Three Self-Adhesive Resin Cements and Their Influence on the Marginal Adaptation of Zirconia-Reinforced Lithium Silicate Single Crowns: An In Vitro Scanning Electron Microscope Evaluation.

Background: In everyday dentistry, monolithic single crowns can be cemented with self-adhesive resin cements. The aim of this in vitro study was to evaluate how the marginal adaptation of full monolithic zirconia-reinforced lithium silicate (ZLS) single crowns is influenced by three different self-adhesive resin cements. Methods: Forty-five typodont teeth fully prepared for full monolithic crowns were divided into three groups (fifteen each) for the use of three different self-adhesive resin cements. A fourth control group (Temp-bond) was created by taking five teeth from each group before cementation with self-adhesive resin cements. All forty-five abutments were scanned using a Primescan intra-oral scanner (IOS), followed by computer-aided design (CAD) and computer-aided manufacturing (CAM) of zirconia-reinforced lithium silicate (ZLS) full crowns using a four-axis machine. Initially, the crowns of the control group were fixed to the abutments using Temp-bond, and the marginal gap was evaluated using a scanning electron microscope (SEM). After removing the control group crowns from the abutments, fifteen crowns in each group were cemented using a different self-adhesive resin cement and observed under SEM for evaluation of the marginal gap. A Kolmogorov-Smirnov test was performed, indicating no normal distribution (p < 0.05), followed by Mann-Whitney tests (α = 0.05). Results: The total mean marginal gap of the temp-bond control group was significantly lower compared to all three groups of self-adhesive resin cement (p < 0.0005). The total mean marginal gap of the G-cem ONE group was significantly lower compared to the TheraCem group (p < 0.026) and RelyX U200 group (p < 0.008). The total mean marginal gap of the TheraCem group was significantly higher than the G-cem ONE group (p < 0.026) but showed no significant difference with the RelyX U200 group (p > 0.110). Conclusions: All four groups showed a clinically acceptable marginal gap (<120 microns). Although all three groups of self-adhesive resin cement showed a significant increase in the marginal gap compared to the temp-bond control group, they were within the limits of clinical acceptability. Regarding the marginal gap, in everyday dentistry, it is acceptable to use all three self-adhesive resin cements, although the G-cem ONE group exhibited the lowest marginal gap for ZLS single crowns.

The Impact of Open versus Closed Computer-Aided Design/Computer-Aided Manufacturing Systems on the Marginal Gap of Zirconia-Reinforced Lithium Silicate Single Crowns Evaluated by Scanning Electron Microscopy: A Comparative In Vitro Study.

This study aimed to compare the impact of CAD/CAM closed systems and open systems on the marginal gap of monolithic zirconia-reinforced lithium silicate (ZLS) ceramic crowns, as both systems are used in everyday dentistry, both chair-side and laboratory. For the closed system, 20 plastic teeth were scanned by a Primescan intra-oral scanner (IOS), and for the open system, the same number of plastic teeth were scanned by Trios 4 IOS. For the closed system, CEREC software was used, and for the open system, EXOCAD software was used. All 40 ZLS crowns were grinded by the same four-axis machine and cemented with Temp-bond, followed by self-adhesive resin cement. For each type of cement, an evaluation of the marginal gap was conducted by scanning electron microscopy (SEM). Before comparisons between the groups, a Kolmogorov-Smirnov test was performed on the study variables showing a normal distribution (p > 0.05). Independent T tests (α = 0.05) and paired-sample T tests (α = 0.05) were used. The independent T test found no significant mean marginal gap differences in the zirconia-reinforced lithium silicate crowns bonded with Temp-bond and scanned by Primescan (28.09 µm ± 3.06) compared to Trios 4 (28.94 µm ± 3.30) (p = 0.401), and there was no significant mean marginal gap differences in zirconia-reinforced lithium silicate crowns bonded with self-adhesive resin cement (Gcem ONE) and scanned by Primescan (46.70 µm ± 3.80) compared to Trios 4 (47.79 µm ± 2.59) (p = 0.295). Paired-sample T tests showed significantly higher mean marginal gaps with Gcem ONE compared to Temp-bond for the total mean marginal gap when scanning with Primescan (p = 0.0005) or Trios 4 (p = 0.0005). In everyday dentistry, both closed systems (Primescan with Cerec) and open systems (Trios 4 with Exocad) can be used to achieve an acceptable (<120 µm) marginal gap for ZLS CELTRA® DUO single crowns. There is a significant difference between cementation with Temp-bond and Gcem ONE self-adhesive resin cement (p < 0.05).

Comparison between Conventional and Digital Impressions for Determining Axes and Distances of Three Implants in Straight and Curved Lines: An In Vitro Study.

Background: In this study, we aimed to compare the effects of conventional and digital impressions on several parameters (inter-implant distance, intra-implant distance, inter-implant axis, and intra-implant axis) of three implants in curved lines and straight lines by using a laboratory scanner (LBS) versus an intra-oral scanner (IOS). Methods: Two 3D models were fabricated using a printer, each model with three internal hex implants analogues at the positions of 15#,16#,17# (straight line) and 12#,13#,14# (curved line). Standard intra-oral scan bodies (ISBs) were used, and the two models were scanned using 7 Series dental wings (LBS, reference model), followed by ten scans with Primescan (digital method). Standard Tessellation Language (STL) files were created. Five polyether impressions were taken from each model (straight and curved), and gypsum type 4 models were poured; each model was scanned five times to create a total of 25 STL files for each group (conventional method). The comparison between all the STL files (conventional and digital) was made by superimposition of the STL files on the STL reference model laboratory file using a 3D analyzing software. A Kolmogorov-Smirnov test was performed, followed by Mann-Whitney tests and Wilcoxon signed-rank tests. (p < 0.05). Results: For the conventional method, the mean errors were significantly higher for the curved line model (12-14) compared to the straight line model (15-17) for most parameters (p < 0.05). For the digital method, the mean errors were significantly higher for the curved-line model (12-14) compared to the straight line model (15-17) in half of the parameters (p < 0.05). Within the curved line model (12-14) and the straight line model (15-17), the mean errors between the conventional method and the digital method were not significant for most variables. Conclusions: The difference between curved lines and straight lines has an impact on the mean error of the conventional method. Both methods are reliable for straight and curved lines in partially dentate situations.

SEM Evaluation of the Marginal Gap of Zirconia-Reinforced Lithium Silicate Full Crowns and the Effect of Post Crystallization: An In Vitro Study.

BACKGROUND: This study compared the influence of crystallization on marginal gap adaptation by using computer-aided design and manufacturing (CAD-CAM) for producing monolithic zirconia-reinforced lithium silicate (ZLS) ceramic crowns. METHODS: A total of 25 plastic teeth were scanned using a Primescan intra-oral scanner (IOS), and ZLS crowns were ground. For each unit (abutment and crown), the marginal gap was evaluated pre crystallization and post crystallization at four regions of interest through the use of a scanning electron microscope (SEM). To compare the marginal gap between the two groups, a Kolmogorov-Smirnov test performed on the study variables indicated a normal distribution (p > 0.05) followed by paired samples T-tests (α = 0.0005). RESULTS: After crystallization, there were significantly higher circumferential marginal gaps (CMGs) for all four surfaces (distal (p = 0.0005), mesial (p = 0.0005), palatal (p = 0.0005), and buccal (p = 0.0005)). The total mean marginal gap (MMG) revealed a significantly higher result for the post-crystallization group (79.82 ± 7.86 µm) compared to the pre-crystallization group (24.25 ± 5.49 µm). CONCLUSIONS: The post-crystallization group showed a significantly higher marginal gap compared to the pre-crystallization group in all parameters, but both groups were in the clinically accepted threshold (<120 microns). In terms of the marginal gap, it is arguable whether to carry out post-crystallization for CELTRA® DUO crowns and achieve better mechanical properties but significantly increase the marginal gap.

The Influence of Laboratory Scanner versus Intra-Oral Scanner on Determining Axes and Distances between Three Implants in a Straight Line by Using Two Different Intraoral Scan Bodies: A Pilot In Vitro Study.

BACKGROUND: The purpose of this in vitro study was to compare the inter-implant distance, inter-implant axis, and intra-implant axis of three implants in a straight line by using a laboratory scanner (LBS) versus an intra-oral scanner (IOS) with two different intra-oral scan bodies (ISBs). METHODS: A 3D model was printed with internal hex implant analogs of three implants in positions 15#, 16#, and 17#. Two standard intra-oral scan bodies (ISBs) were used: MIS ISB (two-piece titanium) and Zirkonzhan ISB (two-piece titanium). Both ISBs were scanned using 7 Series dental wings (LBS) and 30 times using Primescan (IOS). For each scan, a stereolithography (STL) file was created and a comparison between all the scans was performed through superimposition of the STL files by using 3D analysis software (PolyWorks® 2020; InnovMetric, Québec, QC, Canada). A Kolmogorov-Smirnov test was performed followed by a Mann-Whitney test (p < 0.05). RESULTS: The change in inter-implant distance for the MIS ISB was significantly lower compared to the ZZ (p < 0.05). The change in intra-implant angle was significantly lower for the ZZ ISB compared to MIS (p < 0.05). The changes in inter-implant angle between the mesial and middle and between the middle and distal were significantly lower for MIS compared to ZZ in contrast to mesial to distal, which was significantly higher (p < 0.05). CONCLUSIONS: Both ISBs showed differences in all the parameters between the LBS and the IOS. The geometry of the scan abutment had an impact on the inter-implant distance as the changes in the inter-implant distance were significantly lower for the MIS ISB. The changes in the intra-implant angle were significantly lower for the ZZ ISB. There is a need for further research examining the influence of geometry, material, and scan abutment parts on the trueness.

Impact of physical and mental training on dental students' fine motor skills.

BACKGROUND: Mental training can be beneficial when learning new motor skills. OBJECTIVE: To evaluate whether a combination of physical and mental training can replace physical training. METHODS: Sixty dental students were randomly divided into six groups, which were assigned different regimens of physical and mental training: A. 75% mental 25% physical; B. 50% mental 50% physical; C. 75% physical 25% mental; D. 100% mental; E. 100% physical; F. control, no practice. The physical training comprised eight different tasks performed on the Purdue Pegboard: four tasks with direct vision (PD) and four tasks with indirect vision (PIND). The mental training involved listening to a recording explaining the actions to be performed. The tests were performed twice: T0, before training; and T1, at 24 h after training. The non-parametric Mann-Whitney test was used to detect differences between the groups. Changes between T0 and T1 within a group were analysed by Wilcoxon signed-rank test. RESULTS: There were no significant differences between the groups at T0. At T1, members of Groups A, B, C, and E had improved at five to eight tasks, while Groups D and F had improved at two tasks. Notably, Group D improved in the assembly tasks. Ranking the extent of improvement at T1, indicated that For PD Groups B, E > F, D while for PIND B, C, E > A, F and E > D. CONCLUSION: Substituting some physical training by mental training can provide similar improvements in fine motor skills, although the optimal combination remains to be determined. Mental training may be more effective for cognitive tasks.

The Light Reflection Changes of Monolithic Zirconia and Lithium Disilicate after Using Two External Staining Kits following by Thermocycling.

BACKGROUND: The purpose of the study was to evaluate the changes of light reflection% on two materials (monolithic zirconia and lithium disilicate) after using two external staining kits following by thermocycling. METHODS: Specimens were sectioned from monolithic zirconia (n = 60) and lithium disilicate (n = 60) then divided into six groups (n = 20). Two different types of external staining kits were used and applied to the specimens. The light reflection% was measured before staining, after staining and after thermocycling using a spectrophotometer. RESULTS: The light reflection% of zirconia was significantly higher compared to lithium disilicate at the beginning of the study (p = 0.005), after staining with kit 1 (p = 0.005) and kit 2 (p = 0.005) and after thermocycling (p = 0.005). For both materials, the light reflection% was lower after staining with Kit 1 compared to kit 2 (p < 0.043). After thermocycling, the light reflection% of lithium disilicate increased (p = 0.027) and was unchanged with Zirconia (p = 0.527). CONCLUSIONS: There is a difference between the materials regarding light reflection% as the monolithic zirconia showed higher light reflection% comparing lithium disilicate throughout the entire experiment. For lithium disilicate, we recommend using kit 1 as we found that, after thermocycling, the light reflection% of kit 2 was increased.

Assessment of the modified O'Connor Tweezer Dexterity and Purdue Pegboard test for use among dental students.

OBJECTIVES: The current study aimed to assess criteria validity and test-retest reliability of the modified O'Connor Tweezer Dexterity (O'Connor) and the Purdue Pegboard test (PPT) for use among dental students. Occupational therapists were asked to assess dentist-related skills due to the high percentage of students who failed the dental school exams that year. The O'Connor and the PPT are suitable for these purposes, they aim to evaluate fine motor skills requirements. The original tests were modified for use under indirect visualization conditions (through a mirror) to mimic the typical dentists' work environment. MATERIALS AND METHODS: A total of 110 dentists were included in the present study (50 dentists for the O'Connor test and 60 for the PPT). Both tests were conducted twice. Initially, the original version of the tests was followed by the modified versions (through a mirror). For the test-retest reliability assessment, 21 participants (10 participants from the O'Connor group and 11 participants from the PPT group) repeated the evaluation within a 1-week interval using the same settings (original followed by modified versions). RESULTS: Both versions of the O'Connor tests were significantly correlated (r = 0.54, p < 0.01), as were the two PPT versions (r = 0.640, p < 0.01). Significantly test-retest reliability was found for both tests. The interclass correlation ranged between 0.883 and 0.997, p < 0.000. CONCLUSION: The results confirmed our hypothesis, demonstrating a criteria validity and test-retest reliability assessment of the modified O'Connor and the modified PPT for assessing dentists.

Does Augmented Visual Feedback from Novel, Multicolored, Three-Dimensional-Printed Teeth Affect Dental Students' Acquisition of Manual Skills?

Although three-dimensional (3D) printing technology is increasingly used in dental education, its application regarding the provision of online visual augmented feedback has not been tested. Thus, this study aimed to: (1) develop two generations of multicolored 3D-printed teeth that provide visual augmented feedback for students conducting the cavity preparation process, (2) assess students' clinical performance after training on the 3D models, and (3) acquire student feedback. For the first-generation model, augmented feedback was obtained from five 3D-printed teeth models for five cavity preparation procedures. Each model comprised three layers printed in green, yellow, and red indicating whether preparation was acceptable, limited, or unacceptable, respectively. The study used a crossover design in which the experimental group trained on five multicolored models and 10 standard plastic teeth, and the control group trained on 15 standard plastic teeth. Students gave positive feedback of the methodology but complained about the printed material's hardness. Therefore, a second-generation model was developed: the model's occlusal plane was replaced with a harder printed acrylic material, and the experiment was repeated. During training, instructors provided external terminal feedback only for performance on standard plastic teeth. Manual grades for cavity preparations on standard plastic teeth were compared. No significant differences were found between the control and experimental groups in both generations' models. However, less instructor time was needed, and similar clinical results were obtained after training with both generations. Thus, multicolored 3D-printed teeth models promote self-learning during the process of acquiring manual skills and reduce student dependency on instructors.

An interventional study for improving the manual dexterity of dentistry students.

OBJECTIVES: Traditionally, the acquisition of manual skills in most dental schools worldwide is based on exercises on plastic teeth placed in a "phantom head simulator". No manual trainings are done at home. Studies revealed that preliminary training of one motoric task leads to significant improvement in performance of the required motoric task that has similar components. Performing tasks indirectly via a dental mirror are complicated for the young dental students. We hypothesized that instructed training of basic skills required in dentistry at home on a tool simulating the phantom laboratory will improve the capabilities of the students and will be reflected by their clinical grades. METHODS: We developed a portable tool PhantHome which is composed of jaws, gingival tissue, rubber cover and a compatible stand. Specific teeth produced by a 3D printer with drills in different directions were placed in both jaws. Students were requested to insert pins by using tweezers and dental mirror according to instructions initiating with easy tasks and continue to ones that are more complicated. 106 first clinical year dental students participated in the study; 65 trained only in the traditional phantom lab (control). 41 trained at home by the PhantHome tool two weeks before and 2 months during the initial stage of phantom lab. The students grades routinely provided in the phantom laboratory at different stages were compared. RESULTS: Students who trained with the portable tool performed better than the control group in the first direct and second indirect preparations (p<0.05). These exams were taken when the PhantHome was available to the students. Then, the tool was returned and the phantom course continued regularly. We believe that this is why no differences between the grades of the groups were observed further on. CONCLUSIONS: Training by the PhantHome improves motor skills and consequently the clinical performances.

Consolidation of complex motor skill learning: evidence for a delayed offline process.

Following initial acquisition, studies across domains have shown that memories stabilize through consolidation processes, requiring a post-acquisition temporal interval to allow their occurrence. In procedural skill memories, consolidation not only stabilizes the memory, but also simultaneously enhances it by accumulating additional gains in performance. In addition, explicit skill tasks were previously shown to consolidate through sleep, whereas implicit tasks were consolidated following a time interval which did not include a period of sleep. Although previous research has been instrumental in utilizing simple motor tasks designed to model skill learning, whether and how skill consolidation processes operate in complex real-life environments remains to be determined. Here, we tested consolidation in a complex motor skill, used to train execution of fine-motor movements. Since the complex task was explicit, we hypothesized that consolidation will be evident immediately following sleep, as in simple explicit motor skills. However, results show that even though participants were aware of the goal of the complex skill task, consolidation was evident only 24 hr following skill acquisition, and not following a shorter 12 hr interval, even when the latter included sleep. An additional experiment verified that without a temporal interval longer than 12hr, the same skill training does not undergo complete consolidation. These results suggest that task complexity is a crucial characteristic determining the proper terms allowing full consolidation. Due to the enhanced ecological validity of this study, revealing the differences between complex and simple motor skills could enable the facilitation of advanced rehabilitation methods following neurological injuries.

Effect of Two Traditional Polyacrylic Acid Conditioners and 2% Chlorhexidine Digluconate on Cavosurface Microleakage of Glass Ionomer Restorations.

OBJECTIVES: A lack of appropriate adhesiveness is one of the biggest problems in restorative dentistry today and the main cause of microleakage. This is especially true in pediatric dentistry where moisture control is more difficult to achieve. Glass ionomer restorative materials increase adhesion and decrease microleakage given their chemical adhesion to the remaining tooth substance. Pretreatment improves the adhesion quality. The aim of this study was to assess the microleakage of Glass ionomer restorative materials following application of 20% polyacrylic acid, 10% polyacrylic acid or 2% chlorhexidine digluconate in Class V cavities. STUDY DESIGN: Two Class V preparations were prepared on the buccal and lingual surfaces of 24 extracted human molars. The gingival wall was set below or above the CEJ. The teeth were divided into 2 groups. Group 1 was treated with 20% polyacrylic acid or 10% polyacrylic acid. Group 2 was treated with 10% polyacrylic acid or 2% chlorhexidine digluconate. Microleakage was evaluated using a light-reflecting stereomicroscope and stain penetration test. RESULTS: Two percent chlorhexidine digluconate was as efficient as the other conditioners. No statistically significant differences were found among the three types of conditioners. Dye penetration was significantly greater into dentin than into enamel among all three conditioners in both groups (P<0.001). CONCLUSION: Two percent chlorhexidine digluconate, with its known added advantages, can be used as a pretreatment conditioner in GI restorations.

Predicting the clinical performance of dental students with a manual dexterity test.

Dentists must be skilled when using dental mirrors. Working with mirrors requires spatial perception, bimanual coordination, perceptual learning and fine motor skills. Many studies have attempted to determine the predictors of manual skills among pre-clinical students, but consensus has yet to be reached. We hypothesized that valid and reliable occupational therapy test performance regarding indirect vision would differ between dental students and junior dentists and would explain the variance in manual skill performance in pre-clinical courses. To test this hypothesis, we applied the Purdue Pegboard test and O'Connor Tweezer Dexterity test under different conditions of direct and indirect vision. We administered these tests to students in phantom-head academic courses in 2015 and 2016 and to junior dentists. Students performed the tests at three time points: before phantom training (T0), at the end of the training (T1) and in the middle of the following year of study (T2). Dentists performed the same tests twice at 1st and 2nd trials one week apart. The results showed that indirect tasks were significantly more difficult to perform for both groups. These dexterity tests were sensitive enough to detect students' improvement after phantom training. The dentists' performances were significantly better than those of students at T0, specifically with regard to the use of tweezers under direct and indirect vision (the O'Connor test). A regression analysis showed that students' manual grades obtained at the beginning of the phantom course, their performance on the Purdue test using both hands, and their performance on the O'Connor test under indirect vision predicted phantom course success in 80% of cases. The O'Connor test under indirect vision is the most informative means of monitoring and predicting the manual skills required in the pre-clinical year of dentistry studies.