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Major and minor chipping of veneering porcelain are two of the most frequent complications in all-ceramic restorations with zirconia frameworks. In cases of major chipping, replacement of the affected restoration may be necessary. High-strength lithium disilicate ceramic offers new options to serve as veneering material in a sintering technique or as repair material for chipping in combination with the adhesive technique. The purpose of three case presentations here was to describe the use of lithium disilicate ceramic on zirconia frameworks for reliable and esthetic veneering in the posterior region and to repair extended chipping in conventional veneering materials.

Patients with CHARGE syndrome (where CHARGE stands for coloboma of the iris or retina, heart defects or cardiac malformations, atresia/stenosis of the choanae, retardation of growth and development, genital anomalies, and ear abnormalities) present several orofacial anomalies. Their treatment depends on the specific type of manifestation. To perform the complex oral rehabilitation and achieve a conservative, esthetic, and functional exploration of the definitive treatment goal, computer-aided design and computer-aided manufacturing (CAD-CAM) polymers can be used as long-term interim restorations. This article reports the treatment of a young patient with CHARGE syndrome combined with oral alterations. CAD-CAM polymers offer an intermediate treatment with satisfying esthetics and function at low biological cost until bone growth is completed. This period facilitates additional planning for the definitive restoration.

Objective Extraction-socket resorption is considered a major problem that can limit implantological rehabilitation options and compromise the esthetic outcome. Surgical techniques to reduce remodeling are of restricted predictability and commonly require several surgical interventions and grafting. This increases the treatment cost and places a physical and psychological strain on the patient. This clinical case report presents a replacement of an upper canine using the socket-shield technique (SST) with a CAD/CAM surgical guide, resulting in a predictable, high esthetic, and functional result. Clinical considerations The SST is an alternative approach to curbing remodeling and resorption by retaining the facial part of the root during tooth extraction. An immediately placed implant supports the facial root fragment, preventing the collapse of the buccal wall. The SST with digital precision planning in combination with a CAD/CAM surgical guide benefits patients by preserving their tissue architecture and causing only insignificant trauma. Furthermore, the SST reduces the number of surgical and prosthetic interventions required to one each for pre-operative planning, surgical procedures, and prosthetic rehabilitation. Conclusions The socket shield technique is a minimally invasive implantological approach offers patients and clinicians multiple benefits. Clinical Significance The socket-shield technique (SST) represents an alternative approach to intervene remodeling and resorption processes by the maintenance of the facial part of the root during tooth extraction. The immediate placement of an implant supports the facial root fragment and thereby prevents a collapse of the buccal wall. The SST associated with a CAD/CAM fabricated surgical guide, can reduce the amount of appointments, due to the immediate fabrication of the definitive restoration with the existing model. Therefore, no further necessary appointments are required apart from first pre-operative planning, second for surgical treatment, and third for prosthetic rehabilitation. (J Esthet Restor Dent 29:93–101, 2017)

Background The aim of this study was to investigate the effects of storage medium and aging duration on Martens hardness (HM) and indentation modulus (EIT) of self-adhesive resin-based cements (SARCs). Methods A total of 416 discs were fabricated from 8 SARCs (n = 52 per SARC): (i) BeautyCem (BEA), (ii) Bifix SE (BIF), (iii) Clearfil SA Cement Automix (CLE), (iv) RelyX Unicem2 Automix (RXU), (v) SeT (SET), (vi) SmartCem 2 (SMC), (vii) SoloCem (SOC) and (viii) SpeedCEM (SPC). The specimens were ground and stored in (a) physiological saliva, (b) artificial saliva, (c) sodium chloride and (d) distilled water, at 37°C for 1, 7, 14, 28, 90 and 180 days. Non-aged specimens (3 hours after photo-initiation) of each SARC acted as control groups. HM and EIT were assessed using a universal hardness testing machine. Data were analyzed using Kolmogorov-Smirnov and Kruskal-Wallis tests and paired t-test, and 3-, 2- and 1-way ANOVA with post hoc Scheffé test (pResults SARC materials exerted the highest influence on HM and EIT values (pP²] = 0.753 and 0.433, respectively), closely followed by aging duration (pP² = 0.516 and 0.255) and storage medium (pP² = 0.043 and 0.033). The interaction effect of the combinations of the 3 independent parameters was also significant (pP² = 0.163 and 0.133). The lowest initial HM and EIT was presented by CLE, followed by SET and SPC; highest HM was for BIF, followed by RXU and SMC. SET gave a greater HM and EIT percentage decrease than SOC, SPC, BEA, SMC, RXU or CLE. Conclusions Aging duration is a major factor affecting the micromechanical properties of SARCs, while storage medium was shown to have a significant but minor role.

This study evaluated the impact of tooth shade on differences in color (Delta E), lightness (Delta L), chromaticity coordinates a*/b* (Delta alpha and Delta b), transmittance and the degree of fluorescence of CAD/CAM leucite based ceramic (LBC). Ten disks were fabricated of LBC;Empress CAD, A2, thickness of 1.5 mm and eight disks of resin-nano-ceramic (RNC;Lava Ultimate) in different colors to simulate variations in substrate shade. The associations of LBC disks with different color substrates were analyzed with a spectrophotometer;AE, Delta L*, Delta a*, Delta b*, and transmittance were measured and calculated. Fluorescence was evaluated with a fluorescence system (Fluorescence System, Biopdi). All substrate shades influenced the optical properties of LBC, with regard to color, luminosity, coordinate a* and b*, transmittance, and fluorescence (p

To analyse the residual monomer (MMA) elution of polymethyl methacrylate (PMMA) in distilled water after diverse fabrication methods and aging procedures. PMMA specimens (N = 192, PalaXpress; Kulzer, Hanau, Germany) were manufactured (pouring, n = 96/injection, n = 96) and polymerized in water (55°C) without pressure (n = 48) and with 2 bar pressure (n = 48). Specimens were grinded (n = 24) or polished (n = 24) and aged for 12 h in distilled water/37°C (n = 12) or at air/20°C (n = 12) and stored afterwards in distilled water at 37°C. MMA elution was evaluated after 1, 2, 3, 4, 5, 6, 7, 10, 15 days (UV/Vis spectrophotometry). Data were analysed with Kolmogorov-Smirnov, Mann-Whitney-U and Cohen-d test using SPSS (α < 0.5). The pouring procedure resulted in significantly higher MMA elution than the injection procedure up to 5 days. Polymerization with a pressure of 2 bar reduced the MMA elution significantly for poured specimens. Polishing reduced the MMA elution in comparison to grinding. The fabrication procedure (pouring/injection) showed the strongest correlation to the MMA elution (r = 0.500), followed by polishing (r = 0.243), the pressure during polymerization (r = 0.109) and the storage medium (r = 0.053). Higher MMA elution may increase the risk of chemical irritations, allergic reactions and hypersensitivities of the oral mucosa. Technicians and dentists should be aware about the elution differences dependent on the fabrication procedure.

For several years, there has been a clear trend in the dental market towards monolithic tooth-colored restorations. In this context, further developments, particularly in the field of zirconia ceramics, have led to considerable improvement in the materials' optical properties. Modern zirconia materials can be divided into several cohorts, differing from each other with respect to their optical and mechanical properties. The knowledge about indications and limitations of each zirconia cohort is essential for a correct clinical application. Clinical long-term experience for the zirconia of the newest generations is still scarce and only in-vitro data are available. Despite all advancements, clinical long-term success remains closely linked to the specific indications, preparation, material selection, knowledge, and experience of the dental practitioner and dental technician, as well as an adequate luting mode and occlusal concept. Due to the high innovation rate within materials and CAD/CAM technology in general, clinicians and dental technicians need to be well informed in order to be able to work successfully with the various options.

Statement of problem Veneering composite resins (VCRs) are often used to veneer frameworks, but knowledge of mechanical, surface, and discoloring properties is scarce. Purpose The purpose of this in vitro study was to evaluate the impact of thermocycling on flexural strength (FS) and the influence of different staining media on the discoloration (ΔE) and surface free energy (SFE) of VCRs. Material and methods The following VCRs were tested: Ceramage, dialog Vario, Gradia Plus, in:joy, Signum composite, and SR Nexco. FS was tested with enamel and dentin pastes (except SR Nexco: only enamel paste), whereas ΔE and SFE were analyzed for enamel pastes. ΔE was determined by using a spectrophotometer, and SFE was evaluated with contact angle measurements. For FS, rod-shaped specimens (N=660, n=10/subgroup; 25×2×2 mm) were fabricated, thermocycled for 220, 1500, 10 000, 20 000, and 40 000 cycles (5 °C/55 °C). and tested immediately after fabrication (initial) and after aging. For ΔE and SFE, disc-shaped specimens (N=300, n=10/subgroup; 15x15x1.4 mm) were fabricated and stored for 14 days in coffee, red wine, carrot juice, beetroot juice, or curry solution. ΔE and SFE were measured initially after polishing, after discoloration, and after repolishing. Data were analyzed using univariate analysis, 1-way ANOVA followed by the Scheffe post hoc test, Kolmogorov-Smirnov test, Kruskal-Wallis test, Mann-Whitney U test, and Wilcoxon test (α=.05). Results Ceramage had the highest FS, followed by dialog Vario and SR Nexco. Gradia Plus, and in:joy had the lowest FS, followed by Signum composite. FS was reduced by increasing of thermocycles. The highest ΔE was measured for curry and the lowest for carrot juice and red wine, followed by beetroot juice and coffee. The highest ΔE between the initial polished specimens and repolished specimens were observed for Ceramage. The remaining VCRs showed differences in ΔE between 0.95 (Signum composite) and 1.30 (SR Nexco). The SFE of the VCRs was similar. After storage in discoloring media, all VCRs had higher SFE than directly after polishing (initial). Repolishing decreased the SFE values compared with those of specimens measured after storage. Conclusions FS, ΔE, and SFE differed between the VCRs tested. Discoloration of the VCRs depended on the food and beverage and could be corrected to a clinically acceptable range by repolishing.

Purpose To investigate whether hemostatic agents have any detrimental effects on polyether impressions and plaster casts after a clinically viable cleaning protocol. Materials and methods A total of 60 human molar teeth were manually standardized, prepared, and subdivided into five groups (G): G0 (control/no contamination); G1 (ViscoStat Clear); G2 (ViscoStat); G3 (Astringedent); and G4 (Astringedent X). Each tooth was contaminated with a hemostatic agent for 3 minutes and cleaned with a 30-second air/water spray. Before and after contamination, an impression was taken and a plaster cast was poured. The impressions and plaster casts of all teeth were scanned using a light scanner. Data were matched using a three-dimensional analysis software that displayed color-coded maps. Means of the maximum positive/negative values and of the mean deviations in each group were calculated and compared. All color-coded maps were interpreted descriptively using the program's color scale, and all impressions and plaster casts were microscopically evaluated. Results Values of mean deviations throughout all matched scans showed maximum values ranging from -30.1 to +17.5 μm. None of the groups showed significantly different deviation values or patterns when compared to each other. Impressions showed a thin, discontinuous coating for G2, G3, and G4; no changes were found for plaster casts. Conclusion Presented deviations showed the same values and distribution patterns within all groups. A cleaning protocol of 30 seconds of air/water spray is sufficient to remove hemostatic agents, preventing effects to polyether impressions and plaster casts. However, ferric sulfate-containing hemostatic agents left discontinuous coatings on impression surfaces.

Objectives Evaluation of survival and complication rate of monolithic occlusal onlays made of lithium disilicate ceramic used in patients with severe tooth wear up to 11 years of clinical service. Methods In a prospective non-randomized clinical study 7 patients (4 male, 3 female; median age: 44.3 ± 6.56 years old) were restored full mouth with a total of 103 adhesively bonded occlusal onlays made of lithium disilicate ceramic (IPS e.max Press, Ivoclar Vivadent, Schaan, Liechtenstein). All restorations were examined during annual recall visits using periodontal parameters according to the modified United States Public Health Service (USPHS) criteria: (a) marginal discoloration, (b) secondary caries, (c) marginal integrity, (d) surface texture, (e) restoration fracture, and (f) occlusal wear, rating with Alpha, Bravo and Charlie over an observation period up to 11 years (68–139 months; median: 94.9 ± 26.1 months). Data was statistically analyzed using the Kaplan–Meier estimation. Results Monolithic lithium disilicate occlusal onlays presented a 100% survival rate. Four restorations within one patient (3.9%) presented marginal discoloration, one after 60 and three after 108 months (all rated Bravo). One restoration (1%) showed a marginal crack formation (technical complication) after 120 months, rated Bravo. No biological complication, debonding or secondary caries could be found and tested periodontal parameters showed excellent results. Significance Based on the analyzed data up to 11 years, monolithic occlusal onlays made of lithium disilicate ceramic can be considered as a reliable treatment option for full-mouth rehabilitations in patients with severe tooth wear.

To determine the mechanical and optical properties of CAD/CAM composites (LAVA Ultimate, Cerasmart, Shofu Block and two exp. CAD/CAM composites), a hybrid material (VITA Enamic), a leucite (IPS Empress CAD) and a lithium disilicate glass-ceramic (IPS e.max CAD).Three-point flexural strength (FS) was investigated according ISO 6872:2008 (N=240/n=30). Two-body wear (TBW) was analyzed in a chewing simulator (1,200,000 cycles, 50N, 5°/55°C) using human teeth as antagonists (N=120/n=15). Quantitative analysis of wear was carried out with a 3D-scanner and associated matching software. Discoloration rate (DR) after 14 days of storage in cress, curry, red wine, and distilled water (N=384/n=12), and translucency (T) (N=384/n=48) of CAD/CAM materials were measured in a spectrophotometer (400-700nm wavelength). Data were analyzed using two-/one-way ANOVA with Scheffé post-hoc test, Kruskal-Wallis-H test, and linear mixed models (α=0.05).IPS e.max CAD showed the highest FS (p0.001), followed by LAVA Ultimate; however, not different from the remaining CAD/CAM composites (exception: Shofu Block). The lowest FS showed VITA Enamic and IPS Empress CAD (p0.001). IPS Empress CAD, VITA Enamic, exp. CAD/CAM composite 2, followed by IPS e.max presented lower material TBW than the remaining CAD/CAM materials (p0.001). The highest antagonist wear was observed for the tested glass-ceramics and the hybrid material (p0.001). Storage medium (red winecurrycressdistilled water) exerted the highest influence on DR (p0.001), closely followed by CAD/CAM material. Glass-ceramics showed lower DR than CAD/CAM composites (p0.001).CAD/CAM composites presented moderate FS, high T and antagonist friendly behavior. Glass-ceramic demonstrated the most favorable DR and lowest TBW on the material side.

Tooth wear is generally a physiological process; however, it can also be a pathological condition associated with attrition, abrasion, and erosion processes in which the quantity of tooth loss is atypical for the patient's age. Tooth substance loss often causes functional problems, symptoms of discomfort/pain, and esthetic impairments. Patients presenting this condition frequently need restorative treatment, combined with an increase in the vertical dimension of occlusion (VDO). A diagnostic wax-up (DWU) provides assistance in determining a new occlusal plane and VDO, and is a fundamental tool considering the backward planning involved in the execution of a complex rehabilitation. In cases of severe tooth wear, preventive measures must be taken. Yet, when a restorative intervention is needed, the use of a DWU, in conjunction with a mock-up, helps to achieve a predictable and satisfactory outcome. This article presents a case report of a young female patient with pathological tooth wear, related symptomatology, and esthetic complaints. Initially, a DWU and a diagnostic mock-up were created. After esthetic and functional corrections, a second DWU was generated and transferred to the patient's mouth by means of a therapeutic mock-up. This mock-up was used as a trial restoration for the pretreatment phase, to evaluate the new VDO/esthetics/function and to guide tooth preparation. Lithium disilicate (LS2) occlusal onlays were used to stabilize the VDO, and anterior LS2 and feldspathic veneers, combined with direct composite restorations, were executed to reach the planned minimally invasive result.

The purpose of this topic review is to give a general overview of gingival retraction agents used during prosthodontic treatment, and the possible difficulties connected to them that may be faced by the dentist. Hemostatic agents are important for successful gingival retraction and in achieving hemostasis. However, these agents may show numerous negative effects on the prosthodontic treatment and oral tissues of which the practicing dentist must be aware, and which will be elucidated in this review. PubMed and Google Scholar databases were searched for publications up to and including 2017. The following key words were used in different combinations: "hemostatic agent," "astringent," "astringency," "epinephrine," "ferric sulfate," "aluminum chloride," "hemorrhage control," "soft tissue," "hard dental tissue," "self-etch adhesive," "total-etch adhesive," "bond strength," "impression," "gypsum," "plaster cast," and "dental cast." In the last three decades the hemostatic agents used by practicing dentists have changed from epinephrine towards astringents, with AlCl3 and Fe2(SO4)3 now the most popular. All of the currently known hemostatic agents cause some local, temporary gingival tissue damage, but only epinephrine is known to elicit negative systemic effects. Studies concerning the influence of hemostatic agents on impression materials show highly contradictory results regarding the possible polymerization-inhibiting properties of hemostatic agents, probably due to the lack of standardization of methodology. Hemostatic agents seem to alter the dentinal surface properties making it more resistant to acid etching. Therefore the relatively low acidity of self-etch adhesives when compared to total-etch systems may not be strong enough to sufficiently etch a more resistant dentinal surface, and consequently may result in lower adhesive bond strengths.

The aim of this study was to evaluate the transmittance of visible light (VL) (λ: 400-700 nm) and blue light (BL) (λ: 360-540 nm) through six CAD/CAM zirconia blanks (ZiB) in comparison to a lithium disilicate ceramic (LS2). Disks of the zirconia materials Bruxzir (BX), Cercon (CE), Lava Frame (LF), Lava Plus (LP), Prettau (PT), Zenostar (ZS) and LS2 (EM) were manufactured and the transmittance was measured in a spectrophotometer. ZS, followed by CE, PT, LP, LF, and BX showed the lowest transmittance of VL and BL. The highest transmittance was shown by EM. The transmittance of BL was lower than that of VL in all groups. EM ceramics showed higher transmittance than all zirconia materials and the thickness of zirconia materials influenced the transmittance values. Knowledge about VL and BL transmittance would help clinicians to individually tailor the selection of material to the specific indication and to make the right choice regarding the luting procedure and light curing duration.

Adhesive bonding techniques in combination with tooth-colored restorative materials are one of the greatest achievements of restorative dentistry. Adhesively bonded veneers made from various silicate ceramic materials have contributed significantly to this. Ceramic veneers had long been considered to be only esthetic implements. However, their range of indications has been steadily increasing, making ceramic veneers a highly viable alternative to classic, far more invasive forms of restorative treatment. Today these veneers are used to restore the biomechanics of the dentition, to establish adequate function, to mask highly discolored endodontically treated teeth, and for many other purposes. The present article explains the principles of modern veneer technology based on clinical examples, with special emphasis on collaboration with the dental laboratory and communication within the dental team. This includes analyzing the case, defining the treatment goal, determining the right shade, selecting the most suitable ceramic material, finding the best preparation design, and choosing the most appropriate adhesive concept. The article will also explore the long-term prognosis of ceramic veneers as reported by a number of scientific studies.

To investigate discoloration reduction and changes of surface properties of a CAD/CAM resin composite after 14 days´ storage in red wine and polishing with nine different prophylactic polishing pastes (PPPs). Rectangular discs (N = 172) were fabricated and polished (P4000) using GC Cerasmart (GC Europe) to investigate different polishing protocols with 1–4 related descending PPPs (22 in total): Cleanic/CLE-Kerr, CleanJoy/CLJ-Voco, Clean Polish/Super Polish/SPO-Kerr, Clinpro Prophy Paste/CPP-3M, Detartrine/DET-Septodont, Nupro/NUP-Dentsply Sirona, Prophy Paste CCS/CCS-Directa, Proxyt/PXT-Ivoclar Vivadent, and Zircate/ZIR Prophy Paste-Dentsply Sirona. Surface properties (roughness values (RV)/Ra, Rz, Rv, surface free energy (SFE), surface gloss (G), and discoloration (ΔE)) were analyzed before and after storage and additional polishing. Data were examined using Kolmogorov-Smirnov test, three-way ANOVA followed by Tukey-B post hoc, Mann-Whitney U, and Kruskal-Wallis H tests (α

Dental therapy of traumatically ankylosed maxillary anterior teeth with an additional slight root resorption represents a great challenge for the restorative team and requires intensive planning and communication between patient, dentist, orthodontist, periodontist, and dental technician. The inhibition of vertical growth often makes dental intervention indispensable. Porcelain laminate veneers have been successfully used for more than two decades, mainly on anterior teeth, and was the minimally invasive treatment option for the present case report. Preprosthetic planning with a digital approach of the width-length ratio and the red-white esthetics were important prerequisites for a satisfactory treatment result. The treatment goal was clarified using a wax-up and a corresponding template for intraoral verification with a mock-up. The template also served as a preparation guide. Despite all risk factors, including the endodontic treatment, the 3-mm intruded position, and the slight root resorption, the patient and the restorative team decided to restore the situation with two feldspathic-ceramic veneers to provide an esthetic, time-saving, nonsurgical process for the patient.

Objective Oral rehabilitation often requires a multidisciplinary approach including restorative dentistry, prosthodontics, and periodontology to fulfill high esthetic and functional demands, frequently combined with changes in the vertical dimension. The presence of gingival recessions can be associated with numerous factors, such as brushing or preparation trauma and persistent inflammation of the gingiva due to inadequate marginal fit of restorations. Because gingival recessions can cause major esthetic and functional problems, obtaining stability of the gingival tissue around prosthetic restorations is of essential concern. Modifications of the occlusal vertical dimension require sufficient experience of the whole dental team. Especially in patients with functional problems and craniomandibular dysfunction, a newly defined occlusal position should be adequately tested and possibly adjusted. Clinical considerations This case report presents a complete prosthetic rehabilitation combined with a periodontal surgical approach for a patient with gingival recessions and functional/esthetic related problems. The vertical dimension was carefully defined through long-term polymethyl methacrylate provisionals as a communication tool between all parts involved. All-ceramic crowns were inserted after periodontal healing as definitive rehabilitation. Conclusions Complex rehabilitation in patients with high esthetic demands including soft tissue corrections requires a multidisciplinary team approach that consists of periodontal surgeon, dentist and dental technician.

The goal of this study was to explore an innovative approach to single-tooth replacement using an individually custom-fabricated, root-analog, hybrid dental implant, in the esthetic zone, to avoid the microgap and micromovements between the implant and abutment. Moreover, the use of burs to prepare the implant recipient site is not necessary in this technique, reducing the bone removal, heating, and trauma. The process requires capturing accurate root geometry through combined computer-aided design/computer-assisted manufacturing (CAD/CAM) and a three-dimensional (3D) visualization (digital volume tomography [DVT]) of the tooth in situ, which might result in reduced remodeling after insertion. A good esthetic and functional outcome was obtained. The use of a root-shaped tooth analog implant might be in selected cases a viable alternative to current threaded cylindrical and cone-shaped implants. The new concept avoids the microgap between the implant and the abutment and reduces the trauma to the tissue and bone.

Extraction-socket resorption is considered a major problem that can limit implantological rehabilitation options and compromise the esthetic outcome. Surgical techniques to reduce remodeling are of restricted predictability and commonly require several surgical interventions and grafting. This increases the treatment cost and places a physical and psychological strain on the patient. This clinical case report presents a replacement of an upper canine using the socket-shield technique (SST) with a CAD/CAM surgical guide, resulting in a predictable, high esthetic, and functional result.The SST is an alternative approach to curbing remodeling and resorption by retaining the facial part of the root during tooth extraction. An immediately placed implant supports the facial root fragment, preventing the collapse of the buccal wall. The SST with digital precision planning in combination with a CAD/CAM surgical guide benefits patients by preserving their tissue architecture and causing only insignificant trauma. Furthermore, the SST reduces the number of surgical and prosthetic interventions required to one each for pre-operative planning, surgical procedures, and prosthetic rehabilitation.The socket shield technique is a minimally invasive implantological approach offers patients and clinicians multiple benefits.The socket-shield technique (SST) represents an alternative approach to intervene remodeling and resorption processes by the maintenance of the facial part of the root during tooth extraction. The immediate placement of an implant supports the facial root fragment and thereby prevents a collapse of the buccal wall. The SST associated with a CAD/CAM fabricated surgical guide, can reduce the amount of appointments, due to the immediate fabrication of the definitive restoration with the existing model. Therefore, no further necessary appointments are required apart from first pre-operative planning, second for surgical treatment, and third for prosthetic rehabilitation. (J Esthet Restor Dent 29:93-101, 2017).

Background: This in-vitro study examined the impact of storage solution, storage duration, and storage temperature on discoloration of three tooth-colored CAD/CAM materials for final restorations. Methods: Specimens ( N = 288; n = 96 per material) with a thickness of 1 ± 0.03 mm of the following CAD/CAM materials were fabricated: resin composite (Lava Ultimate, 3M), polymer-infiltrated ceramic (VITA Enamic, VITA Zahnfabrik), and leucite ceramic (IPS Empress CAD, Ivoclar Vivadent). After baseline measurement, specimens were stored in red wine, curry solution, cress solution, and distilled water at 37°C or 55°C. The discoloration was measured using a spectrophotometer (Lambda 35 Perkin Elmer, Perkin Elmer Inc.) after 1 and 7 days storage. Data were analyzed using four-way ANOVA followed by the Scheffé post-hoc test and partial eta squared ( ηP²) test ( p < 0.05). Results: The highest influence on ∆ E was exerted by storage duration ( ηP² = 0.295, p < 0.001), followed by storage solution ( ηP² = 0.171, p < 0.001), CAD/CAM material ( ηP² = 0.049, p < 0.001), and storage temperature ( ηP² = 0.033, p < 0.001). Specimens stored for 7 days in staining solutions showed more discoloration than those stored for just 1 day. Higher ∆ E values were achieved for specimens stored in curry solution, followed by red wine, cress solution, and distilled water. Resin composite Lava Ultimate showed larger ∆ E values compared with the resin hybrid ceramic VITA Enamic and leucite ceramic IPS Empress CAD. Specimens stored at 37°C showed significantly less discoloration than those stored at 55°C. Conclusions: The degree of coloration of the materials depends on food and temperature and was most pronounced with Lava Ultimate.

Objectives The authors investigated the use of ceramic primers combined with self-adhesive resin composite cements on the shear bond strength (SBS) to zirconia and compared them with one conventional resin composite cement. Methods The authors divided zirconia substrates (N = 550) into three groups: RelyX Unicem Aplicap self-adhesive universal resin composite cement (3M ESPE, St. Paul, Minn.) (group A) (n = 220); G-CEM Capsule self-adhesive resin composite cement (GC Europe, Leuven, Belgium) (group B) (n = 220); and Panavia 21 with Clearfil Porcelain Bond Activator and Clearfil SE Bond primer (n = 110) (Kuraray Dental, Tokyo) used as a standard comparison (SC). The authors examined the self-adhesive resin composite cements without (0) and with (1) the use of a ceramic primer. They measured SBS initially (37°C for three hours), after water storage (37°C for one, four, nine, 16 or 25 days) and after thermal cycling (5°C and 55°C for 1,500, 6,000, 13,500, 24,000 or 37,500 cycles). The authors analyzed data by using descriptive statistics, the Mann-Whitney test, the Kruskal-Wallis test and a χ 2 test. Results Application of a ceramic primer did not result in a negative impact on SBS. Specimens in the A1 group (that is, RelyX Unicem Aplicap with ceramic primer) exhibited significantly higher SBS before and after water storage and thermal cycling compared with specimens that were not treated with a primer. The self-adhesive resin composite cements combined with ceramic primer exhibited similar or higher SBS values compared with those in the SC group at each aging duration (that is, water storage and thermal cycling). With respect to G-CEM Capsule, the authors observed a significantly positive effect of the primer after nine and 16 days' water storage and after one and four days' thermal cycling. They observed predominantly adhesive failures. Conclusions Ceramic primer in combination with self-adhesive resin composite cement demonstrated a positive effect on SBS to zirconia and should be used for cementation. Practical Implications Long-term adhesion to ceramic plays an important role in the longevity of dental restorations. Therefore, the authors recommend that clinicians use a ceramic primer when cementing zirconia restorations.

Allergic and hypersensitivity reactions to dental impression materials may occur throughout dental treatment, with diverse manifestations from slight redness to severe pain and a burning mouth with total stomatitis. Patients are often unaware of these allergic reactions, which makes early identification of the cause almost impossible. In addition, symptoms usually begin after 24 hours and mostly in patients with a preexisting history of allergic responses. This report describes a patient with a suspected allergic reaction to a polyether dental impression material during prosthetic rehabilitation associated with a mandibular telescopic denture. Although instances of such occurrence are rare, clinicians need to be aware of these symptoms and select materials carefully for patients with a history of allergy.

Minimally invasive treatment options have become increasingly feasible in restorative dentistry, due to the introduction of the adhesive technique in combination with restorative materials featuring translucent properties similar to those of natural teeth. Mechanical anchoring of restorations via conventional cementation represents a predominantly subtractive treatment approach that is gradually being superseded by a primarily defect-oriented additive method in prosthodontics. Modifications of conventional treatment procedures have led to the development of an economical approach to the removal of healthy tooth structure. This is possible because the planned treatment outcome is defined in a wax-up before the treatment is commenced and this wax-up is subsequently used as a reference during tooth preparation. Similarly, resin- bonded FDPs and implants have made it possible to preserve the natural tooth structure of potential abutment teeth. This report describes a number of clinical cases to demonstrate the principles of modern prosthetic treatment strategies and discusses these approaches in the context of minimally invasive prosthetic dentistry.

Organ shortages and increased numbers of nontransplant older patients have necessitated a search for alternatives to heart transplants. The Jarvik 2000 assist device (Jarvik Heart, Inc., Manhattan, NY, USA), as a small long-term axial flow pump, offers many advantages, such as retroauricular power supply, which minimizes driveline infection risks. When implanted biventricularly, the device may offer support for patients with biventricular heart failure, especially for nontransplant patients as a destination therapy.We implanted biventricular Jarvik 2000 systems into 3 men (aged, 65.3 ± 5.0 y; ejection fraction, 24.7% ± 1.5% for left ventricle and 17.7% ± 5.0% for right ventricle). These were the first patients worldwide to receive a biventricular Jarvik 2000 device with retroauricular power supply via a median sternotomy and with additional cardiac surgical procedures.No technical problems were noted during biventricular assist device implant. Mean support time on the device was 224 ± 198 days. All 3 patients showed sufficient cardiac support; 2 patients died from noncardiac complications. Patient 1 died on day 3 as a result of postoperative hepatic failure after preoperative reanimation, and patient 3 died as a result of an ileus and colon perforation after 50 days. Patient 2 died of ventricular fibrillation (after 1.5 y), which occurred 1 year after right ventricular pump shutdown, although significant improvement of right ventricle function was shown (ejection fraction increased by 48%).Our 3 patients were old, had multiple comorbidities, and needed further cardiac surgery. None of the patients died as a result of technical failure of the device but because of complications accompanying their morbidities. If complication rates can be reduced, a biventricular assist device implant could and should be considered as a potential alternative for nontransplant patients.

The complete dental rehabilitation of patients with a vertical dimension loss (VDL) caused by structural enamel deficits associated with amelogenesis imperfecta (AI) represents a difficult challenge for restorative teams. Accurate analysis and treatment planning that includes esthetic and functional evaluations and adequate material selection are important prerequisites for successful results. Long-term provisional restorations play an important role in exploring and elucidating the patients' esthetic demands and functional needs. Restorative treatment options can vary from requiring only oral hygiene instructions to extensive dental restorations that include composite fillings, ceramic veneers, metal-ceramic, or all-ceramic crowns. This case report describes a full-mouth rehabilitation of a patient with amelogenesis imperfecta including the case planning, bite replacement, preparation, and restoration setting steps with an experimental CAD/CAM polymer and porcelain veneers.

Statement of problem Polyetheretherketone (PEEK) can be used to support fixed dental prostheses. However, information about physicomechanical characterization is still scarce. Purpose The purpose of this in vitro study was to assess effects of different aging regimens/durations on roughness, solubility, water absorption, Martens hardness (HM), and indentation modulus/E IT on different computer-aided design and computer-aided manufacturing (CAD/CAM) polymers. Material and methods Forty standardized specimens of the following materials were fabricated: PEEK: Dentokeep (DK); hybrid material: VITA Enamic (EN); composite resins: LAVA Ultimate (LU) and an experimental CAD/CAM nanohybrid-composite resin (EX); poly(methyl methacrylate) (PMMA)-based: VITA CAD-Temp (CT); Telio CAD (TC), artBloc Temp (AT), and ZENOTEC ProFix (ZP). A nanofilled-polymer for interim restorations, Protemp 4 (CG), served as the control group. Specimens were stored in sodium chloride, artificial saliva, physiological saliva, and distilled water at 37°C for 1, 7, 14, 28, 90, and 180 days. Roughness, water absorption, HM, and E IT were investigated after each storage period; solubility was determined after 180 days only. Data were analyzed using weighted 3/2/1-way ANOVA and the post hoc Scheffe tests (α=.05). Results Storage media had no effect on surface roughness and water absorption. Physiological saliva revealed the highest significant impact on solubility followed by artificial saliva, sodium chloride, and distilled water. Water absorption increased significantly with storage duration. PEEK showed the lowest solubility and water absorption values. The highest solubility was observed for the conventional polymer CG, and the highest water absorption was found for the composite LU. PMMA-based TC, ZP, CG, and AT showed the lowest HM and indentation modulus, followed by CT, and PEEK. The highest values were observed for the hybrid material EN, followed by LU and EX. Conclusions The hardness parameters of PEEK were comparable with those of PMMA-based materials.

Little information is available about the translucency of monolithic CAD/CAM materials.The purpose of this study was to evaluate the translucency of restorative CAD/CAM materials and direct composite resins with respect to thickness and surface roughness.In total, 240 disk-shaped specimens (12×14×1 mm and 12×14×2 mm) of 3 different CAD/CAM glass ceramics (CELTRA Duo, IPS e.max CAD, IPS Empress CAD), a fine-structure feldspathic ceramic (VITA Mark II), a hybrid ceramic (VITA Enamic), a resin nanoceramic composite resin (LAVA Ultimate), an experimental (CAD/CAM nanohybrid composite resin), 2 interim materials (Telio CAD; VITA CAD-Temp), and 3 direct composite resins (Tetric EvoCeram; Filtek Supreme XTE; Tetric EvoCeram Bulk Fill) were fabricated (n=10). After 3 different surface pretreatments (polished, rough SiC P1200, or SiC P500), absolute translucency and surface roughness were measured using spectrophotometry and tactile profilometry. The influence of material type, thickness, and roughness on absolute translucency was analyzed using a multivariate analysis, 1-way ANOVA, and the Tukey HSD post hoc test (P.05). Pearson correlations and statistical hypothesis tests were used to assess the results (P.05).The effect of all tested parameters was significant among the materials (P.05). The greatest influence on the measured translucency was thickness (partial eta squared ηP²=.988), closely followed by material (.982), and the pretreatment method (.835). The surface roughness was strongly influenced by the pretreatment method (.975) and type of material (.941).Thickness and surface roughness are major factors affecting the absolute translucency of adhesively luted restorations.

Objective To determine the impact of pre-treatment of adhesive systems on the work of adhesion (WA) between CAD/CAM polymers and resin composite cements and compare with conventional tests of previous studies. Methods Surface parameters were measured by contact angle measurement (2700 measurements) and WA was calculated. Five CAD/CAM polymers were used for fabrication of specimens ( n = 75/subgroup): artBloc Temp (A), Telio CAD (B), Nano Composite CFI-C (C), exp. CAD/CAM nanohybrid composite (D), and LAVA Ultimate (E). Then, air-abraded specimens were pre-treated ( n = 15 per group): Ambarino P60 (I), Monobond Plus/Heliobond (II), visio.link (III), VP connect (IV), and no pre-treatment (V). Resin composite cement specimens ( n = 75) were smoothed out homogeneously on a glass plate ( n = 15/group): RelyX ARC (RXA), Variolink II (VAR), Panavia F2.0 (PAN), RelyX Unicem (RXU), and Clearfil SA Cement (CSA). Contact angles were determined with 3 drops of distilled water and diiodomethane each. Data were analyzed using Kruskal–Wallis-H test and Spearman-Rho correlation ( p Results CAD/CAM materials (B), (A), and (C) showed higher WA compared to (D) and (E). (II) and (IV) resulted in higher WA than (I), (III) and (V). VAR had the significantly lowest WA, followed by RXU, RXA, CSA and PAN. No correlation occurred between WA and TBS/SBS whereas polar component of surface free energy of CAD/CAM resin and spreading coefficient showed significant positive correlation with TBS/SBS. Conclusions Determination of WA is not a proper method to draw conclusions about the bond between resin materials. Destructive test methods are not dispensable. Clinical significance The successful outcome of fixed dental restorations depends, among others, on the quality of bonding between the tooth and the restoration. Additional pre-treatment of the dental CAD/CAM resin restoration by bonding systems can be recommended for clinical use. Pre-treatment showed a significant impact on the surface properties.

The authors investigated the use of ceramic primers combined with self-adhesive resin composite cements on the shear bond strength (SBS) to zirconia and compared them with one conventional resin composite cement.The authors divided zirconia substrates (N = 550) into three groups: RelyX Unicem Aplicap self-adhesive universal resin composite cement (3M ESPE, St. Paul, Minn.) (group A) (n = 220); G-CEM Capsule self-adhesive resin composite cement (GC Europe, Leuven, Belgium) (group B) (n = 220); and Panavia 21 with Clearfil Porcelain Bond Activator and Clearfil SE Bond primer (n = 110) (Kuraray Dental, Tokyo) used as a standard comparison (SC). The authors examined the self-adhesive resin composite cements without (0) and with (1) the use of a ceramic primer. They measured SBS initially (37°C for three hours), after water storage (37°C for one, four, nine, 16 or 25 days) and after thermal cycling (5°C and 55°C for 1,500, 6,000, 13,500, 24,000 or 37,500 cycles). The authors analyzed data by using descriptive statistics, the Mann-Whitney test, the Kruskal-Wallis test and a χ(2) test.Application of a ceramic primer did not result in a negative impact on SBS. Specimens in the A1 group (that is, RelyX Unicem Aplicap with ceramic primer) exhibited significantly higher SBS before and after water storage and thermal cycling compared with specimens that were not treated with a primer. The self-adhesive resin composite cements combined with ceramic primer exhibited similar or higher SBS values compared with those in the SC group at each aging duration (that is, water storage and thermal cycling). With respect to G-CEM Capsule, the authors observed a significantly positive effect of the primer after nine and 16 days' water storage and after one and four days' thermal cycling. They observed predominantly adhesive failures.Ceramic primer in combination with self-adhesive resin composite cement demonstrated a positive effect on SBS to zirconia and should be used for cementation.Long-term adhesion to ceramic plays an important role in the longevity of dental restorations. Therefore, the authors recommend that clinicians use a ceramic primer when cementing zirconia restorations.

To test surface energy, roughness and tensile bond strength (TBS) to self-adhesive resin composite cements without/with plasma treatment combined with different conditioning methods of PMMA-based CAD/CAM blocks.PMMA specimens (10mm×10mm×2mm) were fabricated (N=260), polished and air-abraded (50μm Al2O3, 5s, 0.05MPa). Twenty specimens were selected for surface energy and roughness measurements (without/with plasma n=10 per group). The remaining specimens (n=240) were used for TBS testing without/with plasma treatment and following conditioning methods (n=20 per test group): (i) without conditioning, (ii) Visio.link, (iii) VP connect and luted with Clearfil SA Cement and RelyX Unicem Automix. Specimens were aged (24h 37°C water+5000 thermal cycles, 5°C/55°C), TBS was measured and failure types were assessed. Data were analyzed using descriptive statistics, Mann-Whitney-U and Kruskal-Wallis-H tests, unpaired t-test, Chi(2) and the Spearman correlation test.Plasma treatment of PMMA increased the surface energy significantly (p0.001) but had no impact on the surface roughness (p=0.718). Groups without plasma treatment showed higher TBS than plasma treated groups (p0.001 to p=0.011), except PMMA conditioned with VP connect and luted using RelyX Unicem Automix (p=0.03). Clearfil SA Cement showed higher TBS compared to RelyX Unicem Automix, except for groups conditioned with Visio.link. Both resin composite cements showed the highest TBS for groups conditioned with Visio.link. Also, among Clearfil SA Cement, conditioning with VP connect showed comparable TBS to Visio.link.Plasma treatment of PMMA did not increase the adhesion to self-adhesive resin composite cements.