International Journal of Esthetic Dentistry (EN), 03/2019

Objectives: The aim of this study was to systematically review the literature on the clinical behavior of direct anterior composite restorations and to identify the factors potentially influencing restoration success and longevity. Materials and methods: The search included all existing references until September 2016 cited in the PubMed database, the Cochrane central register of controlled trials and Cochrane Library, EMBASE, an internet search using Google internet search engine (possibly including unpublished data), a hand search (University of Geneva library), and the perusal of the references of relevant articles. Studies with appropriate research protocols and that clearly reported data about the performance of anterior composite restorations were included. Yearly failure rates (YFRs) were computed for each study based on survival rates or, when not reported, using United States Public Health Service (USPHS) scores leading to reintervention. The potential impact of the following factors was evaluated: composite filler technology (microfilled, macrofilled, nanofilled or hybrid), polymerization mode (chemical or light cured), treatment environment (academic, private or social) and operator (single or multiple). The studies were analyzed according to the observation time ( 2 years, 2 to 5 years, and > 5 years). Results: 39 potential studies were identified, from which 24 met the review inclusion criteria: nine randomized controlled trials (CTs), two prospective CTs, one retrospective CT, six prospective case series (CSs), and four retrospective CSs. Conclusion: This review followed a standard approach and explored an alternative review process that limited the significant data loss that occurs when the meta-analysis method is used. Overall, anterior composite restorations have shown a large heterogeneity in performance, as is typically observed in reviews of clinical studies, but the present appraisal identified influential factors such as treatment environment and the number of operators.

Purpose: The present clinical study aimed to investigate the safety and feasibility of cervical marginal relocation (CMR) procedures in cases of deep caries involving supracrestal tissue attachment (STA). Materials and methods: Fifteen patients were selected from those attending the Studio Ghezzi Dental Clinic, Settimo Milanese, Milan, Italy. After following an oral hygiene program with specific counseling sessions, the selected patients were included in a periodic supportive periodontal therapy program. Depending on the treatment they received, the patients were divided into three groups according to a new classification system: a) Class 1: Nonsurgical CMR; b) Class 2a: Surgical CMR (gingival approach); c) Class 2b: Surgical CMR (osseous approach). The primary and secondary outcomes were pocket depth (PD) on probing and residual bleeding on probing (BOP) after 1 year. Results: No differences were found among the three CMR approaches for PD (overall mean value after 1 year: 2.5 ± 0.64 mm; overall mean value after 5.7 years: 2.3 ± 0.49 mm) or residual BOP (40% of the cases after 1 year). Conclusion: Based on the study results, the authors can conclude that CMR procedures do not negatively affect the periodontal health status of patients when the connective compartment of the STA is not violated.

The esthetic treatment of the anterior teeth has always presented a challenge in clinical practice. With the improvement of dental materials, many restorative options such as resin composites, all-ceramic crowns, and ceramic veneers have become available. The current challenge in reconstructive dentistry is how to obtain excellent esthetic results while preserving the biological structures involved as much as possible. Thanks to the introduction of high-strength etchable dental ceramics, clinicians and technicians now have materials and procedures at their disposal that allow for the restoration of esthetics and function through a minimally invasive approach. New-generation, all-ceramic restorations and adhesive systems allow greater preservation of residual hard tooth structures, especially with regard to single elements. Purpose: To evaluate the clinical performance of lithium disilicate (LiDiSi) veneers with a feather-edge finish line margin. Materials and methods: A total of 265 LiDiSi veneers were cemented with resin cement after fluoridric acid and silane surface treatment and observed by different clinicians. These veneers were placed in 53 (32 female, 21 male) patients between October 2009 and April 2015, with a mean observation period of 54.4 months. Of these, 211 veneers were placed in the maxilla (77 central incisors, 65 lateral incisors, 49 canines, 12 first bicuspids, 5 second bicuspids, 2 first molars, 1 second molar), and 54 in the mandible (16 central incisors, 14 lateral incisors, 13 canines, 6 first bicuspids, 1 second bicuspid, 2 first molars, 2 second molars). The clinical evaluation used the modified California Dental Association (CDA) and Ryge criteria after recalling all patients between January and March 2017. The clinical parameters evaluated were color matching, quality of the ceramic surface, the presence of marginal discoloration, and marginal integrity. The data were analyzed through descriptive statistical analysis. Results: The clinical survival of the 265 veneers over the follow-up period was 99.63%. One restoration showed adhesive failure due to a traumatic event after 3 years of clinical service. The color matching parameter was classified as Alfa in 93.9% (248/265) and Bravo in 6.4% (17/265) of the restorations, with no Charlie or Delta ratings recorded. The ceramic surface was rated as Alfa in 97.7% (259/265) and Bravo in 2.2% (6/265), marginal discoloration as Alfa in 97.3% (257/265) and Bravo in 3% (8/265), and marginal integrity as Alfa in 96.9% (256/265) and Bravo in 3.4% (9/265) of the restorations. Conclusion: In this retrospective analysis, LiDiSi veneers with a vertical finish line showed good clinical performance in terms of color matching, ceramic surface, marginal discoloration, and marginal integrity. Despite the present results, further clinical studies are needed in order to investigate the long-term performance of this type of restoration.

Background: The present study evaluated the coronal discoloration induced by different materials or blood as well as the effect of internal bleaching on discoloration. Methods: After tooth color measurement at baseline with a sphere spectrophotometer (CIE L*a*b*), the root canals of molars were partially filled with white mineral trioxide aggregate (MTA), triple antibiotic paste (TAP), or a cotton pellet with bovine blood (control) was placed into the pulp chamber. The color changes were assessed at 30, 60, and 180 days after the procedure. Following the discoloration, internal bleaching was performed with a mixture of sodium perborate and hydrogen peroxide inserted into the pulp chamber, and this mixture was replaced weekly for 3 weeks. At baseline, after staining and after bleaching, the data of each color parameter were individually analyzed by one-way ANOVA, while differences in pooled color changes (∆E00) were assessed by two-way repeated measures ANOVA (α = 0.05). Results: After the staining period, the TAP-stained specimens were darker and greener than the other specimens, and no difference was observed between the teeth stained with blood and those stained with MTA. The walking bleach technique resulted in an improved tooth color without a difference in the color changes among the different groups. Conclusion: The TAP-stained specimens had the greatest tooth discoloration, and the discoloration remained the highest after the walking bleach technique. Practical implications: This in vitro study demonstrated that TAP yielded higher tooth discoloration, and this color might hinder a satisfactory tooth color from being obtained with the walking bleach technique.

The aim of this study was to demonstrate the influence of an adhesive temporary restoration on the effectiveness of the bleaching reaction, regardless of the concentration of the bleaching agent used. Every clinician involved in conservative dentistry understands the incompatibility between 'chemical bond' and 'oxygen.' This awareness often influences clinicians to decide on a temporary 'mechanical retention' filling that is unable to prevent the escape of oxygen ions, forcing the patient into more sessions and therefore raising the risk of complications. The scientific rationale behind the procedure described in this article is based on the bonding capacity of the coronal seal to maintain the rapid dissociation of the hydrogen peroxide exclusively within the pulp chamber, inducing an increase in the internal pressure and a consequent penetration of the oxygen-free radicals directly inside the dentinal tubules. In fact, avoiding the spontaneous dissipation of the oxygen-free radicals in the external environment may limit their effectiveness. This study aimed specifically to prove that it is possible to obtain a rapid bleaching reaction by observing a protocol based on the 'walking bleach' technique, specifically modified not so much by the typology of the mixture used but by fully exploiting the reaction yield of the hydrogen peroxide disproportionation. The results of the documented clinical cases presented here show the effectiveness of this method, which is achieved in a single session, therefore decreasing the possibility of the several operating phases that are necessary with the traditional procedure.

This in vitro study aimed to evaluate the effect of two alternative clinical protocols on the tooth bleaching effectiveness of 37% carbamide peroxide. Thirty enamel-dentin blocks from bovine incisors were stained with a coffee solution for 1 week. After color measurement at baseline with a portable spectrophotometer, the blocks were bleached during two 45-min applications of 37% carbamide peroxide with a 2-day interval between bleaching procedures, according to one of the following protocols: 1) Control: placement of bleaching agent over dried enamel; 2) Moist enamel: placement of bleaching agent over enamel previously humidified with a damp gauze for 1 min; 3) Moist cotton pellet: covering the bleaching agent with a moist cotton pellet during the entire bleaching procedure. The tooth color was assessed 2 days after each bleaching procedure. The data of ΔL, Δa, Δb, and ΔE were individually analyzed using ANOVA and Tukey's test (α = 0.05). In general, applying the bleaching agent to the moist enamel resulted in lower Δa and Δb values, and higher ΔL and ΔE values than the control. No difference was observed between the control and the protocol of covering the bleaching agent with a moist cotton pellet. Regardless of the protocol, the second bleaching procedure resulted in a further increase in ΔL and ΔE, and a reduction in Δa. A further decrease in Δb was observed only for the moist enamel protocol. In conclusion, humidifying the enamel with a damp gauze prior to the placement of 37% carbamide peroxide improved the effectiveness of the bleaching.

Implants in the esthetic zone can be challenging due to the buccal plate resorption that occurs after tooth extraction. The socket shield technique has proven to maintain the buccal bone and midfacial tissue, minimizing the risk of tissue loss that can lead to an unesthetic emergence of the implant restoration. The socket shield technique is, however, a technically difficult procedure to perform. Key aspects for achieving a successful treatment outcome are a careful extraction of the palatal portion of the root, a meticulous buccal shield preparation, and accurate implant drilling and placement. A flapless approach has been described classically in the postextraction socket shield implant scenario. This case report describes an immediate implant in the maxillary right central incisor on a patient with a high lip line and exacting cosmetic demands. An open flap approach to improve the visibility of the partial extraction and to minimize potential complications derived from an inadequate shield preparation is described. No adverse effects such as soft tissue scarring were visible after 1 year of loading, and tissue volume, color, and contour were maintained during the observation period.