Are CAD-CAM milled glass fiber posts better than prefabricated or custom glass fiber posts for endodontically treated teeth? A systematic review with meta-analysis.

STATEMENT OF PROBLEM: Prefabricated and custom glass fiber posts have been successfully used to reconstruct endodontically treated teeth. However, the performance of computer-aided design and computer-aided manufacture (CAD-CAM) milled glass fiber posts is unclear. PURPOSE: The purpose of this systematic review with meta-analysis was to compare the fracture and bond strength and cement layer thickness of CAD-CAM milled glass fiber posts with prefabricated or custom glass fiber posts. MATERIAL AND METHODS: The protocol was registered in the Open Science Framework (http://osf.io/65jm7). Two reviewers searched the PubMed/MEDLINE, Web of Science, Embase, Scopus, and ProQuest databases for articles up to September 2023. In addition, the reference lists were hand searched. A meta-analysis was performed by using the RevMan 5.4 program. The risk of bias was assessed using the RoBDEMAT tool. RESULTS: After screening, a total of 18 studies were included. The CAD-CAM milled glass fiber posts showed higher fracture strength (P=.02; Standardized Mean Difference [SMD]: 0.57; 95% Confidence Interval [CI]: 0.07 to 1.07), bond strength (P=.010; SMD: 1.07; 95% CI: 0.26 to 1.89), and lower cement layer thickness (P=.009; SMD: -2.94; 95% CI: -5.15 to -0.73) when compared with prefabricated glass fiber posts. However, fracture strength (P=.53; SMD: 0.38; 95% CI: -0.79 to 1.54) and bond strength (P=.90; SMD: -0.05; 95% CI: -0.81 to 0.72) were statistically similar between CAD-CAM milled and custom glass fiber posts. Significant and substantial heterogeneity was observed in all meta-analyzes (P<.01; I>60%). The studies sufficiently reported most domains related to bias, except for randomization of samples, sample size rationale and reporting and operator blinding. CONCLUSIONS: CAD-CAM milled and custom glass fiber posts provide an effective and safe option for restoring endodontically treated teeth, especially for weakened teeth or enlarged root canals. However, further well-designed clinical research is recommended to strengthen these findings.

Influence of ceramic crown design (translucent monolithic zirconia vs. bilayered) of implant-supported single crowns after mechanical cycling.

OBJECTIVES: This study aimed to assess the influence of translucent monolithic versus bilayered crowns and whether the use of a CoCr base abutments affects the fatigue and fracture resistance of screwed implant-supported single crowns with external connections under mechanical cycling. MATERIALS AND METHODS: Fifty specimens were divided into groups: (1) metal-ceramic (MC) crown, (2) veneered zirconia crown (Zr), (3) veneered zirconia crown with a CoCr base abutment (ZrB), (4) monolithic translucent zirconia crown (MZr), and (5) monolithic translucent zirconia crown with a CoCr base abutment (MZrB). Specimens underwent mechanical cycling (5 × 106 cycles; 150 N) evaluating fatigue resistance (number of failures) and those that failed were subsequently subjected to fractographic analyses (stereomicroscope and scanning electron microscope) to evaluate failure location and area, and maximum fracture load was also measured. RESULTS: The failure-related survival rate (100%) and maximum fracture resistance of the MZrB were significantly higher than those of MC and Zr (50%; p < 0.05). There were no significant differences in the failure rate and fracture resistance when a CoCr base abutment was used or not in the translucent monolithic Zr groups (p > 0.05;MZrB vs. MZr). Failure location, with MC crowns' fractures, noted at the screw area (p = 0.043), while all-ceramic crowns were mostly in the cuspid and to failure area, the Zr group had the largest mean (15.55 ± 9.17 mm2) among the groups, significant difference only when compared with MC (1.62 ± 0.81 mm2) (p = 0.025). CONCLUSIONS: Translucent monolithic zirconia crowns exhibited significantly higher fatigue and fracture resistance compared with conventional MC and bilayered crowns. CLINICAL SIGNIFICANCE: The appropriate choice of material and manufacturing technique is crucial for predicting the higher clinical performance of single crowns. Enhanced mechanical resistance in terms of fatigue and fracture resistance can be achieved by replacing MC and bilayered restorations with computer-aided design and computer-aided manufacturing monolithic zirconia.

Impact of low-level laser therapy on the quality of life of patients with xerostomia undergoing head and neck radiotherapy: a systematic review.

PURPOSE: To carry out a systematic review to assess whether low-level laser therapy can improve the quality of life of patients with xerostomia undergoing head and neck radiotherapy. METHODS: A systematic search was performed through Embase, Medline/PubMed, Cochrane, Scopus, Web of Science, nonpeer-reviewed clinicaltrials.gov and LILACS. The strategy included clinical studies were selected that prospectively followed or evaluated the quality of life by directly comparing the use of low-level laser therapy for xerostomia induced by head and neck radiotherapy with alternative therapies without the use of a laser. The risk of bias in the studies was assessed by RoB 2.0 and Robins I. RESULTS: After all application of the predetermined criteria, four studies were included, dated between the years 2014 and 2023. Three studies described as randomized clinical trials were included, one of which was a randomized pilot study and only one was a prospective clinical trial. A total of 126 patients were evaluated, all four studies used the infrared wavelength, with two studies using the combination with the red wavelength. It was observed that low-level laser therapy can change the sensation of dry mouth, improving patients' quality of life. In addition, changes related to increased stimulated and unstimulated salivary flow were also identified. CONCLUSION: The use of low-level laser therapy has promising results on xerostomia, consequently improving the quality of life of patients undergoing radiotherapy in the head and neck region.

Rehabilitation with dental prostheses and its influence on brain activity: A systematic review.

STATEMENT OF PROBLEM: The consequences of edentulism depend on its complexity and are far-reaching, but limited evidence regarding its association with neurologic health is available. PURPOSE: The purpose of this systematic review was to establish the relationship between oral prosthetic rehabilitation and the regional increase in brain activity. MATERIAL AND METHODS: This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42021262247), and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Randomized clinical trials, prospective studies comparing the brain activity of patients rehabilitated with and without the use of dental prostheses, and studies that analyzed the human brain by using noninvasive techniques were used as inclusion criteria. The risk of bias in each study was assessed by using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I). RESULTS: The search was carried out in the PubMed/MEDLINE, Embase, Cochrane Library, and https://clinicaltrials.gov databases up to June 2021. After a search conducted by 2 reviewers, 8 articles were included in the review. A regional increase in blood flow and regional cerebral activity during dental prosthesis use was identified in the studies. CONCLUSIONS: A positive association was found between the different types of prosthetic rehabilitation and brain function. Prostheses may preserve and restore neurological health.

Mechanical behavior of titanium and zirconia abutments at the implant-abutment interface: A systematic review.

STATEMENT OF PROBLEM: Zirconia has become popular for dental implant abutments in the esthetic zone but can damage the implant connection interface. Studies have been conducted to compare zirconia abutments with conventional titanium abutments; however, a consensus or systematic review is lacking. PURPOSE: The purpose of this systematic review was to evaluate the performance of abutments made of zirconia and titanium in relation to wear and misfit at the implant-abutment interface. MATERIAL AND METHODS: Electronic databases (PubMed/MEDLINE, Embase, Web of Science) were independently searched by 2 researchers for relevant studies published up to June 2021. The population, intervention, comparison, outcome (PICO) question was "Do zirconia abutments cause greater wear at the implant-abutment interface than titanium abutments under occlusal forces?" Eligible studies included in vitro studies that evaluated changes in the surface of external and/or internal connections and single and/or multiple, screwed and/or cemented prostheses rehabilitated with titanium and zirconia abutments submitted to mechanical cycling. RESULTS: Nine studies were included for qualitative analysis. A total of 172 specimens were analyzed, 86 zirconia and 86 titanium abutments. In terms of wear on the implant connection surface, zirconia abutments caused more severe wear, more scratches, and more rounding of the hexagonal angles at the implant connection interface than titanium abutments. In terms of misfit at the connection interface, zirconia abutments showed greater misfit than titanium abutments. CONCLUSIONS: Zirconia abutments produce more wear at the titanium implant connection interface, titanium abutments showed better fit to the implant connection interface, and the fit can be influenced by the abutment manufacturing method.

Biomechanical Evaluation of Different Implant-Abutment Connections, Retention Systems, and Restorative Materials in the Implant-Supported Single Crowns Using 3D Finite Element Analysis.

This is an in silico study aimed to evaluate the biomechanical influence of different implant-abutment interfaces (external hexagon and Morse taper implants), retention systems (cement and screw retained), and restorative crowns (metal-ceramic and monolithic) using 3-dimensional finite element analysis (3D-FEA). Eight 3D models were simulated for the maxillary first molar area using InVesalius, Rhinoceros, and SolidWorks and processed using Femap and NEi Nastran software. Axial and oblique forces of 200 and 100 N, respectively, were applied on the occlusal surface of the prostheses. Microstrain and von Mises stress maps were used to evaluate the deformation (cortical bone tissue) and stress (implants/fixation screws/crowns), respectively, for each model. For both loadings, Morse taper implants had lower microstrain values than the external hexagon implants. The retention system did not affect microstrain on the cortical bone tissue under both loadings. However, the cemented prosthesis displayed higher stress with the fixation screw than the external hexagon implants. No difference was observed between the metal-ceramic and zirconia monolithic crowns in terms of microstrain and stress distribution on the cortical bone, implants, or components. Morse taper implants can be considered as a good alternative for dental implant rehabilitation because they demonstrated better biomechanical behavior for the bone and fixation screw as compared to external hexagon implants. Cement-retained prosthesis increased the stress on the fixation screw of the external hexagon implants, thereby increasing the risk of screw loosening/fracture in the posterior maxillary area. The use of metal-ceramic or monolithic crowns did not affect the biomechanical behavior of the evaluated structures.