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Objectives: To investigate the effects of low-level laser irradiation (LLLI) on viability/proliferation, migration, osteo/odontogenic differentiation, and in vitro biomineralization of stem cells from human exfoliated deciduous teeth (SHED)., Materials and Methods: SHED cultures were established by enzymatic dissociation from pulps of deciduous teeth. SHED were irradiated with a diode laser (InGaAsP; 940 nm; 0.2 W, continuous mode) at energy fluences 4, 8, and 16 J/cm 2 in the dark, while non-irradiated SHED served as control. Cell viability/proliferation was evaluated by MTT assay and cell mobilization by Transwell™ migration assay. Expression of osteo/odontogenesis-related genes (ALP, BMP-2, BGLAP, DSPP, MSX2, RUNX2) was assessed by real-time PCR, while in vitro biomineralization by Alizarin Red staining. Statistical analysis was performed by two-way ANOVA and Tukey's post hoc tests (*p < 0.05, **p < 0.01)., Results: Statistically significant stimulation of cell viability/proliferation was observed at all energy fluences, reaching the highest effect for the 4 and 16 J/cm 2 . Although the 8 J/cm 2 fluence showed the lowest stimulatory effect on cell viability/proliferation, it was the most effective in inducing SHED migration, upregulation of odontogenesis-related genes (DSPP, ALP, BMP-2) at specific time-points, and the in vitro biomineralization potential of SHED compared to the other two energy fluences., Conclusions: LLLI proved beneficial in promoting SHED biological processes critical for pulp repair in deciduous teeth. Overall, the 8 J/cm 2 energy fluence showed the most beneficiary effects., Clinical Relevance: These results provide insights on a narrow "therapeutic window" of LLLI application in vital pulp therapies of deciduous teeth, paving the way for the establishment of effective clinical protocols.

Statement of Problem: With a number of zirconia ceramic materials currently available for clinical use, an overview of the scientific literature on the adhesion methods and their potential influence is indicated., Purpose: The purpose of this systematic review was to classify and analyze the existing methods and materials proposed to improve adhesion to zirconia surfaces., Material and Methods: The current literature of in vitro studies examining the bond strength on zirconia ceramics, including clinical studies from 1998 until 2014, was analyzed. A search of the English language literature was undertaken using MEDLINE and PubMed, and a hand search was made for any relevant research paper from the library of a dental school. Papers evaluating only alumina restoration bond or ceramic-zirconia bond were excluded., Results: A total of 134 publications were identified for analysis. Different adhesive techniques with different testing methods were reviewed. Results were difficult to compare in that the parameters varied in each research protocol., Conclusions: Airborne-particle abrasion and tribochemical silica coating are reference pretreatment methods. Adhesive monomers are necessary for chemical bonding. Surface contamination and aging have negative effects on adhesion to zirconia. Many factors influence each combination of zirconia material, such as surface treatment, adhesive medium, and aging conditions. Laboratory studies should be confirmed by clinical trials., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Glass-ceramic scaffolds containing Mg have shown recently the potential to enhance the proliferation, differentiation, and biomineralization of stem cells in vitro, property that makes them promising candidates for dental tissue regeneration. An additional property of a scaffold aimed at dental tissue regeneration is to protect the regeneration process against oral bacteria penetration. In this respect, novel bioactive scaffolds containing Mg(2+) and Cu(2+) or Zn(2+), ions known for their antimicrobial properties, were synthesized by the foam replica technique and tested regarding their bioactive response in SBF, mechanical properties, degradation, and porosity. Finally their ability to support the attachment and long-term proliferation of Dental Pulp Stem Cells (DPSCs) was also evaluated. The results showed that conversely to their bioactive response in SBF solution, Zn-doped scaffolds proved to respond adequately regarding their mechanical strength and to be efficient regarding their biological response, in comparison to Cu-doped scaffolds, which makes them promising candidates for targeted dental stem cell odontogenic differentiation and calcified dental tissue engineering.

Background: The prosthetic margin location relevant to the free gingival margin may influence the incidence of secondary caries due to the differences that exist between the micro-environment within the gingival crevice compared to the rest of the oral environment., Objective: The purpose of this study was to systematically review the effect of prosthetic margin placement on caries susceptibility of abutment teeth., Method: Two independent authors identified cohort studies using MEDLINE, EMBASE, CDSR, CENTRAL, Google Scholar and Scopus through March 2012. Reference lists were also scanned. Included studies had to report on caries incidence with regard to location of prosthetic margins, with a minimum follow-up period of two years., Results: A total of 5,541 references were identified and, after application of the inclusion criteria, 22 studies were included in the systematic review. Random-effects meta-analysis could be made in two studies, in which secondary caries incidence did not differ between margins placed subgingivally compared to equi- or supragingivally placed margins for a follow-up period up to ten years. Indications were found of a possible lower secondary caries rate at 15 years of follow up, based on one study., Conclusion: This systematic review and meta-analysis failed to detect a significantly different secondary caries rate of subgingivally located prosthetic margins in the short to mid-term (≤10 years). Due to the small number and the limitations of the included studies the results do not provide conclusive evidence as to the effect of prosthetic margin placement on the incidence of secondary caries.

Titanium and its alloys are widely used in prosthetic dentistry, due to their biocompatibility, excellent mechanical and anti-corrosion behavior. However, delayed fracture of dental prosthetics is frequently encountered. Mechanisms leading to fracture are not generic but are strongly related to the particular environmental (quality of biological fluids) and mechanical loading conditions (mastication habits, presence of prosthetic metallic/ceramic components) in the patients' oral cavity. In this study, a commercially pure titanium implant-screw system has failed after 15 years of operation in the oral cavity of an old female. The system was retrieved in three pieces: the upper part of the implant, part of the abutment screw, and the apical part of the implant to which a part of the screw was embedded. This is considered as a rare case, where the whole dental assembly was retrieved after fracture allowing the extensive fractographic analysis of the conjugate pieces and the establishment of a thorough in-vivo failure scenario. Scanning electron microscopy observations performed on all three retrieved parts indicated a synergistic effect of distinct mechanisms, which led to total failure under extrinsic common fatigue loading. The principal mechanism was the propagation of a main crack, which was previously initiated in the body of the implant and affected by a wedging mechanism due to Ca/P aggregates developed within the crack. Because of the strong fixation between the implant and the abutment screw, this main crack was transferred to the latter causing eventually total failure of the assembly.

Objectives: A wide variety of dental ceramics compositions have been introduced in dental clinical practice in order to combine desired aesthetics with superior mechanical performance. The aim of the present study was to investigate the microstructural changes in three dental ceramics after their sintering according to manufacturers' instructions and to comparatively evaluate some of their physical, mechanical and biological properties., Methods: The analysis of the phases present in each material before and after sintering was performed with scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction analysis (XRD). The thermal properties of ceramic specimens were evaluated with differential thermal and thermogravimetric analysis (TG-DTA). The mechanical properties evaluated were fracture toughness, Young's modulus and microhardness with the Vickers indentation method. MTT assay was used for cell proliferation assessment. One-way analysis of variance (ANOVA) with Bonferroni multiple comparisons tests was used to determine statistically significant differences (significance level of p<0.05)., Results: Results showed a remarkable variation among the three ceramic compositions of leucite content in the starting unheated ceramic powders ranging between 14 and 32 wt.% and in the respective sintered powders ranging between 15 and 41 wt.% The low fusing glass-ceramic and the high fusing leucite-based ceramic presented significantly higher fracture toughness (p<0.001) and microhardness and lower modulus of elasticity (p<0.05) compared to the low fusing feldspathic ceramic. The three ceramics were almost equivalent concerning their in vitro biological behavior., Significance: Variations in crystal structure, distribution and composition are related to differences concerning mechanical properties of dental ceramics.

Objectives: To test the hypothesis that the placement of a crown is associated with improved (long term) survival of root canal treated teeth, using a systematic review process of clinical studies., Data Sources: Papers referring to single crowns on endodontically treated teeth were located by a MEDLINE search and hand searching. One thousand six hundred and nine references were found, and they were subjected to a systematic review procedure., Study Selection: A three-step inclusion-exclusion procedure was applied to identify papers that represented; good scientific practice (GSP), reported results of all patients, restorations on root canal treated teeth (RCT) for more than 2 years and had sufficient data to generate life table analyses. The outcomes were 'survival of RCT restored with crowns' and 'survival of RCT with direct restorations'. Ten studies survived. These data showed an overall mean GSP of 0.605 with a 10-year survival of 81% for crowned RCT and a 10-year survival of 63% for RCT with direct restorations (resin composites, amalgam, cements)., Conclusion: RCTs restored with crowns show an acceptable long-term survival of 10 years, while direct restorations have a satisfactory survival only for a short period.

The paper presents computer-aided methods that allocate a dental implant and suggest its size, during the pre-operative planning stage, in conformance with introduced optimization criteria and established clinical requirements. Based on computed tomography data of the jaw and prosthesis anatomy, single tooth cases are planned for the best-suited implant insertion at a user-defined region. An optimum implantation axis line is produced and cylindrical implants of various candidate sizes are then automatically positioned, while their occlusal end is leveled to bone ridge, and evaluated. Radial safety margins are used for the assessment of the implant safety distance from neighboring anatomical structures and bone quantity and quality are estimated and taken into consideration. A case study demonstrates the concept and allows for its discussion.

Purpose: This laboratory study compared the effect of different surface treatments of a medium-gold, high-noble alloy on the shear bond strength of an indirect, highly filled resin composite to the alloy and on the elemental composition of the alloy surface., Materials and Methods: Ninety disks, cast in a medium-gold, high-noble porcelain-fused-to-metal alloy (V-Deltaloy), received three different surface treatments: sandblasting with 50-microm Al2O3 (group 1) or 250-microm Al2O3 (group 2) and chemical agents, or with 250-microm Al2O3 without chemical agents (group 3) prior to bonding of an indirect resin composite (Artglass, and chemical agents Siloc-pre and Siloc-bond). The specimens were tested in shear, half of them after 24-hour dry storage at room temperature and the rest after 10-day storage in normal saline solution at 37 degrees C and thermocycling (2,500 cycles between 5 and 55 degrees C). Morphologic and qualitative changes on the alloy surface after sandblasting with 50- or 250-microm Al2O3 were examined by SEM using EDS analysis and compared with polished specimens. Statistical analysis was performed using two-factor ANOVA., Results: The mean shear bond strengths (in MPa) after dry or wet storage and thermocycling were 29 and 24 for group 1, 21 and 18 for group 2, and 17 and 12 for group 3, respectively; there was a statistically significant difference among the groups. Sandblasting of the alloy surface led to statistically significant changes in elemental composition. These changes were of greater magnitude when 50-microm Al2O3 particles were used., Conclusion: The particle size used for sandblasting influences the shear bond strength between a high-noble alloy and a highly filled indirect resin composite, as well as the elemental composition of the alloy surface.

Purpose: This laboratory study compared the shear bond strength between three indirect resin composites and a noble alloy using their respective bonding systems., Materials and Methods: One hundred twenty disks cast in a medium-gold, high-noble metal-ceramic alloy (V-Deltaloy) were divided equally into four groups and received different treatments for veneering: Conventional feldspathic porcelain (Omega) was applied on one set of specimens to be used as a control, and three indirect resin composites (Artglass, Sculpture, Targis) with their respective bonding systems were used for the other groups. The specimens were tested in a parallel shear test, half of them after 24-hour dry storage at room temperature and the rest after 10-day storage in normal saline solution at 37 degrees C and thermocycling. The fractured specimens were evaluated to determine the nature of the failure., Results: The mean shear bond strength values (in MPa), before and after wet storage and thermocycling, were 30 and 23 for the metal-ceramic group, 29 and 23 for the Artglass group, 20 and 19 for the Sculpture group, and 17 and 14 for the Targis group, respectively. The metal-ceramic and Artglass groups exhibited significantly higher bond strengths than the other two groups. All specimens, with the exception of the Sculpture group, showed a significant decrease in bond strength after wet storage and thermocycling., Conclusion: No group exceeded the shear bond strength of the metal-ceramic group, but the Artglass group with its respective metal-resin bonding system exhibited similar bond strengths. The Sculpture group showed a stable bond after water storage and thermocycling.

In this cross-sectional study, risk and potentially causative factors of gingival recession were examined and their relationship to apical migration of the gingival margin evaluated. Thirty eight patients (18-60 years), displaying one or more sites with gingival recession but without any significant periodontal disease participated. A total of 28 parameters were evaluated in both 'test' teeth (50 teeth with gingival recession) and 'control' teeth (50 contralateral teeth). The results revealed that gingival margin recession was associated with both high inflammatory and plaque scores, with decreased widths of keratinized and attached gingiva and with the subjects' toothbrush bristle hardness.

The necessity for splinting and the advantages of some types of permanent, semipermanent, and temporary splinting are given. Specific step-by-step instructions are given for a special purpose splint that can be used for stabilizing mobile maxillary teeth when the patient has thin teeth faciolingually and a steep vertical overlap. This can be the treatment of choice for such patients.

The severity of symptoms of craniomandibular disorders was studied during a 2-year period in 195 patients treated with conservative therapeutic schemes. Results revealed a continuing improvement and a statistically significant tendency for the great majority of patients to become asymptomatic or show a decrease in the severity of symptoms. By the end of the 2 years, 66.7% of the patients were symptom free, 25.6% presented with slight symptomatology, and 3.1% were recorded with a fluctuating recurrence of symptoms. This investigation provided the data to develop an exponential model for the hypothesis that stabilization of effectiveness of conservative treatment is achieved between 6 months and 1 year after the initiation of treatment.

The purpose of this study was to investigate the effect of age and sex on craniomandibular disorders. A total of 195 subjects were examined, 148 women and 47 men. The range of age was 16 to 70 years. Clinical and anamnestic examination data established the ratio of women to men as 4:1. The prevalence of clicking, headache, teeth-clenching, hypomobility, difficulty in mastication, and neuromuscular symptoms was greater among young women than in other age and sex groups. There was a statistically significant correlation between severity of symptoms and age among women, and a relative decline by age in the prevalence of symptoms for both sexes. Finally, younger patients showed a greater prevalence of neuromuscular symptoms, whereas older patients had more peripheral symptoms.

Four techniques for making collarless metal-ceramic restorations were investigated in this study to examine the final color consistency, the bacterial plaque accumulation, and the surface characteristics of the porcelain margin. Twenty crowns were constructed and data revealed the superiority of the platinum foil technique in producing consistent color, whereas the shoulder porcelain technique resulted in the most significant color deviation. Metal surfaces exhibited the greatest in vitro bacterial plaque accumulation (42.43%), and the margins of the platinum foil technique accumulated the least plaque (7.23%). In addition, the wax binder and the platinum foil techniques produced the smoothest surfaces, whereas again the shoulder porcelain technique exhibited pronounced surface roughness. From the obtained results, and with the limitations of this in vitro study, one can speculate that surface roughness is not a predominant factor in the initial process of bacterial plaque accumulation.

The proximal tooth surface integrity of 826 patients was correlated with periodontal probing depths. Results show relatively increased probing depths adjacent to restored proximal tooth surfaces, with the greatest probing depths adjacent to overhanging restorations and restorations with recurrent caries. The data confirm the significant tendency of the periodontal condition to deteriorate as a function of decreasing surface quality. Probing depth appeared to increase with the patient's age. Surface condition, however, showed a significant relationship with probing depths in all age groups.

Crown contours represent a group of characteristics critical for the longevity and success of dental restorations. This article presents the theories that have been developed about crown contours, describes each feature in detail, and clarifies potential interrelationships with all components of the mouth. When identified early, crown contours can be incorporated in treatment planning and restorative procedures.

Masseteric silent periods have been evoked in a group of normal subjects under a standardized system and under nonstandardized conditions. In the designed system, head position, electrode placement, bite force, tap force, direction of tap, and surface zone of tap force delivery were controlled. Analysis of data confirmed the hypothesis that standardization of the procedure for eliciting the silent period results in measurements of duration with decreased standard deviations and variances. In the present study, under the standardized system the SPD range of standard deviations was between 1.37 and 3.68 (mean 2.97) and the range of variances was between 1.89 and 13.54 (mean 8.85). The recorded low variability suggests a high degree of reproducibility of the system. High reproducibility and low variability of measurements are necessary if an accurate measure of silent period duration is to be achieved and used in the interpretation of diagnostic findings for craniomandibular disorders.