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Background: Two intra‐coronal preparation designs with varying extensions of cuspal coverage can perform differently regarding their fracture resistance against introral forces. Methods: Two materials (IPS e‐max CAD [EX], VITA ENAMIC [EN]), and two different preparation designs (EX‐D1), (EX‐D2), (EN‐D1), and (EN‐D2) were investigated to compare their fracture resistance. A total of 40 (n = 40) caries free human mandibular molars were used. All the prepared samples were scanned using CEREC Omnicam scanner and the preparations were checked by the software for any sharpness and undercuts before restoration designing and fabrication. All restorations were milled using Cerec MCXL 4.4 milling machine. Duo‐Link resin cement was used for cementation. After thermocycling and chewing simulation, all samples were loaded in the Universal testing machine in order to evaluate fracture resistance of all samples. Results: Fracture resistance testing revealed that e‐max CAD (2134 N) showed statistically significantly higher mean fracture resistance values than Vita Enamic (1728 N). On the other hand, there was no statistically significant difference between mean fracture resistances between the two tested designs. Conclusions: Within the confines of this investigation, it can be said that although preparation design had no appreciable impact on fracture resistance, the CAD/CAM ceramic material utilized did. Clinical Significance: When restoring compound cavitties indirectly; a conservative defect oriented approach should be used. Glass Ceramic are prefered as restorative material. [ABSTRACT FROM AUTHOR]

A conservative approach to restoration assists in preserving the remaining tooth structure of extensively destroyed vital teeth. This case report describes a single-appointment chairside technique for placement of ceramic restorations in posterior teeth. A patient presented for treatment of her mandibular right first molar, which had a fractured resin-based composite restoration. Due to the presence of vital pulp, extent of the restoration, and presence of caries in the tooth, the following treatment plan was proposed: placement of a lithium disilicate glass-ceramic onlay fabricated with a computer-aided design/computer-aided manufacturing workflow. After the dentist removed the restoration and performed selective caries removal, structural analysis guided the reduction of the buccal cusps. Immediate dentin sealing was performed with a 2-step self-etching adhesive system, and a 1-mm-thick layer of flowable resin-based composite was placed as a resin coating. A digital impression was obtained, the onlay restoration was designed, and a lithium disilicate block was milled and subsequently crystallized. When the onlay was completed, the tooth preparation was sandblasted, selectively etched, and coated with a universal adhesive. The intaglio surface of the onlay was cleaned and primed, the onlay was bonded with dual-cure resin cement, and occlusal adjustments were completed. Follow-up examinations at 1 and 4 months revealed the clinical success of the case. From start to finish, it takes approximately 2.5 hours to produce a single-appointment chairside restoration. The technique used in this case offers a fast-paced workflow that is comfortable and practical for the patient and provides a predictable clinical outcome without the need for a temporary restoration. [ABSTRACT FROM AUTHOR]

Background: The Chinese unique inlay Bristow (Cuistow) procedure is a modified Bristow surgery in which an inlay (mortise-and-tenon) structure is added to the contact surface between the coracoid tip and the glenoid. Patients who have undergone the Cuistow procedure have had satisfying clinical performance and excellent postoperative bone healing rates (96.1%). Purpose: To compare the clinical and radiographic outcomes after the arthroscopic Cuistow procedure and the arthroscopic Bristow procedure. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 91 patients who underwent either the Cuistow or Bristow procedure between January 2017 and March 2018 were selected, and 69 patients (70 shoulders; 35 in the Cuistow group and 35 in the Bristow group) were included. Clinical assessment at minimum 24 months postoperatively, including the visual analog scale for pain and instability, American Shoulder and Elbow Surgeons score, Rowe score, subjective shoulder value score, and active range of motion, was completed by independent observers and compared with values collected preoperatively. Assessment with 3-dimensional computed tomography scans was performed preoperatively; immediately after the operation; at 3, 6, and 12 months postoperatively; and at the final follow-up. Results: A total of 69 patients (70 shoulders) were included, with a mean follow-up duration of 34.41 ± 5.99 months (range, 24-50 months). Both groups saw significant improvement in visual analog scale for pain and instability, American Shoulder and Elbow Surgeons, Rowe, and subjective shoulder value scores at the final follow-up compared with the preoperative values (P <.001 for all), with no significant between-group differences on any clinical outcomes at the final follow-up. The 3-month postoperative graft union rate on computed tomography was significantly higher in the Cuistow group compared with the Bristow group (82.9% vs 51.4%, respectively, P =.003), although the graft union rate at the final follow-up was not significantly different (94.3% vs 85.7%, respectively; P =.449). Conclusion: Patients receiving the Cuistow procedure had equivalent clinical outcomes and a significantly higher bone union rate at 3 months postoperatively than those in the Bristow group. The inlay structure used in the Cuistow procedure was found to be associated with accelerated bone union. [ABSTRACT FROM AUTHOR]

Trial design: This is a randomized, controlled, superiority, double-blinded, parallel-group, two-arms trial with an allocation ratio of 1:1. This study aimed to assess whether the cavity design could affect the clinical performance of the CAD/CAM generated indirect resin composite restoration in endodontically treated teeth (ETT) evaluated using the Modified USPHS criteria after a two-year follow up. Methods: A total of 30 participants who underwent endodontic treatment for MOD cavities in permanent molars were divided randomly into two parallel groups (n = 30 restorations) according to the performed cavity design to group 1 in which there was no cuspal reduction (inlay) and group 2 in which cuspal reduction was performed (overlay). All pulp chambers were filled with bulk fill flowable composite, and the cavities were prepared following the criteria of the cavities for indirect restorations and restored using nano-hybrid composite resin blocks (Brilliant, Coltene, Switzerland). The restorations were evaluated using the modified USPHS criteria at baseline, six months, one-year and two years follow-up visits. For qualitative data, frequencies (n) and percentages (%) were used to display the data, while mean and standard deviation (SD) were used for quantitative data. The normality of the data was evaluated using the Shapiro-Wilk and Kolmogorov-Smirnov tests. For every test, P ≤ 0.05 was used as the significance threshold. Results: Twenty-six individuals completed the follow-up period after receiving the assigned intervention.The inter-group comparison showed that, at the 6- months and 12- months observation points, the overlay design had significantly better marginal adaptation, less incidence of discoloration or tooth/restoration fracture, and similar marginal integrity and caries incidence to the inlay design. After 24- months, the overlay design still had better marginal adaptation, less incidence of discoloration or tooth/restoration fracture and less caries incidence in comparison to the inlay design, while there was no difference in the marginal integrity between either design. Conclusions and clinical relevance: Cuspal reduction in endodontically treated teeth showed better clinical performance than the cusp preservation thus, the former is more reliable. [ABSTRACT FROM AUTHOR]

Background: The purpose of this in vitro study was to compare and evaluate the stress distribution of maxillary first premolar residual crowns restored with post-core crowns, endocrowns and inlay crowns after deep margin elevation, to explore the fitting restoration for residual crowns using finite element analysis. Methods: A healthy complete right maxillary first premolar from a male adult was scanned by cone beam computed tomography (CBCT). The finite element model of the tooth was established by reverse engineering software such as Mimics, Geomagic and Hypermesh. On this basis, the residual crown model after deep margin elevation was made, and the experimental group models were divided into three groups, those restored with post core crowns, endocrowns and inlay crowns. Vertical and oblique static loads were applied to the experimental models to simulate the force on the tooth during mastication (the loading position was located in the central fossa of the occipital surface, and the load was 100 N) using Abaqus software. Results: The peak value and distribution of von Mises stress in each part of the experimental model were observed. After deep margin elevation, the peak dentin von Mises stresses were lower than the tensile strength of normal dentin in the post-core crown, endocrown, and inlay crown groups; the lowest stress results were found in the post-core crown group for the dentin, restoration, enamel, and deep margin elevation (DME) layers under vertical and oblique loading. In terms of stress distribution clouds, the peak stresses in the dentin tissue were located in the apical 1/3 of the root after postcore crown restorations for both loads, while stress concentrations were evident in the cervical and root areas after endocrown and inlay crown restorations; regardless of the load and restoration method, the corresponding stress concentration areas appeared at the junction of the DME and dentin tissue at the loading site of the restorations; Conclusions: Post-core crowns, endocrowns and inlay crowns can be used to restore residual crowns after deep margin elevation, and post-core crowns can better protect the residual tooth tissue. [ABSTRACT FROM AUTHOR]

Objectives: To assess the feasibility of producing 3D‐printed intracoronal restorations, thin and ultrathin veneers, and to compare their mechanical behavior, accuracy, biological, and stain susceptibility to the currently applied milled restorations. Materials and Methods: The databases were comprehensively searched for relevant records up to January 2024 without language restrictions. All studies that assessed 3D‐printed partial coverage restorations including inlays, onlays, laminate, and occlusal veneers were retrieved. Results: The web search yielded a total of 1142 records, with 8 additional records added from websites at a later stage. Only 17 records were ultimately included in the review. The included records compared 3D‐printed; alumina‐based‐ and zirconia ceramics, lithium disilicate ceramics, polymer infiltrated ceramics, polyetheretherketone (PEEK), resin composites, and acrylic resins to their CNC milled analogs. The pooled data indicated that it is possible to produce ultrathin restorations with a thickness of less than 0.2 mm. 3D‐printed laminate veneers and intracoronal restorations exhibited superior trueness, as well as better marginal and internal fit compared to milled restorations (p < 0.05). However, it should be noted that the choice of materials and preparation design may influence these outcomes. In terms of cost, the initial investment and production expenses associated with 3D printing were significantly lower than those of CNC milling technology. Additionally, 3D printing was also shown to be more time‐efficient. Conclusions: Using additive manufacturing technology to produce restorations with a thickness ranging from 0.1 to 0.2 mm is indeed feasible. The high accuracy of these restorations, contributes to their ability to resist caries progression, surpassing the minimum clinical threshold load of failure by a significant margin and reliable adhesion. However, before 3D‐printed resin restorations can be widely adopted for clinical applications, further improvements are needed, particularly in terms of reducing their susceptibility to stains. Clinical Significance: 3D‐printed intracoronal restorations and veneers are more time and cost‐efficient, more accurate, and could provide a considerable alternative to the currently applied CNC milling. Some limitations still accompany the resin materials, but this could be overcome by further development of the materials and printing technology. [ABSTRACT FROM AUTHOR]

Limited research is available evaluating whether the reported in vitro benefit of immediate dentin scaling (IDS)-namely, increased bond strength to tooth structure-can be acquired in the era of same-day (SD) dentistry. The purpose of this study was to compare the fracture strengths of ceramic overlays fabricated with a delayed dentin sealing (DDS) technique or an IDS technique under 1-hour SD or 2-week multiple-day (MD) delivery conditions. Forty extracted, healthy maxillary third molars were prepared for a lithium disilicate overlay restoration and divided into 4 groups of 10 teeth each. In the SD-DDS group, the teeth were prepared and then stored for 1 hour in artificial saliva, and the adhesion protocol (bonding agent and resin restoracement) was applied at the time of delivery of the ceramic overlay. In the SD-IDS group, the teeth were prepared, the adhesive protocol was applied immediately, and the teeth were stored for 1 hour before delivery of the overlay. The protocols for the MD-DDS and MD-IDS groups were identical to SD-DDS and SD-IDS, respectively, except that the teeth were provisionalized and stored for 2 weeks prior to delivery of the overlay. Specimens were thermocycled and subjected to cyclic functional loading before they were loaded to failure in a universal testing machine using a rod resting on the buccal incline of the palatal cusp. Two-way analysis of variance tests revealed no statistically significant differences in fracture strength between the groups based on dentin sealing (P = 0.331) or delivery time (P = 0.314). The specimens demonstrated 2 fracture types; either a portion of the ceramic cohesively fractured, leaving the tooth intact, or the ceramic and part of the tooth fractured. There were no instances in which the restoration itself delaminated during fracture testing. A Kruskal-Wallis test indicated there were no statistically significant differences in fracture modes between the groups. In this in vitro study, IDS did not provide a significant increase in the fracture strength of overlay restorations compared with DDS, regardless of whether the restorations were delivered the same day or after 2 weeks of storage. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of different cavity designs and cement types on the fracture resistance of monolithic zirconia inlay-retained fixed dental prostheses (IRFDPs).Materials and Methods: Four study models consisting of a second premolar, a missing first molar, and a second molar were used for the different cavity designs. Four different inlay cavity designs were prepared: DO-MO (disto-occlusal-mesio-occlusal cavity), MOD-MOD (mesio-occlusodistal-mesio-occlusodistal cavity), WDO-WMO (DO-MO with additional wings), and WMOD-WMOD (MOD-MOD with additional wings). A total of 64 epoxy resin models were produced and scanned individually. IRFDPs were then fabricated from monolithic zirconia using CAD/ CAM software. The bonding surface of the IRFDPs was airborne particle abraded (50-μm alumina/2 MPa), then cemented onto the epoxy resin models using two cementation protocols (n = 8 per group): (1) P = cemented with Panavia SA Cement Plus Automix; and (2) Z/C = cemented with MDP-containing primer (Z-Prime Plus) combined with Calibra Universal resin cement. All IRFDPs were fatigued through thermal aging (6,000 cycles/5°C to 55°C) and chewing simulations (600,000 cycles × 50-N load, 2.1 Hz). All IRFDPs were then subjected to a fracture resistance test using a universal testing machine with a crosshead speed of 0.2 mm/minute. Data were statistically analyzed using one- and two-way ANOVA and Bonferroni multiple comparisons test (P = .001).Results: The mean fracture load (N) of the designs were as follows: WMODWMOD = 1,111.1; WDO-WMO = 1,057.4; MOD-MOD = 725.6; DO-MO = 682.7. According to two-way ANOVA, the differences among the cavity designs were statistically significant (P < .05).Conclusion: The cavity design of IRFDPs affected the fracture resistance. However, the fracture resistance of monolithic zirconia IRFDPs with any cavity design was enough to withstand expected posterior chewing forces. [ABSTRACT FROM AUTHOR]

Objective: Teeth prepared for mesial‐occlusal‐distal (MOD) restorations have a significant risk of cusp fracture. Crowns and onlays can provide cusp coverage to reinforce posterior teeth at risk. Onlays are often more conservative of tooth structure which may be an advantage for teeth with large MOD preparations. It remains uncertain how onlays and crowns compare for posterior teeth with MOD tooth structure loss. The purpose of this systematic review was to compare the resistance to fracture, success rate, survival rate, and failure rate of teeth with MOD preparations restored with onlays or crowns. Materials and Methods: An electronic search queried Medline (PubMed), Embase (Ovid), Scopus, the Cochrane Library, and grey literature (OpenGrey) from database inception through April 29, 2023. Results: After eliminating duplicates and irrelevant records, 32 manuscripts were assessed. Only three publications met the criteria for inclusion. Most exclusions were due to poor reporting of restorative design and the amount of tooth structure remaining, or due to combining various restorative designs. Due to the limited sample size and high heterogeneity, no meta‐analysis was conducted. One study observed a better outcome for onlays and two observed no difference. All three studies reported the mode of failure for crowns as more catastrophic whereas teeth with onlays could be salvaged. Conclusions: Onlays may be an advantageous alternative to crowns for teeth with MOD preparations, but the level of evidence is insufficient to draw meaningful conclusions. Clinical Significance: Current evidence is insufficient to determine whether onlays or crowns are providing a different outcome when used to restore posterior teeth with MOD tooth structure loss. However, the fracture of teeth with MOD tooth structure loss restored with onlays appears to be less catastrophic than when restored with crowns. [ABSTRACT FROM AUTHOR]

Background: Many monolithic machined materials have been introduced and provided a suitable mechanical and physical properties for inlay restorations. However, there is shortage in the studies evaluating the marginal adaptation using these materials. Purpose: This study aimed to compare the effect of fabricating inlay restorations from 3 different CAD-CAM materials on marginal gaps before and after thermocycling. Materials and methods: Sixty human premolars were randomly divided into 3 groups (n = 20) according to the material used: (e.max CAD, Ivoclar AG, Schaan, Liechtenstein), (HC, Shofu, Koyoto, Japan) and (Brilliant Crios, Coltene, Altstätten, Switzerland) (n = 20). A scanning electron microscope (SEM) (JSM- 6510 lv, JEOL, Tokyo, JAPAN) was used to for measuring the marginal gaps after cementation of inlay restorations. The magnification was adapted to 250x. Marginal gaps were revaluated with SEM after thermocycling. The temperatures of baths were 5 and 55 °C was applied for a total of 5000 cycles. All data were statistically analyzed by using ANCOVA to demonstrate if there were any statistically significant differences between the gap measures after thermocycling of the three independent (unrelated) groups. A Bonferroni adjustmen was used to perform post hoc analysis (α = 0.05). Results: Post-intervention marginal gap was statistically significantly lower in group EX (110.8 μm) which was statistically significant compared with group SF (112.5 μm) (mean difference=-1.768, P =.007) and group BR (113 μm) (mean difference=-2.272, P =.001), however, in. comparing SF and BR groups, there was no significant difference (mean difference=-0.5, P =.770). Conclusions: Thermocycling affected the marginal gaps of composite based restoration and resin-modified ceramics widely. However, it had a very small effect on glass ceramics marginal adaptation. Clinical implications: The marginal gaps of CAD-CAM inlays varied according to material used (ceramic based, combination, or resin based). Thermocycling has a minor effect on the marginal adaptation of lithium disilicate glass-ceramic inlays, where it affected the margin of resin-modified ceramic and composite based inlays greatly. Using lithium disilicate glass-ceramic might improve the clinical longevity of inlay restored teeth. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the long-term survival and success rates of dental implants placed with autogenous onlay block bone grafts harvested from the mandibular ramus. Materials and Methods: Patients treated with onlay bone graft from the mandibular ramus due to a severe vertical alveolar defect from 2001 to 2017 were included in this study. The marginal bone loss, success, and survival time of the implants were recorded and analyzed with clinical factors, such as time from bone graft to implant placement, type of implant prosthesis connection, history of periodontitis, and insertion depth. Results: Seventy-five implants in 40 onlay bone-grafted areas of 38 patients were included, with a mean follow-up period of 102 months (range: 14 to 192 months). Two grafts were removed before implant placement. Of the 75 implants, 11 implants were lost. History of periodontitis and marginal bone loss at 6 months after implant placement were significantly associated with implant success. The receiver operating characteristic curve showed that a marginal bone loss of 0.75 mm after 6 months of implant placement was related to implant success, with a sensitivity of 72.2% and specificity of 89.6%. Conclusion: Implants placed with onlay bone graft from ramal bone had more frequent biologic complications, and failures may be predicted by measuring the amount of implant bone loss after 6 months of placement. [ABSTRACT FROM AUTHOR]

Patients with a complex problem set involving multiple levels of altered structure challenge the clinician to develop an individualized, appropriate treatment plan. Dentofacial deficiency, occlusal problems, and loss of tooth structure require intervention to establish stability and regain function, speech, esthetics, and masticatory muscle comfort. The comprehensive examination must quantify each problem to specify the diagnosis for realistic treatment planning. The clinical case of a patient with Costello syndrome is presented to illustrate essential concepts in diagnosis and treatment of complex cases, including (1) Global Diagnosis of anterior esthetic relationships, (2) occlusal analysis with diagnostic casts verified in centric relation, (3) comprehensive restoration previewed with a diagnostic wax-up and removable acrylic resin overlay, (4) adhesive monobody composite resin onlays that preserve tooth structure, and (5) programmed occlusion, quantified with digital occlusal analysis, to ensure stability and comfort. Costello syndrome is a neurodevelopmental syndrome causing multisystem effects, including a distinctive craniofacial phenotype, cardiovascular disease, intellectual disability, growth hormone deficiency, and dental abnormalities such as delayed dental development, bruxism, and demineralized enamel lesions. In the present case, quantification of the patient's problem set allowed precise treatment planning that resulted in predictable restoration. [ABSTRACT FROM AUTHOR]

We report here a study seeking to obtain data on the penetration of the chemical self-curing adhesive Tokuyama Universal Bond II into dentin using different bonding techniques. Spectroscopic instruments make it possible to obtain reliable, graphic, and accurate information about the structure and composition of test substances in terms of the absorption spectrum, so spectrophotometric investigation providing highly accurate assessment of levels of penetration of adhesive into the dentin and yielding data on the uniformity of the resulting hybrid layer is relevant and promising. This report describes an optical experimental scheme and presents the technical characteristics of a device. Specimens for research prepared using different methods are presented and the measurement channel of the device, where specimens are mounted to measure the depth boundaries of the interaction between the dental adhesive and dentin, is described. The spectral relationship between the absorption coefficient and depth at the fixation boundaries and adjacent areas of composite inlays with dentin on sections of specimens were obtained using the adhesive Tokuyama Universal Bond II used according to the protocol presented in the instructions, when applying Tokuyama Universal Bond II with an additional 10-s exposure to dentin prior to swelling, and by rubbing Tokuyama Universal Bond II into the dentin surface for 10 s before blowing. [ABSTRACT FROM AUTHOR]

Purpose: To assess the short-term outcomes of two different conservative preparation designs for posterior zirconia inlay-retained fixed dental prostheses (IRFDPs) and to analyze the marginal integrity of such restorations.Materials and Methods: Thirty patients with a missing maxillary first molar participated in this study and were divided randomly into two groups: one that received abutment preparations for inlay retainers (ID group, n = 20), including a proximal box and an occlusal extension, and one that received only proximal box preparations (PB group, n = 10). Zirconia IRFDPs were bonded in position and followed up after 2 weeks, 6 months, 1 year, and then annually. The in situ restorations were duplicated utilizing a single-step putty/wash impression technique at the 2-week and 2-year follow-up visits. Restoration margins were evaluated under scanning electron microscopy, and marginal continuity was calculated as a percentage of the whole margin at the tooth-cement (TC) interface and the zirconia-cement (ZC) interface.Results: After a mean observation period of 26.2 months, all restorations were still in function. The only complication encountered was debonding of restorations; however, they were re-bonded back in place without issue. The cumulative Kaplan-Meier 2-year survival rate for the IRFDPs was 86.6%. There was a significant difference between the two groups regarding percentage of continuous margins (P < .05) after 2 years, with the percentage of continuous margins in the ID group at 92.8% and 91.5% at the TC and ZC interfaces, respectively, and in the PB group at 84.1% and 78.6% at the TC and ZC interfaces, respectively.Conclusion: Zirconia-based monolithic IRFDPs can be recommended for short-term replacement of a single maxillary molar. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the dimensional accuracy of impressions made using a new fast-setting polyether material.Materials and Methods: A metallic reference model with two crown preparations, one inlay preparation, and three stainless steel precision balls was digitized to create a digital reference model. Sixteen one-step impressions were made for each of the four study groups, differing in impression material (regular-setting polyether [RSP] vs fast-setting polyether [FSP]) and technique (monophase vs dualphase), for a total of 64 specimens. Plaster casts fabricated from these impressions were digitized using 3D scans. Global accuracy was studied by evaluating distance and angle deviations between the replica and the reference model. Local accuracy was described in terms of trueness and precision of the aligned individual abutment tooth surfaces.Results: For all impression materials and techniques, the local accuracy at the abutment tooth level was excellent. For surfaces prepared for crowns, mean trueness was < 10 μm, and mean precision < 12 μm. Inlay surfaces were associated with higher inaccuracies (mean trueness < 21 μm and mean precision < 37 μm). The greatest global inaccuracies were generally measured for the cross-arch span, with mean distance changes between -55 μm and -94 μm. For all aspects of studied accuracy, impressions with FSP were at least comparable to those fabricated with RSP.Conclusion: Within the limitations of this study, all tested polyether materials would allow for clinically acceptable impression making. The new fast-setting material could be an alternative to regular-setting polyether materials, especially for single crowns and small fixed partial dentures. [ABSTRACT FROM AUTHOR]

Objectives: Long-term retrospective evaluation of the survival rate and the technical and biologic outcomes of all-ceramic inlays and onlays in premolars and molars. Method and materials: Fifty-four patients treated as part of a prospective clinical trial and having received 157 inlays and 27 onlays made out of a leucite-reinforced glass-ceramic (IPS Empress) in premolars and molars, were invited to the present follow-up examination. The survival of the restorations was evaluated. The biologic outcomes were assessed by measuring the pocket probing depth (PPD), the Plaque Index (PI), and the Sulcus Bleeding Index (SBI). The technical behavior was evaluated using modified US Public Health Service criteria (modUSPHS). Finally, patient satisfaction was recorded with a questionnaire. Data of patients and restored teeth were analyzed descriptively, and continuous variables were given in mean values and standard deviations. For the analysis of the restoration survival over time, the Kaplan-Meier survival estimate was calculated. The level of statistical significance was set at P < .05. Results: Thirty-six patients (20 women, 16 men; mean age 50.9 years) with 132 restorations, 107 inlays and 25 onlays, were examined after a mean observation time of 11.2 ± 4.3 years. The overall 11-year survival rate of the 132 restorations was 80.3%. Inlays exhibited an 11-year survival rate of 80.4% and onlays of 80.0%. Twenty-two technical complications occurred. Ceramic fractures (10.6%) and chipping (2.3%) were the most frequent complications. Six biologic complications occurred (4.5%). Conclusion: Glass-ceramic inlays and onlays presented favorable long-term clinical survival and success rates. Technical complications were predominant, and biologic problems remained rare. More clinical long-term data are needed. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the marginal and internal adaptations of ceramic inlay restorations placed with immediate dentin sealing (IDS) vs delayed dentin sealing (DDS) procedures.Materials and Methods: Mesial and distal Class II cavities were prepared in 12 extracted molar teeth, which were randomly allocated into six groups of 2 teeth each. Lava Ultimate inlays were fabricated and luted to the cavities using All-Bond universal adhesive system and eCEMENT dual-curing resin cement following IDS/immediate cementation (control groups 1 and 2), IDS/delayed cementation (groups 3 and 4), or DDS/delayed cementation (groups 5 and 6) protocols. Teeth in groups 2, 4, and 6 were subjected to thermocycling of 500 cycles between 5°C and 55°C after inlay cementation. Following staining with silver nitrate solution, the marginal and internal gap volumes were determined using microcomputed tomography images. Statistical analyses were conducted using independent t test and one-way analysis of variance followed by Tukey post hoc test (P < .05).Results: Marginal gap volume for DDS (1.856 ± 0.323 mm3) was significantly higher than that of IDS immediately after inlay cementation (0.891 ± 0.281 mm3) (P = .025). Following thermocycling, the internal gap volume for DDS (0.838 ± 0.248 mm3) was significantly higher than that for IDS (0.098 ± 0.066 mm3) (P = .000), but the marginal gap volume of DDS (1.964 ± 0.956 mm3) was not significantly different from that of IDS (1.426 ± 0.725 mm3) (P = .622).Conclusion: Luted ceramic inlays have a superior marginal adaptation right after cementation and a superior internal adaptation after thermocycling when using the IDS technique compared to the DDS technique. However, marginal adaptation after thermocycling was not significantly different between the two techniques. [ABSTRACT FROM AUTHOR]

Background: The accuracy of intraoral scanning plays a crucial role in the workflow of computer-assisted design/computer-assisted manufacturing. However, data regarding scanning accuracy for inlay preparation designs are lacking. The purpose of this in vitro study was to evaluate the influence of the depth of the occlusal cavity and width of the gingival floor of the proximal box on the trueness and precision of intraoral scans for inlay restoration. Methods: Artificial teeth were used in this study. Four types of preparations for mesio-occlusal inlay were performed on each #36 artificial tooth depending on two different depths of the occlusal cavity (1 mm and 2 mm) and widths of the gingival floor of the proximal box (1.5 mm and 2.5 mm). Artificial teeth were scanned 10 times each with Cerec Primescan AC, and another scan was performed subsequently with a laboratory scanner as a reference (n = 10). Standard tessellation language files were analyzed using a three-dimensional analysis software program. Experimental data were analyzed using two-way analysis of variance and the Bonferroni multiple comparison test. Results: The narrow shallow group had significantly higher deviation values for trueness than the wide deep group (p < 0.05). The wide deep group had the lowest average deviation value for trueness and there was no significant difference between the narrow deep and wide shallow groups (p > 0.05). For the mean maximum positive deviation, the wide groups had significantly lower values than the narrow groups (p < 0.05). Trueness was affected by both the width and depth(p < 0.05), whereas the mean maximum positive deviation was affected by the width (p < 0.05). The mean maximum negative deviation was affected by all three factors (p < 0.05). Precision was affected by the depth and the interaction between the depth of the occlusal cavity and width of the gingival floor (p < 0.05). Conclusions: The design of different inlay cavity configurations affected the accuracy of the digital intraoral scanner. The highest average deviation for trueness was observed in the narrow shallow group and the lowest in the wide deep group. With regard to precision, the narrow shallow group showed the lowest average deviation, and the narrow deep group showed highest value. [ABSTRACT FROM AUTHOR]

Treatment of gingival recessions associated with noncarious cervical lesions (NCCL) can be a challenging clinical situation for clinicians. Both periodontal and restorative treatment can be necessary for this kind of defect. By using both digitally precise computer-aided design/computer-assisted manufacture (CAD/CAM) procedures and natural inlay (NI) material for restoration of defects before the coronally advanced flap (CAF) surgery, attachment of soft tissues on the root surface can be achieved successfully. Seven nonsmoking patients with NCCL associated with gingival recessions in the maxillary esthetic zone were treated with NI restoration before CAF surgery. All of the included patients needed at least one tooth extraction, and extracted teeth were used for NI restoration for the CAD/CAM milling procedure. After application of the restorative material onto NCCL defects, CAF surgery was performed for root coverage. The primary outcome was increased mean root coverage percentage and clinical attachment gain after a 6-month follow-up period. Successfully restored NCCL defects were covered with CAF, and 91.67% mean root coverage was achieved with a 1.98-mm attachment gain. Additionally, 71.42% of the root surfaces covered completely. Application of NI restoration materials with CAD/CAM techniques can be a promising procedure for the restoration of NCCL defects before periodontal surgery. This method can achieve a better clinical attachment after root surface coverage. [ABSTRACT FROM AUTHOR]

Objective: This prospective clinical study evaluated the clinical performance of one-, two- and multi-surface composite resin inlays over a 12-year period on premolars and molars. Method and materials: One clinician placed 113 indirect composite resin inlays (Signum, Heraeus Kulzer) in 30 patients that were bonded using a three-step bonding system and composite resin luting cement. Evaluations were made at 3 and 12 years by another clinician who was not involved in the placement of the restorations, using the modified US Public Health Service (USPHS) criteria. Data were analyzed using a nonparametric statistical test (Mann-Whitney U test) followed by Bonferroni correction (alpha = .05). Results: Fourteen patients could not be followed, yielding to the follow-up of 99 restorations. After 12 years, compared to the 3-year follow-up, tooth integrity, secondary caries, and sensitivity criteria showed significant change, while other parameters did not show significant difference (P > .05). Parameters such as loss of marginal integrity, loss of restoration integrity, loss of surface polish, and secondary caries received more frequently delta scores. At the 3-year follow-up, the clinical performance of one- or two-surface inlays did not show significant difference from multi-surface ones (P = .6317), but at the 12-year follow-up, the results were more favorable for multi-surface inlays. Overall, the failure rate at 12 years was 12%. Conclusions: Adhesively bonded indirect composite resin inlays showed acceptable long-term clinical results in terms of function, but surface and margin characteristics changed over time. [ABSTRACT FROM AUTHOR]

Background: Evaluating the effect of different surface treatment methods on the micro-tensile bond strength (µTBS) of two different resin-matrix computer-aided design/computer-aided manufacturing (CAD/CAM) ceramics (RMCs). Methods: A standardized inlay preparations were performed on 100 intact maxillary premolars. According to the type of the restorative material, the teeth were randomly divided into two equally sized groups (n = 50): (polymer-infiltrated ceramic (Vita Enamic) and resin-based composites (Lava Ultimate)). The inlays were fabricated using CAD/CAM technology. In each group, the specimens were randomly assigned to five subgroups (n = 10) according to the surface treatment method: group 1 used was the control group (no surface treatment); group 2, was treated with air abrasion with 50 μm Al2O3 (A) and universal adhesive (UA); group 3, was treated with air abrasion with 50 μm Al2O3 (A) and silane coupling agent (S); group 4, was treated with hydrofluoric acid (HF) and universal adhesive (UA) and group 5, was treated with Hydrofluoric acid (HF) + silane coupling agent (S). The inlays were then cemented to their respective preparations using dual-cure self-adhesive resin cement (RelyX U200, 3 M ESPE) according to the manufacturer's instructions. The µTBS test was conducted in all groups, and stereomicroscope and scanning electron microscope were used to inspect the failure mode. The data were statistically analyzed using a two-way analysis of variance (ANOVA) and Tukey's post-hoc multiple comparison tests at a significance level of p < 0.05. Results: Surface treatments significantly increased the µTBS of the materials compared to the control group (p < 0.05). For CAD/CAM RBCs, the µTBS value highest in group 2 whereas, for PICN, the µTBS value was highest in group 3. Cohesive failure of CAD/CAM restorative material was the most predominant mode of failure in all treated groups, whereas adhesive failure at restoration-cement interface was the most predominant failure mode in the control group. Conclusion: Surface treatments increase the µTBS of resin-matrix CAD/CAM ceramics to tooth structure. Air abrasion followed by universal adhesive and hydrofluoric acid followed by silane application appears to be the best strategies for optimizing the bond strength of CAD/CAM RBCs and PICN respectively. [ABSTRACT FROM AUTHOR]

Objective: Evaluation of the effect of preparation type (inlay, onlay, and crown) on the accuracy of different intraoral scanning (IOS) systems at the preparation and arch segment levels. Materials and Methods: Three molars were prepared for inlay, onlay, and crown. Each preparation was scanned 10 times by CEREC Omnicam, Trios 3 (TS), and Medit i500 scanners. Each image was trimmed twice. The first trimming produced a preparation image (PI), and the second trimming extracted a segment image (SI) that involved the preparation with the adjacent teeth. Trueness and precision were calculated at the PI and SI levels. Results: At the PI level, all IOS systems had similar trueness pattern for all preparations, where the inlay had the best trueness followed by the crown and onlay. At the SI level, the different preparations showed similar trueness. The precision did not show a clear pattern of superiority for any preparation. The TS was significantly more precise than other IOS systems at the PI and SI levels, for every preparation. The proximal areas suffered from the greatest errors, regardless of preparation type. Conclusions: The preparation type influenced PI trueness, and the IOS system affected PI and SI precisions. Clinical Significance: The smaller and less complex preparations have greater IOS accuracy than larger and more complex preparations. As the proximal areas are more affected regardless of the preparation, a more accessible proximal area for scanning is desirable. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the peri-implant soft and hard tissues of dental implants placed in vertically regenerated posterior mandibles with intraoral onlay block bone grafts and patient satisfaction at 3-year follow-up. Materials and Methods: A retrospective study of patients with dental implants placed in posterior mandibular sites vertically augmented with intraoral onlay block bone grafts was carried out between 2005 and 2009 at the University of Valencia. The outcomes assessed at the 3-year follow-up visit were the peri-implant soft tissues (Plaque Index and Bleeding Index, probing depth, keratinized mucosa width, and recession), implant survival and success rates, marginal bone loss, and patient satisfaction. Results: Sixteen patients with 36 implants were included. The mean Plaque Index and Bleeding Index scores were ≤ 0.4. The mean band of facial keratinized mucosa was ≥ 3 mm in 52.7% of implants; 38.8% of the implants showed facial recession. The mean midfacial recession was -0.31 ± 0.75 mm. Implant survival reached 100%, while the success rate was 85%, and the mean marginal bone loss was 1 ± 1.03 mm (range: 0.1 to 5.3). Good quality of life (9.19 ± 0.40) was reported for all patients, and the overall general satisfaction score was 8.07 ± 1.04 (mucosa esthetics: 7.71 ± 1.45; prosthesis esthetics: 8.42 ± 0.6; chewing: 8.68 ± 0.94; ease of cleaning: 8.01 ± 1.03). Conclusion: Considering the limitations of the study, implants in vertically augmented posterior mandibular areas with intraoral onlay block bone grafts showed good soft tissue levels and high patient satisfaction. No implants were lost at 3 years postloading, though one-fifth of the patients showed a statistically significant marginal bone loss. [ABSTRACT FROM AUTHOR]

Background: Currently, there is a lack of data relating to dental practitioners' habits with clinical occlusal assessment and the application of practical techniques in occlusion. Objectives: The aim of this study was to investigate habits with clinical occlusal assessment and the practical application of established concepts in occlusion amongst a cohort of international dentists. Methods: A piloted questionnaire with 20 statements was distributed by 5 recruiters. The recruiters were based in Malta (1), South Africa (1), Malaysia (1) and the UK (2). Outcomes were analysed using descriptives, chi‐squared and Fisher's exact test. All the analyses were carried out in Stata, Version 12. Significance was inferred at p <.05. Results: Four hundred thirty‐five completed responses were included in the sample (response rate, 70.7%). Overall, high levels of agreement were reported with the provision of single‐unit crown and onlay restorations (78.8%) and bridge prostheses (up to 3 units, 77.9%), respectively. One‐third (33.6%) agreed to observing dynamic occlusal relationships during an adult patient dental examination, 40.7% reported using articulators for crown and bridge cases, and 25.1% agreed to taking facebow records. Under half (47.3%) of the dentists expressed dissatisfaction with their undergraduate training in occlusion, with no significant association with the variables of the number of years of experience, the country of practice or being in general practice (p ≥.226). Conclusion: The results indicate a disparity between traditionally taught and applied concepts in clinical occlusion and the undertaking of occlusal assessments and the management of occlusion in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the influence of the presence of adjacent teeth on the accuracy of intraoral scanning (IOS) systems for class II inlay preparation. Materials and Methods: The mesio‐occlusal inlay preparation was prepared in an anatomical model of the maxillary molar. The prepared tooth was secured to a typodont with the mesial adjacent tooth removed or in situ. Ten digital impressions of the inlay preparation were acquired using three IOS systems (CEREC Primescan, 3Shape TRIOS 3, and Medit i500). A laboratory scanner (3Shape E3) was used to obtain the reference scan data. The mean absolute deviation values were calculated to evaluate the accuracy of the digital models. Results: The group with the adjacent teeth present showed lower trueness and precision compared to that without the adjacent tooth (p <.05). Significant differences were observed among the IOS systems (p <.05). Primescan showed the highest accuracy, irrespective of the presence of adjacent teeth. Conclusions: The presence of the adjacent tooth negatively affected the accuracy of all the IOSs tested. Although the performance of Primescan was superior to that of TRIOS 3 and i500, each IOS system showed clinically acceptable levels of accuracy for class II inlay preparation. Clinical Significance: The adjacent tooth can be a confounding factor for accurate digital impressions of class II inlay preparation. [ABSTRACT FROM AUTHOR]

This study aimed to measure real‐time temperature changes in gold‐restored teeth compared with intact teeth during the intake of hot and cold drinks. Sixteen molars, including eight natural intact teeth and eight restored teeth with gold inlays, were selected from the participants. Custom‐made thermocouple sensors were attached to the coronal third of the buccal surface of teeth. Participants consecutively consumed hot and cold drinks according to a standardized regimen. Resting, maximum, and minimum temperatures; time to reach peak temperatures; and heating and cooling velocities were obtained. Statistical analysis was performed using independent two‐sample t‐test. Teeth with gold restorations showed a significantly higher maximum temperature (44.7 °C [SD 2.9]) than did natural teeth (40.5 °C [SD 1.2]) during hot water drinking and showed a lower minimum temperature (25.0 °C [SD 4.9]) than did natural teeth (31.5 °C [SD 3.1]) during cold water drinking. The heating and cooling rates for the teeth with gold restorations were two and three times higher than those of the natural teeth. Gold‐restored teeth showed greater temperature change than intact teeth in terms of magnitude and velocity in response to temperature changes induced by hot and cold drinks. [ABSTRACT FROM AUTHOR]

This paper presents a technical description of the inlay technique performed with an allograft block in the reconstruction of a severely atrophic posterior mandible. It includes a histologic case series of five patients treated with the same grafting procedure and rehabilitated with dental implants 2 months after placement of the graft. The histologic analysis showed large amounts of newly formed bone in tight connection with the allograft and large marrow spaces with intense cellular activity and the presence of osteocytes. Allografts might serve as an alternative to autogenous and heterologous grafting in posterior mandible augmentation using the inlay technique. [ABSTRACT FROM AUTHOR]

Background/purpose: How long do lithium disilicate restorations last before they fail? The aim of this study was to assess the success rate of four different types of restorations made from lithium disilicate. Materials and methods: A total of 87,203 ceramic restorations, classified into four different types (inlay or onlay, veneers (Vs), single crowns (SCs), and fixed partial dentures (FPDs)), were used. All were made of lithium disilicate (IPS e.Max CAD) with Cerec Inlab CAD/CAM system (Sirona Dental Systems, Bensheim, Germany). They were reported by dentists and entered in the database of the private B&R Dental Center between March 2015 and June 2020 and assessed retrospectively up to a period of 5 years based on the following parameters: failure rate and cause of failures (ceramic fracture, debonding, marginal adaptation, color match, endodontic intervention, periodontal disease, and secondary caries). Failure distribution according to gender, arch, and teeth type was also evaluated. The time-dependent time-to-failure/complication and their differences were calculated in months according to the Kaplan Meier and log-rank tests. The Chi-squared test (p 0.05) was used to assess the variations in causes of failure rates between different restorations. Results: Kaplan Meier test showed overall cumulative survival probability of lithium disilicate restorations for up to years was 85.08%. Inlay/onlay and Vs ceramic restorations showed highest cumulative survival probability (99.4%, 98.6, respectively). FPDs had the least cumulative survival probability (52.9%) which was significantly (P < 0.00001) higher than for other ceramic restorations using the log-rank test. Moreover, overall time-dependent time-to-failure/complication occurred after 52.373 months according to Kaplan–Meier (CI: lower bound: 51.875 months; upper bound: 52.871 months). Ceramic fracture in both FPDs and SCs (27.6% and 26.6%, respectively) and debonding in Vs (12.7%) were significant as the main reasons for failure (P = 0.000). The failure rate was significantly higher for the maxillary arch than the mandibular arch (P = 0.021). Fracture and marginal discrepancy were more frequent in the molar region (77.5% and 14.75%, respectively) and significantly higher here than in the anterior and premolar regions (P = 0.000). Conclusion: The medium-term performance of lithium disilicate is ideal. Ceramic fracture was the most common cause of failure in SCs and FPDs. FPDs presented with the highest failure rate based on evaluation for up to 5 years. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate, in a case control study, the esthetic and functional clinical performance of ceramic inlays used for covering the screw access hole in single monolithic lithium disilicate full-contour crowns bonded on computer-aided design/computer-aided manufacturing (CAD/CAM) prefabricated titanium abutments in order to eliminate the drawbacks of alternative restorative methods. Materials and Methods: Twenty-eight patients with missing teeth in the lateral areas (premolars and molars) received screw-retained implant restorations. In half of the restorations (n = 14), composite fillings were used to seal the access hole (control group), while the other half was sealed with ceramic inlays (test group). To determine the restoration occlusal wear, impressions were obtained after the restorations were finalized, at 1 year, and at 2 years follow-up. The casts were scanned with a 3D Scanner Design System recording the anatomical surfaces of the white model replicates. Wear amounts (µm) were calculated as the maximum loss in height of the occlusal surface. The clinical evaluation was carried out using a kit specifically designed for assessing the FDI criteria. Statistics were performed using analysis of variance (ANOVA). Results: A total of 58 restorations were delivered, and after 2 years of follow-up, the wear values were 228.20 ± 54.68 µm for the control group and 65.20 ± 7.24 µm for the ceramic inlay group. One-way ANOVA showed significant differences among the vertical loss between these two groups (P < .001). Clinical outcomes according to the FDI score for assessing dental restorations revealed substantial deterioration within 2 years of follow-up. Conclusion: The use of ceramic inlays appears to be a predictable, esthetic, and successful method of sealing the screw holes of the screw-retained implant restorations. [ABSTRACT FROM AUTHOR]

Objective: This study addresses common errors that may occur during digital impression procedures using the CEREC AC and in-office CAD/CAM systems. Error types and frequencies resulting from digital impressions of the oral cavity were investigated and their origins identified to facilitate the acquisition of more accurate digital impressions. Method and Materials: A total of 1,251 digital impression cases, including 163 onlays and 1,088 inlays, were constructed as restorations using the CEREC AC system. Two evaluators determined five categories of digital errors as a basis for evaluation over two sessions. The five categories were as follows: inappropriate scanner positioning (ISP), improper handling of the scanner (IHS), irregular powder arrangement (IPA), improper cavity preparation (ICP), and insufficient scanned data (ISD). Results: The most frequently encountered errors were non-linear powder application (IPA), inappropriate oral cavity scanner placement (ISP), and insufficient data (ISD). ISP showed that inlays had a slightly higher frequency of errors, but this observation was not statistically significant (P > .05). Conclusion: Most errors are caused by incorrect operation of intraoral scanners or uneven application of powder in acquiring digital impressions. To provide optimal digital impression results, careful chairside technique procedures and operation of intraoral scanners are required. [ABSTRACT FROM AUTHOR]

Oligodontia has a substantial oral functional and psychosocial impact on the quality of life of children. The treatment of oligodontia in adolescence is an interdisciplinary approach which can include extraction of the primary teeth with orthodontic space closure, or prosthodontic rehabilitation. This case report describes a conservative approach for the rehabilitation of a 12-year-old patient with 19 ageneses (excluding third molars) of permanent teeth, infraocclusion of the persisting primary teeth, deep overbite, and reduced mesiodistal dimension of the maxillary incisors with a central diastema. The treatment plan to restore esthetics and function included an initial noninvasive prosthetic rehabilitation for deep bite correction with additive leucite-reinforced glass-ceramic onlays/veneers until definitive orthodontic and implant therapy are reevaluated and determined in adulthood. Esthetics, functional occlusion, and crown-to-root ratio remained stable over a follow-up period of 3 years. No signs of fractures within the all-ceramic restorations or symptoms of a temporomandibular disorder were evident. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the mechanical performance of deep margin elevation technique for carious cavities by considering the shape designs and material selections of inlay using a computational approach combined with the design of experiments method. The goal is to understand the effects of the design parameters on the deep margin elevation technique and provide design guidelines from the biomechanics perspective. Methods: Seven geometric design parameters for defining an inlay's shape of a premolar were specified, and the influence of cavity shape and material selection on the overall stress distribution was investigated via automated modelling. Material selection included composite resin, ceramic, and lithium disilicate. Finite element analysis was performed to evaluate the mechanical behavior of the tooth and inlay under a compressive load. Next, the analysis of variance was conducted to identify the parameters with a significant effect on the stress occurred in the materials. Finally, the response surface method was used to analyze the stress responses of the restored tooth with different design parameters. Results: The restored tooth with a larger isthmus width demonstrated superior mechanical performance in all three types of inlay materials, while the influence of other design parameters varied with the inlay material selection. The height of the deep margin elevation layer insignificantly affected the mechanical performance of the restored tooth. Conclusions: A proper geometric design of inlay enhances the mechanical performance of the restored tooth and could require less volume of the natural dentin to be excavated. Furthermore, under the loading conditions evaluated in this study, the deep margin elevation layer did not extensively affect the strength of the tooth structure. [ABSTRACT FROM AUTHOR]

Background: The maximum conservation of tooth structure and the use of restorative materials with elastic modulus close to the dental structure may promote greater longevity of the tooth/restoration complex. This study was conducted to evaluate the effect of cavity design and material type on fracture resistance and failure pattern of molars restored by computer-aided design/computer-aided manufacturing (CAD/CAM) inlays/onlays. Materials and Methods: In this in vitro study, 55 human maxillary molars were embedded in resin blocks and divided into control group (CG) and five main groups: Group 1: Inlay, Group 2: Conventional onlay/mesiobuccal (MB), Group 3: Conservative onlay/MB, Group 4: Conventional onlay/MB and distobuccal (DB), and Group 5: Conservative onlay/MB and DB. Then, each group was divided into two subgroups: (A) CeraSmart (CS) and (B) Katana Zirconia (KZ). Restorations were cemented by RelyX Ultimate and then thermocycled. The universal testing machine was used to measure fracture loads. Failure was determined using a magnifying lens. Data were statistically analyzed using ANOVA followed by Tukey's post hoc test (P < 0.05). Results: Group 5 showed the highest significant fracture load, whereas the least significant value was recorded in Group 2. KZ recorded higher significant fracture loads than CS in all tested groups. Groups 1, 2, and 3 restored by CS showed lower fracture load than CG, but the difference was insignificant with Group 1. CS restorations showed restorable failure, while unrestorable pattern was predominant in KZ restorations (P < 0.05). Conclusion: KZ inlays and onlays can be used safely in terms of fracture resistance as both have values exceed the physiologic requirements. CS inlays and onlays/MB and DB are of fracture resistance comparable to intact teeth. The use of conservative onlay design with more cusp coverage guarantees better resistance of CS restorations. Being force absorbing material, the predominant failure of teeth restored by CS was restorable. [ABSTRACT FROM AUTHOR]

This study aimed to assess the clinical performance of lithium disilicate restorations supported by natural teeth or implants. Eight hundred sixty lithium disilicate adhesive restorations, including crowns on natural teeth and implant abutments, veneers, and onlays, were made in 312 patients. Parafunctional patients were included, but subjects with uncontrolled periodontitis and gingival inflammation were excluded. Veneers up to 0.5 mm thick were luted with flowable composite resin or light curing cements, while dual-curing composite systems were used with veneers up to 0.8 mm thick. Onlays up to 2 mm in thickness were luted with flowable composite resins or dual-curing composite cements. Crowns up to 1 mm in thickness were cemented with self-adhesive or dual-curing resin cements. The observational period ranged from 12 to 72 months, with a mean follow-up of 3 years. The mechanical and esthetic outcomes of the restorations were evaluated according to the modified California Dental Association (CDA) criteria. Data were analyzed with descriptive statistics. Twenty-six mechanical complications were observed: 17 porcelain chippings, 5 fractures, and 4 losses of retention. Structural drawbacks occurred mainly in posterior segments, and monolithic restorations showed the lowest number of mechanical complications. The clinical ratings of the successful restorations, both monolithic and layered, were satisfactory according to the modified CDA criteria for color match, porcelain surface, and marginal integrity. The cumulative survival rates of lithium disilicate restorations ranged from 95.46% to 100%, while cumulative success rates ranged from 95.39% to 100%. All restorations recorded very high survival and success rates. The use of lithium disilicate restorations in fixed prosthodontics proved to be effective and reliable in the short- and medium-term. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the load-bearing capacities of fiber-reinforced composite (FRC) fixed dental prostheses (FDP) with pontics of various materials and thicknesses. Materials and Methods: Inlay preparations for retaining FDPs were made in a polymer phantom model. Seventytwo FDPs with frameworks made of continuous unidirectional glass fibers (everStick C&B) were fabricated. Three different pontic materials were used: glass ceramics, polymer denture teeth, and composite resin. The FDPs were divided into 3 categories based on the occlusal thicknesses of the pontics (2.5 mm, 3.2 mm, and 4.0 mm). The framework's vertical positioning varied respectively. Each pontic material category contained 3 groups (n = 8/group). In group 1, pontics were fabricated conventionally with composite resin (G-ænial, GC) with one additional transversal fiber reinforcement. In group 2, the pontics were polymer denture teeth (Heraeus- Kulzer). Group 3 had an IPS-Empress CAD pontic (Ivoclar Vivadent) milled using a Cerec CAD/CAM unit. Groups 1 and 2 served as controls. Each FDP was statically loaded from the pontic until initial fracture (IF) and final fracture (FF). Initial-fracture data were collected from the load-deflection graph. Results: ANOVA indicated statistically significant differences between the materials and occlusal thicknesses (p < 0.001). Quadratic analysis demonstrated the highest correlation between the thickness of the pontic and IF and FF values with ceramic pontics (IF: p < 0.001; R² = 0.880; FF: p < 0.001; R² = 0.953). Conclusion: By increasing the occlusal thickness of the pontic, the load-bearing capacity of the FRC FDPs may be increased. The highest load-bearing capacity was obtained with 4.0 mm thickness in the ceramic pontic. However, with thinner pontics, polymer denture teeth and composite pontics resulted in higher load-bearing values. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of the cementation strategy and mechanical cycling (MC) on the microtensile bond strength (MTBS) of feldspathic inlays cemented to premolars. Materials and Methods: Forty-eight human premolars were prepared and porcelain inlays were produced. Specimens were allocated into 3 groups, based on the cementation strategy: 1) conventional adhesive cementation (RelyX ARC, 3M ESPE): application of etch-and-rinse single bottle adhesive to dentin / ceramic surface treated with hydrofluoric acid (HF) and silane (S) / cementation with resin cement; 2) simplified cementation using a self-adhesive resin cement (RelyX U100, 3M ESPE); 3) modified simplified cementation using a self-adhesive resin cement (RelyX U100, 3M ESPE) with HF+S treatment. Half of the specimens from each group were submitted to MC (2x106 pulses, frequency = 4 Hz, load = 100 N). Each specimen was serially sliced for MTBS and the failures were classified. The stress distribution analysis using FEA was verified. Results: All of the bar-samples from G2 were lost during cutting of the specimens. Mechanical-cycling had no significant effect on bond strength, whereas cementation strategy significant affected MTBS results. The most common type of failure was cohesive of cement. FEA showed that stresses were concentrated mainly at the loading region going up to the root fixation. Conclusion: Porcelain inlays cemented with conventional resin cement or self-adhesive resin cement should be associated with ceramic surface treatment. FEA showed the most critical zone for failure is located in the cement region close to the marginal crest. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether 5 × 5 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to implants at least 10 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. Materials and methods: A total of 40 patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 7 mm of bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 6 mm below the maxillary sinus, were randomised according to a parallel group design to receive one to three 5 mm implants or one to three at least 10 mm-long implants in augmented bone at two centres. All implants had a diameter of 5 mm. Mandibles were vertically augmented with interpositional bovine bone blocks and resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cemented metal-ceramic or zirconia prostheses were delivered. Patients were followed up to 1 year post-loading and the outcome measures were prosthesis and implant failures, any complications and peri-implant marginal bone level changes. Results: One maxillary grafted patient dropped out before the 1-year evaluation. In mandibles, 1 grafted patient did not want to go ahead with the treatment because of multiple complications and graft failure, and another grafted patient did not receive his prostheses due the loss of 2 implants. In maxillae, one 5 × 5 mm implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences in prostheses and implant failures. Significantly more complications occurred at both mandibular and maxillary grafted sites: 17 augmented patients were affected by complications versus 8 patients treated with short implants in the mandible (P = 0.0079; difference in proportion = -0.45; 95% CI -0.67 to -0.15), and 5 sinus-lift patients versus none treated with maxillary short implants (P = 0.047; difference in proportion = -0.25; 95% CI -0.44 to -0.06). Patients with mandibular short implants lost on average 0.94 mm of peri-implant bone at 1 year and patients with 10 mm or longer mandibular implants lost 1.03 mm. Patients with maxillary short implants lost on average 0.87 mm of peri-implant bone at 1 year and patients with 10 mm or longer maxillary implants lost 1.15 mm. There were no statistically significant differences in bone level changes up to 1 year between short and longer implants in maxillae (mean difference -0.28 mm, 95% CI -0.56 to 0.01, P = 0.051) and in mandibles (mean difference -0.09 mm, 95% CI -0.26 to 0.08, P = 0.295). Conclusions: One year after loading, 5 × 5 mm implants achieved similar results compared to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity, however 5 to 10 years of post-loading data are necessary before making reliable recommendations. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether 6 mm long by 4 mm wide dental implants could be an alternative to implants at least 10 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. Materials and methods: A total of 20 patients with bilateral atrophic mandibles and 20 patients with bilateral atrophic maxillae, having 5 to 7 mm of bone height above the mandibular canal or below the maxillary sinus, had each side of the jaws randomly allocated according to a split-mouth design. They were allocated to receive one to three 6 mm long and 4 mm wide implants, or implants at least 10 mm long in augmented bone by two different surgeons in different centres. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers, and implants were placed 3 months later. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were placed simultaneously. All implants were submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive metal-ceramic prostheses were delivered. Outcome measures were prosthesis and implant failures, any complication and radiographic peri-implant marginal bone level changes. Results: One patient treated in the mandible dropped out before the 1-year post-loading follow-up. All maxillary implants and prostheses were successful, whereas 2 mandibular prostheses could not be placed on implants at least 10 mm long due to graft failures; one was associated with the loss of 3 implants because of infection. There were no statistically significant differences in implant and prosthesis failures, though significantly more complications occurred at grafted sites in mandibles (P = 0.0078), but not in maxillae (P = 0.1250). In total, 14 complications occurred in 12 patients at augmented sites versus none at 6 mm-long implants. All failures and complications occurred before loading. Patients with mandibular 6 mm-long implants lost an average of 1.05 mm of peri-implant bone at 1 year and patients with mandibular implants at least 10 mm long lost 1.07 mm. These differences were statistically significant (P < 0.001). Patients with maxillary 6 mm-long implants lost an average of 1.02 mm of peri-implant bone at 1 year and patients with maxillary implants at least 10 mm long lost 1.09 mm. These differences were statistically significant (P < 0.001). There were no statistically significant differences in bone level changes up to 1 year between 6 mm and at least 10 mm-long implants in both jaws (mandibles n = 18, mean difference -0.02 mm, 95% CI -0.16 to 0.12, P = 0.7384; maxillae n = 20, mean difference -0.07 mm, 95% CI -0.18 to 0.05, P = 0.2547). Conclusions: Short-term data (1 year after loading) indicate that 6 mm-long implants with a conventional diameter of 4 mm achieved similar if not better results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation, especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity. However, data obtained 5 to 10 years after loading are necessary before making reliable recommendations. [ABSTRACT FROM AUTHOR]

Objective: Following the advent of strong adhesive bonding, the conservative tooth preparation designs without a retentive form gained increasing popularity. This study aimed to evaluate the marginal adaptation of zirconia‐reinforced lithium silicate (ZLS) overlays with different preparation designs. Materials and methods: Forty sound human maxillary first molars were collected and divided into four groups (n = 10) according to their preparation design for the fabrication of ZLS overlays: (O) anatomical occlusal reduction, (OS) anatomical occlusal reduction with rounded shoulder, (OG) anatomical occlusal reduction with a central groove, and (OSG) anatomical occlusal reduction with rounded shoulder and central groove. A video measuring machine (VMM) was used to measure the marginal gap. Statistical analysis was carried out using one‐way ANOVA followed by paired t test and Tukey's test (α =.05). Results: The gap size was significantly different between the groups both before (P =.004) and after (P =.008) cementation, and it was significantly smaller in group O than group OSG (P =.002 before and P =.004 after cementation). Marginal gap increased in all groups following cementation (P <.001). Conclusions: Group O showed comparable marginal adaptation with groups OS and OG while group OSG with the most complex design showed the lowest marginal adaptation for ZLS overlays. Clinical Significance: According to the results of this in vitro study, it may be stated that for defect‐free teeth requiring occlusal restoration, the occlusal surface preparation alone would suffice to achieve optimal marginal adaptation, and retentive and more invasive preparation designs are not required. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical effectiveness of indirect composite restorations in permanent molars with excessive substance loss in pediatric patients who have undergone root canal treatments. Materials and Methods: Molars of 29 pediatric patients underwent endodontic treatment. Sixteen molars were restored with an indirect posterior composite resin restoration and 13 molars were restored with a direct posterior composite resin restoration. The success of the restorations was evaluated for 2 years based on United States Public Health Service (USPHS) criteria, photographs after staining with basic fuchsine, and radiographic data. Data obtained from both groups were compared using the Mann-Whitney U-test and Wilcoxon signed rank test. Results: Evaluation of the clinical and radiographic data revealed no observable, statistically significant differences between the posterior and the indirect posterior composites (p > 0.05). However, evaluation of photos taken of the patients' molars after staining with basic fuchsin revealed that direct posterior composites showed increased staining on the margins of the restorations after six months (p < 0.05). Conclusion: Considering the difficulties of restoring endodontically treated permanent teeth with excessive substance loss in child patients, indirect restorations may be seen as a better option. [ABSTRACT FROM AUTHOR]

A total of 163 monolithic restorations made from Vitablocs Mark II and luted adhesively or with resin cement were followed up for 3 to 70 months. Recall consisted of an evaluation of complete dental and hygiene status as well as quality assessment. Seven of 35 patients were lost to follow-up. Ninety-one percent of the 37 crowns, 23 partial crowns, and 89 inlays evaluated were in the posterior region. Combined survival estimate was 0.92 at the 48-month median observation time. Inlays and partial crowns performed well. Prevalence of complication and failure was highest for crowns (CP = 37.8%, FP = 21.6%). The results demonstrate that success relates to patient factors and restoration type, not luting protocol. [ABSTRACT FROM AUTHOR]

This report describes a successful implant prosthetic rehabilitation in an atrophic left posterior mandible in a 62-year-old man using a cancellous equine bone block as grafting material. Four months later, two bone specimens were retrieved for histologic evaluation and two dental implants were placed. Computed tomography and conventional radiography showed a 5-mm mean vertical bone gain. The biopsies showed new bone formation within the cancellous portion of the blocks and no foreign body reaction. Cancellous equine bone grafts may be an effective alternative to autogenous bone and inorganic bovine bone grafting for reconstruction of the posterior mandible using the inlay technique. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the fracture strength of inlay-retained, surface-retained, and cantilevered fiber-reinforced adhesively fixed dental prostheses (FRA-FDPs) in the anterior region. Materials and Methods: Thirty-two sound human right central incisors and canines were divided into four groups. Test groups were as follows: group 1, both teeth had deep cavity preparation; group 2, both teeth had shallow cavity preparation; group 3, only the canine teeth had deep cavity preparation; group 4, no preparation was made on the abutment teeth. Lateral pontics were restored with FRA-FDPs. All restorations were subjected to fracture loading from the lateral pontic. The restorations were tested in a universal testing machine (LRX Material Testing Machine) with a crosshead speed of 1 mm/min. One-way ANOVA was used for statistical analyses. Fracture modes were examined visually. Results: The highest (667.3 ± 90.4 N) and the lowest (409.3 ± 158.1 N) debonding values were found for groups 4 and 3, respectively. Conclusions: Different preparation designs (inlay-retained, surface-retained) had no significant effect on fracture strength of FRA-FDPs in the anterior region. However, a cantilever design exhibited significantly lower fracture strength. Delamination of the veneering composite was observed as the primary failure type after fracture tests. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate under controlled clinical conditions the outcomes of cast-metal slot-retained resin-bonded fixed dental prostheses (RBFDPs) in which resin composite interlocked the restoration retainers in place after cementation in cases with single missing first molars, and to collect survival data on this esthetic RBFDP design combined with an economical metal fit-surface treatment method and resin luting system. Materials and Methods: Forty-one tub-shaped inlay-retained RBFDPs were clinically observed for up to 7.7 years in 35 recipients of both genders between 18 and 52 years of age. Clinical examinations were performed at baseline and 6 and 12 months after restoration placement, and thereafter at regular 1-year intervals. Modified US Public Health Service (USPHS) parameters, sulcus bleeding index, Silness-Löe plaque index, pocket depths, tooth mobility, pulp vitality, and periapical radiographs regarding the abutment teeth were assessed at these follow-up appointments. The Kaplan-Meier survival estimation method was performed to detect the overall and functional survival rates and mean survival times of the RBFDPs at the end of the study. The Breslow (Generalized Wilcoxon) test was used to evaluate the influence of restoration location and age and gender of the patient regarding the overall survival probability at the end of the follow-up (α = 0.05). Results: At the end of the study, 34 RBFDPs (83%) were still functioning with a mean follow-up of 6.3 years. According to the Kaplan-Meier survival curve, the overall and functional survival probabilities were calculated as 76% and 83%, with mean survival times of 6.8 years and 7.2 years, respectively. All clinical parameters monitored throughout the follow-up period predominantly revealed clinically acceptable results. Breslow test statistics presented nonsignificant differences with better results for the RBFDPs placed in the mandible of female recipients younger than 30 years of age. The most common failure noted with the RBFDPs was fracture of the occlusal veneering composite restoration over the retainer of a single abutment, leading to a predisposition of the restoration to partial debonding. Conclusion: Within the limitations of this prospective cohort study, it can be concluded that cast-metal slot-retained RBFDPs utilizing the interlocking mechanism of a resin composite to obtain additional retention from the abutment cavities show acceptable clinical success rates, and can be considered a minimally invasive, economical, and time-saving treatment alternative for the prosthetic rehabilitation of single missing first molars. [ABSTRACT FROM AUTHOR]

Fixed prosthodontics is the area of prosthodontics focused on permanently attached (fixed) dental prostheses. The superb esthetic and biocompatible characteristic of ceramic and zirconia restorative materials make both the most pioneer materials for the construction of the fix prostheses by the dentist. Such dental restoration is called direct or indirect restorations according to their method of construction. They include crowns, bridges (fixed dentures), inlays, onlays, and veneers. Prosthodontist is a specialist dentist who have trained to select the proper types, material and design of the fixed prostheses. However, comprehensive information about the dental materials are available from the internet websites and social media, which improved the patient's knowledge and consequently they may share physician in their decision in selecting the tooth reconstruction materials. The current survey study concerned three factors that may affect patient's choice for the fix prostheses: (1) internet information, (2) doctor advice, (3) the cost. A total of 100 patients who attending the clinic of the Operative Dentistry in the last 16 months for aesthetic restorations were included in the survey. The samples included 72 female and 28 males of age ranged between 30 and 69 years. The survey based on the criteria for selection the type of fixed metal according to the following items,(1) internet and social media information's, (2) advice of doctor, and (3) the price. The results showed that 67 of patient's choose zircon while 33 of them choose porcelain fused to metal. Furthermore, the results revealed that the internet represented 36% of selection criteria chosen for this study, compared to 34% due to doctor advice and 30%. Due to cost of the treatment The P value were <0.001 significant. The primary reason for selecting zirconia over porcelain fused to metal was the doctor advice and the internet. Where the cost was the main reason in choosing Porcelain fused to metal, plus the sex, age, and marital status. [ABSTRACT FROM AUTHOR]

Objectives: This investigation was a longitudinal, randomized clinical trial to measure the clinical performance of a nano‐ceramic material (Lava Ultimate/3M) for chairside Computer Assisted Design/Computer Assisted Machining (CAD/CAM) fabricated restorations. Materials and Methods: One hundred and twenty chairside CAD/CAM onlays were restored with a CEREC system randomly assigned to 60 leucite‐reinforced ceramic (IPS EmpressCAD/Ivoclar Vivadent AGBendererstrasse 2FL‐9494 SchaanLiechtenstein) onlays and 60 nano‐ceramic (Lava Ultimate/3M) onlays. Equal groups of onlays were cemented using a self‐etch and a total etch adhesive resin cement. The onlays were recalled for a period of 5 years. Results: At 1 week postoperatively, 10% of the onlays cemented with both the self‐etch and total etch adhesive resin cements were reported as slightly sensitive. However, all patients were asymptomatic by the 4th week without treatment. Four leucite‐reinforced onlays and one nano‐ceramic onlay fractured and required replacement. Conclusions: Adhesive retention with a self‐etch or total etch cementation technique resulted in a similar clinical outcome with no reported debonds. The nano‐ceramic onlays had a lower incidence of fracture compared to the leucite‐reinforced ceramic onlays with both having a very low risk of fracture. Nano‐ceramic onlays performed equally as well as glass ceramic onlays over 5 years of clinical service. Clinical Significance: Ceramic materials have been a mainstay for chairside CAD/CAM restorations for the past 30 years and a new category of resilient ceramics with a resin matrix has been introduced reported to offer ceramic‐like durability and esthetics with resin‐like efficiency in handling. There are no long‐term clinical studies on the performance of these materials. This is a 5‐year randomized clinical trial on the performance of nano‐ceramic onlays. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the marginal adaptation of supragingivally relocated cervical margins. Newly developed and reference materials were compared. Materials and Methods: Eighty-eight extracted human teeth were divided into 11 groups. A standardized box-shaped cavity (4.0 mm mesiodistal width, 1.5 mm axial depth) was prepared on each tooth with the cervical margin 1.3 mm below the cementoenamel junction. Seven different restorative materials (Filtek Silorane [Sil], Clearfil AP-X [APX], Clearfil Majesty Posterior [CMP], Clearfil Majesty Flow [CMFlow], RelyX Unicem [RelyX], SDR [SDR], Vertise Flow [VertFlow]) were applied in a layer of 1.5 mm, combined with different adhesive systems (Filtek Silorane Primer + Bond [SilPB], Clearfil Profect Bond [ClePB], Filtek Silorane Bond [SilB]). No indirect restorations (ie, inlays/onlays) were placed on these restorations. SEM analysis was performed to evaluate marginal adaptation in enamel and dentin. The results were subjected to statistical analysis by Kruskal Wallis and Duncan post-hoc tests. Results: In both dentin and enamel, statistically significant differences were present between groups (p < 0.001). In enamel, the lowest percentage of continuous margin was observed for SilPB/CMP, SilPB/APX, and ClePB/SDR, while SilPB/Sil exhibited the highest percentage of continuous margin, although this was not statistically different from other groups except for SilPB/CMP, SilPB/APX, and ClePB/SDR. In dentin, a higher per- centage of continuous margin was observed for all materials than in enamel (p < 0.002). Statistically significant differences were found between ClePB/SilB/Sil, ClePB/SDR, and RelyX, SilPB/APX, ClePB/APX, and ClePB/Sil. ClePB/Sil showed the lowest marginal adaptation. Considering the overall marginal length, the best marginal adaptation was exhibited by ClePB/SilB/Sil, followed by SilPB/Sil, ClePB/SDR, and ClePB/CMP. Conclusion: Marginal adaptation of supragingivally relocated cervical margins is significantly influenced by the materials used. [ABSTRACT FROM AUTHOR]