel," "wear," and "zirconi*" were used. Titles and abstracts were initially screened, and those that fulfilled the inclusion criteria were selected for a full-text assessment. Studies that evaluated only the material wear were not included. RESULTS: The database search strategy retrieved 142 potentially eligible studies. After the duplicate studies were removed, 62 studies were obtained. Titles and abstracts that fulfilled the inclusion criteria were selected for a full-text assessment (25). Seven laboratory studies met the inclusion criteria. In addition, reference lists from the finally selected studies were also screened. CONCLUSIONS: There was a large variation in relation to wear test method quantification, applied force, lateral movement, number and frequency of cycles, number of specimens, and enamel specimen preparation. In all studies, enamel wear rates were lower against polished zirconia. Differences in the test methods did not allow for comparisons of wear rates among the studies. CLINICAL SIGNIFICANCE: Polishing the surface is recommended for a full-contour zirconia restoration because polished zirconia presents favorable wear behavior opposing natural teeth.

Orthodontic bonding to porcelain: a systematic review.

OBJECTIVE: To use a systematic review to determine which materials and technique/protocol present the highest success rate in bonding brackets to porcelain surfaces. MATERIALS AND METHODS: Different databases were searched without limitations up to July 2013. Additionally, the bibliographies of the finally selected articles were hand searched to identify any relevant publications that were not identified earlier. In vitro and in vivo articles were included. RESULTS: No in vivo articles were found that fulfilled the inclusion criteria. A total of 45 in vitro articles met all inclusion criteria. They were published between 2000 to July 2013. CONCLUSIONS: The best protocol described in this review is the etching of 9.6% hydrofluoric acid for 1 minute, rinsed for 30 seconds, and then air-dried. The etching of hydrofluoric acid should be followed by an application of silane. Considering the harmful effects of etching with hydrofluoric acid, another appropriate suggestion is mechanical roughening with sandblasting followed by an application of silane.

Comparison of the compressive strength of 3 different implant design systems.

The aims of this study were twofold: to compare the static compressive strength at the implant-abutment interface of 3 design systems and to describe the implant abutment connection failure mode. A stainless steel holding device was designed to align the implants at 30 degrees with respect to the y-axis. Sixty-nine specimens were used, 23 for each system. A computer-controlled universal testing machine (MTS 810) applied static compression loading by a unidirectional vertical piston until failure. Specimens were evaluated macroscopically for longitudinal displacement, abutment looseness, and screw and implant fracture. Data were analyzed by analysis of variance (ANOVA). The mean compressive strength for the Unipost system was 392.5 psi (SD +/-40.9), for the Spline system 342.8 psi (SD+/-25.8), and for the Screw-Vent system 269.1 psi (SD+/-30.7). The Unipost implant-abutment connection demonstrated a statistically significant superior mechanical stability (P < or = .009) compared with the Spline implant system. The Spline implant system showed a statistically significant higher compressive strength than the Screw-Vent implant system (P < or =.009). Regarding failure mode, the Unipost system consistently broke at the same site, while the other systems failed at different points of the connection. The Unipost system demonstrated excellent fracture resistance to compressive forces; this resistance may be attributed primarily to the diameter of the abutment screw and the 2.5 mm counter bore, representing the same and a unique piece of the implant. The Unipost implant system demonstrated a statistically significant superior compressive strength value compared with the Spline and Screw-Vent systems, at a 30 degrees angulation.