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Purpose. The purpose of this in vitro study was to evaluate the effect of a staining solution on color stability of resins for complete dentures produced with conventional and digital technologies. Materials and Methods. 60 resin specimens were prepared and divided in 6 groups of 10 specimens each: Probase Hot (PH, Ivoclar AG), IvoBase CAD (IBC, Ivoclar AG), Ivotion Dent (ID, Ivoclar AG), Ivotion Dent Multi (IDM, Ivoclar AG), Dima Print Denture Base (DPDB, Kulzer), and Dima Print Denture Teeth (DPDT, Kulzer). One surface of each specimen was polished following the manufacturer’s instructions. The CIELab color differences were evaluated before and after immersion for 28 days in a coffee solution and measured as DE using two dental spectrophotometers. One specimen for each group was selected for SEM analysis at baseline and at 28-day. Results. Data analysis was performed by Kruskal-Wallis test and post-hoc Dunn test for comparison. Regarding specimens analyzed with VITA Easyshade, IDM white zone (polished and unpolished) scored higher (∆E= 0.87 and ∆E = 1.15 respectively). All milled samples (IBC, ID, IDM pink zone), scored significantly higher as compared to PH and DPDT. Regarding Spectroshade, IDM pink zone performed better, regarding both polished and unpolished specimens (∆E=1.57 and ∆E=2.07 respectively). ID demonstrated a statistic higher color stability compared to PH and DPDT. Regarding the SEM analysis any differences in surface morphology was observed between baseline and 28-days immersion analyses. Conclusions. Color stability is significantly higher in resin specimens obtained with digital technologies as compared to conventional resin specimens after immersion in a staining solution. 

Purpose. Evaluate the influence of different Co-Cr framework manufacturing techniques on the bond strength between metal and two types of veneering ceramic with and without a metal primer. Materials and Methods. 72 metal specimens were fabricated using the same Co-Cr alloy (Keramit NP; Nobil Metal) with three different techniques: ingots for casting (Keramit NP); disks for CAD/CAM milling (Synergy Drive Keramit NP); and powder for SLM (Keramit NP-S). Each of the 24-specimen groups, was divided into two subgroups, according to the application, or not, of Nobil Metal Bonding (NMB) (Nobil Metal). Two different veneering ceramic systems were used: Ceramco iC (Dentsply) and Noritake super porcelain EX-3 (Noritake). The bond strength of the metal-ceramic system was evaluated using the three-point bending test and the modality of failure with SEM analysis. Three-way Anova with interactions was used to evaluate the influence of the metal production process, the presence or absence of the bonding agent and the type of veneering ceramic on ceramic-metal adhesion. Results. All specimens exceeded the minimum bond strength of 25 MPa required by ISO Standard 9693 – 1:2012. The highest values of adhesion were registered for specimens manufactured with casted metal/Noritake veneering ceramic (40.59 ± 7.30 MPa). The lowest values were registered for specimens manufactured with CAD/CAM metal/NMB/Ceramco iC veneering ceramic (29.47 ± 3.38 MPa). Conclusions. The fabrication method and the type of veneering ceramic had a significant influence on the mean bond strength. The application of the NMB did not show an influence on bond strength.

Aim: The present in vitro study aimed to evaluate the depth of reading of intraoral scanners (IOSs) within the gingival sulcus. Materials and methods: A knife-edge preparation for a full crown was performed on a Frasaco model. The gingival sulcus of the scanned model was modified using a dedicated software program (Model Creator, exocad DentalCAD 2.4 Plovdiv) by setting the apical width (AW), coronal width (CW), and gingival sulcus depth (D). Two dental models with different gingival sulcus depths (1 or 2 mm) were printed using the digital light processing (DLP) technique. Each model was scanned 10 times. Seven different IOSs were used: Emerald, Trios 3, Carestream 3600, Dental Wings DWIO, CondorScan, True Definition Scanner (TDS), and Cerec Omnicam. Measurements of D values were performed using 3Shape 3D viewer software. The normality of the data distribution was evaluated using the Shapiro-Wilk test (P < 0.05). The nonparametric Levene’s test was used to check for homoscedasticity. The data were statistically analyzed using the Kruskal-Wallis test (α = 0.05) and the Nemenyi test. Results: All IOSs were able to read within the 1-mm–deep gingival sulcus, albeit with some statistically significant differences (P < 0.001). TDS and Trios 3 were able to read within the 2-mm–deep gingival sulcus (P < 0.001). Conclusions: The depth of reading of different IOSs can vary significantly. In the model with a 2-mm gingival sulcus, even in the absence of oral fluids, the depth of reading was incomplete, suggesting that deep preparations into the gingival sulcus are difficult to detect with IOSs. Keywords: intraoral scanner (IOS), gingival sulcus, depth of reading, knife-edge preparation, digital light processing

Purpose: To describe the treatment of malpositioned implants in the esthetic area using the angulated welded abutment (AWA) approach together with peri-implant soft tissue surgery. Materials and Methods: A clinical case with extreme buccal angulation of two implants in the anterior maxilla was used to illustrate the AWA technique. After implant impression-taking, digital analysis was used to determine the ideal prosthetic angulation of the abutment and the ideal position of its screw hole in relation to the gingival margin of the adjacent teeth. The AWA was designed in two combinable components that were meant to be welded together. Before the welding process, an angulated screw was included in the abutment. Since the angulated screw was inside the abutment, the screwdriver hole could be designed as narrow as possible and put in an ideal position. After periodontal and peri-implant surgery were carried out, the AWA was applied to the implants. Results: The AWA allowed correction of the prosthetic axis. Moreover, relocation of the screw hole allowed the gingival tissue to creep over the abutment. In this way, a new esthetic restoration can be placed after the mucogingival surgery. Conclusion: The excessive misangulation of the implants was efficiently recovered. Further studies are needed to evaluate long-term clinical success, and standardization of this technique is required for routine clinical use.

Purpose: To describe the possible adverse effects of sodium hypochlorite (NaOCl) solutions, highconcentration alcohol solutions, and povidone-iodine products indicated for disinfection of inanimate surfaces against human coronavirus of the severe acute respiratory syndrome (SARS-CoV) on prosthesis materials, including zirconia, lithium disilicate, and acrylic resin. Materials and Methods: A systematic literature research was conducted in the SCOPUS, PubMed/Medline, Web of Science, EMBASE, and Science Direct databases from January 2010 to February 2020 using a combination of the following MeSH/Emtree terms and keywords: “sodium hypochlorite”; “alcohol”; “ethanol”; “povidone-iodine”; “dental ceramic”; “zirconia”; “lithium disilicate”; and “acrylic resin”. Results: A total of 538 studies were identified in the search during initial screening, 44 were subject to full-text evaluation, and 24 fulfilled the inclusion criteria. Seven articles on zirconia and lithium disilicate investigated the effect of NaOCl (0.5% and 1%), 96% isopropanol, and 80% ethanol on bond strength after saliva contamination. The remaining articles evaluated color alteration, surface roughness modifications, decrease in flexural strength, and bond strength of all cleaning agents on acrylic resin. Conclusion: NaOCl solution (1%) for 1 minute is recommended to reduce SARSCoV infectivity and to minimize the risk of cross-contamination through prosthetic materials. An increase in surface roughness and color alteration on acrylic resin were recorded using 1% NaOCl, but without any clinical significance. A decrease in bonding strength was determined after using 1% NaOCl, 96% isopropanol, or 80% ethanol solutions on lithium disilicate. Silanization before the try-in procedure and the application of a second layer of silane after cleaning methods are recommended to improve the bond strength.

Purpose: To evaluate the influence of the crown-to-implant ratio (CI) on marginal bone loss (MBL) around short dental implants placed in the posterior mandible. Materials and Methods: All patients treated with short implants (7-mm length) in the posterior mandible between 1994 and 2003 at the Dental Clinic of the Department of Neuroscience of the University of Padua (Italy) were retrospectively included in the analysis. MBL and clinical CI (cCI) were measured on the radiographs. Implant characteristics including implant diameter, prosthetic type, retention mode, antagonist type, veneering material, and implant surfaces were retrieved from local medical records. A generalized linear mixed model was estimated to identify the predictors of MBL. Results: A total of 108 dental implants placed in 51 patients were included in the analysis. Mean follow-up was 16 years (range: 11 to 20 years). Mean cCI was 2.21 (SD = 0.31) with a mean crown height of 10.86 mm (SD = 0.99). Mean MBL was 1.42 mm (SD = 0.38). At multivariable analysis, cCI ≥ 2 was associated with higher MBL (regression coefficient: 0.27; 95% CI: 0.15 to 0.40), while implant characteristics, follow-up, and site were not associated with MBL. The effect of a cCI ≥ 2 was estimated in an increase of 0.28 mm in MBL (95% CI: 0.14 to 0.43 mm). Conclusion: Higher cCI was associated with greater MBL of implant-supported fixed dental prostheses in short dental implants placed in the posterior mandible, while implant characteristics, follow-up, and site were not associated with MBL. However, the increase of 0.28 mm of MBL in patients with a cCI ≥ 2 may not be clinically relevant. Keywords: crown-to-implant ratio, implant-supported dental prosthesis, marginal bone loss, prosthetic parameters, short implant

Purpose: To report the 5-year clinical and aesthetic outcomes of a novel surgical-prosthetic approach for the treatment of buccal soft tissue dehiscence around single dental implants. Materials and methods: Twenty patients with buccal soft tissues dehiscence around single implants in the aesthetic area were treated by removing the implant-supported crown, reducing the implant abutment, coronally advanced flap in combination with connective tissue graft and final restoration. After the first year, patients were recalled three times a year until the final clinical re-evaluation performed 5 years after the final prosthetic crown. Complications, bleeding on probing (BoP), peri-implant probing depth (PPD), clinical attachment level (CAL), keratinized tissue height (KTH), soft tissue coverage and thickness (STT), patient satisfaction (VAS) and aesthetic assessment (PES/WES) were evaluated 5 years after the final restoration. Results: Of the 20 patients enrolled in the study, 19 completed the study at 5 years. A total of 99.2% mean soft tissue dehiscence coverage, with 79% of complete dehiscence coverage, was achieved at 5 years. A statistically significant increase in buccal soft tissue thickness (0.3 mm 0.1-0.4 P 0.001) and keratinized tissue height (0.5 mm 0.0-1.0; P 0.001) at 5 years with respect to 1 year was demonstrated. The patient aesthetic evaluation showed high VAS scores with no statistical difference between 1 year and 5 years (8.75 ± 1.02 and 8.95 ± 0.91 respectively). A statistical significant PES/WES score improvement was observed between baseline and 5 years (9.48 ± 2.68; P 0.001), but not between 1 and 5 years. Conclusions: Successful aesthetic and soft tissue dehiscence coverage outcomes were well maintained at 5 years. The strict regimen of post-surgical control visits and the emphasis placed on the control of the toothbrushing technique could be critical for the successful long-term maintenance of soft tissue dehiscence coverage results. Keywords: aesthetics, connective tissue, dental implant, mucogingival surgery, soft tissue dehiscence Conflict-of-interest statement: The authors declare that they have no conflict of interest.