Effect of intracanal diode laser irradiation on fracture resistance of roots restored with CAD/CAM posts

Aim: To evaluate the fracture resistance of roots restored with CAD/CAM-fabricated posts, receiving or not intracanal laser treatment, compared with glass fiber posts under mechanical cycling. Methods: Twenty-seven endodontically treated, single-rooted teeth were divided into 3 groups: group 1 (control), prefabricated glass fiber posts relined with resin composite; group 2, CAD/CAM-fabricated intraradicular posts using Resin Nano Ceramic (RNC) blocks; and group 3, CAD/CAM-fabricated intraradicular posts using RNC blocks in canals irradiated with a 940-nm diode laser (100 mJ, 300-um optic fiber, coronal-apical and apical-coronal helical movements, speed of 2 mm/second, 4 times each canal). After cementation of the coping, cyclic loading was applied at an angle of 135° to the long axis of the root, with a pulse load of 130 N, frequency of 2.2 Hz, and 150,000 pulses on the crown at a point located 2 mm below the incisal edge on the lingual aspect of the specimen. Every 50,000 cycles, the specimens were evaluated for root fracture occurring below or above the simulated bone crest. Results were analyzed by one-way ANOVA followed by Tukey's test (p<0.05). Results: Group 1 was the least resistant, while groups 2 and 3 were the most resistant. Group 1 differed significantly from groups 2 and 3 (p<0.01), but there was no difference between groups 2 and 3 (p<0.01). Conclusion: Treatment of the intracanal surface with diode laser had no influence on fracture resistance of roots restored with CAD/CAM-fabricated posts, but a longer cycling time is required to evaluate the real benefits of diode laser irradiation

El reto del abordaje quirúrgico en la rehabilitación sobre un implante unitario en un caso de alto requerimiento estético del sector anterior. Descripción a propósito de un caso / The challenge of the surgical approach in the rehabilitation of a unitary implant in a case of high aesthetic requirements of the anterior sector. Case report

Objetivo: Describir de forma detallada el abordaje clínico basado en la evidencia científica actual de un implante postextracción con carga y provisionalización inmediata. Caso clínico: Se presenta el caso de una paciente mujer de 32 años de edad, que acude por presentar una posible fractura radicular del incisivo central superior izquierdo (ICSI), acompañada de la aparición de un absceso periodontal en la región del fondo de vestíbulo de dicho diente. Tras llevar a cabo la exploración clínica y radiológica, se establece que el pronóstico del ICSI es desfavorable para llevar a cabo un tratamiento conservador del mismo. Tras la valoración de las características clínicas del caso presente, el plan de tratamiento se inclinó por la realización de la exodoncia del ICSI con la colocación simultánea de un IOI postextracción y la carga inmediata con una prótesis provisional del mismo. Conclusiones: La rehabilitación sobre implantes en situaciones de pérdida dental en el sector anterior estético y en especial, en pacientes jóvenes, requiere un plan de tratamiento multidisciplinar en cuanto a la extracción del diente y colocación del IOI en la posición tridimensional correcta, existiendo diferentes aspectos a tener en cuenta para ello, especialmente el remanente óseo residual, la posición del margen gingival, así como la preservación y acondicionamiento de los tejidos duros y blandos periimplantarios mediante injertos y un manejo correcto de una prótesis provisional hasta conseguir un perfil de emergencia y contorno gingival ideal antes de la corona definitiva. (AU)

Objective: To describe in detail the clinical approach based on current scientific evidence for a post-extraction implant with immediate loading and provisionalisation. Clinical case: We present the case of a 32-year-old female patient who presented with a possible root fracture of the upper left central incisor (ULCI), accompanied by the appearance of a periodontal abscess in the region of the bottom of the vestibule of said tooth. After carrying out the clinical and radiological examination, it is established that the ULCI prognosis is unfavourable for carrying out conservative treatment of the tooth. After assessing the clinical characteristics of the present case, the chosen treatment plan was to extract the ULCI with the simultaneous placement of a post-extraction osseointegrated implant (OII) and immediate loading of a provisional prosthesis on the implant. Conclusions: Rehabilitation on implants in situations of tooth loss in the aesthetic anterior sector, especially in young patients, requires a multidisciplinary treatment plan in relation to tooth extraction and placement of the OII in the correct three-dimensional position. There are various aspects to be taken into account, particularly the residual remaining bone, the position of the gingival margin, as well as the preservation and conditioning of the peri-implant hard and soft tissues by means of grafts and proper handling of a provisional prosthesis until an ideal emergence profile and gingival contour is achieved before the final crown. (AU)

Pathologic root migration secondary to vertical root fracture and full-coverage crowns: a report of 3 cases.

Occasionally, tooth fractures may demonstrate exaggerated pathologic root migration (PRM), often resulting in tooth loss. The early propagation of the root fracture may not be readily identifiable through clinical inspection and conventional radiographic imaging. Ultimately, increased root separation, isolated deep periodontal probing depth, and characteristic radiolucent changes may facilitate the diagnosis. This article describes 3 patients with unusual presentations of PRM in endodontically treated teeth restored with full-coverage crowns. One case illustrates the use of cone beam computed tomography for restorative assessment following root separation. Although it is efficacious to place crowns on most posterior endodontically treated teeth to maintain structural integrity, patients may remain at risk for catastrophic PRM and tooth loss. Timely extraction of teeth with hopeless PRM may minimize underlying bone resorption and the need for osseous regenerative procedures, ultimately improving the dental implant recipient site.

Diagnosis and management of transverse root fractures.

BACKGROUND: Root fractures are not a common injury, but a thorough understanding of their etiology, healing responses, diagnosis, management, and prognosis is essential. REVIEW: The prognosis is largely related to the patient's age; degree of displacement, if any, of the coronal fragment; and the location and orientation of the fracture. The more apical the fracture is located, the better the prognosis. Teeth with root fractures located supracrestally may have the worst prognosis, but their management and outcome depend on many factors, with the most influential factor being the ability to restore the tooth because the coronal fragment usually needs to be removed. In contrast, root fractures located in the apical and middle thirds and those subcrestally in the coronal third of the root have a good prognosis and usually require little, if any, treatment apart from immediate repositioning (if the coronal fragment has been displaced) and stabilization. Monitoring of root-fractured teeth over time is essential to determine the healing response and to assess whether the pulp survives or not. In some cases, the pulp in the coronal fragment may necrose and become infected, thus requiring root canal treatment, but this should only be done to the fracture line. Pulp necrosis and infection typically occur within the first 3-4 months if it is a direct result of the trauma. However, pulp necrosis and infection can also occur many years later, in which case it is likely to be a result of bacterial penetration via cracks or breakdown of restorations. CONCLUSION: Overall, root fractures should be managed conservatively unless they are located supracrestally.

Management of a Central Incisor with Horizontal Root Fracture for Esthetic and Functional Rehabilitation.

Severely traumatized incisors in young adults are a very common problem, and one that is difficult to treat because healing of these teeth is not always predictable and implant placement has to be delayed until adulthood. This case report of a horizontal root fracture in an avulsed central incisor illustrates the ability to maintain crucial tooth structure. A lateral socket augmentation procedure after extraction of a root fragment combined with an endodontic and regenerative periodontal treatment approach could preserve natural esthetics and function, which are directly related to quality of life. The preservation of alveolar bone volume following partial root removal will eventually facilitate later placement of a dental implant with an improved esthetic and functional prosthodontic result in a patient with a high-risk esthetic profile.

Técnica de collage dentario con colgajo mucoperióstico: reporte de caso / Toot fragment reattachment with mucoperiosteal flap: report of case

La fractura dental coronaria es la injuria dental traumática más común de los dientes permanentes. El collage dentario es una alternativa restauradora que consiste en pegar fragmentos dentarios con un procedimiento semejante al que se utiliza para unir pedazos sueltos mediante pegamentos convencionales. El presente artículo describe el caso de un paciente con fracturas coronarias en las piezas 11 y 21 que fueron tratadas mediante un collage dentario. El paciente acudió a la consulta con los fragmentos fracturados procediéndose a realizar el tratamiento de conductos de dichas piezas y colocación de postes de fibras de vidrio. Posteriormente se procedió a la unión de los fragmentos previa realización de un colgajo mucoperióstico debido a la invasión del espacio biológico. A la evaluación clínica inmediata y a los tres años de seguimiento fue aceptable tanto funcional como estética

Dental crown fracture is the most common traumatic dental injury for permanent teeth. Tooth fragment reattachment is a restorative alternative which consists in adhering tooth fragments with a procedure suchlike the one used to join loose pieces by conventional adhesives. This article describes a clinical case of a patient with upper central incisors crowns fractured which were treated by tooth reattachment. Patient attended dental practice with the broken teeth and their fragments, and was immediately referred to receive root canal treatments and then the placement of fiberglass posts. Later, the fragments attachment was made after carrying a mucoperiosteal flap because of the biological space invasion. There were acceptable functional and esthetic results at the immediate clinical assessment and after three years of monitoring

Perspectiva restauradora para dentes tratados endodonticamente: pino anatômico / Prospect for restoring endodontically treated teeth: anatomical pin

Introdução: o pino anatômico individualizado aumenta a adaptação do pino pré-fabricado às paredes do canal radicular e reduz a espessura da linha de cimentação. Objetivo: apresentar um caso de reabilitação de um dente tratado endodonticamente utilizando pino anatômico. Métodos: foi relatado um caso de substituição de restauração deficiente de compósito em incisivo central superior com tratamento endodôntico. Inicialmente, foi realizada a remoção da resina composta deficiente e do retentor intrarradicular do dente 11. O canal radicular foi retratado endodonticamente. O volume de dentina residual das paredes do canal radicular foi reduzido após a remoção do retentor. Foi planejada a restauração do dente 11 com resina composta após a instalação de um pino-anatômico, moldando as dimensões do canal radicular com um pino de fibra de vidro pré-fabricado e resina composta. Em seguida, a restauração coronária foi concluída com resina composta. Conclusão: a técnica de construção de pinos anatômicos diretos mostrou ser uma boa alternativa para restaurar canais radiculares amplos

Contenção emergencial após traumatismo dental com fratura óssea em bloco: uso de microparafusos / Dental trauma emergency with block bone fracture: contention using micro screws

Traumas dentários envolvem dentes anteriores, influenciando função e estética de crianças e adultos jovens de diversas idades em diferentes especialidades odontológicas. Os dentes mais frequentemente envolvidos são incisivos centrais superiores, incisivos laterais superiores e incisivos centrais inferiores. A proposta deste trabalho foi apresentar caso clínico de traumatismo envolvendo fratura óssea em bloco. Após acidente o paciente foi atendido e ao exame clínico constatou-se fratura em bloco dos elementos dentais 42,41,31,32 e avulsão do 33 com tecido gengival e mucoso dilacerados. Radiograficamente observou-se fratura horizontal do osso mandibular, avulsão dos dentes de seus alvéolos em bloco e diversos fragmentos ósseos. Seguiu-se cirurgia imediata, valendo-se de contenção emergencial com microparafuso e após 7 dias removeu-se a sutura. Realizou-se acompanhamento em 14,21 e 28 dias e após 3 meses foi realizado tratamento endodôntico dos dentes 31, 32, 41 e 42. Os procedimentos realizados alcançaram êxito após a realização dos atendimentos.

Dental traumas involve anterior teeth, affecting both function and aesthetics of children and young adults of different ages in different dental specialties The teeth most frequently involved are the maxillary central incisors, lateral incisors and mandibular central incisors. The airn of this work is to present a clinical case of injury involving bone block fracture. After the accident, the patient underwent clinical examination, which revealed block fracture of dental elements 42, 41, 31, 32 and avulsion of 33 with laceration of the gingival and mucosal tissue. Radiographic results revealed horizontal fracture of the jawbone, tooth avulsion of its wells in the block and several bone fragments. Patient underwent immediate surgery using emergency containment with micro-screws, and suture was removed seven days after. Monitoring was performed at 14,21 and 28 days and endodontic treatment of teeth 31,32,41 and 42 was performed 3 months after. Ali procedures were successful.

Indirect laminate veneer: a conservative novel approach.

Various treatment options and materials are available for restoration of an endodontically treated tooth. Laminate veneer is conservative treatment usually employed for aesthetic correction or improvement. The indirect composite is available in a wide range of shades and specific characterisation is easily performed chair side in the operatory area, which makes it a quick procedure and time saving for both the patient and the dentist. The physical properties and optical properties are good enough to use it as indirect restorative material, so in this particular case it was the material of choice for fabrication of laminate veneer on anterior tooth. In this case, the endodontically treated tooth with a fractured incisal edge was restored with indirect composite material.

Cerec omnicam and the virtual articulator--a case report.

This case report demonstrates how two opposing teeth were restored with full crowns using Cerec software version 4.2 (pre-release version). In addition, an anterior tooth was provided with a veneer. The situation was scanned with the Cerec Omnicam. The new virtual articulator was used for the design to obtain correct dynamic contacts. The Cerec Omnicam can scan the entire situation prior to preparation without the help of an assistant, as no surface pretreatment is necessary. The locations of the occlusal contacts can be marked with articulating paper and are indicated on the virtual models. Selective deletion of individual areas allows the prepared teeth to be rescanned, considerably speeding up the workflow. A video demonstration is available of the acquisition and design procedure.

Definitive abutment-driven stage-two surgery as a means to reduce peri-implant soft tissue changes: introduction of a new concept.

This report introduces an innovative approach for optimizing esthetics and minimizing soft tissue changes in clinical scenarios that involve extensive site preparation and submerged implants. The existing soft tissue morphology is registered at the time of implant uncovery, and an optimal peri-implant transmucosal contour is created indirectly in the lab. The customized definitive abutment is inserted during stage-two surgery and subsequently guides the peri-implant soft tissue, replicating an optimal emergence profile. The concept is demonstrated through the presentation of two clinical cases.

Mechanical, biological and clinical aspects of zirconia implants.

The objective of this narrative overview is to discuss several in vitro and in vivo studies regarding the performance of one-piece zirconia implants in combination with the description of two clinical scenarios where zirconia implant prototypes were utilized with emphasis on the possible scientific and clinical concerns that may affect the functional, biological and esthetic long-term outcomes.

Mandibular molar rehabilitation using orthodontic extrusion associated with odontoplasty.

The aim of this clinical report is to describe the successful treatment of a mandibular first molar presenting an extensive fracture at the buccal aspect in a young patient. The extension of the fracture was a negative prognostic factor for tooth maintenance. An alternative clinical treatment was proposed since the patient was young and presented with good oral hygiene and periodontal health. The treatment was based on orthodontic forced eruption associated with odontoplasty. A 3-year follow-up after the surgical procedure demonstrated the maintenance of periodontal health and good plaque control. It can be concluded that orthodontic forced eruption associated with odontoplasty promoted favorable conditions for prosthetic rehabilitation and is a feasible procedure in the treatment of tooth fracture extended below the cementoenamel junction.

CAD/CAM treatment for the elderly--a case report.

BACKGROUND: When elderly develop signs and symptoms of Alzheimer's disease they lose their independence and neglect dental hygiene. Dentists are increasingly confronted by seniors who are in need but who have limited access to dental care. Caretakers and family are also often confronted with behaviour problems besides the dental problems. OBJECTIVE: To report the importance of shorter and lower impact treatment for seniors when caretakers and family are confronted with a behavioural problem in addition to the dental problem. MATERIALS AND METHODS: In this case report, the oral management of a patient with Alzheimer's disease was described using chairside computer-aided design/computer-aided manufacturing (CAD/CAM) technology while constructing a bonded bridge. DISCUSSION: The case report emphasises the importance of interaction with the patient and added a treatment method for patients with limited cognitive skills who become easily agitated or aggressive. CONCLUSION: The fabrication of a full ceramic bonded bridge utilising the Cerec 3D chairside CAD/CAM technology in an Alzheimer patient has been shown to be a feasible, precise, aesthetic and durable solution. It added a technique for intervening with patients with limited tolerance for dental procedures, which improves the quality of life of both patient and family.

Oral rehabilitation of severe dentoalveolar trauma: a clinical report.

This clinical report describes the oral rehabilitation of an adult male who suffered severe dentoalveolar trauma as a result of a motor vehicle accident. The specific objectives of this treatment were to restore esthetics and masticatory function. Treatment included removal of fractured roots, placement of multiple endosseous implants, and placement of anterior and posterior metal-ceramic crowns and fixed partial dentures. Three year clinical examination revealed no pathology associated with the rehabilitation. The patient's esthetic and functional expectations were successfully achieved.

Recovering the function and esthetics of fractured teeth using several restorative cosmetic approaches. Three clinical cases.

The teeth most commonly affected by trauma are the maxillary central incisors. The most frequent types of traumatic dental injuries to permanent teeth are enamel fractures, enamel and dentine fractures, and enamel and dentine fractures with pulp involvement. This article describes three clinical cases with different levels of traumatized maxillary incisors and several cosmetic approaches for recovery of the esthetics and the masticatory function, as well as the social/psychological aspects of treatment. All cases involved young adult men. The three clinical cases involve dentin and enamel fractures, dentin and enamel fractures with pulp exposure, and dentin and enamel fractures with pulp exposure associated with root fracture. The cosmetic treatments used to resolve fractures were direct composite resin by layering technique, indirect all-ceramic restorations (laminate veneer and ceramic crowns over the teeth), and immediate implant after extraction followed by immediate loading (ceramic abutments with ceramic crown over implant). In all three cases, excellent functional and esthetic results were achieved by use of these treatment modalities. The patients were very satisfied with the results.