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Purpose: To investigate the influence of a single infrapositioned ankylosed tooth or implant-supported restoration on smile esthetics. Materials and Methods: A series of 48 digitally modified images that simulated varying degrees of infraposition (from 0.25 to 2.0 mm, with a step of 0.25 mm) were created for each maxillary anterior tooth by altering the full-portrait image of a smiling man, adjusted to show medium and high smile lines. For the model with the high smile line, a series of 24 digitally modified images were created that simulated the infraposition of a single anterior tooth with a restored incisal edge. Smile esthetics for each of the images were evaluated by 160 participants (80 dentists and 80 laypersons), and a visual analog scale (VAS) was implemented. Results: For the images with the high smile line, an infraposition of ≥ 0.25 mm in the central incisor region and ≥ 0.5 mm in the region of the lateral incisor or the canine had a negative effect on the perceived smile esthetics for both the dentists and the laypersons. Regarding the medium smile line, an infraposition of ≥ 0.5 mm in the central and lateral incisor region had a negative effect on the perceived smile esthetics for both groups of observers. In the canine area, an infraposition of ≥ 0.5 mm for the dentists and ≥ 0.75 mm for the laypersons also had a negative impact on the smile esthetics. Conclusions: Even a minor infraposition of a single maxillary anterior ankylosed tooth or implant-supported restoration can reduce the perceived attractiveness of the smile. Infraposition in the canine site can be better tolerated in a medium smile line compared to a high smile line. In patients with a high smile line, prosthetic intervention is needed to restore the incisal edge of an infrapositioned tooth without harmonizing the gingival contour; this can be beneficial for the lateral incisor but ineffective for the central incisor and unfavorable for the canine. [ABSTRACT FROM AUTHOR]

Purpose: To assess the impact of implant placement at different time intervals on the esthetic and clinical outcomes in the esthetic zone. Materials and Methods: A literature screening was conducted in PubMed (MEDLINE), ScienceDirect, and Cochrane databases. Relevant articles were included according to selection criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was collected from studies published from 2017 to 2022 in English. Results: Nine articles were included, in which a total of 495 implants were placed; 250 of the implants were immediate, 109 were early, and 136 were delayed. Immediate implant placement (IIP) showed no statistically significant difference in Pink Esthetic Score (PES) compared with delayed implant placement (DIP). IIP showed significantly higher PES in comparison with early implant placement (EIP) (mean difference [MD] = -0.76; 95% CI = -1.50 to -0.02; P = .04). The probing depth (PD) was considerably greater for immediate implants than for delayed implants (MD = -0.62; 95% CI = -1.05 to -0.18; P = .005), and the Plaque Index (PI) was statistically greater for early implants compared with immediate implants (MD = 0.15; 95% CI = 0.11 to 0.19; P < .00001). All other soft tissue outcomes showed equal results. The marginal bone loss (MBL) was statistically higher in early implants compared with immediate implants (MD = 0.09; 95% CI = 0.02 to 0.16; P = .02). Conclusions: IIP had significantly superior PES, MBL, and PI results when compared with EIP. The PD was significantly higher for immediate implants compared with delayed implants. All other outcomes showed no significant difference between the three implant groups. It is important to highlight the limitations of this review such as the small number of studies included and the few reports on esthetic indices. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the esthetic outcomes based on the color differences in zirconia (Zr) of varying thickness, resin cement color, and types of titanium (Ti) implant surface treatments. Materials and Methods: Overall, 28 high-translucency monolithic zirconia (HTMZ) specimens were arranged into four groups based on Zr thickness: 1.0, 1.5, 2.0, and 2.5 mm (n = 7 per thickness). Each group was tested using two resin cement colors (clear and opaque) in combination with six surface-treated Ti groups (n = 7), including untreated titanium (UT), anodization (AN), 50-µm alumina airborne-particle abrasion followed by AN (SBAN), AN followed by 50-µm alumina airborne-particle abrasion (ANSB), 9.5% hydrofluoric acid followed by AN (HFAN), and AN followed by 9.5% hydrofluoric acid (ANHF). This created a total of 48 experimental groups, including the use of composite resin (n = 7, shade A2D) for four control groups. All specimens were measured using a spectrophotometer and subsequently compared with composite resin (control) with the corresponding Zr thickness to establish color differences. A color difference of < 2.7 was considered clinically acceptable. The data obtained were statistically analyzed using ANOVA and post hoc test (P = .05). Results: Zr thickness, resin cement color, and type of Ti implant surface treatment significantly affected the observed color differences (P < .05). When using 2.5-mm HTMZ with clear resin cement on AN, UT, SBAN, HFAN, and ANSB, the mean color differences were below the clinically acceptable values, and the 95% CIs of color differences were below the clinically acceptable values for AN, UT, and SBAN groups. Conclusions: HTMZ with a minimum thickness of 2.5 mm and clear resin cement on AN, UT, and SBAN groups potentially result in acceptable color matching with 95% CIs. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effect of taper, length, angle, and number of vertical axial walls on the retentive strength of a cemented crown on a partially customized hybrid abutment in the esthetic zone. Materials and Methods: A total of 35 metal copings were used and divided into two groups. One group had 30 copings cemented to their corresponding 8-degree tapered abutment with lengths from 3 to 8 mm, increasing in 1-mm increments (5 copings per length). The other group had the remaining 5 copings and consisted of a standardized metal coping that matched a hexagonal abutment with 3-mm vertical axial walls and the sequential removal of 1, 2, and 3 contiguous vertical axial walls. Dislodgment tests were performed for all copings in both groups. Maximum retentive forces were measured in retentive strength (kgF), with a conversion factor of 9.807 N = 1 kgF. Results: At each tapered abutment length, the retentive strength increased proportionally and was significantly different, ranging from 31.67 ± 4.10 kgF to 67.68 ± 11.22 kgF (F [5,24] = 20.46, P < .001). An unmodified hexagonal abutment demonstrated the highest retentive strength (70.15 ± 12.97 kgF). The sequential removal of 1, 2, and 3 contiguous vertical axial walls of the hexagonal abutment resulted in retentive strength values of 59.89 ± 10.06 kgF, 57.01 ± 9.62 kgF, and 55.99 ± 9.35 kgF, respectively, with no significant difference (P > .05) in strength. Conclusions: A partially customized abutment with vertical axial walls on one side and a profile reduction on the opposite side can provide comparable retention to cemented copings at one-third the length and at one-sixth the surface area of an 8-mm abutment with an 8-degree taper. [ABSTRACT FROM AUTHOR]

Dental implants are commonly used to replace missing single teeth. However, esthetic rehabilitation of an adjacent tooth may also be required due to diastemas, crowding, or existing large direct restorations to improve the final esthetic outcome. With the advancements in ceramics and bonding techniques, minimally invasive esthetic approaches have become viable for compromised spacing issues. This case report describes a dental technique for the esthetic rehabilitation of compromised anterior spacing with a customized zirconia implant abutment at a maxillary central incisor site and a partial ceramic veneer bonded to the adjacent central incisor. [ABSTRACT FROM AUTHOR]

The aim of this report is to describe a new sling suturing method with papillary anchorage that is clinically applicable within the available conventional root-coverage tunneling procedures. Although caution is advised to not increase excessive tension on the fragile papilla tips, as they provide coronal and palatal suspension, the tension used with this method ascertains a firm and stable connection for the entire buccogingival graft complex into the horizontal and vertical dimensions of both single and multiple recession defects. This technical note describes the "trapezoidal sling suture" technique, which allows fixation and stabilization for the graft and flap around both natural teeth and implants. [ABSTRACT FROM AUTHOR]

Purpose: To perform a bibliometric study in the literature about the increasing number of global studies on dental esthetics in recent years. Materials and Methods: Articles on dental esthetics published between 1980 and 2021 were pulled from the Web of Science (WoS) database. In this comprehensive bibliometric study on dental esthetics, a summary of 2,858 articles published in the last 41 years was shared. Network visualization maps were used to identify citation analyses and trending topics. Spearman correlation coefficient was used for correlation studies. The exponential smoothing estimator was used to estimate the number of articles to be published in the coming years. Results: Of the 3,666 publications, 2,858 (77.9%) were articles. The top three contributing countries to the literature were the USA (816, 28.5%), Brazil (286, 10%), and Italy (246, 8.6%). The most active institution was the University of Bern (n = 55). The journal with the highest number of articles was Journal of Prosthetic Dentistry (n = 178). According to the average number of citations per article, the most influential journal was Journal of Periodontology (citations: 55.6). Conclusions: Keywords of the trending topics related to dental esthetics are perception, bleaching, cleft lip, connective tissue graft, smile esthetics, adolescent, esthetic region, soft tissue augmentation, and clinical studies. In regard to the global output in dental esthetics, this article is a useful resource for clinicians, scientists, and dental students. [ABSTRACT FROM AUTHOR]

Purpose: To examine if there are differences in smile esthetic evaluation scores by orthodontists and prosthodontists and if there are changes in those scores when two evaluations are performed, when the time of observation is increased, and when the lips are present or absent from the images. Materials and Methods: In total, 12 individuals participated in this pilot study. Two digital images were taken from each individual. The first digital image was a smile view, and the second image was an intraoral view. Two presentation files were prepared, with two images for each individual. The smile and dental attractiveness ratings were obtained from 10 specialists. Results: Repeated measures ANOVA was applied including all four within-subject factors, the evaluator (E), the repetition (R), the time of observation (T), and the presence or not of lips (L). Factors E, T, and L each had a statistically significant main effect. E and R had a statistically significant combined effect. In particular, the esthetic score for the view with smile was overall higher than for the intraoral view. The same results were obtained when the analysis was repeated with the 10 evaluators grouped to prosthodontists and orthodontists, and the prosthodontists tended to score higher than the orthodontists. Conclusions: The evaluator and the presence of lips have a statistically significant effect. The present pilot study has found that three (E, L, R) out of four factors (T) are important for the evaluation of dental esthetics. [ABSTRACT FROM AUTHOR]

Purpose: This prospective study evaluated the marginal bone level and periodontal parameters 6 years after placement of a convergent transmucosal neck implant. Materials and Methods: In total, 71 implants were placed in 60 patients. Of these, 52 implants were placed with a flapless technique and with the convergent neck exposed by 1 mm (early and delayed placement), while 19 implants were placed immediately after extraction (immediate placement). At least 3 months after insertion, customized abutments were applied and provisional resin crowns were cemented, while being careful to prevent any tissue compression. After 3 weeks, definitive metal-ceramic crowns were designed with the finish line at the soft tissue level and free from any compression. The implant survival rate at 6 years, marginal bone level changes (ΔMBL, mm), and Pink Esthetic Score (PES) were evaluated. Gingival phenotype was determined before the implant surgeries (thin/thick). A three-level hierarchical model was examined with a random intercept and random slope on follow-up time at the patient level and a random intercept at the implant level. Results: In all, 57 patients with 67 implants reached the 6-year point; 3 patients (5.0%) dropped out. The implant survival rate was 100%. ΔMBL from baseline to 24 months was 0.58 mm (95% CI: 0.48, 0.68), while ΔMBL from 24 to 72 months was 0.33 mm (95% CI: 0.19, 0.47). PES improved steadily from 6 to 48 months (+0.96; 95% CI: 0.71, 1.20), with overall stability at 72 months. No correlation between MBL and PES was observed. A significant association was found between thick gingival phenotype and less MBL variation. Greater implant diameter offered more MBL stability after 3 years but resulted in lower PES values. Conclusions: The use of convergent transmucosal neck implants placed with a flapless transmucosal approach with the crown margin positioned at the gingival level preserved marginal bone and guided gingival morphology for up to 72 months. The gingival phenotype was the parameter that most affected the soft and hard tissues. In the long term, implant placement timing was not related to MBL. [ABSTRACT FROM AUTHOR]

Purpose: To validate an innovative 3D volumetric method of evaluating tissue changes proposed by Lee et al in 2020 by comparing the results of this method--in which the scanned peri-implant surfaces were transformed, visualized, and analyzed as 3D objects--to the results reported by an existing method based on calculation of the mean distance between measured surfaces. The null hypothesis was that there was no statistically significant difference between the two methods. Additionally, the present study evaluated peri-implant tissue changes 5 years after single implant placement in the esthetic zone. Materials and Methods: Both methods were applied to 11 oral implant site casts (6 maxillary central incisor sites, 5 maxillary lateral incisor sites) taken from 11 patients at crown placement and at follow-up examinations 5 years later. The methods are based on digital workflows in which the reference and 5-year casts are scanned and the resulting STL files are superimposed and analyzed for three regions of interest (mesial papilla, central area, and distal papilla). The volumetric changes reported by the Lee et al method and the mean distance method were calculated and compared using the Spearman rank correlation coefficient (P < .01) and the Wilcoxon signed-rank test (P < .05). Results: The correlation between the two sets of measurements was very high (Spearman rank correlation coefficient = 0.885). The new volumetric method indicated a mean volume loss of 2.82 mm3 (SD: 5.06), while the method based on the measurement of mean distance showed a mean volume loss of 2.92 mm3 (SD: 4.43; Wilcoxon signed-rank test result: P = .77). No statistically significant difference was found. The two methods gave equivalent results, and the null hypothesis was accepted. Conclusions: The new volumetric method was validated and can be considered a trustworthy tool. [ABSTRACT FROM AUTHOR]

Autotransplantation has been proven as a viable method of reconstructing missing teeth. While preparing the recipient site, the bone reduction location depends largely on the surgeon's experience. Inappropriate overpreparation can cause biologic and esthetic complications, such as buccal or lingual bone resorption. This paper provides an innovative method to aid clinicians in precisely preparing a recipient site with the assistance of medical image-processing software and a real-time navigation system. This case report presents the autotransplantation of a mandibular molar using this technique with good short-term (6 months) clinical outcomes, including radiographic bone fill, normal probing pocket depth, physiologic tooth mobility, acceptable gingival level, and satisfactory restoration. [ABSTRACT FROM AUTHOR]

The socket shield technique has been proposed as a surgical method to prevent the collapse of the buccal plate following tooth extraction, leading to excellent soft tissue stability and long-term esthetic outcomes. Despite its success, this technique is still not without potential risks. One of the most common complications is internal exposure of the socket shield, which can present as inner soft tissue inflammation with or without exposure of a portion of the shield. This case series discusses this complication's etiology, diagnosis, treatment, management, and prevention. Data from 10 patients with 12 internally exposed sites are presented. [ABSTRACT FROM AUTHOR]

Traditional GBR procedures have been associated with frequent complications and compromised peri-implant esthetics. Tunneling techniques have been proposed as a promising alternative in this regard. More recently, a subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART) was reported to have been clinically successful in a prospective case series. This technique includes the use of a bone graft/recombinant human platelet-derived growth factor-BB combination delivered to the site by a tunneling method. However, published histologic information regarding the nature of the regenerated tissue has been limited. The current study evaluated the histologic and histomorphometric findings of four human specimens harvested at 2, 5, 9, and 14 months after ridge augmentation using the SMART method. Evaluations of the wound healing and bone regeneration sequence over time found that the ridge augmentation was the result of extensive new bone formation that progressed through the woven bone to lamellar bone stages, with remodeling of the xenogeneic graft material and replacement by patient bone. This is the first study utilizing sequential human specimens to histologically examine the chronology of wound healing following alveolar ridge augmentation. [ABSTRACT FROM AUTHOR]

Ultrathin ceramic veneers are a viable therapeutic option to manage esthetic challenges in the anterior zone. Proper conditioning of the intaglio surface of porcelain veneers is essential to achieve an adequate bonding. In clinical practice, this is typically done with chemical etching using an acid-containing agent, such as hydrofluoric acid. While it is well established that the etching effect is dependent on etching time and the acid concentration, little is known about the impact of etching time and the veneer fabrication method. The purpose of this pilot study was to evaluate, using scanning electron microscopy (SEM), the effect that different etching-time protocols have on the intaglio surface characteristics of ultrathin ceramic veneers fabricated with either the platinum foil technique or the refractory die technique. Several replicas of an ultrathin feldspathic ceramic veneer for a maxillary central incisor were fabricated. Individual specimens were processed according to different intaglio surface-etching protocols: no etching, etching for 90 seconds, etching for 120 seconds, and etching for 150 seconds (9.6% hydrofluoric acid used for all etching groups). It was observed that the 120-second etching protocol resulted in a favorable microroughness surface pattern in the platinum foil group. This pattern was comparable to that obtained by etching for 90 seconds with hydrofluoric acid the intaglio surface of veneers fabricated with the refractory die technique. Increasing the etching time to 150 seconds did not result in a more favorable roughness pattern. [ABSTRACT FROM AUTHOR]

Successful rehabilitation of severely atrophic, short-span edentulous ridges in esthetic regions can seldom be done without some form of vertical ridge augmentation (VRA). The best available evidence shows that guided bone regeneration procedures may present a very predictable option with reduced potential for complications compared to alternative options. The present case series presents a novel technique to achieve predictable VRA with a low complication rate using tenting screws and cross-linked resorbable membranes. A total of 10 patients (5 men, 5 women) with severe vertical defects in the esthetic zone participated in this study. Following a mean healing time of 9.3 months, the mean defect resolution was 80%, with a mean vertical bone gain of 6.2 ± 1.61 mm. Only one case presented with reduced defect resolution (50%); however, the bone gain for this case was 6 mm. [ABSTRACT FROM AUTHOR]

The authors talk about the transformation of the dental profession from a practical, hands-on profession to one that is more academically or educationally focused. They discuss a report on the prevalence of dental caries among children, the lack of investment of dentistry in human capital in the age of digitization and artificial intelligence (AI), and the efforts of the global dental community in the 20th century to improve the lives of patients.

Esthetics is important for any dental implant but crucial for implants in the anterior region. Restorations in this region are demanding, and the goal of re-establishing an attractive smile without revealing differences from the natural teeth is difficult to achieve. The aim of this study was to examine the clinical success of the socket-shield technique regarding soft tissue stability and overall esthetic outcome. Pink esthetic scores (PESs) were collected at two time points (T1: 6 months; T2: 6 years) by three different specialists. This prospective cohort clinical study involved 30 patients (7 women and 23 men) with a mean age of 42.3 years. There were no significant differences in PES values assessed by the oral surgeon and prosthodontist (P > .05) at either of the assigned time points. The periodontist found differences in PES values between T1 and T2 (P < .05), but they were modest in value. Analyses of each individual variable at given time intervals revealed significant differences in the shape of the distal papillae (χ² = 6.182; P < .05) and soft tissue margin level (χ² = 6.507; P < .05). The final results suggest that the socket-shield technique is promising for implant placement in the esthetic zone. [ABSTRACT FROM AUTHOR]

This randomized controlled trial aimed to determine the clinical efficacy of xenogeneic collagen membrane (XCM) derived from porcine peritoneum in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue grafts (CTGs). A total of 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo RT 1/2 gingival recession defects in maxillary canines and premolars were randomly treated either with CAF + XCM or CAF + CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG), and width of attached gingiva (WAG) were recorded at baseline and at 3, 6, and 12 months. Patient perceptions of pain and esthetics and the modified root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF + CTG: 2.73 ± 0.79 mm to 0.33 ± 0.61 mm; CAF + XCM: 2.73 ± 0.88 mm to 1.20 ± 0.77 mm). At 12 months, CAF + CTG sites had a mean root coverage percentage (MRC%) of 85.60% ± 28.74%, whereas CAF + XCM sites had an MRC% of 55.13% ± 31.22%. CAF + CTG-treated sites had significantly better outcomes, with a greater number of sites achieving complete root coverage (n = 11) and higher MRES scores than the porcine peritoneal membrane group (P < .05). [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effects of experience level on the clinical and esthetic results of coronally advanced flap (CAF) surgery. A postgraduate student's first 40 CAF operations in the periodontology residency program were followed. The Miller Class I gingival recessions were divided into four chronologic groups (n = 10 in each). Clinical and esthetic evaluations were performed at baseline and after 6 months. The results of chronologic intervals were statistically compared. While the overall mean root coverage (RC) percentage was 73.6% and the complete RC was 60%, the mean RC percentages of the groups, respectively, were 45%, 55%, 86%, and 95%, showing that the mean and complete RC percentage increased as the experience level increased (P < .05). Similarly, as the experience level increased, closure of the gingival recession depth and width and esthetic scores increased, while the surgical time decreased significantly (P < .05). Complications were observed in three patients during the first interval and in two patients during the second interval, while no complications were observed in the other groups. This study showed that experience level can significantly affect the clinical and esthetic outcomes, operative time, and complication rates of CAF surgery. All education programs should determine how many of each surgical procedure residents must perform before they are considered experienced or expert surgeons who can work independently and predictably achie vesafe, acceptable outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to quantify the buccal bone thickness, area, and perimeter following guided bone regeneration (GBR) using stabilizing periosteal sutures. The loss in hard tissue volume may impair proper implant placement. GBR has been used to regenerate the lost alveolar ridge prior to or at the same time as dental implant placement. The most important factor for GBR success is graft stability. The periosteal mattress suture (PMS) stabilizing technique is an alternative to pins and screws to stabilize bone grafting material and has the advantage of not requiring the removal of the fixing devices. CBCT scan was acquired before and 6 months after surgery from six patients who underwent GBR with the PMS stabilizing technique. Images were analyzed for buccal bone thickness, area, and perimeter. The mean change in buccal bone thickness was 3.42 ± 1.31 mm and proved statistically significant (P = .005). The mean change in bone crest area also proved statistically significant (P = .001). No significant difference was found in bone perimeter (P = .12). The PMS technique delivered optimal results without clinical complications. This study shows the potential of this technique as an alternative to pins or screws for graft stabilization in the esthetic zone. [ABSTRACT FROM AUTHOR]

Successful rehabilitation of the anterior maxilla remains a challenge, primarily due to postextraction ridge collapse, which can lead to gingival recession and a nonesthetic appearance. The socket shield technique presents a viable alternative for immediate dental implant placement in the esthetic zone. This pilot study aimed to evaluate the survival, complication rates, and marginal bone loss around body-shift implants placed in fresh extraction sockets with the socket shield technique to replace maxillary incisors. After socket shield preparation, 14 hopeless incisors were extracted and immediately replaced by a body-shift implant (Inverta, Southern Implants) at baseline. Patients were followed up for 12 to 39 months (mean: 18.1 ± 8.2 months). The average age was 52.3 ± 16.9 years, and the survival rate was 100%. One socket shield presented minimal internal exposure that was successfully treated with a connective tissue graft. The mean PES score was 12.9 ± 1.2. Mean interproximal marginal bone loss was -0.4 ± 0.5 mm. Body-shift implants can be a promising alternative for immediate tooth replacement combined with the socket shield technique. The superior esthetic outcomes remained stable, suggesting that the extra space created by the narrow cervical portion of the implant is beneficial for preserving the alveolar bone and limiting internal shield exposure. [ABSTRACT FROM AUTHOR]

Tooth loss or extraction is associated with significant reduction in alveolar ridge volume, extensively expressed in the anterior zone, and immediate implant placement is insufficient to overcome this problem. The proposed approach combined immediate implant placement with buccal tissue enhancement by applying a crosslinked collagen matrix hydrated with crosslinked hyaluronic acid (xHyA). All 10 cases presented with a retained but narrow buccal socket wall, so immediate implant placement with the "tunneled sandwich" technique was performed after tooth extraction. The tunneled sandwich technique helped create a subperiosteal pouch for insertion of the collagen matrix buccal to the alveolar bone crest. The implants healed transmucosally by receiving either a gingiva former or an immediate temporary restoration. Ten sites in 10 patients demonstrated stable, noninflamed peri-implant conditions and suitable ridge volume at the implant neck and achieved high pink esthetic scores 6 months after implant loading. The tunneled sandwich technique is a suitable method to preserve buccal volume, which biologically and esthetically contributes to favorable long-term results. [ABSTRACT FROM AUTHOR]

Dental implants are currently the preferred choice to restore function and esthetics. Nonetheless, explantation is sometimes inevitable in cases with advanced bone loss, implant fracture, or improper implant position. This study aimed to propose an algorithm for reimplantation at sites of previous failure. There is limited evidence on the replacement of failed implants, most of which are case reports or clinical trials with a small number of patients. To the best of the authors' knowledge, this is the first study proposing a clinical-decision algorithm to help clinicians manage implant failures with new implants. There are a variety of reasons contributing to implant failure: The etiologic factor of failure and the morphology of the residual defect have paramount importance on implant removal techniques and subsequent treatment modalities. There is no consensus on a distinct protocol to replace failed implants. However, the clinicians and patients should know that placing a new implant in an area with a history of failure, regardless of early or late implant failure, may have a lower survival rate. [ABSTRACT FROM AUTHOR]

The article discusses socket shield technique (SST), a surgical approach to minimize postextraction osseous and gingival changes. Topics include same clinical outcome in practice between the SST and the root membrane technique, one key requirement for the application of SST, complications reported with the technique, and gradual modifications made on SST as a novel technique.

Although connective tissue grafts (CTGs) have been found to increase gingival thickness and reduce facial gingival recession in immediate implant placement and provisionalization (IIPP), they are associated with significant loss of buccal bone thickness. This loss is thought to be related to the preparation of the facial CTG recipient site. This technical report presents a modified dual-zone therapeutic concept in which the bone zone is grafted with bone graft and the tissue zone is grafted with tuberosity CTG without elevation of a facial partial- or full-thickness envelope. [ABSTRACT FROM AUTHOR]

Immediate full-arch loading is a highly complex and techniquesensitive procedure. Digital impression techniques aim to replace conventional analog systems to carry out dental treatments in a more predictive, safer, and less time-consuming way. This case report describes a patient with a guarded periodontal prognosis, who was rehabilitated with implant-supported fixed prostheses after full-mouth extractions. Immediate full-arch loading was performed by means of two digital impression systems: photogrammetric technology with PIC dental in the maxillary arch, and MedicalFit in the mandible. Immediate provisional prostheses in acrylic resin (polymethyl methacrylate) were milled and placed within 12 hours after implant placement surgeries. Both provisional structures fitted properly providing adequate esthetics and function. After the implant osseointegration period, final digital impressions were registered, and definitive zirconia full-arch implant-supported prostheses were delivered. The 24-month follow-up did not show biologic or mechanical complications. [ABSTRACT FROM AUTHOR]

The design and manufacture of a stackable surgical guide for implant placement with immediate prosthetic loading of completely edentulous cases is described in this dental technique. To achieve this, the stackable attachment is designed using free-form designing software, which is later joined to the implant placement guide and the dental prosthesis. This technique should provide the patient with a same-day implant and an esthetic restoration accurately placed in the predesigned position of the centric occluding relationship. It also reduces the number of visits and prosthetic complications related to the improper implant position. [ABSTRACT FROM AUTHOR]

Objectives: Addressing a single-tooth gap in the anterior region, resulting from aplasia or trauma, poses both esthetic and functional challenges. This case report presents the restoration ofa young adult with a cleft, exhibiting anterior hypoplasia and aplasia in the canine and incisor regions, using all-ceramic cantilever resin-bonded fixed dental prostheses. Method and materials: After verification of esthetic and functional considerations through a diagnostic wax-up and an intraoral mock-up, three anterior all-ceramic cantilever resin-bonded fixed dental prostheses made of veneered zirconium dioxide were planned in the region ofthe maxillary right lateral incisor and maxillary left canine. The impression was made with an intraoral scanner. The framework fit was evaluated. Glaze bring and full adhesive cementation under rubber dam followed. Results: The final restoration met the patients' expectations and restored facial esthetics and function. Conclusions: All-ceramic cantilever resin-bonded fixed dental prostheses offer a promising minimally invasive therapeutic option for cleft patients. [ABSTRACT FROM AUTHOR]

Purpose: To examine the remodeling process of both the soft and hard tissue components of the postextraction socket around immediately loaded dental implants after tooth extraction in maxillary esthetic areas. Materials and Methods: Subjects underwent immediate placement of single implants in postextraction sockets without bone grafting, and their immediate provisionalization with custom tooth-like interim crowns were fabricated using digital diagnostic impressions and a dental milling machine. Intraoperative and 1-year follow-up layered scans of the postextraction sockets after implantation were acquired using a 3D optical system. In the short term, subjects underwent computed tomographic scans. Digital impressions for gingival contours, originally stored as STL (standard tessellation language) files, were converted to DICOM (Digital Imaging and Communications in Medicine) files with the implant shoulder working as a referral point, which were then superimposed to 3D radiologic images. The observed volumetric and linear outcomes were measured using a program known as DentaScan. The width of the alveolar crest at the level of the implant shoulder and marginal bone levels were acquired. Nonparametric tests were applied with a level of significance set at P < .01. Results: No failure was reported after a follow-up of 1 year. Little or no inflammation of the treated areas was registered, and there were practically no signs of suppuration. The areas showed a significant reduction in the overall volumes for both soft and bone tissue, with a P value < .0001 from the baseline (0.983 ± 0.172 cm3) to the 1-year survey (0.865 ± 0.156 cm3). If the soft and bone tissue changes were separately evaluated, a significant loss (with a P value < .0001) was registered for only the bone tissues (from 0.434 ± 0.075 to 0.355 ± 0.061 cm3). Moreover, changes in gingival tissue from baseline to the 1-year survey (-0.040 ± 0.067) appeared to be significantly different from the overall volume loss (-0.118 ± 0.083 cm3). A shrinkage in width (-0.5 ± 0.7 mm) was found from baseline (12.6 ± 0.6 mm) to the 1-year followup (12.1 ± 0.9 mm). Marginal bone levels were 0.97 ± 0.70 mm and 0.39 ± 0.78 mm, respectively, at the mesial and distal aspects of the implants. Conclusions: The present analysis suggested that immediately customized provisionalization was effective enough to prevent both volume loss and linear shrinkage at the layers of the treated areas. Moreover, the buccal aspects seemed to be the areas most affected by the loss of volume. The mean loss in width, which amounted to roughly 0.5 mm, appeared to be negligible when compared to the overall width measured before surgery. [ABSTRACT FROM AUTHOR]

The purpose of this case series was to assess the application of a novel selfcutting, tapered implant (Straumann BLX) in combination with a digital integrated prosthetic workflow for immediate placement and restoration. Fourteen consecutive patients who required replacement of a single hopeless maxillary or mandibular tooth in the esthetic area and met the clinical and radiographic criteria for immediate implant placement were treated. All cases followed the same treatment procedure of extraction and immediate implant placement. Immediate temporization with full contoured screw-retained provisional restorations was performed using an integrated digital workflow. After implant placement and dual-zone bone and soft tissue augmentation, connecting geometries and emergence profiles were finalized. The average implant insertion torque was 53.2 ± 14.9 Ncm (range: 35 to 80 Ncm), allowing immediate provisional restoration in all cases. Final restorations were delivered 3 months after implant placement. An implant survival rate of 100% was observed at the 1-year postloading follow-up. The results of this case series suggest that immediate placement of novel tapered implants and immediate provisionalization using an integrated digital workflow can result in predictable and functional and esthetic results for the immediate transition of failing single teeth in the esthetic area. [ABSTRACT FROM AUTHOR]

The alveolar bone crest level is essential in determining the need for bone removal in subjects with altered passive eruption (APE). This study assessed the validity of CBCT and transgingival probing in determining the alveolar bone crest level. Patients presenting with APE were assessed. Transgingival probing was performed to clinically assess the distance between the cementoenamel junction (CEJ) and the bone crest at the midpoint of the maxillary anterior teeth. CBCT was used to assess this distance at the same point. Upon reflection of a full mucoperiosteal flap, the actual distance was measured. Similar actual and CBCT measurements of the distance between the CEJ and bone crest at teeth 13, 22, and 23 (FDI numbering system) were recorded (P > .05). However, in teeth 11, 12, and 21, the distance was significantly greater on CBCT scans (P < .05). No significant difference was detected between transgingival probing and the actual distance at all teeth assessed. Careful transgingival probing provides an accurate measure of the distance between the CEJ and bone crest. CBCT gives an accurate estimate, though it may not be justified for each patient in the presence of safer methods. [ABSTRACT FROM AUTHOR]

Peri-implant soft tissue deformities are an increasingly common phenomenon in the esthetic zone. While the most widely studied esthetic complications are peri-implant soft tissue dehiscences, there are other esthetic concerns in routine clinical practice that require investigation and treatment. Thus, this report on two clinical cases describes a surgical approach using the apical access technique to treat peri-implant soft tissue discoloration and fenestration. In both clinical scenarios, the defect was accessed via a single horizontal apical incision without removing the cement-retained crowns. A bilaminar technique using apical access with a simultaneous connective tissue graft seems to offer promising results for the treatment of peri-implant soft tissue deformities. At the 12-month reevaluation, an increase in peri-implant soft tissue thickness was observed, resolving the pathologies presented. [ABSTRACT FROM AUTHOR]

The purpose of this clinical study was to assess the feasibility of forced orthodontic extrusion with the Tissue Master Concept to retain subgingivally fractured teeth as abutments for which extraction and replacement would be equal treatment opportunities. Participants were recruited from a group of consecutive patients in need of prosthodontic rehabilitation. In total, 36 deeply destroyed teeth in 31 patients underwent forced orthodontic extrusion with forces exceeding 50 g to reestablish biologic width and ensure a 2-mm dentin-ferrule design prior to single-crown restoration. The primary endpoint was the success of the extrusion in terms of the ability to restore the respective abutment tooth. Information about overall treatment time, frequency, and reasons for failure were collected. Four patients dropped out of the treatment. For the remaining 27 participants, data were fully collected. The amount of extrusion ranged between 2 and 6 mm (3.5 ± 0.9 mm), and the mean duration until retention was 20 ± 12 days. On average, patients returned three (± 3) times for control visits after extrusion. Adhesive failure (n = 6) and orthodontic relapse (n = 2) were the most frequent complication types. Forced orthodontic extrusion may be a useful tool to restore teeth evaluated as nonrestorable. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Materials and Methods Results Conclusions Clinical Significance Thai Clinical Trial Registry The aim of the study was to compare medium to long‐term clinical and patient‐reported outcomes between implants placed with computer‐assisted implant surgery (CAIS) and freehand protocols.Thirty dental implants in the anterior maxillary region with an average of 4 years after loading were assessed by means of Pink Esthetic Scores (PESs), marginal bone level (MBL), and clinical and patient‐reported outcomes.CAIS significantly outperformed freehand placement with regard to PES scores (p = 0.011). Likewise, implants placed with CAIS showed significantly higher MBLs (p < 0.001). Bleeding on probing, probing depth, and prevalence of mucositis did not differ between the groups, while no peri‐implantitis was diagnosed.The use of CAIS leads to superior outcomes in terms of esthetics and MBLs for implants placed in the esthetic zone as observed in medium to long‐term follow‐up. No difference was however observed with regard to peri‐implant mucosa inflammation.This article highlights the outcome of computer‐assisted implant surgery in achieving higher esthetic, MBL, and esthetic satisfaction compared to freehand implant placement.TCTR20240422015. [ABSTRACT FROM AUTHOR]

Background: Pulp canal occlusion (PCO) increases the difficulty of root canal treatment as well as tooth preservation and restoration. This is the first case report of successful localization of a calcified root canal under the guidance of a dynamic navigation system (DNS) for complete root canal retreatment and aesthetic restoration after a failed attempt to locate the calcified root canal with a traditional dental operating microscope (DOM). Case presentation: The patient was scheduled for root canal treatment for a labially inclined maxillary central incisor and post-core crown restoration with resin veneers in another hospital, but the calcified root canal could not be located with a microscope, so the patient was referred to our department. Root canal retreatment was planned for tooth #8, and the calcified root canal of tooth #9 was planned to be located and dredged under the guidance of a DNS. We used a DNS for successful positioning and to complete the root canal retreatment operation in the following 4 steps: preoperative CBCT imaging, preoperative plan design, calibration and registration, and real-time dynamic navigation. Three months later, teeth #8 and #9 presented no clinical symptoms, after which the fiber post-cores and zirconia all-ceramic crown restorations were completed. At the 12-month follow-up visit, the patient continued to be symptom-free, and satisfied with the final aesthetic restoration. Conclusions: This case report suggests that DNS may be a promising technique with high accuracy and effectiveness to reduce the risk of iatrogenic errors and provide maximal preservation of dentin, when the traditional treatment of calcified root canals approaches failure (lateral perforation). [ABSTRACT FROM AUTHOR]

Introduction: The esthetics of immediate implant dentistry can be challenging. Clinical considerations for immediate implant placement have demonstrated long‐term success rates comparable to traditional delayed implant protocols. However, it is a sensitive technique that requires proper treatment planning as well as meticulous execution to be predictable and successful in the long term. Methods: This clinical situation demands extensive knowledge of soft and hard tissue management for atraumatic tooth extraction followed by implant therapy, along with an understanding of the available materials to meet esthetic needs. This case report features a female patient with the chief complaint of needing to replace an anterior crown due to loss of retention. After a comprehensive oral assessment and cone beam computed tomography (CBCT) radiographic examination, it was determined that the crown on Tooth #9 was fractured at the subgingival level. Furthermore, gingival zenith positions displayed differences at the keratinized mucosa level in Teeth #7, #8, and #9, and the metal marginal areas of the porcelain‐fused‐to‐metal (PFM) crowns in the anterior area of Teeth #5, #7, #8, #9, and #10 were apparent. The procedure involved atraumatic extraction of Tooth #9, followed by immediate implant placement. Crowns on Teeth #5, #7, #8, and #10 were replaced, and veneers on Teeth #6 and #11 were fabricated using press lithium disilicate‐reinforced ceramic. Connective tissue graft (CTG) was contoured before final implant restorations. Results: The final implant crown was restored using a prefabricated abutment with a titanium base and lithium disilicate ceramic dental material. A well‐planned combined treatment, including atraumatic tooth extractions for immediate implants and ideal contouring of soft tissues, can significantly impact the outcome of esthetic restorations. Conclusions: Single immediate implant–supported crowns in the esthetic zone were able to fulfill the patient's esthetic expectations. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Materials and Methods Results Conclusions Clinical Significance This study aimed to evaluate, through a case report combined with in vitro study, whether a new diagnostic white tip for the transillumination technique during resin infiltration influences the procedure and degree of conversion (DC).A clinical case report demonstrated resin infiltration using the transillumination technique with a new white diagnostic tip (Radii Xpert LED diagnostic tip, SDI, Bayswater, VIC, AU) along with a light‐curing device to enhance aesthetic results. An in vitro study assessed the DC of two diagnostic white tips (Radii Xpert LED diagnostic tip [SDI, Bayswater, VIC, AU] and Valo Grand White Light Lens [Ultradent Prod., South Jordan, UT, USA]) compared to that achieved using conventional tips of both light‐curing devices. Statistical analysis was performed using two‐way ANOVA and Tukey's test (α = 0.05).The clinical case achieved complete masking of the white spot lesion. In vitro, the diagnostic white tips exhibited significantly lower DC values compared to conventional tips (p = 0.001), regardless of the light‐curing unit.The diagnostic white tip used in the transillumination technique improves resin infiltration visibility without compromising the degree of conversion.The transillumination technique with the diagnostic white tip enables monitoring of resin infiltration while maintaining effective polymerization. [ABSTRACT FROM AUTHOR]

Objective: This study aims to present the bio‐restorative approach in implant dentistry, which combines biological and restorative concepts through digital planning. This concept combines periodontal, surgical, and prosthetic variables, aiming to reduce patient morbidity while achieving satisfactory esthetic and functional outcomes in implant‐supported restorations in the long term. Overview: Implant dentistry evolved from a primarily surgical to a recent prosthetically driven approach. This evolution was partly due to advancements in bone reconstructive techniques and an increased demand for esthetic outcomes. Recently, digital planning has introduced a new paradigm that allows for the full integration of both approaches. The bio‐restorative concept considers functional, esthetic, and biological variables in a virtual planning environment. This is achieved through the simultaneous digital assessment of (A) anatomical site characteristics and (B) implant restorative variables. These variables include digital tooth arrangement, soft–hard tissue conditions, implant variables, supra‐platform components, and a surgical plan that respects or modifies peri‐implant phenotype. Conclusions: The bio‐restorative concept is intended to improve contemporary implant dentistry by integrating updated biological and prosthetic notions through digital planning. Adopting this paradigm has the potential to redefine the standards in implant dentistry, fostering a holistic and patient‐centered approach. Clinical Considerations: It enhances patient and clinician satisfaction through more efficient and less invasive procedures. Significantly, it improves predictability, leading to successful implant‐supported restorations in the long term. [ABSTRACT FROM AUTHOR]

Background/Objective: A contemporary concept states that dental midline deviation towards the direction of facial flow line (FFL) can mask the compromised smile esthetics. This study aimed to identify a range of midline deviations that can be perceived towards or away from the FFL influencing smile esthetics. Materials and Methods: A cross‐sectional study was conducted using a frontal smile photograph of an adult female. The photograph was altered on Adobe Photoshop software into six different photographs by deviating the dental midlines towards and away from the FFL. A constant deviation of chin towards the left side was incorporated in all the photographs. Forty‐three laypersons (LP) and dental professionals (DPs) evaluated those photographs. Independent t‐test was used to compare the perception of dental midline deviation between LP and DPs. Simple linear regression was run to identify the factors associated with the scoring. Results: A statistically significant difference was observed for picture two with 4 mm towards FFL in the perception of midline deviation between LP and DPs. LP could not perceive the midline deviations up to 4 mm while DPs were able to perceive deviations above 2 mm. The greater the age the better the scores were and female raters had a greater inclination towards poor scores. Conclusions: From 2 to 4 mm of midline deviation towards the FFL can be tolerated by LP and DPs. Clinical Significance: These findings underscore the importance of considering facial symmetry in orthodontic and cosmetic dental treatments to optimize smile esthetics. [ABSTRACT FROM AUTHOR]

Objective: To assess the 2D and 3D natural symmetry of the maxillary incisors. Materials and methods: Maxillary alginate impressions were taken of 59 young adult volunteers. Gender, orthodontic treatment history, and dominant hand were collected. For 2D analysis, a digital caliper was used for measurements on maxillary casts. For 3D analysis, the casts were scanned using a lab scanner, and the labial surface symmetry of contralateral incisors was evaluated. Mann–Whitney tests and Student's t‐test were performed, α = 0.05. Results: Results indicated a lack of identical lengths among contralateral central or lateral incisors, with minimal occurrences of identical width measurements. 68% of central incisors and 73% of lateral incisors showed differences in length exceeding 0.2 mm. Central incisors showed more similarities than lateral incisors in width, with 61% central incisors and 47% lateral incisors having differences under 0.2 mm. The differences between highly asymmetrical contralateral teeth are situated at the transitional lines. The influence of sexual dimorphism, orthodontic factors, and the dominant hand on incisors' symmetry was not statistically significant. Conclusions: 2D and 3D symmetry of the natural maxillary incisors are rare. 3D symmetry remains consistent across orthodontic treatment status, gender, and dominant hand, suggesting its independence from such parameters. Clinical significance: To achieve a natural and aesthetic smile rehabilitation, the symmetry of the maxillary incisors must be well understood. In our study, 2D and 3D symmetry of the maxillary incisors occurred rarely, but central incisors showed more similarities than lateral incisors in width, with differences under 0.2 mm. On the other hand, differences between highly asymmetrical contralateral teeth are situated at the transitional lines. These conclusions should be included in further computer‐assisted three‐dimensional smile designs. [ABSTRACT FROM AUTHOR]

Objective: This case report presents a female adult patient who exhibits poor oral hygiene, a mutilated dentition with multiple missing teeth, and skeletal asymmetry. Clinical Considerations: Interdisciplinary treatment was necessary to maintain oral hygiene, treat caries, extract residual roots, and upright a horizontally impacted third molar using a miniplate. Additionally, orthodontic mini‐implants were utilized as anchorage to improve sagittal relationship and space closing. Space management was completed with orthodontic treatment, followed by restoration of the multiple missing teeth with dental implants. Conclusion: Consequently, an esthetic smile and functional occlusion were achieved by interdisciplinary treatment using orthodontic skeletal anchorage devices and dental implants. Clinical Significance: Missing mandibular first molar spaces were closed with retraction of the anterior teeth and protraction of the mandibular second molars using orthodontic mini‐implants. The mandibular right third molar, which should have erupted, was protracted with the second molar, while the horizontally impacted mandibular left third molar was uprighted using a miniplate and was protracted with an orthodontic mini‐implant. The missing maxillary lateral incisors were replaced with the maxillary canines, and the maxillary canines were replaced with the maxillary first premolars. The missing maxillary right second premolar and first molar and left first and second molars were successfully restored with dental implants. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to provide recommendations in order to facilitate communication between dental professionals and surgeons who are collaborating in the field of dentofacial esthetics. Clinical Considerations: Smile esthetics are beyond the scope, both of the surgeons who are collaborating with facial esthetics and of the dentists, as a wide range of treatment options from both sides is available. It can be difficult for the surgeon or the dentist that first comes in contact with the patient to conduct an individualized global treatment plan, in order to find out how the various phases of the treatment can be sequenced, as a workflow for an efficient interaction between facial surgery and dentistry still does not exist in the scientific literature. Conclusions: Facial cosmetic procedures and dental treatment have to be planned as individual elements of the whole dentofacial esthetic rehabilitation. The treatment has to be initiated with the design of the smile and the intraoral mock‐up, followed by the required surgical interventions, and to be finished with the delivery of the definitive dental restoration. Clinical Significance: Dentofacial esthetics require comprehensive communication between surgeons and dentists. Following the proposed recommendations, an individualized interdisciplinary treatment plan can be conducted, defining the role of each specialty. [ABSTRACT FROM AUTHOR]

Objective: This article describes an interdisciplinary treatment that helped a patient with displaced upper anterior teeth. A gingivectomy, root canal therapies, digital smile design, digital wax‐up, and guided tooth preparations were applied. Clinical Considerations: A patient with pathologically migrated teeth asked for treatment without orthodontic involvement due to a primary failed orthodontic treatment history. A smile photo was taken and superimposed with the dentition in a CAD software to accomplish a digital smile design. The jaw movements were recorded with two different methods, a mechanical articulator and an intraoral scanner with Patient‐Specific‐Motion function. The occlusal contacts during protrusive and lateral movements were compared and the digital wax‐up was designed according to the later occlusal data. An aesthetic crown lengthening and pre‐op root canal treatment were carried out in advance accordingly. After guided tooth preparation with a silicone index, the final fixed restorations were manufactured and cemented. A 2‐year follow‐up showed that our prosthesis functions well. Conclusions: This clinical report revealed that an intraoral scanner with Patient‐Specific‐Motion function can effectively record individual dynamic occlusal patterns and these data can be integrated into the CAD/CAM process to enhance the fulfillment of clinical requirements. Clinical Significance: This clinical procedure with a 2‐year follow‐up demonstrated that a prosthodontic‐based interdisciplinary treatment of pathologically migrated teeth using dynamic occlusal recording with an intraoral scanner could achieve satisfactory esthetics in a relatively short treatment period. The Patient Specific Motion module may be used to record a personalized functional movement and the data can be integrated into the design process of the final restorations. [ABSTRACT FROM AUTHOR]

Background: Children with dental caries are treated with stainless steel metal crowns (SSC), but the aesthetics and precision still need to be improved. Currently, both 3D‐printed resin crowns (PRC) and computer‐aided design/computer‐aided manufacture (CAD/CAM) resin crowns (CRC) meet the clinical requirements for crown applications in terms of strength, production time, cost, and aesthetics. Aim: This study replaced SSC with customized resin crowns by 3D printing and CAD/CAM. Design: In this study, PRC, CRC, and SSC were used for incisor and molar restorations, and 60 crowns were made with 10 for each group. The fabrication efficiency, surface characteristics, marginal fit, and stability of the two different crowns were evaluated. Results: PRC and CRC show superior color and surface characteristics, though production times are longer (5.3–12.4 times and 3.3–9.1 times, respectively) than for SSC (p <.05). They, however, can be completed within 80 min. Edge gaps for PRC and CRC are significantly lower (13.0–19.2 times and 13.0–13.7 times) than for SSC (p <.05). All materials exhibit good stability. Conclusion: The 3D‐PRCs and CAD/CAM resin crowns may replace SSCs as a potential choice for clinical child caries. [ABSTRACT FROM AUTHOR]

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ABSTRACT Objective Materials and Methods Results Conclusions Clinical Significance Data on the stability of soft tissues at pontic sites of resin‐bonded fixed dental protheses (RBFDP) are lacking. The purpose of this study was to evaluate soft tissue changes at pontic sites of cantilever zirconia ceramic RBFDPs with and without surgical pretreatment after different follow‐up periods in the esthetic zone.Impressions were taken after the insertion of the restorations and an intraoral scan was performed at follow‐up examinations. Dental casts were digitalized and superimposed with the follow‐up scan. Vertical and horizontal soft tissue changes were measured buccally and lingually at mucosal margin at the central cross‐section of each pontic, and for horizontal change at 1 and 2 mm below. One‐way ANOVA and Kruskal–Wallis test were performed to analyze the collected data.A total of 36 pontic sites with (n = 7) and without surgical pretreatment (n = 29) were evaluated at a follow‐up period of either > 4, > 6, or > 10 years (n = 12). The follow‐up period had no significant effect on the tissue change. Surgical pretreatment showed significantly higher tissue loss at 2 mm below the lingual mucosal margin than for sites without surgical pretreatment.Soft tissues at pontic sites remained stable with a tissue gain at the mucosal margin up to 10 years.Based on the findings of this study, cantilever resin‐bonded fixed dental protheses provide excellent functional and esthetic outcomes with preservation of soft tissues in the edentulous area of single missing incisors and a gingival sulcus‐like tissue growth at the mucosal margin forming an emergence profile at pontic sites similar to that of a natural tooth. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Materials and Methods Results Conclusion While the importance of gingival aesthetics is increasingly recognized, a questionnaire quantifying its psychosocial impact is still lacking. We have adapted the validated Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) for the gingival context. This study's aim was to develop a new Psychosocial Impact of Gingival Aesthetics Questionnaire (PIGAQ) and test its validity for the general population in Spain, exploring the underlying dimensions of the construct assessed.The PIDAQ was adapted to address gingival aesthetics. PIGAQ (23 items) was completed by 200 patients aged from 18 to 85 years, and socio‐demographic variables were recorded. The four‐dimensional structure of the PIDAQ was respected, adapting the subscales to focus on the gingiva. Descriptive analysis, assessments of reliability and validity and an exploratory factor analysis were performed.The revised PIGAQ (now containing 20 items) has a Cronbach's alpha coefficient of 0.88 with four underlying factors explaining 61.5% of the total variance. Three items (SI‐1, PI‐2 and PI‐5) were eliminated because of unacceptable fit indices. The Cronbach's alpha coefficients for the subscales are as follows: Gingival Self‐Confidence, 0.85; Social Impact, 0.84; Psychological Impact, 0.79; and Aesthetic Concern, 0.76.PIGAQ is a reliable and potentially valid instrument for assessing psychosocial perceptions of gingival aesthetics. The scale was shown to have a satisfactory factor structure and level of internal consistency. [ABSTRACT FROM AUTHOR]

Objective: To compare the levels of functional impairments, discomfort and satisfaction experienced by those treated with full-mouth customized lingual appliances (Lingual appliances), full-mouth self-ligating bracket (Labial appliances), or upper lingual and lower labial appliances (Mixed appliances) using questionnaires. Materials and methods: Patients within one year of the end of treatment were included in the survey and given a questionnaire concerning different kinds of discomfort and difficulties during the treatment process. The questionnaires focused on the following aspects including speech difficulty, pain (lip, cheek or tongue), difficulty in chewing, difficulty in tooth brushing and overall aesthetics and comfortability. Ordinary one-way ANOVA Tukey's multiple comparison tests and Kruskal–Wallis tests were employed to analyze the data. Results: A total of 115 patients participated in the study. In terms of functional impairments and discomfort, the rate and degree of speech difficulty was significantly higher in the Lingual appliances Group than that in the Labial appliances Group. But there was no difference among the three groups for difficulty in chewing and tooth brushing. Both lingual and labial appliances caused a similar level of overall pain, however, those treated with lingual appliances experienced more tongue pain, and those treated with labial appliances experienced more cheek and lip pain. The most common sites of irritation were the tongue lateral and tongue tip in the Lingual appliances Group, tongue lateral and cheek in the Mixed appliances Group, and cheek and lower lip in the Labial appliances Group. In total, patients gave highest scores to mixed appliances for comfortability and lowest scores to labial appliances for aesthetics when it came to satisfaction. Conclusions: Lingual and labial appliances caused similar level of overall pain. Taking into account the overall comfortability, aesthetics and cost, the mixed appliances may be suitable for some patients who have aesthetic and comfort pursuits. [ABSTRACT FROM AUTHOR]