Evaluation of the Relationship between Subjects? Perception and Professional Assessment of Esthetic Treatment Needs

PURPOSE

The purposes of the present study were to (1) evaluate the esthetic dental treatment need by means of two special questionnaires, (2) determine the reliability and the construct validity of the measurement scales derived from these questionnaires, and (3) investigate the relationship between Greek subjects' perception and a professional examiner's assessment regarding the esthetic treatment need.

MATERIALS AND METHODS

Participants in this survey consisted of 132 subjects (48 males with mean age 39.0 +/- 14.5 years old, 84 females with mean age 41.7 +/- 14.5 years old) with natural teeth and fixed restorations. Subjects were asked to complete a special self-evaluation questionnaire consisting of 12 items. During the next stage, all participants were clinically examined by an experienced examiner and the data collected were used to fill out a second special professional assessment questionnaire consisting of 20 items. The forms structure used were in accordance with well-established indices used in orthodontics for assessing esthetic treatment need.

RESULTS

The reliability of the multiple correspondence analysis (MCA) analysis-derived scales was very satisfactory (Cronbach's a coefficient: a =0.82) for the total scale of the self-evaluation measurement. For the professional assessment scale, the reliability of the total scale was almost perfect (a=0.92). The MCA revealed one reliable factorial construct for the self-evaluation measurement scale and two reliable constructs for the professional measurement scale. Pearson's correlation coefficient indicated a very low agreement between self-evaluation and professional measurement scales.

CONCLUSION

The findings of this survey suggest that there was a relative disagreement between subjects' perception and professional assessment regarding the need for esthetic dental treatment. CLINICAL SIGNIFICANCE In the present survey, the agreement between subjects' perception and clinical assessment of esthetic dental treatment need was found to be very low, which highlighted the discrepancies between patients' and dentists' perceptions of esthetic needs.

Comparison of cell proliferation on modified dental ceramics

The aim of this study was to investigate the influence of substrate characteristics such as chemical composition and surface morphology of dental ceramics to support cell attachment and proliferation. Thus, body (B) and shoulder (S) porcelain differing on their surface morphology and composition were treated with oxides CaO or CaO and P(2)O(5) and four modified ceramics BCa, BCaP, SCa, SCaP were constructed, respectively. The modified ceramics differ from their controls concerning their surface morphology as evaluated by Scanning Electron Microscope (SEM), and their surface chemical composition (Na, KP and Ca) as evaluated by Energy Dispersing Spectroscopy (EDS). All modified ceramics support better than the control ceramics the cell proliferation over 72 h incubation period. Furthermore, higher rates of cell proliferation was detected in shoulder modified ceramics (SCa and SCaP) than in all other cases.

Evaluation of color stability of preshaded and liquid-shaded monolithic zirconia

STATEMENT OF PROBLEM

The effect of thermal aging on the color stability of monolithic zirconia has not been thoroughly investigated.

PURPOSE

The purpose of this in vitro study was to evaluate the color stability before and after thermocycling of monolithic zirconia specimens, which were either preshaded or characterized in the laboratory through the assessment of color parameters L*, a*, and b*.

MATERIAL AND METHODS

A total of 80 specimens (10×10×15 mm) were prepared from zirconia disks (BruxZir) and divided into 2 groups. The first group consisted of preshaded specimens from disks 100, 200, 300, and 400, and the second group consisted of white specimens characterized before the sintering stage with coloring liquids in shades A2, B2, C2, and D2. Ten specimens of each shade were used. A double-beam ultraviolet-visible light recording spectrophotometer was used to assess the color parameters L*, a*, and b* before and after thermocycling. The color difference ΔE was calculated based on ΔΕ=[(ΔL*)²+(Δa*)²+(Δb*)²]^½. The reliability of the examiner was investigated by MedCalc v12.5 software, and the tests of normality, homogeneity of variances, and 1-way ANOVA statistical analysis of variance were performed by IBM Statistics SPSS v20.0 software (α=.05).

RESULTS

No statistically significant ΔΕ (P>.05) was observed among the different groups after thermocycling. All ΔΕ values were below the limit of the 3.7 that an untrained observer can perceive. Only for the specimens in shades 200 and 400 was ΔΕ above 1, revealing a visible color difference, which, however, was still clinically acceptable. The L*, a*, and b* values for both liquid-shaded and preshaded zirconia specimens were not significantly affected by thermocycling. A higher color stability for laboratory-characterized compared with preshaded monolithic zirconia was observed irrespective of the color shade.

CONCLUSIONS

Within the limitations of this in vitro study, monolithic zirconia specimens of any shade, either preshaded or characterized in the laboratory, can be considered as color-stable materials after thermocycling.

Effect of Immediate Dentin Sealing on the Bond Strength of Monolithic Zirconia to Human Dentin

Objective:

This study evaluated the shear bond strength (SBS) of pretreated monolithic zirconia surfaces bonded to human dentin following immediate dentin sealing (IDS) using two different self-adhesive resin luting agents.

Methods and Materials:

Sixty intact human third molars were collected, stored, sectioned appropriately, and molded according to ISO 29022:2013, resulting in 120 dentin specimens. Ceramic cylindrical specimens were fabricated using CAD/CAM technology and sintered as recommended (final bonding area A=2.56 mm2). Specimens were randomly assigned to eight groups (15≥n≥14) depending on dentin conditioning method (IDS or delayed dentin sealing [DDS]), zirconia surface pretreatment (airborne particle abrasion [APA] with 50 μm Al2O3 particles at 3 bar for 10 seconds or tribochemical silica coating [TBC] with 30 μm CoJet particles at 2.8 bar for 10 seconds), and adhesive luting agent type (Panavia F2.0 [PAN] or PermaCem Dual Smartmix [PER]). Bonded specimens were water-stored (37°C, 24 hours) and subjected to SBS testing (50-kgF load cell, 1 mm/min). Fracture type was evaluated with stereomicroscopy. Data (MPa) were statistically analyzed using three-way analysis of variance (α=0.05).

Results:

All factors significantly affected SBS values (p<0.001). Dentin conditioning method presented the greatest effect. Mean SBS values ranged from 12.603 MPa (PER-APA-DDS) to 40.704 MPa (PER-TBC-IDS). Based on the fracture type, adhesive failures at the luting agent–zirconia interface were the least common.

Conclusion:

Bonding strategies for monolithic zirconia restorations could potentially benefit from IDS, regardless of the adhesive luting agent system used.

In vitro evaluation of the shear bond strength and bioactivity of a bioceramic cement for bonding monolithic zirconia

STATEMENT OF PROBLEM

Adhesive cementation is the most common bonding strategy for zirconia restorations. Although cementation with a bioactive luting agent has been proposed as an alternative, how the bond strength compares is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate shear bond strength after cementing a monolithic zirconia ceramic to human dentin with a bioceramic cement, compare it with a traditional cement, and evaluate its bioactive properties.

MATERIAL AND METHODS

A total of 120 dentin specimens and 120 yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) (BruxZir) cylindrical specimens were used. Zirconia and dentin specimens were randomly divided into 8 study groups (n=15) based on 2 luting cement types (a bioceramic cement or glass ionomer cement as control), 2 airborne-particle abrasion protocols (50 μm or 110 μm), and 2 water storage durations (24 hours or 30 days). After the shear bond strength test using a universal machine at a crosshead speed of 1 mm/min, fracture patterns were evaluated under a stereomicroscope and a scanning electron microscope. Strength values were statistically analyzed with a 3-factor ANOVA model (α=.05). Bioactivity was evaluated in simulated body fluid (SBF).

RESULTS

The control glass ionomer cement achieved significantly greater shear bond strength compared with the tested bioceramic cement. Mean bond strength values ranged from 2.52 MPa to 5.23 MPa for the bioceramic cement tested and from 4.20 MPa to 6.61 MPa for the control cement. The duration of water storage played a significant role in the bond strength, with groups stored for 30 days reaching higher bond strength values, whereas the particle size of airborne-particle abrasion did not have a significant effect. Failure types were primarily mixed. No apatite formation was recorded on the surface of the specimens even after 30 days of immersion in SBF.

CONCLUSIONS

The evaluated cement did not develop apatite in SBF, and its bond strength values were below the control glass ionomer cement.

Screwmentable implant-supported prostheses: A systematic review

STATEMENT OF PROBLEM

Screwmentable prostheses were developed to combine the benefits of screw retention and cement retention. However, data are limited on the clinical performance of this type of prosthesis.

PURPOSE

The purpose of this systematic review was to collect scientific evidence on screwmentable prostheses and evaluate their long-term clinical behavior.

MATERIAL AND METHODS

An electronic search was conducted by 2 independent reviewers for articles published in scientific dental journals in English from 2004 to April 2020. The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were scientific studies concerning the screwmentable type of prosthesis.

RESULTS

The search provided 494 records. Of these, 24 studies fulfilled the inclusion criteria and were included in the review. The included articles presented significant heterogeneity concerning the manufacturing process and the materials used. One randomized clinical trial, 2 prospective clinical studies, 14 in vitro studies, 3 protocol descriptions, 1 case series, and 3 case reports were included.

CONCLUSIONS

Based on the systematic search of the literature, it is concluded that the screwmentable prosthesis combines advantages of both cement-retained and screw-retained restorations, including passive fit, retrievability, excess cement control, tissue-friendly emergence profile, and improved esthetics. Nevertheless, data from well-designed clinical trials are limited, and further research is required to provide evidence on their long-term clinical behavior.

The Effect of Angulation and Scan Body Position on Scans for Implant-Treated Edentulism: A Clinical Simulation Study

INTRODUCTION

The acquisition of digital impressions has become an integral part of clinical dentistry. The purpose of the present clinical simulation study was to evaluate the accuracy of digital impressions for maxillary full-arch implant-supported prostheses using two modern intraoral scanners with different acquisition technologies.

MATERIAL AND METHODS

Two models of edentulous maxilla, with six implants at positions #16,14,12,22,24,26 (FDI World Dental Federation System, ISO 3950) or #3,5,7,10,12,14 (Universal Numbering system) were digitally designed, and 3D-printed in resin material (Asiga DentaMODEL, Australia). In the first scenario, all implants were parallelized, while in the second, implants #12/#7 and #22/#10 had a 20° angulation buccally, while implants #16/#3 and #26/#14 20° angulation distally. The models were scanned with two different intraoral scanners, Trios3 (3Shape, Denmark) and CS3600 (Carestream Dental, USA). Linear (x, y, z axes-top point) and angular deviations (x, y, z axes-Δφ) were assessed. Statistical analysis was performed using Kolmogorov-Smirnov tests (significance at p < 0.05).

RESULTS

Implant angulation showed a significant impact on accuracy, while the two scanners showed statistically significant differences. CS3600 demonstrated superior trueness, while Trios3 superior precision in both clinical scenarios. In the first clinical scenario a predominant occurrence of angular deviations was observed, while in the second scenario both angular and linear deviations were recorded. Scan body position also influenced scanning outcomes, with the last scan body captured demonstrating higher deviations.

CONCLUSION

Both scanners provided acceptable accuracy in the acquisition of digital impressions. Implant angulation and scan body position significantly affected trueness and precision. Clinicians should carefully consider implant angulations in full-arch implant restorations, as well as the scanning protocol.

"Biological responses of two calcium-silicate-based cements on a tissue-engineered 3D organotypic deciduous pulp analogue"

OBJECTIVES

The biological responses of MTA and Biodentine™ has been assessed on a three-dimensional, tissue-engineered organotypic deciduous pulp analogue.

METHODS

Human endothelial (HUVEC) and dental mesenchymal stem cells (SHED) at a ratio of 3:1, were incorporated into a collagen I/fibrin hydrogel; succeeding Biodentine™ and MTA cylindrical specimens were placed in direct contact with the pulp analogue 48 h later. Cell viability/proliferation and morphology were evaluated through live/dead staining, MTT assay and Scanning Electron Microscopy (SEM), and expression of angiogenic, odontogenic markers through real time PCR.

RESULTS

Viable cells dominated at day 3 after treatment presenting typical morphology, firmly attached within the hydrogel structures, as shown by live/dead staining and SEM images. MTT assay at day 1 presented a significant increase of cell proliferation in Biodentine™ group. Real-time PCR showed significant upregulation of odontogenic markers DSPP, BMP-2 (day 3,6), RUNX2, ALP (day 3) in contact with Biodentine™ compared to MTA and the control, whereas MTA promoted significant upregulation of DSPP, BMP-2, RUNX2, Osterix (day 3) and ALP (day 6) compared to the control. MSX1 presented downregulation in both experimental groups. Expression of angiogenic markers VEGFa and ANGPT-1 at day 3 was significantly upregulated in contact with Biodentine™ and MTA respectively, while the receptors VEGFR1, VEGFR2 and Tie-2, as well as PECAM-1 were downregulated.

SIGNIFICANCE

Both calcium silicate-based materials are biocompatible and exert positive angiogenic and odontogenic effects, although Biodentine™ during the first days of culture, seems to induce higher cell proliferation and provoke a more profound odontogenic and angiogenic response from SHED.

Multidisciplinary Therapeutic Approach of a Patient With Sjogren's Syndrome: A Three-Year Follow-Up Study

Sjögren's syndrome is a chronic, inflammatory autoimmune disorder characterized by lymphocyte infiltration of the exocrine glands. Notably, the rehabilitation of partially edentulous patients with Sjögren's syndrome is limited by the scarce availability of studies that could inform therapeutic modalities and potential challenges during clinical procedures. This case report aimed to present the oral rehabilitation of a patient with Sjögren's syndrome who received fixed partial dentures (FPDs). A 28-year-old female patient sought treatment to restore her missing teeth. She was diagnosed with Sjögren's syndrome by a rheumatologist adhering to the revised version of the European criteria proposed by the American-European Consensus Group and was on a medication regimen including prednisolone, hydroxychloroquine, pantoprazole, pilocarpine, and tear substitutes to manage her condition. The final treatment plan consisted of extractions, management of gingivitis, post-and-core restorations, and a 2 mm vertical dimension increase with the placement of 15 porcelain-fused-to-metal (PFM) crowns and 4 short-span bridges. The patient underwent regular clinical and radiographic evaluations every 3 months since June 2020. Throughout this period, the fixed prostheses, teeth, and periodontal tissues demonstrated remarkable stability and exhibited no complications. This three-year case study provides evidence that meticulous planning and clinical execution can facilitate successful oral rehabilitation in young edentulous patients with Sjögren's syndrome. Tooth-supported fixed prostheses can effectively restore oral function and aesthetic appeal in these individuals, provided they undergo more frequent dental examinations than the general population and maintain a cooperative attitude throughout the treatment process.

Evaluation of marginal/internal fit of fixed dental prostheses after digital, conventional, and combination impression techniques: A systematic review

Advances of digital technology are rapidly adopted in dental practice. This systematic review aimed to collect evidence on the accuracy of fit of different types of fixed dental prostheses (FDPs) fabricated through digital, conventional, or combination impression techniques. Data collection was based on the guidelines of the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Two databases (PubMed, Scopus) were searched for articles in English published between 2010 and 2021 resulting in 480 articles. Of those, 35 studies fulfilled the inclusion criteria. These articles referred to three groups of materials/techniques including all-ceramic (zirconia; lithium disilicate) and porcelain-fused-to-metal (PFM) restorations. Results showed clinically acceptable marginal fit (< 120 μm) for all materials and impression techniques. Α fully digital workflow appears more promising for the construction of short-span zirconia FDPs. Nevertheless, most articles evaluated marginal/internal fit of single crowns or short-span FDPs in vitro, while clinical data are limited for long-span FDPs. The necessity for gingival retraction remains a major drawback of all impression techniques, increasing procedural time and patient discomfort. Besides, factors related to the fabrication process, including milling and 3D printing of working models significantly influence the outcome. Overall, there still some way to go before digital technology can be incorporated in complex treatment plans in prosthodontics.

Haptics in fixed prosthodontics and their role in dental education: A literature review

Technological progress leads to new advances in dental education. One of the applications involves the use of virtual and augmented reality as educational aids. The emerging question is to establish if and how these enhancements may prove beneficial to the overall student learning process. A review of recent literature was conducted with the aim of providing evidence for the development of relevant clinical guidelines. The proposed topic attempted to provide answers to the questions of (a) how participants perform when using haptic devices compared to traditional tooth preparation methods on typodonts, (b) how the use of simulators is perceived by both students and educators, and (c) what added value simulators may have in prosthetic dentistry training. The main findings of this study showed that participants expressed satisfaction with the educational experience, finding it both stimulating and very similar to the actual clinical environment. However, differences between haptic and conventional methods were also apparent. Haptics was a significant predictor of clinical crown performance. Significantly better results and shorter preparation times tended to increase with experience. In conclusion, self-directed learning appears to be beneficial in the clinical education that follows data-driven approach. At the pre-laboratory level, simulators may act as an initial familiarization instrument. At the preclinical level, they may aid in detecting students who require extra assistance, or to provide extra training hours for students lacking adequate competency to enter the clinical training phase.

Tissue-Engineered Oral Epithelium for Dental Material Testing: Toward In Vitro Biomimetic Models

Tissue-engineered oral epithelium (ΤΕΟΕ) was developed after comparing various culture conditions, including submerged (SUB) and air-liquid interface (ALI) human cell expansion options. Barrier formation was evaluated via transepithelial electrical resistance (TEER) and calcein permeation via spectrofluorometry. TEOE was further assessed for long-term viability via live/dead staining and development of intercellular connections via transmission electron microscopy. Tissue architecture was evaluated via histochemistry and the expression of pancytokeratin (pCK) via immunohistochemistry. The effect of two commonly used dental resinous monomers on TEOE was evaluated for alterations in cell viability and barrier permeability. ALI/keratinocyte growth factor-supplemented (ALI-KGS) culture conditions led to the formation of an 8-20-layer thick, intercellularly connected epithelial barrier. TEER values of ALI-KGS-developed TEOE decreased compared with all other tested conditions, and the established epithelium intensively expressed pCK. Exposure to dental monomers affected the integrity and architecture of TEOE and induced cellular vacuolation, implicating hydropic degeneration. Despite structural modifications, the permeability of TEOE was not substantially affected after exposure to the monomers. In conclusion, the biological properties of the TEOE mimicking the physiological functional conditions and its value as biocompatibility assessment tool for dental materials were characterized.

Development of an Oral Epithelial Ex Vivo Organ Culture Model for Biocompatibility and Permeability Assessment of Biomaterials

In the present study, a customized device (Epi-ExPer) was designed and fabricated to facilitate an epithelial organ culture, allowing for controlled exposure to exogenous chemical stimuli and accommodating the evaluation of permeation of the tissue after treatment. The Epi-ExPer system was fabricated using a stereolithography (SLA)-based additive manufacturing (AM) method. Human and porcine oral epithelial mucosa tissues were inserted into the device and exposed to resinous monomers commonly released by dental restorative materials. The effect of these xenobiotics on the morphology, viability, permeability, and expression of relevant markers of the oral epithelium was evaluated. Tissue culture could be performed with the desired orientation of air-liquid interface (ALI) conditions, and exposure to xenobiotics was undertaken in a spatially guarded and reproducible manner. Among the selected monomers, HEMA and TEGDMA reduced tissue viability at high concentrations, while tissue permeability was increased by the latter. Xenobiotics affected the histological image by introducing the vacuolar degeneration of epithelial cells and increasing the expression of panCytokeratin (pCK). Epi-ExPer device offers a simple, precise, and reproducible study system to evaluate interactions of oral mucosa with external stimuli, providing a biocompatibility and permeability assessment tool aiming to an enhanced in vitro/ex vivo-to-in vivo extrapolation (IVIVE) that complies with European Union (EU) and Food and Durg Administration (FDI) policies.

Effectiveness of conservative therapeutic modalities for temporomandibular disorders-related pain: a systematic review

PURPOSE

The aim of this systematic review was to evaluate the effectiveness of conservative different therapeutic modalities for temporomandibular disorders (TMD) pain.

MATERIALS AND METHODS

An electronic systematic search was conducted in the MEDLINE (PubMed) database to identify the randomized clinical trials (RCTs) published between 2001 and 2021. The following, simple or multiple conjunctions, search keywords were selected: TMD pain, TMD management or conservative treatment or treatment strategies and TMD pain, therapeutic modalities or interventions and TMD. Studies included must have patients older than 18 years, with painful TMD, which diagnosis was performed by Research Diagnostic Criteria for TMD or Diagnostic Criteria for TMD. Outcome variables were pain relief and post treatment pain intensity reduction. Data were analysed with non-parametric tests and the level of significance was set at p<.05.

RESULTS

Out of 1599 articles obtained, 28 RCTs fulfilled all selection criteria and were included. The results of this study show that there was a significant decrease in short-term post-treatment TMD pain with the use of occlusal splint alone or in combination with other therapeutic modalities when compared with the control group. Statistically significant differences were also detected between laser and photobiomodulation group and the control, in short-term treatment TMD-related pain.

CONCLUSIONS

The primary findings of the present systematic review showed that the occlusal splint alone or combined with other therapeutic intervention presented positive effect on short-term TMD pain reduction. Secondary outcome suggests that laser and photobiomodulation therapy had, also, a significant role in short term pain relief.