THE DENTAL PROFESSION EXPERIENCES HIGH PREVALENCE RATES OF BURNOUT AND EMOTIONAL EXHAUSTION

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Moro JDS, Soares JP, Massignan C, Oliveira LB, Ribeiro DM, Cardoso M, Canto GL, Bolan M. Burnout syndrome among dentists: a systematic review and meta-analysis. J Evid Based Dent Pract. 2022 Sep;22(3):101,724. doi: 10.1016/j.jebdp.2022.101724. Epub 2022 Apr 2. PMID: 36162888 SOURCE OF FUNDING: University funds.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Lack of keratinized mucosa increases peri-implantitis risk

DESIGN

A systematic appraisal and statistical aggregation of primary studies in humans.

DATA SOURCES

The researchers utilized PubMed (Medline) and Scopus databases as the primary data sources for this study. They performed a comprehensive literature search based on free keywords and Medical Subject Heading (MeSH) terms to enhance the search accuracy. The database search was concluded on November 13, 2022. Furthermore, a meticulous examination of the references cited in the selected studies was conducted to identify additional relevant articles that could be incorporated into the analysis.

STUDY SELECTION

The systematic review focused on partially or fully edentulous patients receiving dental implants and aimed to determine if the lack of keratinized mucosa at the implant site increased the risk of peri-implantitis compared to patients with adequate keratinized mucosa. Human studies with a minimum of 100 implants, cross-sectional, cohort, or case-control designs, and a follow-up period of at least one year were included. Studies lacking a clear case definition or information on peri-implantitis and those that did not investigate keratinized mucosa as a risk indicator were excluded.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently utilized a systematic review screening website (Rayyan, Qatar Computing Research Institute, Qatar Foundation) to select potential articles, and conflicts were resolved through discussion or consultation with a third reviewer. The data extraction process involved recording information from the included articles, such as study design, patient and implant numbers, prosthesis type (fixed or removable), follow-up duration, peri-implantitis case definition, prevalence at patient and implant levels, keratinized mucosa cutoff value, odds ratio (OR) of peri-implantitis considering keratinized mucosa, and conclusions on the potential effect of keratinized mucosa from each study. The Newcastle Ottawa scale (NOS) and a modified version of NOS were used, respectively, to assess the quality of cohort and cross-sectional studies. Studies scoring below 6 out of 9 points were classified as low quality. For the meta-analysis, the relationship between peri-implantitis and keratinized mucosa was evaluated using the odds ratio (OR) and standard error (SE). Heterogeneity was assessed through the Chi2 test and I2 index, determining whether a random-effects or fixed-effects model should be applied. Subgroup and cluster analyses were conducted based on specific criteria, and forest plots and funnel plots were generated to visualize results and identify potential study bias. Sensitivity analysis was performed to verify the robustness of the meta-analysis, with statistical significance set at p < 0.05. The Review Manager (RevMan) software facilitated data analysis. The GRADE rating system was used to determine the level of evidence, considering factors such as bias risk, imprecision, inconsistency, indirectness, and publication bias. The certainty of the evidence was evaluated based on the overall outcomes of analyzed subgroups.

RESULTS

Twenty-two primary studies were identified, and a meta-analysis was conducted on 16 cross-sectional studies. The prevalence of peri-implantitis ranged from 6.68% to 62.3% at the patient level and from 4.5% to 58.1% at the implant level. The overall analysis revealed a significant association between the lack of keratinized mucosa and a higher prevalence of peri-implantitis (OR = 2.78, 95% CI 2.07-3.74, p < 0.00001). Subgroup analyses with a consistent case definition of peri-implantitis (MBL ≥ 2 mm) showed similar results (OR = 1.96, 95% CI 1.41-2.73, p < 0.0001). Studies focusing on fixed prostheses only demonstrated that the lack of keratinized mucosa was associated with an increased prevalence of peri-implantitis (OR = 2.82, 95% CI 1.85-4.28, p < 0.00001). Among patients under regular implant maintenance, the absence of keratinized mucosa significantly raised the occurrence of peri-implantitis (OR = 2.08, 95% CI 1.41-3.08, p = 0.0002). Studies adjusting for other variables also confirmed a higher risk of peri-implantitis with inadequate keratinized mucosa (OR = 3.68, 95% CI 2.32-5.82, p = 0.007). Although some publication bias was observed, the certainty of evidence based on the GRADE system was judged to be "moderate."

CONCLUSIONS

The lack of keratinized mucosa increased the risk of peri-implantitis, emphasizing the need to consider it during dental implant placement. Inadequate data on patient-specific factors and the predominance of cross-sectional studies influenced the evidence quality (i.e., moderate). Future studies with consistent methodologies shall confirm these findings and identify additional risk indicators to improve implant dentistry practices.

Combination of minimal- and non-preparation techniques with ceramic veneers for managing esthetic deficiencies

Non-preparation (non-prep) ceramic veneers are a convenient and conservative treatment option, but controversy exists about their predictability. Concerns remain about possible overcontouring, poor-quality margins, and early esthetic failure. The present clinical report describes the combination of minimally invasive and non-prep ceramic laminate veneers in the esthetic zone with a 6-year follow-up to replace stained composite resin veneers on both maxillary central incisors. Composite resin veneers on the maxillary central incisors were replaced with ceramic veneers, and a non-prep ceramic veneer was placed on the maxillary right lateral incisor. A diagnostic additive wax-up was done, followed by a mock-up guide to conservatively prepare both maxillary central incisors. The three feldspathic porcelain veneer restorations were cemented under rubber dam isolation. The 6-year follow-up showed that stained composite resin veneers can successfully be replaced with minimally invasive and non-prep ceramic veneers to meet the patient's esthetic wishes. Overall, well-planned and well-executed restorative procedures combining minimal preparation and non-prep for ceramic laminate veneers can achieve esthetically pleasing outcomes and maximize tooth structure preservation in the maxillary anterior region.

Peri-implantitis and systemic inflammation: A critical update

Peri-implantitis is an inflammatory condition induced by bacterial biofilm that affects the soft and hard tissues surrounding dental implants, compromising the success of implant therapy. Recent studies have highlighted the potential links between peri-implant health and systemic inflammation, including uncontrolled diabetes mellitus, psychological stress, cardiovascular disease, obesity, and infectious diseases such as COVID-19. As an inflammatory disease, peri-implantitis may trigger systemic inflammation by elevating circulating levels of pro-inflammatory cytokines, which could have unknown impacts on overall health. While the relationship between periodontal health and systemic conditions is better understood, the association between peri-implant disease and systemic inflammation remains unclear. Therefore, this comprehensive review aims to summarize the most recent evidence on the relationship between peri-implantitis and systemic inflammation, focusing on biological complications, microbiology, and biomarkers. This review aims to enhance our understanding of the links between peri-implantitis and systemic inflammation and promote further research in this field by discussing the latest insights and clinical implications.

Injectable Flowable Resin-based Composite Veneers Prior to Ceramic Veneers

OBJECTIVES

This case report describes the clinical protocols for using injectable flowable resin-based composite veneers without tooth reduction as long-term prototype restorations, followed by conservative feldspathic veneer restorations.

CLINICAL CONSIDERATION

The patient's primary concern was to improve her smile. After clinical evaluation, injectable flowable resin composite veneers were recommended as long-term prototypes followed by conservative tooth preparation and ceramic veneers. Flowable composite veneers were created with a transparent silicone index fabricated from a diagnostic wax-up approved by the patient. No tooth reduction was required to place this type of composite veneer. Later, a printed reduction guide was used to provide conservative tooth preparation followed by the cementation of thin feldspathic porcelain veneers under full isolation with a rubber dam.

CONCLUSIONS

Injectable flowable resin-based composite veneers can successfully act as long-term esthetic prototypes before ceramic veneers. The outcome of these restorations is very predictable because the diagnostic wax-up anatomy is transferred to the mouth through the transparent silicone index, and they can be placed without tooth reduction. Conservative tooth preparation can be performed on the composite veneers so that minimal tooth structure is removed to maximize the bonding performance of ceramic veneers.

Pulpotomy versus root canal treatment in permanent teeth with spontaneous pain: comparable clinical and patient outcomes, but insufficient evidence

DESIGN

A systematic appraisal and statistical aggregation of primary studies.

DATA SOURCES

Scopus/ELSEVIER, PubMed/MEDLINE, Clarivate Analytics' Web of Science (i.e., Web of Science Core Collection-WoS, Korean Journal Database-KJD, Russian Science Citation Index-RSCI, SciELO Citation Index-SCIELO), and Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library.The complementary searches consisted of OpenGrey, Google Scholar (first 100 returns), Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, DART-Europe E-theses Portal-DEEP, Opening access to UK theses-EThOS.

STUDY SELECTION

Human clinical trials studies in English language with at least 10 patients with mature or immature permanent teeth with pulpitis characterized by spontaneous pain in each arm (i.e., root canal treatment [RCT] and pulpotomy) at the end of the study, comparing the patient- (Primary: survival, pain, tenderness, swelling assessed by clinical history, clinical examination, and pain scales; Secondary: tooth function, need for further intervention, adverse effects; OHRQoL using a validated questionnaire) and clinical-reported outcomes (Primary: emerging apical radiolucency as per intraoral periapical radiograph or limited FOV CBCT scan; Secondary: radiological evidence of continued root formation and presence of sinus tract).

DATA EXTRACTION AND SYNTHESIS

Two independent review authors conducted study selection, data extraction and risk of bias (RoB) assessment and a third reviewer was consulted for solving disagreements. When insufficient or absent information, the corresponding author was reached out to for further explanation. The Cochrane RoB tool for randomized trials (RoB 2.0) was evaluated the quality of studies.The meta-analysis was performed on a fixed-effect model to estimate pooled effect size such as odds ratio (OR) and 95% confidence intervals (CIs) were performed using the R software. The quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach (GRADEpro GDT: GRADEpro Guideline Development Tool [software], McMaster University, 2015).

RESULTS

Five primary studies were included. Four studies referred to a multicentre trial assessing postoperative pain and long-term success rate after pulpotomy compared with one-visit RCT in 407 mature molars. The other study was a multicentre trial assessing postoperative pain in 550 mature molars treated with pulpotomy and pulp capping with the calcium-enriched mixture (CEM), pulpotomy and pulp capping with mineral trioxide aggregate (MTA) and one-visit RCT. Both trials primarily reported first molars from young adults. When looking at the results of postoperative pain, all the trials included had a low RoB. However, when evaluating the clinical and radiographic outcomes of the included reports, it was determined that there was a high RoB. The meta-analysis found that the likelihood of experiencing pain (i.e., mild, moderate, or severe) at the 7th postoperative day was not affected by the type of intervention (OR = 0.99, 95% CI 0.63-1.55, I2 = 0%).The study design, risk of bias, inconsistency, indirectness, imprecision, and publication bias domains were used to grade the quality of evidence for postoperative pain between RCT and full pulpotomy, resulting in a 'High' grade. In the first year, clinical success was high for both interventions, with a rate of 98%. However, the success rate declined over time, with pulpotomy showing a 78.1% success rate and RCT showing a 75.3% success rate at the 5-year follow up.

CONCLUSIONS

This systematic review was limited by the inclusion of only two trials, indicating a lack of sufficient evidence to draw definitive conclusions. Nonetheless, the available clinical data suggests that patient-reported pain outcomes do not differ significantly between RCT and pulpotomy at Day 7 postoperatively, and that the long-term clinical success rate of both treatments is comparable, as demonstrated by a single randomized control trial. However, to establish a more robust evidence base, additional high-quality randomized clinical trials, conducted by diverse research groups, are needed in this field. In conclusion, this review underscores the insufficiency of current evidence to draw solid recommendations.

Ceramic versus Composite Resin Polishing Systems on the Surface Roughness of Milled Leucite-Reinforced Ceramics

Background and Objective: This study aimed to compare the surface finish of milled leucite-reinforced ceramics polished with ceramic and composite polishing systems based on the manufacturers' recommendations. Materials and Methods: Sixty subtractive computer-aided manufactured (s-CAM) leucite-reinforced glass-ceramic specimens (IPS-Empress-CAD) were assigned into six groups: no polishing, a ceramic polishing kit, and four composite kit groups. The roughness average (Ra) was evaluated in microns using a profilometer, and scanning electron micrographs were obtained for qualitative analysis. A Tukey HSD posthoc test (α = 0.05) was used to determine significant intergroup differences. Results: After surface evaluation of the ceramics, the Ra values of the polishing systems ranked OptraFine (0.41 ± 0.26) < Enhance (1.60 ± 0.54) < Shofu (2.14 ± 0.44) < Astropol (4.05 ± 0.72) < DiaComp (5.66 ± 0.62) < No Polishing (5.66 ± 0.74). Discussion: Composite polishing systems did not provide as smooth surfaces as the ceramic polishing kit for CAD-CAM leucite-reinforced ceramics. Thus, using ceramic polishing systems, polishing leucite ceramics is recommended, whereas composite polishing systems should not be considered as an alternative for use in minimally invasive dentistry.

Effects of over-the-counter at-home whitening products with LED light on surface roughness of partially- and fully crystalized CAD/CAM lithium disilicate ceramics

The aim of this study is to evaluate the effect of over-the-counter (OTC) at-home whitening products with LED light on partially- and fully-crystalized CAD/CAM lithium disilicate ceramics. Two partially-crystalized CAD/CAM lithium disilicate ceramics, Amber Mill and IPS e.max CAD, and one fully-crystalized CAD/CAM lithium disilicate ceramic, n!ce Straumann, were used. The specimens were divided based on treatment with OTC whitening products: no treatment provided, Colgate Optic, Crest 3D and Walgreens Deluxe. The surface roughness of the specimens was evaluated with an optical profilometer and scanning electron microscopy. The three LED whitening products significantly increased the surface roughness and changed surface morphology of Amber Mill and IPS e.max CAD but no differences for n!ce Straumann. OTC at-home whitening products with LED light can significantly increase the surface roughness of restorations fabricated with these partially-crystalized CAD/CAM lithium disilicate ceramic restorations. However, these products do not increase the surface roughness of restorations fabricated with this fully-crystalized lithium disilicate ceramic.

Decellularized Scaffolds of Nopal (Opuntia Ficus-indica) for Bioengineering in Regenerative Dentistry

Opuntia Ficus-indica, or nopal, is traditionally used for its medicinal properties in Mexico. This study aims to decellularize and characterize nopal (Opuntia Ficus-indica) scaffolds, assess their degradation and the proliferation of hDPSC, and determine potential pro-inflammatory effects by assessing the expression of cyclooxygenase 1 and 2 (COX-1 and 2). The scaffolds were decellularized using a 0.5% sodium dodecyl sulfate (SDS) solution and confirmed by color, optical microscopy, and SEM. The degradation rates and mechanical properties of the scaffolds were determined by weight and solution absorbances using trypsin and PBS and tensile strength testing. Human dental pulp stem cells (hDPSCs) primary cells were used for scaffold-cell interaction and proliferation assays, as well as an MTT assay to determine proliferation. Proinflammatory protein expression of COX-I and -II was discovered by Western blot assay, and the cultures were induced into a pro-inflammatory state with interleukin 1-β. The nopal scaffolds exhibited a porous structure with an average pore size of 252 ± 77 μm. The decellularized scaffolds showed a 57% reduction in weight loss during hydrolytic degradation and a 70% reduction during enzymatic degradation. There was no difference in tensile strengths between native and decellularized scaffolds (12.5 ± 1 and 11.8 ± 0.5 MPa). Furthermore, hDPSCs showed a significant increase in cell viability of 95% and 106% at 168 h for native and decellularized scaffolds, respectively. The combination of the scaffold and hDPSCs did not cause an increase in the expression of COX-1 and COX-2 proteins. However, when the combination was exposed to IL-1β, there was an increase in the expression of COX-2. This study demonstrates the potential application of nopal scaffolds in tissue engineering and regenerative medicine or dentistry, owing to their structural characteristics, degradation properties, mechanical properties, ability to induce cell proliferation, and lack of enhancement of pro-inflammatory cytokines.

Ultrathin Partial Ceramic Veneers in the Esthetic Zone with Tooth Whitening: A 5-year Case Report

OBJECTIVE

This case report describes a minimally invasive approach with tooth whitening and partial ceramic veneers in the esthetic zone with a 5-year follow-up.

CLINICAL CONSIDERATIONS

The patient was initially concerned about the tooth color and previous direct resin composite restorations that chipped on the incisal edges of both maxillary central incisors. Tooth whitening and partial veneers for both central incisors were recommended after clinical evaluation. Two sessions of in-office tooth whitening, first with 35% hydrogen peroxide and later with 10% carbamide peroxide from first premolar to first premolar, were provided. Minimal tooth preparation that only removed the fractured composite restorations was performed followed by placement of feldspathic porcelain ultrathin partial ceramic veneers for both central incisors. We emphasize the benefits of minimal tooth preparation paired with partial ceramic veneers and the importance of masking discolored tooth structure with such thin veneers, including potential tooth whitening.

CONCLUSIONS

Overall, we demonstrate a well-planned and executed restorative procedure combining tooth whitening and ultrathin partial ceramic veneers to achieve desired results in the esthetic zone that remained successful for five years.

An Innovative 3D Printed Tooth Reduction Guide for Precise Dental Ceramic Veneers

Tooth reduction guides allow clinicians to obtain the ideal space required for ceramic restorations. This case report describes a novel design (CAD) for an additive computer-aided manufactured (a-CAM) tooth reduction guide with channels that permitted access for the preparation and evaluation of the reduction with the same guide. The guide features innovative vertical and horizontal channels that permit comprehensive access for preparation and evaluation of the reduction with a periodontal probe, ensuring uniform tooth reduction and avoiding overpreparation. This approach was successfully applied to a female patient with non-carious lesions and white spot lesions, resulting in minimally invasive tooth preparations and hand-crafted laminate veneer restorations that met the patient's aesthetic demands while preserving tooth structure. Compared to traditional silicone reduction guides, this novel design offers greater flexibility, enabling clinicians to evaluate tooth reduction in all directions and providing a more comprehensive assessment. Overall, this 3D printed tooth reduction guide represents a significant advancement in dental restoration technology, offering clinicians a useful tool for achieving optimal outcomes with minimal tooth reduction. Future work is warranted to compare tooth reductions and preparation time for this guide to other 3D printed guides.

Ultra-Translucent Zirconia Laminate Veneers: The Influence of Restoration Thickness and Stump Tooth-Shade

This in vitro study aimed to evaluate the final shade of translucent zirconia laminate veneers with varying thicknesses over teeth with different shades. Seventy-five chairside computer-aided design/computer-aided manufacturing (CAD/CAM) shade A1 third-generation zirconia dental veneers, with thicknesses of 0.50 mm, 0.75 mm, and 1.00 mm, were placed on resin composite teeth with shades ranging from A1 to A4. The laminate veneers were divided into groups based on thickness and background shade. All restorations were evaluated with a color imaging spectrophotometer, to map the veneer surface from A1 to D4. Regardless of the thickness or background shade, all dental veneers showed color alteration from the original shade. Veneers with 0.5 mm thickness tended to display the B1 shade, while veneers with 0.75 mm and 1.0 mm thickness primarily exhibited the B2 shade. The thickness of the laminate veneer and background shade significantly modified the original shade of the zirconia veneer. One-way analysis of variance was performed and a Kruskal-Wallis test was used to determine the significance between the three veneer thicknesses groups. The results indicated that the thinner restorations showed higher values with the color imaging spectrophotometer, suggesting that thinner veneers may result in more consistent color matching. This study underscores the importance of carefully considering thickness and background shade when selecting zirconia laminate veneers, to ensure optimal color matching and overall aesthetic outcomes.

3D-Printed Overlay Template for Diagnosis and Planning Complete Arch Implant Prostheses

Dental implants are a reliable alternative to treating edentulism. In clinical situations where the dentition has been severely affected by partial edentulism, advanced wear, or periodontal disease, establishing important occlusal elements such as the occlusal plane, incisal guidance, and esthetics can be hard to visualize at the diagnostic stage. Contemporary data-acquisition technologies such as 3D scanners and CAD/CAM systems permit the precise manufacture of highly complex devices applicable to any stage of restorative treatment. The present clinical report presents an alternative technique for evaluating the projected artificial tooth relationships, vertical dimension, and occlusal plane in patients with severely weakened dentition by using a 3D-printed overlay template.

Full-Mouth Rehabilitation of a Patient with Sjogren's Syndrome with Maxillary Titanium-Zirconia and Mandibular Monolithic Zirconia Implant Prostheses Fabricated with CAD/CAM Technology: A Clinical Report

Dental implants have become a well-established treatment modality for the management of complete and partial edentulism. Recent advancements in dental implant systems and CAD/CAM technologies have revolutionized prosthodontic practice by allowing for the predictable, efficient, and faster management of complex dental scenarios. This clinical report describes the interdisciplinary management of a patient with Sjogren's syndrome and terminal dentition. The patient was rehabilitated using dental implants and zirconia-based prostheses in the maxillary and mandibular arches. These prostheses were fabricated using a combination of CAD/CAM and analog techniques. The successful outcomes for the patient demonstrate the importance of appropriate use of biomaterials and the implementation of interdisciplinary collaboration in treating complex dental cases.

Minimally Invasive Laminate Veneer Therapy for Maxillary Central Incisors

Minimally invasive dentistry is a considered process that requires the clinician to be prepared with the ideal sequence and the tools needed. This report describes a well-planned ultraconservative approach using only two ceramic laminate veneers for the maxillary central incisors to significantly improve the patient's overall smile. A 30-year-old female presented with the chief complaints of having diastemas between the central and lateral incisors as well as incisal wear. Diagnostic wax-up and mock-up were performed, and the patient approved the minimally invasive treatment with veneers only for central incisors. A reduction guide aided the conservative tooth preparations, and hand-crafted feldspathic veneers were bonded under total isolation with a rubber dam. The two final conservative veneers significantly improved the smile and fulfilled the patient's expectations. Following proper planning and sequencing, predictable outcomes were obtained and fulfilled the patient's esthetic demands. Minimally invasive restorative dentistry with only two single veneers can impact the entire smile frame. Overtreatment in the esthetic zone is unnecessary to meet a patient's esthetic expectations.

Polychromatic Composite and Resin Infiltration Restorations in the Esthetic Zone: A Five-year Clinical Report

OBJECTIVE

This case report describes the use of a combination of a polychromatic resin composite restoration and resin infiltration to achieve a satisfactory esthetic outcome that has lasted over five years.

CLINICAL CONSIDERATIONS

The patient's primary complaint was a desire to replace an existing stained resin composite on the facial and mesial surfaces of the maxillary left central incisor, and a white spot on the facial surface of the maxillary right central incisor. After clinical evaluation, the patient was offered either replacement of the restoration with a polychromatic restoration simulating a white spot, or a combined treatment with polychromatic composite and resin infiltration restorations, which was recommended. The patient selected the latter treatment. A putty matrix was fabricated, and a quick mock-up was done using various enamel and dentin shades of resin composite to determine proper material selection. The previous resin composite restoration was removed, and layers of new dentin, body, and enamel composite were placed. An interproximal matrix was used in order to provide ideal contour and contact. Finishing and polishing procedures were performed. The maxillary right central incisor was treated with resin infiltration in order to subdue the white spot on the facial surface.

CONCLUSIONS

Polychromatic resin composite and resin infiltration restorations to replace a stained restoration and mask a white spot can achieve desired results in the esthetic zone and maintain them for five years.

FOR PERI-IMPLANT SOFT TISSUE AUGMENTATION, SOFT TISSUE SUBSTITUTES MAY IMPROVE PATIENTS' SURGICAL AND POSTOPERATIVE EXPERIENCE COMPARED TO AUTOGENOUS GRAFTS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Thoma DS, Strauss FJ, Mancini L, Gasser TJW, Jung RE. Minimal invasiveness in soft tissue augmentation at dental implants: A systematic review and meta-analysis of patient-reported outcome measures. Periodontol 2000. 2022 Aug 11. doi:10.1111/prd.12465. Online ahead of print. PMID: 35950734.

SOURCE OF FUNDING

Not reported.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Health and Well-Being through COVID-19 Vaccination: Physical, Oral, and Psychological Effects

The Coronavirus Disease 2019 (COVID-19) pandemic and its evolving variants have spurred a worldwide effort to control its transmission and reduce its impact [...].

Consequences of COVID-19 and Its Variants: Understanding the Physical, Oral, and Psychological Impact

The highly infectious severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) caused the coronavirus disease 2019 (COVID-19) pandemic, which affects the lives of people worldwide in a variety of unprecedented ways [...].

Dynamic navigation may be used for most implant surgery scenarios due to its satisfactory accuracy

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Wei SM, Zhu Y, Wei JX, Zhang CN, Shi JY, Lai HC. Accuracy of dynamic navigation in implant surgery: A systematic review and meta-analysis. Clin Oral Implants Res. 2021 Apr;32(4):383-393. doi: 10.1111/clr.13719.

SOURCE OF FUNDING

Shanghai Jiao Tong University School of Medicine (grant no. DLY201822); Shanghai Clinical Research Center for Oral Diseases (grant no. 19,411,950,100); Clinical Research Plan of SHDC (grant no. 16CR3033A).

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Effectiveness of Different Polishing Kits for Chairside CAD/CAM Provisional Restorative Materials

Objective: To investigate the efficacy of three specially designed polishing kits for provisional restorations made from three chairside computer-aided design and computer-aided manufacturing (CAD/CAM) provisional resin blocks.

Method: Ninety-six chairside CAD/CAM provisional restorations were milled out of three chairside CAD/CAM provisional resin blocks: (1) ArtBloc Temp (Merz Dental); (2) Telio CAD (Ivoclar Vivadent); and (3) Vita CAD-Temp (VITA Zahnfabrik). The provisional restorations for each material were allocated into the following groups: (1) milled restorations (no polish); (2) polished with CADMaster CAD/CAM Adjustment & Polishing Kit (CM, Shofu); (3) polished with KUT Ultimate Bisacryl (Temporaries) Polishing Kit (KU, Dental Savings Club); and (4) polished with K0330 PMMA Adjusting, Finishing & Polishing (KP, Brasseler USA). Optical profilometry and atomic force microscopy (AFM) were used to assess the surface roughness (Ra) of each provisional restoration at the microscale and nanoscale, respectively, and obtain topographical images. In addition, the milled and polished restorations were visually evaluated by 16 dentists.

Results: There was a strong positive correlation with Ra values between optical profilometry and AFM. Only KP significantly improved the surface roughness of CAD/CAM provisional restorations compared to the milled equivalent, regardless of material type or measurement modality (ie, lateral length scale). Although surface topography imaging with AFM revealed some shallow scratches, even for KP polished specimens, all KP polished restorations were categorized as clinically acceptable for provisional restorations in visual inspections from dentists.

Conclusion: Specially designed polishing kits for provisional restorations did not all improve the surface roughness of chairside CAD/CAM provisional restorations, regardless of the measurement method. KP was more consistently effective in polishing milled chairside CAD/CAM provisional restorations than CM and KU.

Effects of Accelerated Aging on Color Stability and Surface Roughness of a Biomimetic Composite: An In Vitro Study

The aim of this in vitro study is to compare the color stability and surface roughness of conventional and self-blending resin composites before and after staining and aging. Three conventional composites (Filtek Z350, IPS Empress Direct, and Estalite Palfique LX5) and one self-blending (Omnichroma) resin composite were used in this study. Sixty discs were prepared and polymerized in a metal mold (n = 15 per group). Samples were then finished and polished by Layan discs. Color testing and roughness testing were measured as a baseline (T0) by a spectrophotometer and profilometry. Samples were then stained with tea for 24 h, water aged for 30 days, and then a second reading (T1) was performed. Finishing and polishing were performed again, and a third reading (T2) was collected. All groups showed significant decrease in all color parameters (L*, a*, and b*); however, after polishing, all groups showed color enhancements matching pre-experiment baseline colors in all color parameters (L*, a*, and b*), except for Estelite Palfique LX5, which showed a significant difference in L relative to the baseline. Furthermore, Estalite Palfique LX5 showed increased roughness after staining compared to the baseline, unlike other groups. No significant differences in color stability were found between self-blending composites and other composite materials. Accelerated aging and staining had minimal effects on the surface roughness of self-blending composite.

Diagnostic Mock-Up as a Surgical Reduction Guide for Crown Lengthening: Technique Description and Case Report

Background and Objectives: The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. Materials and Methods: The patient's primary concern was improving her smile due to her "gummy smile" and short clinical crowns. After clinical evaluation, surgical crown lengthening accompanied by maxillary central full-coverage single-unit prostheses and lateral incisor veneers was recommended. The diagnostic mock-up was placed in the patient's maxillary anterior region and used as a soft tissue reduction guide for the gingivectomy. Once the planned gingival architecture was achieved, a flap was reflected to proceed with ostectomy in order to obtain an appropriate alveolar bone crest level using the overlay. After six months, all-ceramic crowns and porcelain veneers were provided as permanent restorations. Results: A diagnostic mock-up fabricated with a putty guide directly from the diagnostic wax-up can be an adequate surgical guide for crown-lengthening procedures. The diagnostic wax-up was used to fabricate the diagnostic mock-up. These results suggested that it can be used as a crown-lengthening surgical guide to modify the gingival architecture. Several advantages of the overlay used in the aesthetic complex case include: (1) providing a preview of potential restorative outcomes, (2) allowing for the appropriate positioning of gingival margins and the desired alveolar bone crest level for the crown-lengthening procedure, and (3) serving as a provisional restoration after surgery. Conclusions: The use of a diagnostic mock-up, which was based on a diagnostic wax-up, as the surgical guide resulted in successful crown lengthening and provisional restorations. Thus, a diagnostic overlay can be a viable option as a surgical guide for crown lengthening.

Ceramic and Composite Polishing Systems for Milled Lithium Disilicate Restorative Materials: A 2D and 3D Comparative In Vitro Study

Purpose: This study aims to evaluate the effectiveness of two ceramic and two composite polishing systems for a novel chairside computer-aided design/computer-aided manufacturing (CAD/CAM) lithium disilicate ceramic with three-dimensional and two-dimensional microscopy images. This ceramic material can be used for implant-supported or tooth-borne single-unit prostheses. Materials and Methods: Sixty flat samples of novel chairside CAD/CAM reinforced lithium disilicate ceramic (Amber Mill, Hass Bio) were divided into five groups (n = 15/group) and treated as follows: Group 1 (NoP), no polished treatment; group 2 (CeDi), polished with ceramic Dialite LD (Brasseler USA); group 3, (CeOp) polished with ceramic OptraFine (Ivoclar Vivadent); group 4, (CoDi) polished with composite DiaComp (Brasseler USA), and group 5 (CoAs), polished with composite Astropol (Ivoclar Vivadent). The polished ceramic surface topography was observed and measured with three-dimensional and two-dimensional images. Results: All polishing systems significantly reduced the surface roughness compared with the non-polished control group (Sa 1.15 μm). Group 2 (CeDi) provided the smoothest surface arithmetical mean eight with 0.32 μm, followed by group 3 (CeOp) with 0.34 μm. Group 5 (CoAs) with 0.52 μm provided the smoothest surface among the composite polishing kits. Group 4 (CoDi) with 0.66 μm provided the least smooth surface among all polishing systems tested. Conclusions: Despite the effectiveness of ceramic polishing systems being superior to composite polishing systems of the CAD/CAM lithium disilicate restorative material, both polishing systems significantly improved the smoothness.

Additive Wax-Up and Diagnostic Mockup As Driving Tools for Minimally Invasive Veneer Preparations

This report describes the importance of and outlines steps for additive wax-up and diagnostic mockup for anterior teeth as diagnostic and driving tools for non-prep and minimally invasive veneer preparations. A 35-year-old male presented to the clinic with the chief complaint of spaces between his front teeth. Diagnostic additive wax-up provided the possibility of offering minimally invasive preparations, and the use of a diagnostic intraoral mockup fulfilled the patient’s esthetic demands for treatment approval. Veneer preparations over the diagnostic mockup were provided as they are minimally invasive. Ceramic veneers were hand-crafted following the previous diagnostic wax-up, and restorations were bonded under rubber dam isolation. Overall, additive wax-up provides information needed to know if minimally invasive veneer preparations are possible, and the diagnostic mockup displays a physical, tentative outcome for the patient’s evaluation before irreversible tooth preparations. These simple, but effective, techniques can drive the diagnosis and prognosis of minimally invasive veneer restorations.