Recontouring teeth and closing diastemas with direct composite buildups: A clinical evaluation of survival and quality parameters

Randomized Clinical Trial on Direct Composite and Indirect Ceramic Laminate Veneers in Multiple Diastema Closure Cases: Two-Year Follow-Up

In recent years, laminate veneer restorations should be considered as a minimally invasive treatment option for several aesthetic reasons. This study compared direct composite veneers' and indirect ceramic laminate veneers' longevity in multiple diastema closures. A total of 28 patients with a mean age of 26 years received 60 direct resin composite (Estelite Asteria; n = 14) and 60 indirect ceramic veneers (IPS e.max Press; n = 14) on the maxillary anterior teeth with diastema closure. Veneers were evaluated at baseline and thereafter every 6 months for up to 2 years using USPHS criteria. Data were analyzed with Fisher's exact and chi-squared tests, while Kaplan-Meier curve was used to assess time to event. In total, three failures were observed in the form of debonding (n = 1) and fracture (n = 2) in the indirect ceramic veneers. No significant difference was observed between the survival rates of composite and ceramic veneers (Estelite Asteria: 93.4%, IPS e.max Press: 95%; p > 0.05). The overall survival rate was 94.2% (Kaplan-Meier). Staining (n = 11) and roughness (n = 14) were frequently observed for the resin composite veneers up to the final recall. Thereby, the preliminary results from this clinical trial comparing two veneer materials indicated that their survival rates were statistically similar. However, surface quality changes were more frequent in the composite veneer material.

Entire Dental Arch Mesial Movement after Extraction of Maxillary Right Central Incisor due to Root Fracture Treated with Temporary Anchorage Devices

This case report describes a 19-year-old woman with skeletal Class I crowding and an unsalvageable maxillary right central incisor. She visited our clinic with the chief complaint of mobility of the maxillary right central incisor due to a traffic accident. After extraction of the maxillary right central incisor, the space was closed orthodontically. All the maxillary right teeth were moved mesially with an elastic chain attached to a palatal lever arm which was connected to palatal temporary anchorage devices (TADs). After orthodontic treatment had been completed, the maxillary right lateral incisor and peg-shaped left lateral incisor were restored with a porcelain laminate veneer. The maxillary right canine was morphologically reshaped and built up with composite resin. Consequently, esthetically ideal occlusion and functional lateral guidance with uncontacted molars were obtained. These results show that mesial movement of the entire dental arch with TADs is a useful orthodontic treatment option in patients in whom the maxillary central incisor has been extracted.

Testing mechanical properties and degree of conversion of resin-based composite material containing contact killing antibacterial agent in comparison with fluoride composite resin

Background

A major drawback of resin composites is their tendency to accumulate microbial biofilms that can lead to secondary caries. The objective of this study was to compare the mechanical properties and the degree of conversion of commercial resin-based composite materials containing a contact-killing antibacterial agent, dimethylaminohexadecyl methacrylate (DMAHDM), at different concentrations, with a fluoride-releasing composite material.

Materials and methods

Four groups were tested: Tetric N Ceram composite material (G1), Tetric Evo Ceram (G2), and Tetric N Ceram with the addition of contact-killing antibacterial agent DMAHDM at concentrations of 3% (G3) and 5% (G4). The mechanical properties, including flexural strength, elastic modulus, and Vickers microhardness and the degree of conversion were investigated.

Results

Adding 3 % and 5 % DMAHDM resulted in flexural strength values that were comparable to Tetric Evo Ceram. Tetric N Ceram was comparable to the group containing 3 % DMAHDM (p > 0.05). However, it was significantly greater when compared to Tetric Evo Ceram (93.3 ± 9.4) and 5 % DMAHDM (p < 0.05). Both the elastic modulus and Vickers microhardness values of Tetric N Ceram were significantly higher than those of the other groups (p < 0.05). Furthermore, the elastic modulus of Tetric Evo Ceram showed similar results to groups with 3 % and 5 % DMAHDM. Nevertheless, the Vickers microhardness value is significantly higher when compared to 5 % DMAHDM (0.394 ± 0.021) (p < 0.05) while it was comparable to that of 3 % DMAHDM (0.484 ± 0.016) (p > 0.05). There was no statistically significant difference in the degree of conversion between the groups (p > 0.05).

Conclusion

Adding 3% DMAHDM to Tetric N Ceram resulted in flexural strength values that were similar to those of Tetric N Ceram and Tetric Evo Ceram. DMAHDM did not affect the degree of conversion of Tetric N Ceram composite.

The Effect of Ground and Unground Enamel on the Clinical Performance of Direct Composite Build-up After Orthodontic Treatment: Five Years of Follow-up

PURPOSE

To assess the clinical performance of restorations with ground and unground enamel for diastema closure.

METHODS AND MATERIALS

Twenty-four patients attended and received two to ten composite build-ups for diastema closure. The restorations were performed separately by grinding and not grinding the enamel on the proximal surfaces on symmetric teeth. A nanofill direct composite (Filtek Ultimate Universal Restorative System, 3M ESPE, St Paul, MN, USA) was used with a three-step etch-and-rinse adhesive (Scotchbond Multi-Purpose, 3M ESPE) for restorations. Restorations were evaluated according to the modified United States Public Health Service (USPHS) criteria at baseline and 1-, 2-, 3-, 4-, and 5-year recalls.

RESULTS

The cumulative success rate of direct composite build-up with ground and unground enamel was 100% and 88.7%, respectively. Six restorations with unground enamel failed due to fracture. No significant difference was found between the restorations with ground enamel and unground enamel with regard to the evaluation criteria.

CONCLUSION

The 5-year success rates of restorations with ground and unground enamel were excellent. The success rate of restorations with ground enamel was higher than that of restorations with unground enamel. Fracture was the reason for failure in the restorations with unground enamel.

Esthetic Rehabilitation of Pediatric Patients Using Direct Bonding Technique—A Case Series Report

Pediatric esthetic dentistry is a sensitive technique, as children can be less cooperative; hence, minimal appointments are preferred. The most conservative treatment modality for anterior esthetic rehabilitation is using direct composite veneer restorations. In many instances, esthetic improvements using composite resin are the only possible option until the growth phase of the pediatric patient is complete. In this article, we present three different case scenarios in young teenagers with different treatment needs requiring esthetic restorations. The first case report is a patient with amelogenesis imperfecta, the second is with generalized spacing, and the third is with localized microdontia. All three patients were followed up for six months post direct composite veneering and were highly satisfied with their treatment outcomes, which boosted their self-confidence.

Longevity of Direct Resin Composite Restorations in Maxillary Anterior Crown Fractures: A 4-year Clinical Evaluation

OBJECTIVES

To investigate the longevity of direct composites for Class IV restorations and the possible reasons of failure.

METHODS AND MATERIALS

The longevity of 168 Class IV restorations in 50 adult patients was evaluated, in terms of modified United States Public Health Service criteria, for 4 years. Restorations were performed using a monochromatic layered microhybrid, resinbased composite (RBC) (Essentia, Universal Shade, GC Corporation, Japan; n=76) and polychromatic layered micro/nanohybrid (MD and LE shades, Essentia, GC Corporation, Japan; n=92) RBCs, by a single operator.

RESULTS

The majority of the teeth (n=156) remained acceptable at the end of 4 years, and the overall survival (OS) rate was considered as 92.86%. Survival rates for the monochromatic layering technique (MLT) and polychromatic layering technique (PLT) were 90.8% and 94.6%, respectively. Mean survival was 46 months for MLT and 47 months for PLT, indicating no significant difference (p=0.343). Fracture of the restoration was the most common reason for failure (4.2% out of 7.1% of general failures) for both the layering techniques.

CONCLUSIONS

Under the conditions of this mid-term clinical study, MLT and PLT as well as microhybrid and nanohybrid resin composite materials, showed similar clinical durability. In terms of simplicity, monochromatic layering can be preferred for Class IV restorations, when the right indication criteria are met.

Low-Shrinkage Resin Matrices in Restorative Dentistry-Narrative Review

Dimethacrylate-based resin composites restorations have become widely-used intraoral materials in daily dental practice. The increasing use of composites has greatly enhanced modern preventive and conservative dentistry. They have many superior features, especially esthetic properties, bondability, and elimination of mercury and galvanic currents. However, polymeric materials are highly susceptible to polymerization shrinkage and stresses that lead to microleakage, biofilm formation, secondary caries, and restoration loss. Several techniques have been investigated to minimize the side effects of these shrinkage stresses. The primary approach is through fabrications and modification of the resin matrices. Therefore, this review article focuses on the methods for testing the shrinkage, as well as formulations of resinous matrices available to reduce polymerization shrinkage and its associated stress. Furthermore, this article reviews recent cutting-edge developments on bioactive low-shrinkage-stress nanocomposites to effectively inhibit the growth and activities of cariogenic pathogens and enhance the remineralization process.

Affordable aesthetic management for a patient from low income strata to improve social well-being: A case report

Background:

Aesthetic correction involves a holistic approach which considers the oral cavity as a whole by the norms of the treatment. Aesthetics enhance the facial profile and also the smile line of the patient which improves the quality of life of a patient enabling them to a better socioeconomic status. Smile correction of a patient paves the path for a systematic approach to the treatment and also imparts an improved level of confidence which leads to new opportunities both in the personal and professional field. AeEsthetic correction provides challenging aspects concerning patient satisfaction and functional demands. This is the most affordable treatment for patients’ who are not financially sound in developing countries like India. The other treatment modalities such as Veneers or All-ceramic crowns are aesthetically pleasing but are quite expensive for people in the lower income strata. Due to this, direct composite treatment is very economical and it also improves the patient’s overall confidence and it helps them to socialise well and carry out their daily routine activities without any hindrance and difficulty.

Case Report:

This case report deals with the esthetic correction of midline diastema and spacing in the maxillary and mandibular anterior region. Conclusion: Aesthetic correction involves meticulous treatment planning to revive the essence of lost beauty as well as improve the functional aspect for the patient.

Conclusion:

Aesthetic correction involves meticulous treatment planning to revive the essence of lost beauty as well as improve the functional aspect for the patient.

Spectrophotometric evaluation of restorative composite shades and their match with a classical shade guide

Objectives

The aim of this study was to verify the match between 5 shades of composites from different manufacturers with a shade guide and among the systems using a portable spectrophotometer.

Materials and Methods

Shade measurements were performed on specimens of Z350 XT (3M ESPE), Charisma Diamond (Heraeus Kulzer GmbH), Esthet X-HD (Dentsply Caulk), and Empress Direct (Ivoclar-Vivadent) for shades A1, A2, A3, B1, and C3 using a Vita Easyshade spectrophotometer (Vita Zahnfabrik) against a white background. Corresponding shades of Vitapan Classical (Vita Zahnfabrik) guide were measured likewise and shade variation (ΔE) was calculated based on International Commission on Illumination L*a*b* parameters. The ΔE of the composites in each shade was compared by one-way analysis of variance and Tukey's post hoc test (α = 0.05).

Results

All composites presented ΔE > 3.7 compared with the shade guide. Variation in shades A3, B1, and C3 was significantly different for all composites. ΔE of Z350 XT was significantly lower for A1 than for the other shades, whereas ΔE of Z350 XT and Charisma Diamond were significantly lower for A2 than for the other shades.

Conclusions

No composite shade matched with the shade guide. Equivalent shades of the restorative composite from different manufacturers may show clinically noticeable ΔE.

The "Pre-Finishing" Approach in Direct Anterior Restorations. A Case Series

In esthetic restorations of anterior teeth the clinician has to manage several aspects in order to have a predictable outcome. A deep knowledge of the anatomy as well as the adhesive procedures and the optical properties of resin-based composites are mandatory to achieve esthetic results. Contemporary restorative materials present either several shades and different translucency properties and therefore they are able to mimic teeth’s optical behavior thus providing a natural aspect to anterior restorations. The wrong thickness of different composite layers may provide unpleasant results such as low value (grayish) restorations that often requires reintervention. A precise step-by-step procedure is therefore mandatory to provide the proper shade at the correct place. There is therefore the need of some corrections and adjustments during the layer procedure in order to avoid errors in shade positioning that could affect final result. The authors present a case series (six clinical cases) treated with the proposed technique with up to five years follow-up.

Longevity of direct diastema closure and recontouring restorations with resin composites in maxillary anterior teeth: A 4-year clinical evaluation

OBJECTIVES

To evaluate the clinical performance of resin composite restorations and to investigate causes of failure.

MATERIALS AND METHODS

The longevity of 216 restorations in 53 patients (mean age, 33.3 years) was retrospectively evaluated according to Fédération Dentaire Internationale (FDI) criteria. Dental history and photographic data were used to evaluate diastema closure (n = 199) and recontouring (n = 19) restorations comprising microhybrid (Essentia Universal, GC Corp.), nanohybrid (Ceram.x One, Dentsply Sirona), and nanofilled (Estelite Asteria, Tokuyama Dental) composites. Data were analyzed with the Kaplan-Meier log-rank test, Cox regression analysis, Pearson chi-square test. p < 0.05 was considered statistically significant. The overall survival rate was 90.3 % and the mean survival duration was 46.2 months during the for 4 - year study period. The annual failure rate was 0.9 % - 3.4 %. Mean survival durations for diastema closure and recontouring restorations were 46.2 and 45.9 months, respectively (p = 0.328). Mean survival durations for Essentia Universal, Estelite Asteria, and Ceram.x One were 46.1, 46.7, and 45.7 months, respectively (p = 0.677). If we include failed restorations that were repaired and remained functional, the overall survival rate was 100 %.

CONCLUSION

Longevity was similar among composites and restoration types. The long-term clinical performance of monochromatic anterior composite restorations was robust. Composite repair may be suitable for diastema closure and recontouring restorations.

CLINICAL SIGNIFICANCE

There is a lack of long-term clinical evidence regarding the performance of direct anterior composite restorations. Monochromatic direct composite restorations may meet both the esthetic and functional expectations with even simpler restorative techniques. This 4 - year follow-up study evaluated the clinical performance of monochromatic anterior diastema closure and recontouring restorations with three different composite materials. The longevity of the restorations and the reasons for failure were investigated.

5-year retrospective evaluation of direct composite restorations in orthodontically treated patients

OBJECTIVES

In patients affected by dimensional discrepancy between size of anterior maxillary and mandibular teeth, orthodontic therapy could be necessary to solve occlusal problems. However, anterior restorations are indicated to finalize the aesthetic aspect of the therapy. The aim of the present retrospective clinical study was to evaluate the long-term outcomes of direct additive composite restorations performed to correct anterior teeth discrepancies persisting after orthodontic treatment.

METHODS

Patients with dimensional teeth discrepancy, subjected to a combined orthodontic-restorative treatment, between January 2009 and January 2019, were recalled for the present retrospective evaluation and divided in two groups according to the restoration performed: G1) diastema closure; G2) tooth shape modification. All patients, after ortho therapy, were subjected to a standardized restorative rehabilitation of the anterior area. All restorations were performed by a single experienced operator employing the same materials. During recall visits, two calibrated examiners evaluated the restorations and recorded USPHS data. Kaplan-Meier estimator and Cox-regression analysis were performed. Statistical significance was set for p < 0.05.

RESULTS

53 patient were included, with a total of 169 restoration (G1:110;G2:59). The mean study time period was 5 year (ranging from 6 month to 10 years). The overall survival rate of additive restoration was 2,59% (G1:2,07%; G2:0,47 p < 0.05). Chipping of the material was the most frequent adverse event (G1:13,64%; G2:1,69), followed by composite wear (G1:9,09%; G2:5,17).

CONCLUSIONS

Based on the obtained results, good clinical performances were shown at a 5-year interval. A low number of failures were collected and most of them were classified as reparable. Only few cases needed complete reintervention.

CLINICAL SIGNIFICANCE

Showing that a direct approach in restoring anterior teeth for diastema closure or shape modification is a valid alternative in terms of durability and aesthetics to more invasive procedure such as indirect restorations.

Occlusal and Esthetic Enhancement: A Noninvasive Approach to an Old Dilemma

This article describes an indirect composite restoration technique for diastema closure and tooth lengthening with a noninvasive approach using regularly available materials such as silicone, composite resin, and an adhesive system. The procedure resulted in occlusal and functional improvement, with diastema closure, protrusive guide adjustment, and an increase in central incisor length. The procedure provided an adequate proportion of the central incisors with an esthetically natural appearance. It also resulted in simple, fast, and accurate manufacturing with a noninvasive esthetic indirect rehabilitation compared with more invasive preparation of ceramic veneers.

Advances in materials and concepts in fixed prosthodontics: a selection of possible treatment modalities

The introduction of adhesive techniques in combination with translucent restorative materials has greatly influenced treatment concepts in fixed prosthodontics. Modern production technologies offer access to new polymer materials that provide innovative pre-treatment options for complex prosthetic rehabilitations. Additionally, computer-aided design and manufacturing (CAD/CAM) provides access to new ceramic types and thus extends the range of indications for metal-free restorative options. With these developments, important changes of treatment concepts in fixed prosthodontics have occurred which affect the professional life of dental practitioners with a focus on prosthetic dentistry. This article gives an overview of the advances in selected fields of fixed prosthodontics and provides support in material selection for different kinds of indications, from single-tooth restorations to fixed dental prostheses.

The Success of Dental Veneers According To Preparation Design and Material Type

BACKGROUND:

Due to their high aesthetic outcome and long-term predictability, laminate veneers have become a common restorative procedure for anterior teeth. However, because of the variety in the preparation designs and the material types, the clinician faces a dilemma of which approach to use.

AIM:

To compare the survival rate of dental veneers according to different preparation designs and different material types. The sub-aim is to reach a favourable preparation design and material based on scientific evidence.

METHODS:

Comprehensive electronic search of the dental literature via PUBMED, MEDLINE and Scopus databases was performed using the following keywords: “porcelain veneers”, “composite veneers”, “all-ceramic veneers”, “success of porcelain veneers”, “preparation design”, “preparation geometry”, “patient’s satisfaction”. Additionally, references from the selected studies and reviews were searched for more information.

RESULTS:

Under the limitations of the available literature, the clinician preference is the decisive factor for choosing the preparation design. Nonetheless, incisal overlap preparation seems to have the most predictable outcome from all the preparation designs.

CONCLUSION:

Porcelain veneers show excellent aesthetic results and predictable longevity of the treatment, while composite veneers can be considered as a good conservative option, but with less durability.

Five-year Clinical Evaluation of a Nanofilled and a Nanohybrid Composite in Class IV Cavities

The purpose of this study was to evaluate a nanofilled and a nanohybrid composite, in combination with manufacturer-recommended etch-and-rinse adhesives, in class IV cavities. Thirty-four patients aged 14-46 years (mean age, 27.1 years) comprised the study group. Twenty-six patients received two class IV restorations and eight patients received four class IV restorations. For each patient, half the number of restorations were performed using a nanohybrid composite (Ceram X duo) and the remaining half used a nanofilled resin composite (Filtek Supreme XT), with two- (XP Bond) and three-step (Scotchbond Multipurpose) etch-and-rinse adhesives, respectively. Two experienced examiners evaluated the restorations for retention, color match, marginal discoloration, wear/loss of anatomic form, caries formation, marginal adaptation, and surface texture to compare the baseline (after placement) and annual recalls over 5 years. The cumulative success rates for the Filtek Supreme XT and Ceram X duo restorations after five years were 86.2% and 89.7%, respectively. Four Filtek Supreme XT and three Ceram X duo restorations failed. There was no statistically significant difference between the nanofilled and nanohybrid composites at any of the evaluation periods for any of the parameters evaluated. Despite the limited number of restorations, all restorations were clinically acceptable regarding retention, color match, marginal discoloration, wear or loss of anatomic form, the formation of caries, marginal adaptation, and surface texture, except the failed restorations. Fracture was the main cause of restoration failure.

Effects of adhesive used as modeling liquid on the stability of the color and opacity of composites

OBJECTIVE

This study evaluated the effects of adhesive type used as modeling liquid on the stability of the color and opacity of composites submitted to thermal cycling in staining solutions followed by a bleaching procedure.

METHODS

Thirty cylinder-shaped composite specimens (10 mm diameter × 1.5 mm thickness) were built using or not using (control) an adhesive (Adper Universal or Scotchbond Multipurpose) as the modeling liquid. After polishing procedures, the color and opacity were measured, and the specimens were submitted to 200 thermal cycles with 10 s of dwell time in baths of grape juice at 5°C, water at 37°C, and coffee at 55°C. Changes in opacity and color caused by the staining solutions were measured. Then, the specimens were bleached with 35% hydrogen peroxide for 45 minutes followed by color/opacity measurements. Data were analyzed by ANOVA and Tukey's test (α = 0.05).

RESULTS

The use of modeling liquids did not affect the initial color and opacity of composite. Reduced changes to color (E₀₀  = 3.44) and opacity (+2.67%) were observed for specimens modeled using Adper Universal. Bleaching procedures reduced the color (E₀₀  = 1.9-3.8) and opacity (-2.3 to 3.1%) alterations caused by staining solutions but were unable to restore the values observed at baseline.

CONCLUSION

The use of universal adhesive as modeling liquid significantly reduced the color and opacity changes caused by staining solutions, and the bleaching procedure partially re-established the opacity and color of the composites.

CLINICAL SIGNIFICANCE

This study evaluates whether using adhesive systems for modeling a composite affects the color and opacity changes caused by staining solutions followed by a bleaching procedure. The findings suggest that the use of a universal adhesive as modeling liquid can reduce the alterations in optical properties caused by staining solutions, and the application of high-concentrated hydrogen peroxide over the composite reduce the color changes without fully recover the initial color.

A multidisciplinary approach to the management of a maxillary midline diastema: A clinical report

A maxillary midline diastema (MMD) is a common complaint of dental patients. An MMD can be closed with treatment from different disciplines, including operative dentistry and orthodontics. A comprehensive smile analysis is also a necessity before beginning treatment. This article highlights the closure of a 3-mm MMD by using a combination of orthodontics and direct composite resin restorations.

Microhybrid versus nanofill composite in combination with a three step etch and rinse adhesive in occlusal cavities: five year results

Objectives

The aim of the study was to evaluate the 5-year clinical performance of occlusal carious restorations using nanofill and microhybrid composites, in combination with 3-step etch-and-rinse adhesives, in patients who were going to commence orthodontic treatment.

Materials and Methods

A total of 118 restorations for occlusal caries were conducted prior to orthodontic treatment. Occlusal restorations were performed both with Filtek Supreme XT (3M ESPE) and Filtek Z250 (3M ESPE) before beginning orthodontic treatment with fixed orthodontic bands. Restorations were clinically evaluated at baseline and at 1, 2, 3, 4, and 5-year recalls.

Results

None of the microhybrid (Filtek Z250) and nanofill (Filtek Supreme XT) composite restorations was clinically unacceptable with respect to color match, marginal discoloration, wear or loss of anatomical form, recurrent caries, marginal adaptation, or surface texture. A 100% success rate was recorded for both composite materials. There were no statistically significant differences in any of the clinical evaluation criteria between Filtek Z250 and Filtek Supreme XT restorations for each evaluation period.

Conclusions

The composite restorations showed promising clinical results relating to color matching, marginal discoloration, wear or loss of anatomical form, recurrent caries, marginal adaptation, and surface texture at the end of the 5-year evaluation period.

Clinical Performance of Different Solvent-based Dentin Adhesives With Nanofill or Nanohybrid Composites in Class III Restorations: Five Year Results

Purpose:

To evaluate the clinical performance of water, acetone, ethanol, and ethanol-water solvent-based dentin adhesives with nanofill or nanohybrid composites in Class III restorations.

Methods and Materials:

A total of 22 patients aged between 14 and 48 years (mean age: 25.2 years) participated in the study. Each patient received four Class III restorations, which were performed using water (Scotchbond Multipurpose), acetone (Prime&Bond NT), ethanol (XP Bond) and ethanol-water (Xeno V) solvent-based dentin adhesive systems with a nanofill (Filtek Supreme XT) or nanohybrid composite (CeramX Duo). Two experienced examiners evaluated the restorations with regard to retention, color match, marginal discoloration, wear/loss of anatomic form, caries formation, marginal adaptation, and surface texture at baseline and at one-, two-, three-, four-, and five-year recalls.

Results:

The five-year survival rates were 100% for Scotchbond Multipurpose, Prime&Bond NT, and XP Bond and 81.2% for Xeno V–bonded restorations. Only three Xeno V–bonded restorations failed. With the exception of marginal discoloration, there were no statistically significant differences among the four adhesive-bonded restorations in any of the evaluation periods in terms of the evaluation criteria.

Conclusions:

With the exception of marginal discoloration and marginal integrity deterioration of Xeno V–bonded restorations, all four adhesive-bonded restorations exhibited good long-term results. However, adhesion strategy (such as self-etch or etch-and-rinse) is more important than the solvent content of dentin adhesive systems in the success of Class III restorations.

Esthetic smile rehabilitation of anterior teeth by treatment with biomimetic restorative materials: a case report

BACKGROUND

In daily clinical practice, esthetics of anterior teeth is a common presenting complaint of patients.

OBJECTIVE

This case report discusses the management of asymmetric smile associated with unsatisfactory extensive composite restorations and describes a clinical protocol using the direct composite resin for smile enhancement to restore the dental harmony of anterior teeth.

METHODS

The treatment planning was based on a diagnostic wax-up and cosmetic mock-up. After clinical and patient approvals were obtained, the patient was subjected to direct and indirect restorative treatment.

CONCLUSION

Nanocomposites are an effective alternative for anterior teeth restorations. Additionally, good planning enables satisfactory esthetic results, leading to the correction of an inappropriate axial inclination of incisors.

Direct resin composite restorations for fractured maxillary teeth and diastema closure: A 7 years retrospective evaluation of survival and influencing factors

OBJECTIVES

This retrospective study evaluated the survival rate of anterior direct resin based composite (RBC) build-ups in vital teeth made of microhybrid and nanofill RBC materials and the influence of bruxism, beverage consumption and smoking on the long-term performance of restorations.

METHODS

Patients receiving anterior restoration between 2006 and 2011, with the diagnosis of fracture or diastema, were selected. A total of 65 adult patients (mean age: 25.2) with 163 restorations (78 Filtek Supreme XT and 85 Enamel Plus HFO) were evaluated using the USPHS criteria. Data were analyzed with Fisher's Exact Test, Extended Cox-regression analysis and Kaplan-Meier method.

RESULTS

Mean observation period was 7.2 (±1.4) years and the mean annual failure rate for this period was 1.43%. The reasons of failures included restoration fracture and color mismatch. Nanofill restorations had significantly higher rate of color mismatch (p=0.002), microhybrids more frequently failed in fracture of restoration (p=0.034). The overall difference in potential hazard of using Enamel Plus HFO or Filtek Supreme XT was not significant (p=0.704). Chipping or fracture of the restoration was more frequent in the first year after placement (p=0.036), while beverage consumption was significantly correlated with discoloration of the restorations (p=0.005).

SIGNIFICANCE

The application of direct RBC restorations provides an excellent treatment option for fractured teeth and for closing diastemas. The overall survival rate was 88.34% up to 10 years. Microhybrid and nanofill RBC restorations showed similar survival rates, however nanofills discolored at a higher rate, meanwhile chipping of the restoration occurred frequently with microhybrids.

Case Report: A Predictable Technique to Establish Occlusal Contact in Extensive Direct Composite Resin Restorations: The DSO-Technique

This paper describes the application technique of direct shaping by occlusion (DSO) for large composite restorations including the entire occlusal surface. For this technique, matrix bands and wedges are inserted without interference with antagonists in the desired occlusion. The final increment of soft-composite resin is shaped by letting the patient occlude on the uncured composite. Due to the nature of the technique, special care has to be taken for moisture control and handling of contamination. The procedure, advantages, and limitations of the technique are discussed.

Multiple diastema closure in periodontally compromised teeth: How to achieve an enamel-like emergence profile

This article describes a direct composite resin technique for the closure of multiple diastemas. The described procedure allows an anatomic and esthetic emergence profile of the apical third of the tooth to be obtained in periodontally compromised teeth without the use of interproximal wedges.

A Conservative Esthetic Approach Using Enamel Recontouring and Composite Resin Restorations

Conservative clinical solutions, predictable esthetic, and immediate outcomes are important concepts of restorative dentistry. The aim of this case study was to recognize the selective enamel removal as an interesting conservative alternative to achieve optimal esthetic results and discuss the clinical protocol. This clinical report described an alternative esthetic and conservative treatment to transform the long and sharp aspect of the maxillary canines with a slightly aggressive aspect into features of slightly curved teeth with delicate lines. An accurate diagnostic and esthetic analysis of the smile was initially performed. The selective enamel removal was performed, and direct composite restoration was strategically placed. Clinical assessment showed good esthetic outcomes, enabling a smile harmony with an immediate, simple, and lower-cost technique. Practitioners should be exposed to conservative approaches to create esthetic smiles based on the selective enamel removal technique combined with composite resin.

Conservative Approach for the Esthetic Management of Multiple Interdental Spaces: A Systematic Approach

PURPOSE

To describe a conservative approach using resin-based composites following a buccolingual layering technique with a customized silicon index for the management of multiple diastemas.

CLINICAL CONSIDERATIONS

This clinical article describes the case of a patient with their anterior teeth esthetically compromised by multiple diastemas, incisal wear, and dull/low-value cervical composite resin restorations that were managed with nanofilled composite resin using the "buccolingual technique" with a customized silicon index made from a wax-up to build up the restorations. The first layer of composite placed lingually that represents the enamel replacement was placed directly on the silicon index so that it provides in one single step the lingual profile and the position of the incisal edge of the restoration. Then, dentine and effect composite resin can be applied in a precise three-dimensional configuration.

CONCLUSIONS

To solve esthetic dental problems, as anterior diastemas, in a very conservative and even reversible way, the use of direct resin composites for layering is an excellent choice, but should be performed based on simple and reproducible techniques, as the buccolingual technique.

CLINICAL SIGNIFICANCE

The clinical technique described in this paper shows the advantages of a conservative approach to correct diastemas on maxillary anterior teeth. The application of these techniques can not only help achieve optimal esthetics, but also avoid the removal of extensive dental hard tissue and achieve a predictable final result, especially in esthetically demanding cases.

Prefabricated composite resin veneers--a clinical review

OBJECTIVE

This clinical technique article is focused on the use of prefabricated veneers to enhance the esthetic appearance of the anterior dentition in patients who needed an alternative esthetic solution more affordable than traditional porcelain veneers.

CLINICAL CONSIDERATIONS

Because prefabricated composite veneer systems have been recently introduced, they are not widely used. The Componeer system (Coltene, Altstätten, Switzerland) contains thin pre-polymerized hybrid composite shells, several shades of a direct hybrid composite resin, an etch-and-rinse adhesive system, and restorative accessories including finishing points and disks. The prefabricated restorations can be customized in the mouth for color and shape. The technique described in this article can be used to restore function and esthetics in one office visit.

CONCLUSIONS

The prefabricated composite veneer technique has some of the advantages of direct composite restorations, as only one session is required without the need to take impressions to send to the dental laboratory. This new treatment option may open new opportunities for dental professionals and their patients. However, it is paramount to carry out controlled clinical studies with this restorative technique prior to recommending it without restrictions in general practice.

CLINICAL SIGNIFICANCE

The clinical technique described in this paper has the potential for being used routinely to lengthen anterior teeth, to correct malpositioned teeth, to mask discolorations, and to close diastemas. The technique can also be used to restore extensive caries lesions and tooth fractures, and to refurbish large old anterior restorations, especially when other treatment options are out of reach for the patient for financial reasons.

Influence of Gender on the Patient's Assessment of Restorations on the Upper Anterior Teeth

OBJECTIVE

The aim of this study was to assess the level of patients' satisfaction with appearance of maxillary anterior teeth restorations and to determine if there is a significant difference in patients' assessment of restoration appearance with regard to gender.

MATERIALS AND METHODS

Two hundred subjects evaluated the colour, anatomical shape and surface texture of maxillary anterior teeth restorations (composite fillings, acrylic faceted metal crowns, porcelain-fused-to-metal crowns and all-ceramic crowns) in comparison with adjacent natural teeth. The data were expressed in patients' average assessment scores for colour, anatomical shape and surface texture as well as overall patients' average assessment scores for every type of restoration and overall patients' average assessment scores for colour, anatomical shape and surface texture of all the restorations in general. Patients also assessed the general impression of their maxillary anterior teeth restorations and rated it as satisfactory or unsatisfactory.

RESULTS

There was a statistically significant gender difference in patient assessment of colour and surface texture for composite fillings and the overall patient average assessment score for colour of all assessments (p <0.05). Women were more dissatisfied with the general impression of their restorations on the upper teeth than men (p >0.05). Only overall patients' average assessment score for composite restorations almost reached the level of significance (p = 0.069) on patients' general impression.

CONCLUSION

Colour of the restorations and the composite material are significant factors which affect dental appearance of maxillary anterior teeth in patients.

Nanoparticle release from dental composites

Dental composites typically contain high amounts (up to 60 vol.%) of nanosized filler particles. There is a current concern that dental personnel (and patients) may inhale nanosized dust particles (<100 nm) during abrasive procedures to shape, finish or remove restorations but, so far, whether airborne nanoparticles are released has never been investigated. In this study, composite dust was analyzed in real work conditions. Exposure measurements of dust in a dental clinic revealed high peak concentrations of nanoparticles in the breathing zone of both dentist and patient, especially during aesthetic treatments or treatments of worn teeth with composite build-ups. Further laboratory assessment confirmed that all tested composites released very high concentrations of airborne particles in the nanorange (>10(6)cm(-3)). The median diameter of airborne composite dust varied between 38 and 70 nm. Electron microscopic and energy dispersive X-ray analysis confirmed that the airborne particles originated from the composite, and revealed that the dust particles consisted of filler particles or resin or both. Though composite dust exhibited no significant oxidative reactivity, more toxicological research is needed. To conclude, on manipulation with the bur, dental composites release high concentrations of nanoparticles that may enter deeply into the lungs.

Longitudinal evaluation of simulated toothbrushing on the roughness and optical stability of microfilled, microhybrid and nanofilled resin-based composites

OBJECTIVES

The aim of this study was to evaluate the influence of simulated toothbrushing over ten weeks on the roughness and optical stability (colour, translucency and gloss) of microfilled - Mf (Durafil VS), microhybrid - Mh (Empress Direct) and nanofilled - Nf (Z 350) resin-based composites (RBC).

METHODS

The roughness, colour, translucency and gloss of each RBC were measured before and after storage in distilled water (DW) and propionic acid (PA) for ten weeks. The specimens were removed from the media each week, submitted to toothbrushing simulation and the properties measured. The obtained data were analyzed using a multifactor analysis of variance (MANOVA) and Tukey's HSD test (α=0.05).

RESULTS

The roughness significantly increased after ten weeks for the three RBCs (p<0.05), with the final values of roughness presenting no statistical differences among them (p>0.05). Only Mf and Nf immersed in DW and Mh immersed in PA presented a change in colour after ten weeks (p<0.05), although the change in colour was lower after immersion in PA for the three RBCs (p<0.05). None of the RBCs presented significant changes in translucency after ten weeks (p>0.05). Only Mh immersed in DW presented gloss stability after ten weeks (p>0.05).

CONCLUSIONS

Toothbrushing increased the roughness and diminished the gloss of the three RBCs. The translucency was not influenced by the toothbrushing. The immersion in propionic acid produced lower alterations in colour than did immersion in distilled water.

CLINICAL SIGNIFICANCE

In general, the three RBCs presented similar optical behaviours after toothbrushing over ten weeks. Thus, it is possible that anterior restorations produced with these materials will not present perceptible differences over time.

Change of optical properties of contemporary resin composites after one week and one month water ageing

OBJECTIVES

To compare color and translucency changes after water ageing for one-week and one-month in light and dark shades of contemporary polychromatic resin composites.

METHODS

Enamel (e) and dentine (d), light and dark (A1 and A4 or equivalents) shades were selected from the composites Enamel-Plus HRi/Micerium, Miris-2/Coltene, IPS Empress-Direct/Ivoclar and Filtek-Supreme/3M ESPE and light and dark shades from the TPH-Spectum/Densply monochromatic composite. Five disks (d = 10mm, h = 1mm) per material, enamel/dentine and light/dark shade were prepared. A colorimetric evaluation, over white and black background, according to the CIELab system was performed just after preparation and after one-week and one-month dark water-storage at 37°C. Color (ΔEab) and translucency (ΔTP) differences were calculated. Results were analysed by ANOVA and Scheffe's test, paired t-test and linear regression analysis (a = 0.05).

RESULTS

One-week water ageing provided a wide range of ΔEab values (0.79 Filtek(e)/D2 to 5.19 Filtek(d)/A1) and ΔTP values (-2.74 Hri/UD1 to 1.03 TPH/A1). After one-month water ageing ΔEab ranged from 1.09 Filtek(e)/D2 to 7.94 Filtek(d)/A1 and ΔTP values from -2.71Hri/UD1 to 1.07 Filtek(d)/A4. Significant changes in ΔEab between one-week and one-month water ageing were noted for Filtek and Miris dentine and Miris light enamel shades. As for ΔTP, significant difference was recorded only for IPS(e)/A4. ΔEab was significantly correlated with ΔL, Δα, Δb and ΔTP after one-week and with ΔL and Δα after one-month ageing.

CONCLUSIONS

Water ageing caused remarkable color changes, which were material and shade depended. Thirteen out of eighteen of the tested composites exhibited clinically perceptible (ΔEab>2.6) color changes even after short water ageing period.

Diastema closure using direct bonding restorations combined with orthodontic treatment: a case report

Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

Proximal contact tightness between direct-composite additions in the posterior dentition: an in vitro investigation

PURPOSE

The aim of the study was to test whether a novel three-step matrix technique for posterior direct-composite additions creates sufficiently strong proximal contacts.

MATERIALS AND METHODS

Contact tightness was measured between direct-composite additions and between original teeth on a model. Therefore, the frictional forces required to remove a straight, 0.05-mm-thick, metal matrix band inserted between adjacent teeth and held by a universal testing machine (Zwicki, Zwick GmbH, Ulm, Germany) were recorded. Measurements were taken at three time points to carry out reference analysis: at baseline, after removal of the maxillary right second premolar (tooth #15) to simulate a diastema, and after closure of the diastema by inserting two direct-composite additions with the three-step matrix technique on the maxillary right first premolar (tooth #14) and first molar (tooth #16). Measurements were performed in the maxillary right (first) and left (second) quadrants to document sagittal displacement.

RESULTS

The original contact tightness values were between 1.65 ± 0.88 N and 3.05 ± 0.60 N in the first quadrant and between 1.23 ± 0.51 N and 2.18 ± 0.43 N in the second quadrant. After removal of tooth 15, values decreased significantly in the first quadrant and insignificantly in the second. After reconstruction, the contact tightness between teeth 14 and 16 was significantly stronger (tighter) (3.20 ± 0.80 N) than the originally measured contact tightness between teeth 14 and 15 (2.86 ± 0.64 N) and teeth 15 and 16 (1.65 ± 0.88 N) (p=0.006 and 0.001, respectively).

CONCLUSIONS

Within the limitations of an in vitro investigation, this study has shown that by using a novel, three-step matrix technique, direct posterior composite additions can form sufficiently tight proximal contacts.