Clinical survival of indirect, anterior 3-unit surface-retained fibre-reinforced composite fixed dental prosthesis: Up to 7.5-years follow-up

Terminology focused on design and retention methods used for anterior resin-bonded fixed partial dentures in English literature: A scoping review

Purpose

Novel terms describing several designs of resin-bonded fixed partial dentures (RBFPDs) continue to appear. Indeed, a variety of terms are used in the English scientific literature The use of a standard terminology is important for a fair and efficient understanding. This study aimed to investigate if the terminology used to describe designs and retention methods for anterior RBFPDs is standard.

Methods

An electronic search in the English literature was conducted in PubMed/Medline to identify all publications reporting RBFPDs in the anterior region until August 2022. This search was completed by hand searching. Terms indicating different designs of RBFPDs were listed and then classified. Percentages of their use were calculated to determine the commonly used terms. Analysis of the use of these terms was performed based on the standards determined by the latest edition of the Glossary of Prosthodontic Terms (GPT). The impacts of the MeSH Thesaurus and GPT on the nomenclature used for RBFPDs was assessed.

Results

A total of 125 articles were eligible for this review. In the retained articles, 86 terms were found. Among them, thirty-nine terms were classified into three groups. Only six terms were defined in the latest edition of GPT (GPT-9). Several classified terms that are commonly used were not identified in the GPT-9. Conversely to the GPT-9 which impact was insignificant, the MeSH Thesaurus had an important impact on the nomenclature used for RBFPDs.

Conclusion

The terminology used to describe designs and retention methods for anterior RBFPDs was non-standard. The GPT-9, constituting an important reference, defined a limited number of terms related to RBFPDs and had no significant impact on the standardization of the terminology used for RBFPDs. Efforts should therefore be continued to standardize the terminology. A specialized mini-glossary grouping and defining all the terms found in this study will helpful in clarifying the terminology used for the anterior RBFPDs.

Clinical survival of No-prep indirect composite laminate veneers: a 7-year prospective case series study

BACKGROUND

The no preparation technique which is a reversible form of treatment characterized by the absence of tooth tissue preparation and preserves the soft tissue architecture while preserving all natural tooth structures is indicated in cases where the tooth structure allows material to be added. The aim of this study is to evaluate the clinical performance and survival rates of indirect composite laminate veneers with no preparation after 7 years.

MATERIALS AND METHODS

A total of 80 indirect composite veneers were placed on maxillary anterior teeth in 35 patients (n = 80). Diastema (n = 64), wedge tooth anomalies (n = 9) and re-shaping (n = 7) were the main indications for veneer treatments. All laminate veneers were fabricated with an indirect microhybrid composite material (Gradia, GC Dental). No tooth preparation was performed. Light-cured resin cement (Choice 2, Bisco) was used to lute the veneers. Composite veneers were evaluated using Modified United States Public Health Service criteria. Survival rates of the veneers were calculated using Kaplan-Meier statistics. The data containing the results of the USPHS criteria at baseline, 2 years and 7 years was statistically analyzed using Wilcoxon Signed Rank test at the 0.05 level of significance.

RESULTS

The overall survival rate was 91.3%. After 7 years, 7 absolute failures including 4 debonding (marginal adaptation, score 4) and 3 fractures (fracture of restoration, score 3) were noted. Color match was scored as 1 (n = 34) and 2 (n = 15). Slightly rough surfaces (41 of 73 laminates) and slight marginal discoloration (15 of 73 laminates) were noted. The overall scores after 84 months were significantly higher than the baseline scores for the marginal adaptation (p = 0.008), color match (p = 0.000), marginal discoloration (p = 0.000), surface roughness (p = 0.000), and fracture of restoration (p = 0.001) criteria.

CONCLUSIONS

In this study, indirect composite veneers without any preparation on maxillary anterior teeth showed acceptable performance in terms of both survival rate and quality of restorations. This procedure offers a predictable and successful treatment that ensures maximum preservation of the intact tooth.

Reconstruction of Natural Smile and Splinting with Natural Tooth Pontic Fiber-Reinforced Composite Bridge

Teeth replacement is challenging in old patients with severe periodontal disease, limiting prosthetics treatment options. Here, we report a fiber-reinforced composite (FRC) resin bridge using natural tooth pontic in a patient with severe periodontitis. A 60-year-old lady complaining of teeth mobility was diagnosed with severe periodontitis, recession, bone loss, and crowding in the anterior maxillary teeth. Due to a hopeless periodontal prognosis, lateral incisors were extracted and sectioned using a cylindrical diamond bur. The pulp chamber was debrided and filled with self-adhesive flowable composite resin. After three weeks, the pontics were fixed in proximal contact areas, and the FRC bridge was fabricated directly using the resin fiber strip followed by occlusion adjustment, finishing, and polishing. Esthetic, occlusion, and periodontal status were re-evaluated after six months. Here, FRC using natural pontic could successfully reconstruct a natural smile, splint the adjacent teeth, eliminate crowding, and provide stable occlusion. Therefore, this method may be considered for similar cases.

Survival Rates of Anterior-Region Resin-Bonded Fixed Dental Prostheses: An Integrative Review

This study aimed to review clinical publications involving anterior-region resin-bonded fixed partial dentures to evaluate their survival rates vis-à-vis their materials and design. An electronic search was conducted using PubMed/MEDLINE to identify articles that reported on the longevity of anterior resin-bonded fixed dental prostheses published between 2000 and 2020. Only primary clinical studies that involved a follow-up after at least 3 years were included in this review. A statistical analysis was performed to evaluate resin-bonded fixed dental prostheses’ survival rates in relation to their materials and design. This review ultimately included 23 clinical publications, comprising prospective studies, retrospective studies, and randomized controlled trials. Its statistical analysis estimated the studied prostheses’ 5-year survival rate at 86.2% for metal-framed prostheses, 87.9% for zirconia prostheses, 93.3% for alumina prostheses, 100% for glass or ceramic prostheses, and 81.7% for fiber-reinforced composite restorations. Failure rates did not significantly differ between the different material groups or between the single- and double-retainer groups. Resin-bonded fixed dental prostheses present excellent 5-year clinical longevity in the anterior sector and a favorable benefit/risk/cost ratio. Currently, no consensus has been established on an ideal material for these restorations. Cantilever design tends to limit constraints on the prostheses’ retainers and, thus, increases their survival time. All-ceramic cantilever fixed partial dentures can be considered as a definitive therapy, given their high success and survival rates. They are an optimal solution for adolescents or young adults facing potentially continuous growth.

Interfacial Evaluation of CAD/CAM Resin Inlays on the Cavity Floor Using Swept-source Optical Coherence Tomography

CLINICAL RELEVANCE

When a resin nanoceramic inlay is cemented using self-adhesive cement, a universal dentin adhesive can be applied to the prepared cavity. The application of the adhesive before self-adhesive cement placement provides similar or better interfacial adaptation than without the adhesive.

SUMMARY

Purpose: The first objective of this study was to determine whether the luting material used for computer-aided design and computer-aided manufacture resin nanoceramic inlays affected interfacial adaptation. The second objective was to investigate whether application of a universal dentin adhesive before cementation affected interfacial adaptation. The final objective was to compare the inlay-side and dentin-side interfaces in the cement space.Methods and Materials: Seventy-four class I cavities were prepared on extracted human third molars. Cavities were optically scanned, and resin nanoceramic inlays were milled using Lava Ultimate blocks (3M ESPE). For the control groups, the fabricated inlays were cemented using Panavia V5 (Kuraray Noritake) or FujiCem 2 (GC). For the experimental groups, the teeth were randomly divided into groups I and II. Group I contained four subgroups using different luting materials; in all subgroups, the inlays were cemented and dual cured without pretreatment. Group II contained six subgroups in which inlays were cemented and dual cured after application of a universal dentin adhesive. After thermocycling, interfacial adaptation was measured using swept-source optical coherence tomography (SS-OCT) imaging and statistically compared among groups.Results: Interfacial adaptation was different depending on the luting material used (p<0.05). After application of a universal adhesive, some subgroups showed improved interfacial adaptation (p<0.05). In the comparison of inlay-side and dentin-side interfaces, no difference was found in interfacial adaptation (p>0.05).Conclusions: Interfacial adaptation for resin nanoceramic inlays differed with luting material. For some self-adhesive cements, application of a universal adhesive before cementation improved interfacial adaptation.

Fiber-reinforced composite fixed dental prosthesis using an additive manufactured silicone index

OBJECTIVE

Digital tools such as facial and intraoral digitizers and additive manufacturing (AM) technologies assist restorative treatments. The objective of the present manuscript was to describe a workflow procedure for treatment planning and fabricating a fiber-reinforced composite fixed dental prosthesis (FDP) replacing an absent maxillary lateral incisor, using additively manufactured silicone indices to facilitate the clinical intervention.

CLINICAL CONSIDERATIONS

The elaboration of a direct fiber-reinforced composite restoration is a technique sensitive procedure which might be time-consuming for the clinician. The digital waxing helped to determine the exact position and size of the lingual wings and connectors of the fiber-reinforced FDP and to design a three-piece index. And the AM of the index helped to transfer the information to the patient's dentition accurately.

CONCLUSIONS

The protocol minimizes the time of clinical intervention by facilitating the transference of the virtual diagnostic waxing teeth into the patient's mouth. The three-piece silicone index provides an individualized path of insertion of each index part while also providing a customized space and location of the lingual wings of the restoration.

CLINICAL SIGNIFICANCE

The usage of AM silicone indices facilitates the clinical intervention by translating the size and position of the diagnostic wax-up teeth into the patient's mouth, minimizing clinical procedure's time.

Load bearing capacity and Weibull characteristics of inlay-retained resin-bonded fixed dental prosthesis made of all-ceramic, fiber-reinforced composite and metal-ceramic after cyclic loading

PURPOSE

The objectives of this study were to evaluate the load bearing capacity of RBFDPs made of different materials after cyclic loading, and classify the failure types after loading.

MATERIALS AND METHODS

Sound human mandibular first premolars and first molar pairs (N = 60 per tooth type, n = 10 per group) were randomly divided into six experimental groups to receive one of the following inlay-retained RBFDP types: RC: Resin composite only, DFRC: Direct E-glass fiber-reinforced composite (FRC), IFRC: Indirect E-glass FRC, LS: Lithium disilicate glass-ceramic, ZR: Yttria-stabilized tetragonal zirconia, MC: Metal-ceramic. Box preparations were made in abutment teeth using diamond burs followed by standardized ultrasonic burs. The teeth were conditioned employing an etch-and-rinse adhesive system and the indirect RBFDPs were cemented adhesively. The specimens were subjected to cyclic loading for x1.200.000 in distilled water alternating between 5 and 55 °C (Zurich Chewing Simulator). They were then loaded to failure from the occlusal surface in the Universal Testing Machine (cross-head speed: 1 mm/min). Failure types were classified as repairable or irreparable depending on the location and size. Data were analyzed using Welch and Tamhane's T2 post-hoc tests (α = 0.05). Weibull modulus for each group was calculated based on parametric distribution analysis of censored data for maximum fracture load.

RESULTS

Mean load bearing capacity (N) of Groups LS (1274 ± 270), ZR (1567 ± 363) and MC (1544 ± 787) were significantly higher than those of other groups (p < 0.05). RC, DFRC, IFRC (601 ± 130 - 819 ± 270) and MC did not show significant difference (p > 0.05). Weibull modulus (m) was the highest in Group LS (m = 5.3) followed by Group RC (m = 5.1). Other groups presented Weibull moduli ranging between 1.4 and 3.3. Only in Group ZR, 2 early debonding occurred during cyclic loading. While in this group predominantly irreparable failures (debonding with without tooth fracture) were observed (8 out of 10), all other groups presented mainly single or a combination of repairable failures (chipping in the veneering material). DFRC, IDRC and MC did not show any debonding from the abutment teeth.

CONCLUSION

Considering load bearing capacity, repairable failure types and Weibull moduli, lithium disilicate seem to be more durable than those of other material options for posterior inlay-retained RBFDPs. Due to early debondings and catastrophic irreparable failure types, zirconia RBFDPs should be indicated with caution in the posterior region.

Fiber-reinforced composite resin bridges: an alternative method to treat root-fractured teeth

The replacement of missing teeth, especially in the anterior region, is an essential part of dental practice. Fiber-reinforced composite resin bridges are a conservative alternative to conventional fixed dental prostheses or implants. It is a minimally invasive, reversible technique that can be completed in a single visit. The two cases presented herein exemplify the treatment of root-fractured anterior teeth with a natural pontic immediately after extraction.

Microtensile bond strength of CAD/CAM-fabricated polymer-ceramics to different adhesive resin cements

Objectives

This study evaluated the microtensile bond strength (µTBS) of polymer-ceramic and indirect composite resin with 3 classes of resin cements.

Materials and Methods

Two computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated polymer-ceramics (Enamic [ENA; Vita] and Lava Ultimate [LAV; 3M ESPE]) and a laboratory indirect composite resin (Gradia [GRA; GC Corp.]) were equally divided into 6 groups (n = 18) with 3 classes of resin cements: Variolink N (VAR; Vivadent), RelyX U200 (RXU; 3M ESPE), and Panavia F2 (PAN; Kuraray). The μTBS values were compared between groups by 2-way analysis of variance and the post hoc Tamhane test (α = 0.05).

Results

Restorative materials and resin cements significantly influenced µTBS (p < 0.05). In the GRA group, the highest μTBS was found with RXU (27.40 ± 5.39 N) and the lowest with VAR (13.54 ± 6.04 N) (p < 0.05). Similar trends were observed in the ENA group. In the LAV group, the highest μTBS was observed with VAR (27.45 ± 5.84 N) and the lowest with PAN (10.67 ± 4.37 N) (p < 0.05). PAN had comparable results to those of ENA and GRA, whereas the μTBS values were significantly lower with LAV (p = 0.001). The highest bond strength of RXU was found with GRA (27.40 ± 5.39 N, p = 0.001). PAN showed the lowest µTBS with LAV (10.67 ± 4.37 N; p < 0.001).

Conclusions

When applied according to the manufacturers' recommendations, the µTBS of polymer-ceramic CAD/CAM materials and indirect composites is influenced by the luting cements.

An overview of development and status of fiber-reinforced composites as dental and medical biomaterials

Fibr-reinforced composites (FRC) have been used successfully for decades in many fields of science and engineering applications. Benefits of FRCs relate to physical properties of FRCs and versatile production methods, which can be utilized. Conventional hand lamination of prefabricated FRC prepregs is utilized still most commonly in fabrication of dental FRC devices but CAD-CAM systems are to be come for use in certain production steps of dental constructions and medical FRC implants. Although metals, ceramics and particulate filler resin composites have successfully been used as dental and medical biomaterials for decades, devices made out of these materials do not meet all clinical requirements. Only little attention has been paid to FRCs as dental materials and majority of the research in dental field has been focusing on particulate filler resin composites and in medical biomaterial research to biodegradable polymers. This is paradoxical because FRCs can potentially resolve many of the problems related to traditional isotropic dental and medical materials. This overview reviews the rationale and status of using biostable glass FRC in applications from restorative and prosthetic dentistry to cranial surgery. The overview highlights also the critical material based factors and clinical requirement for the succesfull use of FRCs in dental reconstructions.

Direct Fiber-Reinforced Interim Fixed Partial Dentures: Six-Year Survival Study

PURPOSE

Mechanical and optical studies of glass fiber composites have revealed great resistance and satisfactory bonds between the glass fibers and composite resins. This study aimed to evaluate the long-term survival of anterior and posterior direct glass fiber-reinforced composite (FRC) fixed partial dentures (FPD).

MATERIALS AND METHODS

Twenty-three patients (9 men, 14 women) aged 18 to 67 received 23 d-FRC-FPDs. The frameworks of the FPDs were unidirectional pre-impregnated glass fibers (ever Stick C&B). The retainers were inlay composite resin retainers (n1 = 19) and composite resin wings (n2 = 4). The FPD that used inlay retainers and composite resin wing retainers was called the hybrid design. The mean follow-up period was 4.91 years with 12-month check-ups performed by two independent operators. The survival rates of the glass fiber FPDs were determined.

RESULTS

Six-year survival rates for the two types of FPDs were 94.7% for the inlay retainer type versus 25% for the hybrid type, with a statistically significant difference (log-rank test χ² (1) = 11.422, p = 0.001). The inlay retainers were functional, with only one patient with a fracture line in the connector held by the glass fibers. Kaplan-Meier survival curves were drawn to show the difference between the two types of retainers.

CONCLUSION

According to the results of this study, these long-term interim FRC-FPD were resistant enough to allow mastication, minimally invasive and also esthetic, with inlay composite retainers as the better solution.

Effectiveness of high-power LEDs to polymerize resin cements through ceramics: An in vitro study

STATEMENT OF PROBLEM

The cementation of ceramic veneers using light-polymerized resin cement is largely dependent on the proper light activation of the cement. Light activation using high irradiance could shorten the time required to lute multiple restorations.

PURPOSE

The purpose of this in vitro study was to evaluate the light transmission of dental light-polymerizing units through ceramic cylinders and its effect on the polymerization kinetics of a resin cement.

MATERIAL AND METHODS

Ceramic ingots (IPS Empress Esthetic, shade ET1) were sectioned to produce cylinders 0.5, 1.0, and 2.0 mm thick. Two light-emitting diode units were evaluated: SmartLite Focus and Valo Cordless, the latter used in either Standard or Xtra Power (XP) modes. Light transmission (average of irradiance, total energy, and light-emission profile) through the cylinders was measured (n=3). The polymerization kinetics of a resin cement light polymerized through the ceramic was monitored for 5 minutes (n=3). The degree of conversion was measured again after 72 hours. Data were individually analyzed with 2-way ANOVA and the Tukey HSD test (α=.05).

RESULTS

Valo at XP presented the highest values of irradiance and SmartLite the lowest, irrespective of the ceramic thickness. Regarding the total energy, XP showed the lowest values. The total energy and irradiance lessened with the increase in ceramic thickness. In general, except for Valo at XP, the ceramic thickness did not affect the degree of conversion. Valo at XP and interposing 2.0 mm ceramic resulted in the lowest values of Rp_max.

CONCLUSIONS

The reduction of total energy and irradiance by ceramic interposition had only a slight effect on polymerization kinetics.

Longevity of fiber-reinforced composite fixed partial dentures (FRC FPD)-Systematic review

OBJECTIVES

to assess FRC FPDs longevity through systematically reviewing contemporary clinical evidence. Population investigated comprised patients requiring replacement of a single missing anterior/posterior tooth. Intervention was FRC FPDs. No control/comparison selected. Outcome was longevity of FRC FPDs. The focus question was: 'What is the longevity of FRC FPDs used to replace one anterior or posterior tooth in patients?'

DATA

Randomised, non-randomised, controlled, prospective and retrospective clinical studies were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were applied. The Overall Strength of Clinical Recommendation (OSCR) was assessed using the Strength of Recommendation Taxonomy system. Survival of FPDs was assessed using the Kaplan-Meier method. Analysis of FPD-survival according to location and occurrence of different failures was performed using Logrank and Chi-square testing.

SOURCES

PubMed, MEDLINE, and Web of Science databases were searched between January 2007 and December 2015.

STUDY SELECTION

Nine studies were included, involving placement of 592 FRC FPDs in 463 patients. Follow-up periods ranged between 2 months and 8 years. Kaplan-Meier overall survival probability was 94.5% (95%C.I: 92.5%-96.5%) at 4.8 years. There was no significant difference in survival probability of anterior versus posterior FRC FPDs (P=0.278). Veneering material fracture/delamination occurred significantly more than other types of failures (Ps<0.05). A meta-analysis could not be performed. OSCR was moderate.

CONCLUSIONS

FRC FPDs demonstrated high overall survival with predictable performance outcomes. However, long-term performance remains unclear.

CLINICAL SIGNIFICANCE

FRC FPDs are viable medium-term management alternatives for replacing single anterior or posterior teeth in patients.

Preparation and characterization of high radio-opaque E-glass fiber-reinforced composite with iodine containing methacrylate monomer

OBJECTIVE

The purpose of this study was to prepare radio-opaque E-glass fiber-reinforced composite (EFRC) with synthesized iodine containing methacrylate monomer.

METHODS

The synthesized iodine containing methacrylate monomer 2-hydroxy-3- methacryloyloxypropyl(2,3,5- triiodobenzoate) (HMTIB) was mixed with Bis-GMA and MMA in different mass ratio to prepare resin impregnating solution (RIS), and RIS without HMTIB was used as control. CQ and DMAEMA were added as photoinitiation system. E-glass fiber was thoroughly wetted by resin impregnating solution to prepare radio-opaque EFRC. Degree of double bond conversion (DC) was investigated by FT-IR analysis. Fiber volume fraction was analyzed by combustion and gravimetric analyzes. The Flexural strength (FS) and modulus (FM) of EFRC were measured using a three-point bending set up. Water sorption (WS) and solubility (SL) were measured until the mass variation of EFRC in distilled water kept stable. Radiographs were taken to determine the radiopacity of EFRC.

RESULTS

The FT-IR and ¹H NMR spectra of HMTIB revealed that it was the same as designed. ANOVA analysis revealed that increasing HMTIB concentration in RIS would decrease DC and increase fiber volume fraction. When compared with control EFRC, all of HMTIB containing EFRCs had higher or comparable FS and FM, no matter before or after water immersion. WS of EFRC decreased with increasing HMTIB concentration, while SL was nearly kept the same. Radiopacity of EFRC increased with increasing HMTIB concentration.

SIGNIFICANCE

The synthesized monomer HMTIB could be used to prepare EFRC with high radiopacity. Moreover, HMTIB containing EFRC would also have high mechanical properties and low WS.