Periodontal Behavior and Patient Satisfaction of Anterior Teeth Restored with Single Zirconia Crowns Using a Biologically Oriented Preparation Technique: A 6-Year Prospective Clinical Study

Zirconia in fixed prosthodontics: a review of the literature

The purpose of this narrative review is to organize information and knowledge about the properties of the clinical evidence of zirconia-applied dental restorations and to provide relevant information to establish application methods to obtain long-term clinical prognosis of zirconia-applied dental prostheses. From PubMed and manual searches, found "zirconia," "crown," "survival," and "success" keywords were searched. Case reports, case series, reviews, abstracts, in vitro studies, and observational studies were excluded. Additionally, implant superstructures not supported by the periodontal ligament and partially covered crowns were excluded. A total of 42 studies were identified. According to the studies in this review, the most common complication of porcelain-layered zirconia restorations is porcelain fracture, but the long-term prognosis is stable. However, complications of monolithic zirconia restorations include crown fractures and fractures of the abutment tooth and root, and long-term clinical evidence is not available yet. Additionally, bruxism can be a complication factor with both types of restorations, so it is important to carefully examine the oral habits, including bruxism, before treatment. Therefore, the success of zirconia-based restorations in clinical practice requires a careful approach in addition to accurate knowledge of the zirconia material and identification of applicable cases.

Advancing teeth whitening efficacy via dual-phototherapeutic strategy incorporating molybdenum disulfide embedded in carrageenan hydrogel for dental healthcare

Teeth discoloration poses a widespread challenge in dental health across various regions. Conventional teeth whitening methods often result in enamel deterioration and soft tissue harm due to the utilization of incompatible whitening agents and continuous intense light exposure. Here, we propose an effective phototherapy technique for teeth whitening, employing pathways of energy transition through intersystem crossing. The integration of MoS2 nanosheets into carrageenan gel (MoS2 NSs@Carr) facilitates both photothermal-hyperthermia and the generation of reactive oxygen species (ROS) through photocatalytic processes. The efficacy of ROS generation by the phototherapeutic MoS2 NSs@Carr on teeth whitening in the scenario. This approach ensures comprehensive teeth whitening by eliminating deep-seated stains on the teeth while preserving structural integrity and avoiding any tissue toxicity. This research highlights the efficacy of the phototherapeutic MoS2 NSs@Carr for dental whitening and underscores the potential of exploring nanostructures based on MoS2 NSs for managing dental healthcare issue.

Evaluation of periodontal parameters on abutment teeth rehabilitated with single-unit crowns: A 12-month follow-up

Purpose

This prospective study evaluated the effects of the metal-free crowns on the periodontal tissues of abutment teeth during a 12-month follow-up.

Materials and Methods

A sample of 24 patients (N = 32 abutment teeth) who needed a single-tooth restoration were enrolled to receive either a metal-ceramic (n = 21) or lithium disilicate (n = 11). The single-unit crowns were evaluated at baseline, 3-and 12-month follow-up. The periodontal parameters were evaluated: plaque index (PI), gingival bleeding index (GBI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), radiographically and clinical crown fitting, bone resorption, and marginal finish lines. Statistical analyses were performed using the Exact Fisher and Mann-Whitney tests, and the Wilcoxon signed-rank test as a post hoc test for Friedman (95 % confidence interval).

Results

The marginal finish line showed a statistical difference with a biomaterial type (p =.004). After a 12-months, a significant increase was observed in PI and mean PD for abutment teeth of metal-ceramic crowns. The metal-free crowns presented higher values for GBI and CAL (p2 < 0.05). Only distal cervical evaluation and dental biofilm formation in the abutment teeth showed a statistical difference between the groups at the 12-month follow-up. The supragingival margin metal-ceramic group revealed higher PI values (p2 = 0.005) between the period and the subgingival margin of both biomaterials showed greater GBI scores (p2 < 0.05).

Conclusions

Metal-free crowns showed better periodontal outcomes compared to metal-ceramic crowns. Single-unit crown marginal location affects the periodontal tissue condition of the abutment teeth. The marginal fit was not changed regarding the biomaterial type.

Comparative Analysis of Periodontal Parameters and Patient Satisfaction Utilising Different Temporary Crown Fabrication Techniques: A Parallel-Group Randomised Controlled Trial

Aim The study aims to evaluate the efficacy of different techniques for temporary crown fabrication in maintaining periodontal health and patient satisfaction, addressing a critical gap in the existing literature and informing evidence-based clinical practices. Materials and methods This study, conducted in accordance with CONSORT guidelines, was a parallel-group randomised trial conducted at a dental institute in India. In total, 36 participants aged 18-65 requiring anterior tooth region crowns were randomly assigned to three groups: direct (control), indirect (Test Group 1) and direct-indirect (Test Group 2) fabrication techniques. Participants were selected from outpatient departments based on eligibility criteria, and interventions were allocated using randomization tables. Outcome assessments included gingival health metrics and patient satisfaction levels, with statistical analyses performed using the Kruskal-Wallis test. Results Significant differences were observed in the pink esthetic score (PES) and patient satisfaction (P=0.029) among the three groups, with the direct-indirect technique group demonstrating the highest median PES (9 out of 10). However, no significant disparities were noted in the plaque index (PI) or probing depth (PD) among the groups. Conclusion The direct-indirect technique demonstrated superior PES and patient satisfaction, indicating potential benefits for periodontal health and patient experiences. Integration of virtual preparation workflows may optimise outcomes, but further research is needed for validation and guideline development.

Clinical solutions for natural abutments with preexisting defected crown margin in the aesthetic area

Crown replacement has remained one of the difficult methods for installing fixed prosthesis but is often performed because of aesthetic factors and invasion of biological width. This article focuses on the clinical scenario in which preexisting crown margin has defects. Given that clinical decisions regarding restoration management and perio-dontal tissues have to be made with caution, a decision tree of the decision making process for natural abutments in aesthetic area with preexisting defected crown margin is presented. The re-establishment of a new crown margin is the key to the success of a new restoration, and the new margin should be located at the proper esthetic position and right biological position. It should have fine, smooth, and continuous morphology.

"Afterglow" Photodynamic Therapy Based on Carbon Dots Embedded Silica Nanoparticles for Nondestructive Teeth Whitening

Teeth staining is a common dental health challenge in many parts of the world. Traditional teeth whitening techniques often lead to enamel damage and soft tissue toxicity due to the use of bioincompatible whitening reagents and continuous strong light irradiation. Herein, an "afterglow" photodynamic therapy (aPDT) for teeth whitening is proposed, which is realized by energy transition pathways of intersystem crossing. The covalent and hydrogen bonds formed by carbon dots embedded in silica nanoparticles (CDs@SiO2) facilitate the passage of energy through intersystem crossing (ISC), thereby extending the half-life of reactive oxygen species (ROS). The degradation efficiency of aPDT on dyes was higher than 95% in all cases. It can thoroughly whiten teeth by eliminating stains deep in the enamel without damaging the enamel structure and causing any tissue toxicity. This study illustrates the superiority of aPDT for dental whitening and the approach to exploring carbon-dots-based nanostructures in the treatment of oral diseases.

Potential Impact of Prosthetic Biomaterials on the Periodontium: A Comprehensive Review

The success of a prosthetic treatment is closely related to the periodontal health of the individual. The aim of this article was to review and present the importance of prosthetic restorative materials on the condition of the periodontium, the changes that occur in the composition of the subgingival microbiota and the levels of inflammatory markers in gingival crevicular fluid. Articles on the influence of different prosthetic restorative materials on subgingival microbiota and proinflammatory cytokines were searched for using the keywords "prosthetic biomaterials", "fixed prosthesis", "periodontal health", "subgingival microbiota", "periodontal biomarkers" and "gingival crevicular fluid" in PubMed/Medline, Science Direct, Scopus and Google Scholar. The type of material used for prosthesis fabrication together with poor marginal and internal fit can result in changes in the composition of the subgingival microbiota, as well as increased accumulation and retention of dentobacterial plaque, thus favoring the development of periodontal disease and prosthetic treatment failure. Biological markers have helped to understand the inflammatory response of different prosthetic materials on periodontal tissues with the main purpose of improving their clinical application in patients who need them. Metal-free ceramic prostheses induce a lower inflammatory response regardless of the fabrication method; however, the use of CAD/CAM systems is recommended for their fabrication. In addition, it is presumed that metal-ceramic prostheses cause changes in the composition of the subgingival microbiota producing a more dysbiotic biofilm with a higher prevalence of periodontopathogenic bacteria, which may further favor periodontal deterioration.

Three-year clinical evaluation of zirconia and zirconia-reinforced lithium silicate crowns with minimally invasive vertical preparation technique

Objectives

Large part of the tooth is required to be removed during crown preparation. A minimally invasive method for preparing single crowns is required to increase the durability of teeth. The aim of this study was to evaluate the clinical performance of two ceramic systems fabricated with minimally invasive vertical preparation.

Materials and methods

Forty endodontically treated maxillary premolars were prepared with vertical preparation and received temporary crowns for a period of 21 days. Twenty zirconia-reinforced lithium silicate (Celtra Duo HT, Dentsply Sirona, Germany) and 20 monolithic high translucency zirconia (Katana HT, Kuarary Noritake, Japan) crowns were fabricated by CAD/CAM and cemented with dual-polymerizing luting resin. The crowns were evaluated clinically and radiographically for 36 months following modified FDI criteria. Statistical analysis was conducted with t Student test (Cochran Q).

Results

Over the follow-up period, there was no need to replace any of the study’s crowns. The overall survival rate of the 40 crowns was 100% according to the Kaplan–Meier survival method. The clinical quality of all crowns and the patient’s satisfaction were high. No caries was detected and no adverse soft tissue reactions around the crowns were observed. Periodontal probing depth was reported to be increased at mesial and distal sites more than the facial one in the 36-month follow-up with no statistically significant difference between both materials (P = 0.186).

Conclusions

Zirconia and zirconia-reinforced lithium silicate could be used as a material for restoration of teeth prepared with vertical preparation technique. Both ceramic materials achieved good esthetic results, promotes healthy and stable soft tissues with no mechanical complications after 3 years of clinical evaluation.

Clinical relevance

Monolithic high translucency zirconia and zirconia-reinforced lithium silicate ceramics can be used for the restorations of minimal invasive vertical preparation in premolar area with 0.5 mm margin thickness.

The Concluding Editorial Regarding the Special Issue “Latest Advances in Prosthodontics: Improving Patient-Centered Outcomes”

According to the current holistic concept of health, all patients require a thorough assessment of their physical, psychological, and emotional well-being, not merely a confirmation or classification of disease [...]