Intrusion is frequently observed as a complication associated with tooth-implant-supported prostheses: the natural tooth that serves as an abutment moves apically and out of occlusion. However, intrusion of teeth proximal to implants has yet to be reported in the literature. In this manuscript, three presentations of tooth intrusion proximal to implants are reported; potential causes of the phenomenon are discussed; and a potential treatment for patients experiencing this condition is presented. Intrusion of teeth surrounded by freestanding implants is a rare phenomenon, a cause of which may be excessively tight proximal contacts that are below the height of contour of adjacent implants. Alleviating these contacts enables the intruded tooth to erupt back and should be considered a viable treatment option.

This study aimed to compare the marginal and internal fit of five-unit zirconia fixed dental prostheses fabricated using digital scans and conventional impressions. Nine master models with three zirconia abutments were scanned with an intraoral scanner (test group), and nine conventional impressions (control group) of these same models were also made. The stone casts from theses impressions were scanned with a laboratory extraoral scanner (D700, 3Shape, Copenhagen, Denmark). A total of 18 five-unit zirconia fixed dental prostheses frameworks (test group, n = 9; control group, n = 9) were manufactured. Marginal and internal fit (in μm) were evaluated using the replica method under micro-computed tomography. Analysis of variance (one-way ANOVA) and Kruskal Wallis tests were used to compare continuous variables across two groups. A level of P <0.05 was accepted as statistically significant. The mean ±standard deviation of the marginal fit was 95.03 ±12.74 μm in the test group and 106.02 ±14.51 μm in the control group. The lowest marginal mean value was observed in the test group, with a statistically significant difference comparing to the control group (F = 14. 56, P <0.05). The mean ±standard deviation of the internal fit was 103.61 ±9.32 μm and 106.38 ±7.64 μm, respectively, in the test and control groups, with no statistically significant difference (F = 1.56, P >0.05). The mean values of both groups were clinically acceptable. The five-unit zirconia fixed dental prostheses fabricated with digital scans showed better fit than conventional impressions group. Within the limitations of this study, these results are encouraging and continued progress in the digital field should allow for more accurate long-span restorations. This article is protected by copyright. All rights reserved.

Atheromas can be detected incidentally in routine dental cone beam computed tomography (CBCT) images. This study aims to assess prevalence and risk factors associated with these vascular lesions. The maxillofacial CBCTs of 458 subjects were evaluated and divided into 4 groups based on the presence of calcified atheroma: subjects with no calcified atheroma, subjects with intracranial calcified atheroma (ICA), subjects with extracranial calcified atheroma (ECA), and subjects exhibiting combined lesions. Age, sex, medical conditions, family history, and size were documented. Analysis of variance followed by a multiple comparison test was used for data satisfying parametric test assumptions. Chi-squared tests were used to assess categorical data. The Spearman Rho test was used to assess the correlation between the incidence of calcified atheroma and subjects' medical condition. Of the 458 CBCTs evaluated, 29.90% presented with calcified atheroma. Calcified atheroma prevalence was significantly higher in older patients versus younger patients (p=0.004) and in males compared to females (p=0.004). Males were more likely to have the combination of ICA and ECA, whereas females were more likely to have ICA alone (p≤0.040). Patients with calcified atheroma were significantly more likely to have a history of hyperlipidemia (p=0.001), hypertension (p=0.001), and myocardial infarction/coronary artery diseases (p=0.001). Overall, patients exhibiting both intracranial and extracranial lesions were more likely to have cardiovascular risk factors (p=0.001). Incidentally detected calcified atheromas in CBCTs are common. Subjects with combined atheroma lesions are at higher risk for cardiovascular disease. The diagnosis of incidental calcified atheromas in CBCT's warrants early referral to medical specialists, especially if there is no medical history of existing cardiovascular disease.

To examine the fracture strength and fracture mode of flared root canals reinforced with different post and core materials. Forty endodontically treated bovine teeth structured to mimic human mandibular premolars with flared root canals were reinforced with resin composite and glass fiber post (FRC), composite resin (RC), ceramic core (LD), and ceramic core with resin composite reinforcement (RLD), and restored with single zirconia crowns (n = 10 in each group). The fracture strength and mode of the root canals restored with zirconia crown were assessed. The fracture strength was compared with a one-way analysis of variance (ANOVA) following Tukey HSD tests. A multiple regression analysis was conducted to test the effect of the post/core materials on the fracture loads. Fisher's exact test was used in the failure mode analysis. The mean fracture strength of RLD was significantly higher than RC, FRC, and LD (p < 0.05), while no significant differences were found among RC, FRC, and LD (p < 0.05). The regression analysis found that the fracture strength using the lithium disilicate was significantly lower for the post and higher for the core than that using the resin composite (p < 0.05), and there were no significant difference in the fracture strengths between the resin composite and glass fiber used for the post (p > 0.05). Most of the specimens exhibited root fractures, and no significant differences were observed among the groups (p < 0.05). The results of this study suggest that reinforcement of flared root canals using a combination of resin composite for the core and lithium disilicate ceramic for the post is superior to resin composite and glass fiber in mechanical properties when restoring a single crown.

The use of dental implants in pediatric patients may create unique complications. A 38-year-old patient presented with a mobile, cement-retained implant crown due to an abutment screw loosening. The maxillary right central incisor implant was placed when the patient was 10 years old. Pus discharge from the peri-implant sulcus was observed. The mucosal margin of the implant was at the level of the mucogingival junction of neighboring teeth. Radiographically, the platform of the implant appeared to be at the level of the apical third of the adjacent roots. After removing the existing implant-retained crown, the inflamed peri-implant tissue covering the implant platform was removed and the stability of the implant was confirmed. A new screw-retained implant crown was made using an angulated screw channel to correct the labiopalatal angulation of the implant and allow for retrievability. Pink porcelain was used to match the mucosal margin of the implant crown to that of the maxillary left central incisor. This case report highlights the risk of implant placement in pediatric patients and agrees with previous reports that implants should be delayed until growth is complete.

Centric relation (CR) is a universally recognized term and an acceptable reference position with a long history of success. The problem is that there is little consensus as to its definition or the method of recording it, and this has created an uprising to abolish it. A review of pertinent literature related to its definition, method of recording, anatomic considerations, and long-standing principles was conducted. Centric relation is an established term but there are valid concerns over its definition and method of recording. There is consensus on using it as a restorative position in a patient in need of full-arch reconstruction, and there is no substantive clinical research to contradict this. If a clinician decides to use a different position, it should have a different name. Centric relation is a reproducible reference position that can be utilized for diagnostic and restorative dental procedures with substantial scientific evidence to support that premise. There are numerous well-documented techniques, all of which are intermaxillary, that can replicate the position. There is little scientific evidence to support a premise as to where the exact position of the condyle should be in relation to the fossa.

This study aimed to investigate the effect of surface treatment and type of composite resin material on the color stability and surface roughness of different denture characterizing composites. Two nanohybrids [Gradia Plus Gum, (GP) and SR Nexco Paste Gingiva, (SR)] and one microhybrid gingiva-colored composite resin [Amaris Gingiva, (AG)] were investigated. A total of 120 disk-shaped samples were prepared, 40 of each material. Samples were divided into two groups (n = 20) for each material according to the surface treatmentapplied: conventional polishing (control) and coated with a sealant in addition to the surface polishing. All groups were thermocycled. The surface roughness (Ra) was measured using a profilometer after thermal cycling. The samples were then divided into 2 subgroups (n = 10) and stored for 7 days in distilled water or coffee solution. Color differences (ΔE00 ) were calculated with a spectrophotometer. Results were evaluated with Kruskal-Wallis and Mann-Whitney U statistical analysis. The type of denture characterizing composite material and surface treatment method revealed statistically significant differences for the ΔE00 (after immersion both in coffee and distilled water) and the Ra values of denture characterizing composite (p < 0.001 for both). All sealed groups showed significantly higher Ra than the all polished groups. Both in the polished groups and the sealant applied groups, the GP had the highest mean Ra values (0.29 ±0.05μm and 0.47 ±0.09μm, respectively). It was followed by SR (0.23 ±0.06μm and 0.41 ±0.10μm, respectively), and AG groups (0.20 ±0.06μm and 0.39 ±0.09μm, respectively). According to the mean ΔE00 results, all composite groups showed significantly higher ΔE00 values immersed in coffee solutions compared to distilled water. In coffee solutions, the highest ΔE00 was observed in the polished GP (1.90 ±0.40), and the lowest ΔE00 was observed in the polished SR (0.97 ±0.36). The sealed groups showed higher ΔE00 than the polished groups, except for GP. The surface roughness value of sealant applied groups were significantly higher than those of the polished groups. The surface sealant applicationsignificantly increased the staining of all composite groups compared to conventional polishing, except for GP.

PurposeThis double‐blind randomized controlled trial analyzed patient‐reported outcome measures in terms of subjective patient satisfaction compared to objective dental evaluation of prosthetic treatment with 3‐unit monolithic zirconium dioxide implant fixed dental prostheses (iFDPs) in 3 digital workflows.Material and methodsTwenty patients were restored with 3 iFDPs each on Straumann TL‐implants with 2 completely digital workflows using different intraoral optical scanning systems with model‐free fabrication of the restoration (Trios 3/3Shape [Test‐1]; Virtuo Vivo/Straumann [Test‐2]), and mixed analog‐digital workflow with conventional impressions and digitized gypsum casts (Impregum/3M Espe [Control]). The order of impression‐taking and the prosthetic try‐in were randomly allocated. Sixty iFDPs were compared for patient satisfaction and dental evaluation using ANOVA.ResultsFor iFDP evaluation, patients generally provided more favorable ratings than dental experts, regardless of the workflow. ANOVA revealed no significant difference for overall satisfaction when comparing Test‐1, Test‐2, or Control, either for patients (f‐ratio: 0.13; p = 0.876) or dentist (f‐ratio: 1.55: p = 0.221). Secondary, patients clearly favored the digital impression workflows over the conventional approach (f‐ratio: 14.57; p < 0.001). Overall, the 3Shape workflow (Test‐1) received the highest scores for all analyses.ConclusionsThe different digital workflows demonstrated minor influence on the subjective and objective evaluation of the monolithic zirconium dioxide iFDPs in nonesthetic regions; however, the dentist may significantly increase patient satisfaction by choosing intraoral scanning instead of conventional impressions. The dentist has to consider individual patients’ needs to fulfill their expectations for a personalized solution.

To synthesize the literature regarding noncarious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated. A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration. NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V-shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies, whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineralization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin-modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multistep and single-step adhesives have been used. Dentin etching should be increased to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion. Noncarious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V-shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multistep or single-step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators.

To investigate the translucency parameters of traditional, milled, and 3D-printed denture base materials at 3 different thicknesses and the color masking ability of each material against a metallic background between different thicknesses. A traditional heat-polymerizing polymethylmethacrylate (PMMA) (H-Lucitone) material was used as the control group. Two milled pre-polymerized resin blocks (M-Lucitone and IvoBase) and five 3D-printed denture base materials (P-Lucitone, Dentca LP, Dentca OP, Formlabs, and Kulzer) were used as experimental groups. A total of 240 samples, (n = 30, per material) were fabricated to a final specimen dimension of 12×12mm and in thicknesses of 1.0, 2.0, and 3.0mm (n = 10 per thickness/material) according to themanufacturers' recommendations. The color coordinates (L*, a*, b*) in CIELab color space for all specimens placed against a white, black, and metallic background were measured with a spectrophotometer. The translucency parameters (TP00 ) at each thickness and the color differences between 1mm and 2 mm (dE00M1-2 ) and between 2 mm and 3 mm (dE00M2-3 ) against the metallic background were calculated with the CIEDE2000 color matrix. Comparisons between the groups for differences in TP00 were made using One-way ANOVA separately for each thickness. Comparisons of groups and materials for differences in dE00M1-2 and dE00M2-3 were made using Two-way ANOVA and Fisher's Protected Least Significant Differences (α = 0.05). The TP00 decreased with increasing thickness in all 8 material groups. All 3D-printed materials, except P-Lucitone, had higher TP00 than milled pre-polymerized resin materials (M-Lucitone and IvoBase), and traditional heat-polymerizing PMMA (H-Lucitone) material (P<.001) at all thicknesses. In the 1 mm and 2 mm thickness, heat-polymerizing acrylic resin (H-Lucitone) had the lowest TP00 , and in the 3 mm thickness, milled acrylic resin (M-Lucitone and IVOBase) had had lowest TP00 (p < 0.001). All material groups had significantly lower values of dE00M2-3 than dE00M1-2 (p < 0.001). The color differences dE00M2-3 were significantly lower in H-Lucitone, M-Lucitone, P-Lucitone, and IvoBase groups than in other materials, while the color difference of dE00M1-2 was significantly lower in H-Lucitone, P-Lucitone and Dentca LP than other materials (p < 0.001). The results from this study provide clinicians and dental technicians with information regarding the selection of denture base materials to achieve desired color masking outcomes, according to available prosthetic space. Thicker prostheses significantly improved the color masking abilities of denture acrylic resins against a metallic background. In a thickness of 1 and 2 mm, the heat-polymerizing acrylic resin had a lower translucency parameter and better color masking ability. When the prosthesis thickness reached 3 mm, the milled acrylic resin had a lower translucency parameter and better color masking ability. When compared to the heat-polymerizing resin and milled acrylic resin materials, except for one 3D-printing resin (P-Lucitone), the color masking abilities of the remaining 3D-printing resin materials were low, regardless of prosthesis thickness.