Retention and marginal leakage of provisional crowns cemented with provisional cements enriched with chlorhexidine diacetate

Biological interaction, esthetics, handling, and loss rate of temporary luting cements - a clinical single-blind randomized controlled trial

OBJECTIVES

To evaluate three temporary luting cements in terms of their restoration loss rates, biological interactions, esthetic properties, and handling characteristics.

MATERIALS AND METHODS

75 adults requiring fixed prosthodontics voluntarily participated in a single-blind, randomized controlled trial. After preparation, temporary restorations were luted with a randomly selected temporary luting cement (either Provicol QM Plus (PQP), Bifix Temp (BT), or Provicol QM Aesthetic (PQA)). Clinical examinations were performed one to two weeks after cementation. The following criteria were evaluated: tooth vitality, percussion, hypersensitivity, gingival bleeding, odor formation, esthetics, cement handling, removability, cleanability, and retention loss. Antagonistic teeth served as controls. Statistical analysis was performed using the paired t-test, one-way ANOVA, Pearson's chi-square and Fisher's exact test, where appropriate.

RESULTS

The overall loss rate of temporary restorations was 16.0%, showing no cement-specific differences. Postoperative hypersensitivity occurred in 8% of cases regardless of cement type. Esthetic impairment was reported by 31% of the PQP-fixed restorations, compared with 4.0% and 4.2% of the BT and PQA-bonded restorations. Cement application was reported to be easy in 100% of cases, excess removal in 88-96%, depending on the cement used.

CONCLUSIONS

The choice of luting material affects the esthetic appearance of a temporary restoration and should be considered, particularly in restorations in esthetically demanding areas. No significant differences between the cements were identified regarding biocompatibility, handling, and loss rate.

CLINICAL RELEVANCE

Translucent cements can help to reduce color interferences, resulting in a more appealing appearance of the temporary restoration.

Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a systematic review and meta-analysis

BACKGROUND

Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical pathosis in such teeth are still unknown. Therefore, this systematic review and meta-analysis aimed to investigate the incidence of and influential factors on pulp necrosis and periapical pathosis of vital teeth following indirect restorations.

METHODS

The search was conducted in five databases, using MEDLINE via PubMed, Web of Science, EMBASE, CINAHL, and Cochrane Library. Eligible clinical trials and cohort studies were included. The risk of bias was assessed using Joanna Briggs Institute's critical appraisal tool and Newcastle-Ottawa Scale. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were calculated using a random effects model. Subgroup meta-analyses were also performed to determine the potential influencing factors for pulp necrosis and periapical pathosis. The certainty of the evidence was assessed using the GRADE tool.

RESULTS

A total of 5,814 studies were identified, of which 37 were included in the meta-analysis. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were determined to be 5.02% and 3.63%, respectively. All studies were assessed as having a moderate-low risk of bias. The incidence of pulp necrosis following indirect restorations increased when the pulp status was objectively assessed (thermal/electrical testing). The presence of pre-operative caries or restorations, treatment of anterior teeth, temporization for more than two weeks, and cementation with eugenol-free temporary cement, all increased this incidence. Final impression with polyether and permanent cementation with glass ionomer cement both increased the incidence of pulp necrosis. Longer follow-up periods (> 10 years) and treatment provided by undergraduate students or general practitioners were also factors that increased this incidence. On the other hand, the incidence of periapical pathosis increased when teeth were restored with fixed partial dentures, the bone level was < 35%, and the follow-up was > 10 years. The certainty of the evidence overall was assessed as low.

CONCLUSIONS

Although the incidences of pulp necrosis and periapical pathosis following indirect restorations remain low, many factors affect these incidences that should thus be considered when planning indirect restorations on vital teeth.

DATABASE REGISTRATION

PROSPERO (CRD42020218378).

Evaluation of the effects of finish line type and width on the fracture strength of provisional crowns

This study aimed to investigate the impacts of finish line type and width on the fracture resistance of provisional crowns, and to determine the suitable type of crown material to use for that purpose. Chamfer and rounded shoulder preparations were done with stainless steel master models with a width of 0.6 mm and 1.0 mm and a total convergence angle of 6°. The provisional crowns were obtained using computer-aided design/computer-aided manufacturing (CAD/CAM) polymethyl methacrylate (PMMA) material in the mandibular left first molar. From the obtained molar tooth, a silicon mold was used to obtain the provisional crowns from the CAD/CAM PMMA, bis-acrylic resin, and self-curing composite materials. The lowest fracture strength was found in the bis-acrylic resin group made using the rounded shoulder preparation with a width of 0.6 mm (699 N). The highest fracture strength was found in the CAD/CAM PMMA group made using the rounded shoulder preparation with a width of 1 mm (1339 N). The fracture strength is higher for CAD/CAM PMMA than the other provisional crown materials; thus, it is recommended that this material be used in provisional crown restorations due to its other advantages.

Influence of a Retentive Shoulder Design to Prevent Early Failure of Three Core Build-Ups

This study evaluated the influence of a retentive shoulder design to prevent early failure of three resin composite build-ups on molars. Ninety-six intact extracted human maxillary third molars were assigned to two groups (n=48) based on occlusal, buccal cusps only and all cusps reduction. The groups were divided into two subgroups: pin retained and non-pin retained build-ups resulting in four groups (n=24), according the cusps reduction: pin retained/partial, pin retained/complete, non-pin retained/partial, non-pin retained/complete. Occlusal reduction was 3 mm with a semi-lunar retentive shoulder of 3 mm and an axial wall height of 1.5 mm. Groups were restored using a microhybrid, flowable or titanium reinforced resin composite. Modified self-curing acrylic resin provisional crowns were fabricated, cemented with non-eugenol temporary cement and thermal cycled. An instron machine applied tension to the provisional crowns parallel to the long axis of the tooth until dislodgement. A three-way analysis of variance was conducted on the influence of the variables on the retention of the core build-up. Ninety-three build-ups were retained under tensile load, while three core build-ups without pins were dislodged. Three-way analysis of variance showed no statistically significant difference between core build-ups using a retentive shoulder and pin retained core build-ups when tested under tensile load. With the advent of adhesive systems, increased surface area and retentive shoulder design can provide a retentive core foundation to prevent early failures of core build-ups during indirect restoration fabrication which will contribute to the longevity of final restorations.

Effect of cement application techniques on the adaptation and retention of provisional crowns

BACKGROUND

A well-made and properly cemented provisional restoration is essential for the health of abutment teeth and periodontium. Few focused studies are available on the effect of cementation techniques on the fit as well as on the retention of the provisional crowns.

OBJECTIVE

To investigate the effect of six cement application techniques on the adaptation and retention of provisional crowns.

METHODS

Seventy-two provisional crowns (Bisacryl resin) were fabricated over identical self-cured resin dies and were divided into six groups (N= 72; 6 ×n= 12) of cement application techniques (Temp Bond NE, Kerr Corporation). Group-A (Bulk Fill); Group-B (Cement on inner walls); Group-C (Cement on axial walls); Group-D (Cement on crown margin); Group-E (Cement on tooth margin); Group-F (Cement with vent-holes). Adaptation was assessed before and after cementation with digital caliper (0.001 mm). Universal testing machine was used for retention measurement in Mega Pascal's (MPa). Data was analyzed by SPSS using Paired T-Test and Tukey's test (p< 0.05).

RESULTS

The highest and lowest difference between the two measurements was observed for the Group A (0.095 mm) and Group C (0.030 mm) respectively. Paired T-Test revealed significance (p< 0.05) between before and after cementation. Group-F (0.6094 MPa) and Group-E (0.1858 MPa) showed the highest and lowest retention respectively. Group-E (Cement on tooth margin) with lowest retention significantly differed (Tukey's Test; p< 0.05) from other groups.

CONCLUSIONS

Bulk filling of the provisional crown with luting cement significantly increases the adaptation discrepancies. Discrepancies are more when luting cement is applied on the occlusal surface of the crowns. However, it didn't influence the retention of the crowns. Cement application on axial walls and cervical third of intaglio surface of crowns was the method of choice with regards to adaptation and retention combined. Addition of vent-holes improved the adaptation with best possible retention.

Can 1% chlorhexidine diacetate and ethanol stabilize resin-dentin bonds?

OBJECTIVES

To examine the effects of the combined use of chlorhexidine and ethanol on the durability of resin-dentin bonds.

METHODS

Forty-eight flat dentin surfaces were etched (32% phosphoric acid), rinsed (15 s) and kept wet until bonding procedures. Dentin surfaces were blot-dried with absorbent paper and re-wetted with water (water, control), 1% chlorhexidine diacetate in water (CHD/water), 100% ethanol (ethanol), or 1% chlorhexidine diacetate in ethanol (CHD/ethanol) solutions for 30 s. They were then bonded with All Bond 3 (AB3, Bisco) or Excite (EX, Ivoclar-Vivadent) using a smooth, continuous rubbing application (10 s), followed by 15 s gentle air stream to evaporate solvents. The adhesives were light-cured (20 s) and resin composite build-ups constructed for the microtensile method. Bonded beams were obtained and tested after 24-h, 6-months and 15-months of water storage at 37°C. Storage water was changed every month. Effects of treatment and testing periods were analyzed (ANOVA, Holm-Sidak, p<0.05) for each adhesive.

RESULTS

There were no interactions between factors for both etch-and-rinse adhesives. AB3 was significantly affected only by storage (p=0.003). Excite was significantly affected only by treatments (p=0.048). AB3 treated either with ethanol or CHD/ethanol resulted in reduced bond strengths after 15 months. The use of CHD/ethanol resulted in higher bond strengths values for Excite.

CONCLUSIONS

Combined use of ethanol/1% chlorhexidine diacetate did not stabilize bond strengths after 15 months.