The International Journal of Prosthodontics, Pre-Print

The aim of this short communication is to present a technique to rehabilitate severely discolored teeth with computer-aided designed and computer-aided manufactured (CAD-CAM) zirconia crowns. After confirming the absence of periapical lesions and sufficient crown structure, any caries or fractured restorations can be removed and replaced by an interim composite restoration. A shoulder subgingival preparation is performed and scanned with an intraoral scanner to design a CAD-CAM zirconia crown using a monolithic zirconia material. This crown is highly polished using a specific polishing kit, but not glazed. This technique is suggested to be useful in cases of dark discolored teeth due to staining endodontic materials such as resorcinol-formaldehyde resin. Keywords: computer-aided design, computer-aided manufacturing, tooth discoloration

This retrospective study evaluated the clinical long-term survival of 1405 double-crown retained removable partial dentures (DRPDs) over 30 years of follow-up. Kaplan Meier survival rate for DRPDs was 96.6% after 5 years, 88.2% after 10 years, 61.7% after 20 years, and 38.3% after 30 years. Survival rates of abutment teeth were 94.3% after 5 years, 80.2% after 10 years, 51% after 20 years, and 27% after 30 years. Key failure risk factors of DRPDs were age, ≤ 3 abutment teeth, and complete denture in opposing jaw. Abutment teeth failure risk factors included age, anterior abutment teeth, punctual support, and non-vital teeth. Keywords: removable partial denture, double crowns, survival rate, severely reduced dentition, clinical study

This study aimed to investigate the efficiency of different cements for luting implant restorations. Standard restorations were bonded with different cements, including a zincoxide-based temporary cement (ZOE), a resin-modified glass ionomer cement (GIC) and a resin-based, eugenol-free cement (RBEFC). The restorations were stored under moist conditions and were subsequently subjected to thermal cycling and mechanical loading (TCML). Retention forces were determined with an axial tensile test and removabilty of the restorations was analyzed with a pneumatic crown remover. GIC provided significantly higher retention forces than RBEFC, which provided significantly higher values than ZOE. After storage, retention forces were significantly higher than after TCML. With regard to removability, no significant differences were identified between ZOE and RBEFC, but a significantly higher number of applications was required to remove restorations luted with RBEFC. All cements provided sufficient retention forces, yet removal of restoration might be more demanding if luted with RBEFC.

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.

Purpose. The objective of this clinical study was to evaluate comfort, satisfaction, chewing ability and complications with digital complete dentures (DCD) and conventional complete dentures (CCD). Materials and methods. For 16 edentulous patients, two sets of upper and lower dentures were fabricated by students in a university dental clinic. The impression for the DCD was done using indirect scanning of the cast. When the patients were pain free, each set of dentures was worn for four weeks. OHIP-14 and a DSI (Denture Satisfaction Index)were used to measure patient satisfaction and chewing ability respectively. Both questionnaires were administered before fabrication and after wearing each set. Adjustments made during the follow up period were included. At the end of the study, patients could express which set of dentures they preferred. The 25 dental students involved in fabricating the dentures, were questioned in terms of discomfort, preference and future use for both techniques. Results. OHIP-14 showed significantly higher scores for the DCD for the domain concerning psychological discomfort. DSI showed no significant difference for both sets of dentures. In terms of complications, a significant difference was found for occlusion. The DCD required more occlusal adjustments. A minority of the patients (37.5%) chose the DCD as their favourite set. The students preferred the wax try-in and workflow of the CCD. Conclusions. The CCD and DCD showed differences in patient satisfaction. Chewing ability was comparable for both sets of dentures. More occlusal complications were seen in the DCD. Both students and patients preferred the CCD.

Purpose. The aim of this prospective clinical study was to evaluate the 12 and 24-month clinical results of overlay and one-piece endodontic crown restorations applied with additively manufactured 3D printed permanent ceramic-filled resin (PCR) according to the Modified US Public Health Service (USPHS) criteria. Materials and Methods. A total of 33 indirect restorations (16 overlay, 17 endocrown) (4 premolar, 29 molar) produced using PCR (Formlabs) were applied to 30 patients by a single dentist. The restorations were evaluated according to the modified USPHS criteria at baseline (7 days), 12 and 24 months times by two independent evaluators. The study registration number is NCT05168852. In the comparisons of the dependent criteria scores, the Related Samples Cochran Q test was used, and in post-hoc paired comparisons, the Bonferroni test. The Fisher-Freeman-Halton test was applied in the comparisons of categorical variables according to the restoration type groups (α = 0.05). Results. No statistically significant difference was determined between the evaluation criteria scores at baseline, 12 months, and 24 months for the marginal adaptation (P=0.05), retention (P=1), interproximal contact (P=0.368), color match (P=1), surface texture (P=1), and patient satisfaction (P=1). The only score criteria that showed a statistically significant difference between baseline and 24 months (P=0.001) among all other criteria was marginal discoloration. This criteria’s score change was from 100% A score to 69.7% A score. Conclusion. In the 2-year follow-up of indirect single-tooth restorations produced with 3D-printed PCR, all restorations showed acceptable clinical performance. (≥99.5%A+B score at 2 years). Keywords: 3D printing, permanent crown resin, clinical study, indirect restoration, fixed restoration

Purpose: To evaluate the mechanical properties of the 3D printed provisional restoration material that was repaired using different materials. Material and Methods: The bar specimens have been manufactured using three-dimensional printing technology in accordance with the ISO 10477:2020 standards and divided into 5 groups randomly. For repair material application and replacement on the standardized silicone mold, the test specimens were ground at the center by 1x2x2 mm. No grinding was done on the control group specimens. Flowable composite, bis-acrylic composite resin, polymethyl methacrylate resin, and temporary 3D printing resin are utilized as repair materials (n=16). The specimens underwent a three-point-bending (3PB) test, with a cross-head speed of 1mm/min, in order to assess their flexural strength (FS) and flexural modulus (FM). The data received statistical analysis with one-way ANOVA and Tukey test. A Weibull analysis was performed, and the Weibull modulus of specimens was calculated. Results: Control group specimens were showed the highest FS (142±12.6 MPa) and FM (4497±1205 MPa) values. Among the test groups, the utilization of temporary 3D printing resin as a repair material exhibited the greatest FS (67±33.3 MPa) values and showed statistical significance when compared to all other groups. Conclusion: Repairing 3D-printed provisional resin material weakens its mechanical properties. However, utilizing the own resin made of 3D-printed provisional resin material can be an effective choice for implementing minor modifications and additions.

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: The aim of this study is to examine the effect of gastric acid on the surface roughness of additive and subtractive manufacturing resin. Materials and Methods: In this study, two subtractive manufacturing CAD-CAM resin nanoceramic (CerasmartTM270 (CS), LavaTM Ultimate (LU)) and two additive manufacturing 3D printing permanent resin (VarseoSmile Crownplus (VSP), Crowntec (CT)) was used. CS and LU samples were turned into 10 mm diameter cylinders with a scraper and cut into 2 mm slices on the cutting device. CT and VSP samples were produced on a 3D printer (2mm thickness-10mm diameter) (n:15). All samples were exposed to a cycle of 60 seconds of gastric acid, 5 seconds of distilled water, and 30 minutes of artificial saliva, 6 times a day for 10 days. Surface roughness mean (Ra) and depth (Rz) was measured with a contact profilometer at baseline and after gastric acid cycling. Data were analyzed using SPSS (22.0), One way ANOVA, post-hoc Tukey's and Independent-t test (p <.05). Results: Ra-Rz values of CT and VSP were significantly higher than CS and LU at baseline and after the gastric acid cycle (p <.05). After the gastric acid cycle, the Ra-Rz values of all materials increased significantly compared to the baseline (p <.05) but the Ra values of all materials were at a clinically acceptable level (<0.2µm). Conclusion: Although additive manufacturing 3D printing permanent resins offered higher roughness values, they weren’t at a clinically unacceptable level. Therefore, they can be an alternative to subtractive manufacturing CAD-CAM resin nanoceramics. 

Purpose: To compare the maximum occlusal force in endodontically treated teeth and their vital contralateral counterparts and to evaluate the intraoral factors affecting them. Materials and Methods: Thirty adult participants presented with an endodontically treated tooth and its vital contralateral counterpart were recruited, with 15 males and females in each group. Maximum occlusal forces were measured using a wireless sensor network occlusal force recorder, and the mean maximum occlusal force of endodontically treated teeth was compared with that of their vital contralateral counterparts. Multiple-factor ANOVA was used to examine the association between various clinical factors and maximum occlusal force. Results: The mean maximum occlusal force for endodontically treated teeth was significantly higher than their vital counterparts (215.44 ± 74.11N and 202.40 ± 70.67N, respectively) (P < 0.001). Among the clinical factors, the maximum occlusal forces were significantly influenced by the location of teeth (P < 0.01) and the crown root ratio (P = 0.01). Upon further analysis of endodontically treated teeth and control groups, the location of teeth was identified as a sole factor associated with maximum occlusal force, with P < 0.05. Conclusion: The maximum occlusal forces for endodontically treated teeth were statistically significantly higher than those of their corresponding vital contralateral teeth. 

Purpose: The study aims at evaluating the impact of a full digital workflow on the restoration of masticatory function and aesthetic features in subjects rehabilitated with fixed prosthesis. Materials and methods: The study involved 12 adult participants in need of complex rehabilitation due to masticatory dysfunction. They underwent a comprehensive diagnostic examination involving intraoral scan, facial 3D-photos, jaw kinematics recording, and Cone Beam Computed Tomography extended to temporo-mandibular joint. The subjects were consecutively treated with fixed prosthesis following surgical and implant therapy using a full-digital individualized workflow. Three different study moments were set: diagnostic phase (T0), one week after the delivery of the prototype (T1) and one week after the delivery of the final prosthetic solution (T2). Results: Jaw kinematics recording showed a widening of movements at T2 compared to T0. Sagittal movements increased by 5.7±6.4 mm (95%CI from 1.7 to 9.8, P = 0.010), frontal movements increased by 7.2±5.6 mm (95%CI from 3.6 to 10.8, P = 0.001), and horizontal movements increased by 1.7±4.5 mm (95%CI from -1.1 to 4.6, P = 0.210). Occlusal adjustment timing at T1 was 350±175 seconds, while at T2 was 677±286. At T2 functional VAS was 9.4±0.4 while aesthetic VAS was 9.3±0.4. Conclusions: The rehabilitation process using the full digital workflow showed a widening of the sagittal and frontal masticatory movements with short occlusal adjustment time and with functional and aesthetic satisfaction by all the subjects.  Keywords: Case series, Dental occlusion, Digital technology, Kinematics, Occlusal adjustment, Prosthetic dentistry

This study examined changes in facial geometry while playing wind instruments. Nine musicians participated (6 men, 3 women, mean age 52 years) in part 1 of the study, and 3 musicians participated (3 women, mean age 41 years) in part 2. In part 1, the high and low notes of each instrument were selected as test sounds. Facial geometry data were recorded using a 3D scanner. In part 2, facial geometry data were recorded using a 4D scanner while a melody was played. Data were superimposed and analyzed using 3D analysis software. Numerical values and color maps of deviations were obtained. The results of part 1 revealed that the median 3D deviation was 1.1 mm (range 0.42-1.45 mm), indicating that facial geometry while playing high and low notes was varied. The results of part 2 showed that the stable part was the frontal region and dorsal part of the nose. The approach used in this study has potential applications for evaluating facial geometry during musical instrument performances.  Keywords: dentistry for musicians, geometric evaluation, 3D scanning, high and low notes, facial scanner

Purpose: This paper aims to identify specific personality traits that could potentially undermine the overall satisfaction of the patient with the prosthodontic treatment. Materials and Methods: A literature review was conducted to identify the personality traits (PT) relevant to patients requiring dental treatment. Later, a Delphi process was employed to classify the selected PT into risk levels to prosthodontic treatment satisfaction, ultimately leading to the development of a personality risk profile (PRP) proposal. The expert panel consisted of specialists with over ten years of practice. The Delphi process involved three rounds of evaluation and consensus building. Results: Twenty-six PT associated with dental treatment satisfaction were identified. Following the three rounds of the Delphi method, a consensus was achieved, resulting in the classification of these PT into three PRP, as follows: Low Risk (cooperative, understanding, compliant, trusting, concerned about their health, willing, thankful, and responsible), Moderate Risk (Insecure, Over-informed, Demanding, Appearance-obsessed, and Pessimistic), and High Risk (mistrustful, skeptical, unwilling, defiant attitude, unrealistic expectations, neglectful, treatment resistant, patient refers negatively about other dentists, violent, irresponsible, idealise the dentist, and controller). Conclusions: This study identified and categorized PT that have the potential to adversely impact prosthodontics treatment satisfaction. Through this PRP proposal, dental professionals can recognize these patients before initiating prosthodontic interventions. Keywords: Delphi Technique, Personality Traits, Dental Care, Prosthodontics, Patient Satisfaction, Psychological Classification

Purpose: The purpose of the current study was to investigate the shear bond strength of composite resin in five different ceramic repair systems for three different ceramic materials. Materials and Methods: 225 monolithic zirconia (Zr) and lithium disilicate (LDS) and cobalt chromium (CoCr) specimens with feldspathic porcelain (FP) veneer were fabricated (N=75 per material). The specimens underwent thermo-cycling and were randomly divided into five groups for the following intra-oral repair systems (n=15): 1) Clearfil Ceramic Primer Plus, Kuraray Noritake, Japan; 2) Ibond Intraoral Repair Kit, Kulzer, Germany; 3) VOCO Cimara, VOCO GmbH Germany; 4) Ivoclar Vivadent, Ceramic Repair System Kit, IvoclarVivadent, Liechtenstein; 5) Ultradent Porcelain Repair Kit, Ultradent Products Inc, USA. After surface conditioning, composite was applied using a cylindrical mold and a second round of thermocycling was performed. Each specimen was then subjected to shear load until failure. Microshear bond strength was compared using analysis of variance (one-way ANOVA, Tukey´s test, a <0.05). Results: Type of porcelain repair kit significantly affected the shear bond strength. For Zr, the repair systems from Kulzer and VOCO had significantly higher shear bond strength than the other systems (p<0.001) without significant difference between Kulzer and VOCO. For the LDS and CoCr with FP, hydrofluoric acid had the highest shear bond strength (p<0.001). Conclusion: For zirconia, a 10-Methacryloyloxydecyl dihydrogen phosphate (10-MDP) system should be used. The results also suggest that a cleaning bur may be beneficial. For glass-based ceramics and feldspathic porcelain, etching with hydrofluoric acid remains the product of choice. Keywords: Ceramic repair, ceramics, composite resins, shear bond strength

Defects in the facial region can be treated by maxillofacial prostheses however, fabrication of the prosthesis is a time-consuming process. The short lifetime of silicone material due to inherent deterioration has stimulated a search for more practical methods. This case report involves a semi-digital workflow for replacement of an ear prosthesis. The existing contralateral intact ear and retentive bar of the existing prosthesis were scanned using an intraoral scanner. Resin models of the bar and the mirror image of the ear were fabricated using a 3D printer and wax replicas were obtained using silicone impression material. This method was successful, time-saving, and comfortable for the clinician and patient. Keywords: 3D-printing, auricle prosthesis, maxillofacial prostheses

Purpose: This study evaluates the antibiofilm action of 2.5 mg/mL peracetic acid (PA), 0.5 mg/mL cetylpyridinium chloride (CPC), and 160 mg/mL N-Acetylcysteine (NAC) against multispecies biofilm of Streptococcus mutans, Staphylococcus aureus, Candida albicans, and Candida glabrata, developed on surfaces of heat-polymerizing acrylic resin (AR) and cobaltchromium (Co-Cr) alloy. Materials and Methods: A multispecies biofilm was grown on the surface of AR and Co-Cr specimens (Ø 12×3mm). After biofilm maturation, the specimens were immersed in experimental solutions and evaluated through biofilm viability (CFU) (n=9), biofilm metabolic activity (XTT) (n=9), biofilm-covered areas (Live/Dead) (n=2), effects on the extracellular polymeric substance (EPS) (n=2) and biofilm morphology (n=1). Data were analyzed by ANOVA and the Tukey post-test or Kruskal-Wallis followed by the Dunn post-test (α=.05). Results: Overall, all evaluated solutions impacted biofilm viability. PA presented wider activity by reducing CFU of all microorganisms on both surfaces, XTT (P<.001) and Live/Dead (P<.001). NAC had a notorious effect in reducing the viability of bacteria without affecting the yeasts. NAC reduced XTT on AR (P=.006) and Co-Cr (P=.003) but did not reduce the aggregated biofilm layer. CPC had distinct effect according to the surface, being most effective in reducing CFU on AR than the Co-Cr surface. However, it did not influence XTT, and the amount of residual aggregated biofilm. Conclusions: PA provided the greatest antibiofilm action, while CPC and NAC showed intermediate action. Nonetheless, no solution was able to completely remove the biofilm adhered to the surfaces of heat-polymerizing AR and Co-Cr alloy. Keywords: Biofilms. Removable partial denture. Denture cleansers. Cobalt-chromium alloys. Acrylic resin

Lab-side-fabricated abutments and hybrid zirconia crowns, which are bonded to titanium bases with resin-based composites, require disinfection before insertion. This study investigated the effect of cleaning procedures (ultrasonic, autoclaving) and aging methods (24h, 90d, thermocycling) on the shear bond strength between alumina particle air-abraded titanium and zirconia (3Y-, 4Y- and 5Y-TZP) specimens luted with phosphate monomer containing adhesive systems and resin-based composite. Autoclaving significantly improved SBS (F (27,231) = 17.265, p < .001) compared to no cleaning and three-stage disinfection. No differences were identified with regard to zirconia or aging methods. Bond strength initially benefits from autoclaving but continuously approaches the comparative values over longer periods.

This paper presents an efficient method for fabricating a full-arch implant prosthesis within one day, using a verification index through a three-dimensional (3D)-printed surgical guide. The technique involves the use of simple impression coping and laboratory analogs to ensure accurate prosthesis placement. Directly using 3D-printed surgical guides as a verification index simplifies and streamlines the procedure, offering a significant clinical advantage. This approach provides a clinically relevant advancement in prosthodontic practices by demonstrating a practical and instructive approach to enhance treatment outcomes.

Purpose: The improvement of computer-aided design and computer-aided manufacturing (CAD/CAM) has changed the methods of fabricating laminate veneers. The objectives of this study were to evaluate the marginal and internal fit of ceramic veneers manufactured with different CAD/CAM techniques. Materials and methods: A metal die was made by copying a prepared plastic maxillary central right incisor and scanned for designing a laminate veneer. One hundred laminate veneers were made with four different CAD/CAM techniques (n=25), including milled lithium disilicate (MLD), heat-pressed lithium disilicate with 3-dimensional (3D) printed wax patterns (PLD), milled zirconia (MZ), and 3Dprinted zirconia (PZ). The virtual marginal and internal fit of fabricated veneers was evaluated with digital crown fitting software. The actual marginal and internal fit was measured with the silicone replica method under a digital microscope. The measured data were analyzed using the one-way analysis of variance and the Turkey test. Results: There were significant differences in marginal and internal fit (P < 0.001) among manufacturing techniques. Both the virtual and actual marginal and internal gaps were higher in the PLD and PZ groups compared to the MLD and MZ groups. Conclusion: All four CAD/CAM techniques of manufacturing veneers, that is, milled lithium disilicate, heat-pressed lithium disilicate with 3D-printed wax patterns, milled zirconia, and 3D-printed zirconia, have clinically acceptable marginal and internal fit. Milled zirconia and lithium disilicate veneers demonstrated superior marginal and internal fit compared to 3D-printed zirconia and heat-pressed lithium disilicate veneers with 3D-printed wax patterns. Keywords: Ceramic laminate veneers, silicone replica, marginal fit, zirconia, lithium disilicate

Purpose: To evaluate the elution of residual monomers from resins used in additive and subtractive manufactured permanent restorations over a period of one month, using highperformance liquid chromatography (HPLC). Materials and Methods: Two additive manufacturing permanent crown resins (Crowntec, CT and VarseoSmile Crown Plus, VS) and a subtractive manufacturing resin nanoceramic (Cerasmart, CS) were used to fabricate 30 disc-shaped samples (10 × 2 mm) (n=10). The elution of bisphenol A ethoxylate dimethacrylate (BisEMA), urethane dimethacrylate (UDMA), and triethylene glycol dimethacrylate (TEGDMA) monomers was measured with HPLC at 1 day and 30 days after immersion. One-way analysis of variance (ANOVA) and post-hoc Tukey tests were used to evaluate differences in eluted monomer concentrations. Paired-sample t tests were used to test the differences in monomer concentration between storage times. Results: CS released BisEMA and UDMA residual monomers, while VS and CT released BisEMA and TEGDMA residual monomers. The residual monomer elution from CT was consistently lower than that from VS for both BisEMA (p <0.001) and TEGDMA (p <0.001). CS showed a decreasing release pattern in BisEMA (p =0.002) and UDMA (p <0.001) residuel monomers, whereas VS and CT showed an increasing release pattern in BisEMA (p <0.001) and TEGDMA (p <0.001) residuel monomers. Conclusions: The additive manufactured composite resins released higher amounts of residual monomers than the subtractive manufactured resin nanoceramic. Although the amounts of residual monomers released in the additive manufactured composite resins increased over time in contrast to subtractive manufactured resin nanoceramic, these values were below cytotoxic levels.

Purpose: Sintering procedures influence the properties of zirconia. This study evaluated the effect of varying sintering rates on flexural strength (σ) of 3, 4, and 5 mol% yttria (Y) containing monochrome (Mo) and multilayer (Mu) zirconia. Materials and Methods: 270 specimens (width×length×thickness = 11.2×20×1.5 mm) were prepared from Mo and Mu of 3Y, 4Y, and 5Y zirconia and randomly sintered at regular (RS: 10 °C/min), fast (FS: 35 °C/min), and speed (SS: 70 °C/min) sintering (n = 15/group). Three-point bending test was determined for σ. ANOVA and Bonferroni test were analyzed for significant differences of σ (a=0.05). The microstructure and crystalline [monoclinic (m), tetragonal (t), and cubic (c)] phases were evaluated by SEM and XRD.Results: σ of zirconia was affected by zirconia type, shade pattern, and sintering rate. Significant higher σ for 3Y>4Y>5Y (p<0.05). Significant greater σ for Mu>Mo (p<0.05). Significant reduction of σ upon SS than RS and FS (p<0.05). However, no significant effect on σ upon varying sintering rates within each type of zirconia (p>0.05). SEM indicated greater grain size in 5Y than in 4Y and 3Y. XRD indicated higher t phase in 3Y, whereas higher c phase in 5Y. Mo indicated a higher c phase than Mu.Conclusions: σ was influenced by Y content (3Y>4Y>5Y), shade pattern (Mu>Mo), and sintering rate (RS@FS>SS). Nonetheless, no influence of varying sintering rates on σ for each type of zirconia, suggesting sintering zirconia with RS and FS for expecting higher σ and at SS for acceptable σ for chair-side cost-effective restoration. Keywords: flexural strength, monochrome zirconia, multilayer zirconia, sintering rate, sintering process.

The review focuses on the progressive role of 3D-printing in dentistry, particularly emphasizing the use of zirconia-based and lithium disilicate (LS2) -based ceramic materials. Celebrated for their biocompatibility and esthetic resemblance to natural teeth, these materials have shown promising results with high success rates. Digital light processing (DLP) and stereolithography (SLA) have been noted for producing superior 3D-printed ceramic products. Despite facing challenges such as surface defects, mechanical strength limitations, and esthetic inconsistencies, active research is dedicated to refining the quality and esthetics of 3D-printed zirconia-based and LS2-based ceramics. The review acknowledges the need to mitigate the steep costs of this manufacturing form and recognizes the current shortfall in clinician and technician awareness of these advanced techniques. Addressing these issues through focused research on improving surface quality, dimensional accuracy, and mechanical properties of 3D-printed dental prostheses is crucial, as is enhancing the dental community's understanding and acceptance of this innovative technology.

Purpose: To investigate the available evidence on the accuracy of conventional and digital workflows for complete arch implant supported frameworks. Materials and methods: This scoping review was conducted according to the 5-stage framework of Arksey and O’Malley. A systematic literature search was performed adhering to the PRISMA guidelines to identify studies with a direct comparison of conventional and digital methods for the fabrication of complete arch implant supported frameworks. 58 in-vitro studies with the focus on edentulous arches with at least four implants published between 2000 and 2024 were included. The reported outcomes were examined to determine the value of a statistical analysis for adding up the individual errors to a cumulative error of the workflow. Results: Evidence on the accuracy assessment of digital and conventional workflows for complete arch implant supported frameworks is available. However, also studies with the same assessment methods and outcome units appear to be too heterogeneous to perform a statistical analysis of error accumulation. While there is no consensus in the impression and cast fabrication stage, digital techniques show a superior accuracy for the fabrication of complete arch implant supported frameworks compared to conventional casting. Conclusion: In-vitro studies assessing the accuracy of entire workflows and classifying their outcomes regarding the clinical relevance are lacking. Keywords: computer-aided design, intraoral scanning, dental implants, dimensional measurement accuracy, CAD-CAM

Purpose: To evaluate the preferences of dental practitioners for tooth-supported crowns dental ceramics by means of an online survey and to assess the influence of age, gender, years of experience, and dental specialty on those preferences. Materials and Methods: An anonymous questionnaire was delivered online through Google Surveys, targeting 796 dentists. It contained 17 dichotomous, closed questions with two sections. The first section dealt with general characteristics, including age, gender, years of experience, training in prosthodontics, and hours worked per week. The second section included questions regarding preferences of different materials for crowns, and the use of digital workflows. Analyses were carried out with Stata 14.0 software (StataCorp, TX, USA). A significance level of p=0.05 was adopted. Results: 248 surveys were answered. Practitioners in Chile preferred lithium disilicate for the anterior region (55.2%) but also for the posterior area (40.7%), regardless of their age, gender, years since graduation, hours worked per week or any training in prosthodontics. Chilean dentists over 50 years old considered zirconia almost 4 times more than those under 30 years old for anterior crowns (51.85%). 59.68% of dentists take digital impressions, and 37.10% have access to chairside CAD/CAM technology. In this group, 54.4% preferred feldspathic ceramic for anterior and 23.9% for posterior crowns. Conclusions: While there is a wide range of dental ceramic materials, these results provide a snapshot of the current trends in Chile where lithium disilicate is the most preferred ceramic material for tooth-supported crowns, and metal-ceramic is the least preferred material. Keywords: Ceramics, survey, zirconia, CAD/CAM, questionnaire

Additive manufacturing (AM) also known as 3D-printing has become one of the pillars of digital technology in the dental field particularly in prosthodontics. With the burgeoning development in the already existing AM technology and the evolution of new techniques, concurrent with the development of printable biomaterials, the range of application of the technology has broadened from the construction of diagnostic models to more complex applications such as maxillofacial prosthetics and implant planning. Full understanding of the technology and the related fabrication parameters will enable the maximum benefit from such technology. Therefore, the aim of this review is to represent a road trip along which the prosthodontists and dental technicians can cast a closer look on different AM technologies, advantages and disadvantages of each technique, the application of technology in the field of Prosthodontics, areas of current research in the field and finally recommendations for areas of future investigations. Keywords: Additive Manufacture, Complete Dentures, Removable Partial Dentures, Fixed Partial Dentures, Maxillofacial Prostheses

Objective: To investigate the effect of digital scanning combined with reverse engineering technology in the demonstration of full crown tooth preparation. Methods: Thirty-one students were randomly divided into the two groups. The students in the control group carried out traditional demonstration by the use of eye-measurement methods. The students in the experimental group carried out improved demonstration by the use of digital intraoral scan with 3D measurement data. The students in both groups were provided with two resin teeth to conduct full crown tooth preparation on head model dental simulators. The teeth prepared before and after demonstration were scored by Chinese Stomatological Association Group Standards, with a total score of 100 points. Analysis of covariance was performed to comparatively analyze the scores related to the tooth surfaces, and convergence angle between two groups. Results: Analysis of two prepared teeth (tooth #11 and #16) in two groups showed that there was a statistical significant difference in the mean score between the control group and experimental group (tooth #11, P = 0.0039) (tooth #16, P = 0.0120).The demonstration of the tooth #16 showed that there were statistical significant differences in the scores related to buccolingual surface (P = 0.0205) and proximal surface (P = 0.0023) between the control group and experimental group; There was a statistical significant difference in the score related to the convergence angle of buccolingual surface between the control group and experimental group (P = 0.0265). Conclusion: The digital methods can effectively improve the quality of tooth preparations and has a pedagogical advantage for posterior teeth, which present greater operational challenges. Keywords: Tooth preparation; Prosthodontics; Computer-Assisted instruction; Three-dimensional printing

Purpose. To compare the influence of 0, 45 and 90 degrees build direction on fracture load and surface roughness of additively manufactured three-unit fixed provisional restoration, and to compare with provisionals fabricated using conventional materials. Material and methods. Mandibular typodont right second molar and premolar were prepared for missing mandibular first molar to receive three-unit fixed partial denture. Six groups of 10 samples each, 3-unit provisionals were fabricated using additional manufacturing at 0,45 and 90 degrees, heat polymerized polymethyl methacrylate, auto polymerizing resin and bis-acryl composites resins and tested for fracture load and surface roughness. One way ANOVA and Tukey tests were used to analyze the data. Results. For fracture load, lowest mean value was obtained for auto polymerizing bis-acrylic resin (464.9N) and highest value for 0 degree (596 N), while surface roughness values were lowest for heat polymerized polymethyl methacrylate (0.132μm), and the highest for auto polymerizing polymethyl methacrylate (0.836 μm). Significant differences were obtained between three build directions for fracture load and surface roughness (p=0.001); in all pairwise comparisons except between 0 and 90 degrees (p=0.502) for fracture load; and between all three build directions for surface roughness (p=0.01). On comparing with other provisional materials, significant difference (p=0.001) was observed between all groups. Conclusion- Build direction affected the mechanical properties of additively manufactured three-unit provisionals with 0 degree printed provisionals showing highest fracture load and lowest surface roughness. On comparing with other provisional materials, 0 degree showed highest fracture load, with surface roughness similar to heat polymerized provisionals.

As implant-supported restorations have become very popular, there is a tendency to extract teeth and replace them with implants. However, the first goal of dentistry should always be the preservation of natural teeth, given the prerequisite that these can be maintained with the application of appropriate treatment modalities. Therefore, individual tooth risk assessment and prognosis are very important in the treatment plan process. Four important factors influencing the dentist's decision on whether to save or extract a compromised tooth have been identified, and an extensive search of the related English language literature has been performed. Additionally, hand-search in related journals was implemented, and classical textbooks were consulted. Identified articles on patient-related, periodontal, endodontic, and restorative factors were thoroughly analyzed, focusing on diagnosis and tooth prognosis. Fifty-two selected references have been carefully selected and reviewed. Available information was used to develop a color-coded prognostic decision chart with four different factors and up to fourteen crucial parameters. All factors and parameters were analyzed in an effort to help the restorative dentist make a prognostic decision. The proposed color-coded prognostic decision chart can be helpful when a treatment plan is made, and predictable restorative care is planned. This comprehensive prognostic decision chart can aid dentists in providing clinical care of high quality and establishing a consensus on available restorative options. It can additionally establish appropriate communication with patients and third-party individuals in the restorative care process, effectively manage risk factors, and provide a framework for quality assessment in restorative treatment. Keywords: patient-related factors; periodontal factors; endodontic factors; restorative factors; tooth prognosis; treatment planning Introduction

Purpose: To determine whether digital training improves conceptual skills acquisition for custom tray fabrication and tooth arrangement in the preclinical curriculum for complete denture fabrication. Materials and methods: A crossover design study compared third-year student grades after conventional (manual) and digital training. Half the students were trained with conventional techniques prior to digital, while the other half were trained with digital techniques prior to conventional. The first part of the study (DP1) focused on custom tray fabrication and involved 154 students. The second part (DP2) focused on tooth arrangement with 204 students. The effect of preliminary digital training on conceptual skills was assessed by comparing the results of the students using a Student's t-test. Results were also analyzed by ranking on the students’ Perceptual Ability Test (PAT) score. Finally, students’ satisfaction with the training was investigated. Results: Students who completed the initial digital session achieved better custom tray fabrication and tooth arrangement in the subsequent manual sessions. For manual laboratory work, the most dexterous students (PAT1 group) demonstrated the best performance. However, PAT2 students had the best performance during the digital sessions during DP1, and PAT1 and PAT2 students had the best performance during the digital sessions during DP2. Additionally, 40% of DP1 and 12% of DP2 students expressed satisfaction with digital sessions. Conclusion: With complementary manual and digital teaching, digital tools may be useful for enhanced student learning. Digital training has contributed to improve results in manual sessions but did not affect student satisfaction and remained a limited tool to detect learning difficulties. Keywords: complete denture curriculum; digital dentistry; digital learning; preclinical simulation; custom tray; tooth arrangement; pedagogical study

Aims: The aim of this prospective study was to evaluate and compare the implant survival rate, marginal bone levels and prostheses failure rate, of three-unit fixed dental prostheses (FDPs) supported by three vs. two implants immediately loaded in the posterior area. Material and Methods: Partially edentulous patients in need of a three-unit implant supported FDP in the maxillary/mandibular posterior region were recruited and randomly split into two groups: Group 1 with three-unit FDP supported by three implants (Control); Group 2 with three-unit FDP supported by two implants (Test). Implants were inserted and immediately loaded with a temporary FDP. Results: Sixty-three patients were included in the study. A total of 178 implants were placed and immediately loaded (128 maxillary/50 mandibular) to support 74 immediate provisional fixed prostheses (52 maxillary and 22 mandibular) delivered on the same day of implant insertion/placement; 30 in Group 1 and 44 in Group 2. The comparison of three vs. two implants resulted in comparable implant survival rate, marginal bone loss, and prostheses failure rate. All implants healed uneventfully with no adverse clinical and radiographical signs or symptoms except for one implant failure in Group 1 resulting in a cumulative success rate of 99,5%, 98,9% for Group 1 and 100% for Group 2 with a follow-up of 6-to-10 (mean 7 years). Once loaded, the implants remained in function from a minimum of 6 years to 10 years. Conclusions: Although more studies and larger sample sizes are needed to validate this study, the results showed no difference between the two Groups, demonstrating the potential viability of both clinical options. Keywords: Partially Edentulous, Immediate Loading, Posterior Rehabilitation, Implant fixed dental prostheses

Effect of model resin and shaft taper angle on the trueness and fit of additively manufactured removable dies in narrow ridge casts Purpose. To evaluate how model resin and shaft taper affect the trueness and fit of additively manufactured removable dies in narrow ridge casts. Material and methods. A typodont model with a prepared mandibular molar was scanned to design virtual dies with different shaft tapers (0-degree (straight), 5-degree, and 10-degree tapered). Fifteen dies and one hollowed cast per taper were additively manufactured from two resins (G-PRINT 3D Model, GP and DentaMODEL, DM). Dies and casts were digitized to evaluate their trueness (root mean square (RMS)). The fit of the dies was evaluated with crown portion’s RMS when seated in the cast and with distance deviations. Kruskal-Wallis and Mann-Whitney U tests were used to analyze data (α =.05). Results: GP dies had lower overall, root, and base RMS, while DM dies had lower crown RMS (P≤.016). Straight dies had the highest overall, root, and base RMS within GP (P≤.030). Ten-degree dies had the lowest overall and base RMS, lower crown RMS than straight, and lower root RMS than 5-degree dies within DM (P≤.047). When the dies were seated, GP had lower crown portion RMS within 5- and 10-degree dies, and 5-degree dies had the highest RMS within DM (P≤.003). GP had lower distance deviations within 5- and 10-degree dies. Five-degree dies had the highest deviations within DM (P≤.049). Conclusions: GP dies mostly had higher trueness and better fit. Straight dies mostly had lower trueness within GP. Ten-degree taper mostly led to higher trueness within DM. The shaft taper affected DM dies’ fit.

Objective: To investigate the prosthetic parameters, clinical indices, crestal bone levels, and inflammatory biomarkers in peri-implant crevicular fluid as influenced by two different implant restorative materials i.e., metal ceramic and monolithic zirconia at baseline, 1 Year and 2 Years. Materials and Methods: Twenty patients with bilateral implants placed in the same arch were selected. Monolithic zirconia (4Y-PSZ) crown was placed on one side whereas a metal ceramic (M C) crown was inserted on the contralateral side after randomization. Interproximal marginal bone level (MBL), clinical parameters, MMP-8 levels in PICF, and prosthetic characteristics (as determined by modified USPHS criteria) were evaluated at baseline, 1-year, and 2-year follow-ups. Data were descriptively examined. The results were evaluated using the Chi-Square Test, ANOVA, and student t-test. At p < .05., statistical significance was determined. Results: Twenty MC crowns and twenty Mono-ZrO2 crowns were delivered. A 100% survival of the implants and the prosthetic crowns was achieved across all patients with no instances of failure noted throughout the two-year follow-up period. The periodontal changes observed in the participants were analysed and demonstrated statistically insignificant alterations. Prosthetic alterations were assessed according to USPHS criteria, revealing minor ceramic chippings and instances of screw loosening within the MC group during both the 1- and 2-year follow-up periods. These incidents were collectively categorized as technical issues. Regarding anatomical form and color match to the surrounding dentition, the Mono- ZrO2 crowns obtained much lower evaluations when compared to the M-C crowns. However, when evaluating the loss of marginal bone and level of inflammatory markers there were no discernible variations between the groups. Conclusions: The null hypothesis that there is no similarity in the survival rates and interactions at the peri-implant interface between the two types of restorations was rejected. Both monolithic zirconia and metal ceramic crowns demonstrated no statistical differences across all parameters examined in the present prospective investigation.

Purpose This study evaluated the color alterations, flexural strength and microhardness properties of two different 3D-printed permanent crown resins. Materials and Methods Samples were produced from two different 3D Print permanent crown resins: Group 1 (Saremco Crowntec; Saremco, Switzerland), Group 2 (P-crown Version 2; Senertek, Turkey). Color changes (ΔE values), flexural strenght and vickers hardness number of the samples were calculated. Data were analyzed with Shapiro–Wilk normality test, Independent-t test, and Mann Whitney-U tests. Significance level was accepted as P<0.05. Results ΔE values for red wine were found to be significantly higher in Group 1 (6.43Å}2.26; P<0.001). The flexural strength values (MPa) of Group 1 were significantly higher than Group 2 in all three solutions (P<0.001). There was no significant difference between the VHN values of the samples kept in wine and coffee solutions (P= 0.271; 0.827). Conclusion 3D printing resins are affected at different levels by coloring solutions. Microhardness and flexural strength of 3D print samples kept in different coloring agents are different.In the use of 3D printing resins, product selection should be made by taking into account the individual factors such as the eating and drinking habits of the patients and the physical properties expected from the sample. Keywords: 3D Printing, Permanent Crown Resin, Color Alterations, Flexural Strength, Vickers Hardness Test.

Objective. Evaluate the roughness and color stability of different types of resins used to immerse denture bases in various denture cleansers overnight. Metodology. A total of 150 resin samples were made, which were divided into 3 groups of denture resin (conventional thermally activated, milled and 3D printed) (n= 50) and subdivided into 5 denture cleaners (Distilled water, Corega Tabs, Efferdent, NaOCl 1.0%, Listerine Cool Hint) (n= 10). The roughness properties (Ra) and chromatic difference (ΔE00) were evaluated during 90 days and 180 days of overnight cleaning. Data were evaluated by two-way ANOVA and Tukey's test for multiple comparisons (P<.05). Results. Listerine had significantly higher Ra and ΔE values (P<.001) compared to other solutions, being significant in conventional resin at 180 days (P<.001). Conclusions. The use of Listerine as an overnight cleaner presents greater damage to the optical and surface properties of denture base resins, mainly with conventional resin, with 1% NaOCl being a valid option in relation to cost-benefit. Keywords: Dentures; Denture cleaners; Disinfection; CAD/CAM.

Mandibular deviation (MD) is a common reconstruction sequela after segmental mandibulectomy. Although proper postoperative rehabilitation is critical for MD management and minimization, the information available is limited. This report describes postoperative rehabilitation with an occlusal splint fabricated using computer-aided design (CAD) and computer-aided manufacturing (CAM) (CAD/CAM-OS) and the results of a threedimensional occlusal analysis using an intraoral scanner after hemimandibulectomy and plate reconstruction. Despite the short follow-up, adherence to postoperative rehabilitation with CAD/CAM-OS for MD correction, even during radiotherapy, was demonstrated by the digital workflow and analysis results.

Background: A minimally invasive aesthetic suturing technique was employed in aesthetic crown lengthening surgery (ACLS). The objective of this report was to evaluate the clinical and patient- reported outcomes of this technique for ACLS. Methods: Fifteen patients who underwent ACLS were treated utilizing the described suturing technique. Clinical parameters, including plaque index (PI), gingival index (GI), bleeding index (BI), papilla index score (PIS), early wound healing index (EHI), visual analogue scale (VAS), pink esthetic score and white esthetic score (PES/WES), were recorded at baseline, immediately post-surgery and during follow-up visits spanning 5 days to 24 months. The two-sample t-test was performed to evaluate statistical significance (α = 0.05). Result: 100% of the patients reported a high level of satisfaction, with a stable high postoperative VAS scores. From baseline to 5-day postoperation, there was no statistically significant increase in PI, although there was a slight deterioration observed in GI (0.13Å}0.23, P＜0.05) and BI (0.49Å}0.55, P＜ 0.05). Early wound healing (EHI 1) was achieved by all patients at 5 days post-surgery. Additionally, 3 patients exhibited changes in PIS within the initial 3 months following surgery, after which, all patients attained an optimal degree of papilla filling (degree III). Conclusion: The application of the minimally invasive aesthetic suturing technique in ACLS demonstrates favorable outcomes in terms of patient satisfaction and long-term stability. However, the assertion of its superiority over conventional suturing methods for ACLS necessitates substantiation through rigorous investigation via well-designed randomized controlled clinical trials. Keywords: Minimally invasive, Suture technique, Aesthetics, Crown lengthening

Purpose: To evaluate the adherence of three types of bacteria [Staphylococcus (S) aureus, Escherichia (E) coli, Pseudomonas (Ps) aeruginosa] and the size of the microgap of three different implant systems (JD, ORA, and Ankylos) under four different screw torque values. Materials and Methods: Ten samples for each tested implant system were used under different torques to determine the width of the gaps. The abutments were connected to the fixtures using a universal digital wrench. A torque value of 10 N/cm was applied for all samples. After the assessment of the microgap, the fixture was repositioned into the Bench Vice, and the torque was increased to 20, 30, and, finally, 40 N/cm. The microgap assessment was done using a Scanning Electron Microscope. Before the torque increased to 40, eleven samples for each tested implant system were used under 30 N/cm torque to determine the leakage in the tested implants for S. aureus, E. coli, and Ps. aeruginosa. Data were analyzed with multiple one-way ANOVA, Post Hoc, and chi-square tests. Results: The Ankylos system showed the widest gap under all torques (p < 0.005), whereas the JD system demonstrated the lowest (p < 0.005). Regarding the bacteria leakage, JD showed the highest adherence to the bacteria, and the adherence was mainly to the Ps. Aeruginosa, while the Ankylos system showed the lowest (p < 0.005). Conclusion: Within limits, the higher torque provides a higher fit to the IAI, offering more stability. Ankylos implant showed the widest gap, while JD showed the narrowest. Regarding the bacteria leakage, JD showed the highest adherence to Ps. Aeruginosa, while the ORA system showed the highest adherence to E. coli. Keywords: implants microgap; bacterial leakage; implant-abutment interface; ORA; Ankylos, JD system.

Purpose: The aim of the present study was to investigate the influence of three post-and-core systems and two crown materials on stresses in restored premolars using Finite Element Analysis (FEA). Materials and Methods: A maxillary second premolar 3D model was created in SolidWorks 2014 (Dassault Systémés). Severe loss of tooth structure was simulated with six restorative options: 1) glass-fiber-reinforced composite post and composite core (GFRC)+CAD/CAM leucite-reinforced glass-ceramic crown (LRC); 2) carbon-fiberreinforced composite post and composite core (CFRC)+LRC; 3) metal cast post-and-core (MPC)+LRC 4) GFRC+CAD/CAM composite resin crown (CC); 5) CFRC+CC; 6) MPC+CC. Three-point occlusal loading (150N) was simulated and von Misses and maximum principal stresses calculated. Results: Although maximum von Mises stresses in the crown and dentin were similar across groups (137.9-139.2MPa crown; 17.2-19.6 dentin), there were important differences in stress distribution in dentin. Only in MPC+CC group the maximum stresses were on the bottom of the post preparation cavity. Stress values within the posts were: CFRC(4.8MPa)>GFRC(6.7MPa)>MPC(10.3MPa). CC-restored models presented higher von Mises stresses within the post-and-core compared to the LRC groups. Maximum principal stresses were lower compared to von Mises stresses, following the same trend, and were distributed similarly in all the groups. Conclusions: Both GFRC and CFRC showed favourable stresses distribution in the dentin and restorative materials, while MPC increased stresses in core, post and post cement. The more rigid crown material seems to transmit less stresses to the underlying core and crown cement compared to CC. Keywords: cast post-and-core; fiber-reinforced composite post; composite crown; ceramic crown; finite element analysis

Purpose. To evaluate the effect of cheek retractors on the accuracy of capturing peripheral borders in totally edentulous digital scans by comparing the conventional impression technique to digital scans made using two different cheek retractors. Material and Methods. Sixteen edentulous maxillary impressions were made using three techniques: the conventional impression technique, using modeling thermoplastic compound and zinc oxide eugenol paste; the digital intraoral scanning technique using the DIO scan retractor (DIO); and using the Br.nemark lip retractor (BRAN). The control impressions of each patient were poured, scanned using a desktop scanner, then transferred into a three-dimensional analysis software. DIO and BRAN groups were scanned using an intraoral scanner, imported, and superimposed using best fit algorithm on the corresponding control. The root mean square for the whole surface and for particular interest regions were calculated to assess the degree of trueness. The patients' perceptions of the impression techniques were the secondary outcomes. Statistical analyses were performed using the one sample T-test and Wilcoxon test (α=.05). Results. Significant discrepancies were found for BRAN and DIO compared to the control. No significant discrepancies were found when comparing RMS of BRAN and DIO at different regions. Scan retractors had a significant impact on patient satisfaction, with patients preferring DIO. Conclusions. Edentulous intraoral scans made using cheek retractors had similar deviations when compared to each other but diverged from the conventional impression in edentulous maxilla. Patient preferences for intraoral scans over conventional impressions were confirmed. Clinical Implications. The use of different retracting methods during intraoral scanning of totally edentulous maxillary arches does not affect the peripheral border registration.

Purpose: To update data on the transfer accuracy of digital implant impressions by using a coordinate-based analysis, latest intraoral scanners (IOSs) were investigated in an established clinical close model set-up. Materials and Methods: An implant master model (IMM) of the maxilla with four implants in the posterior area (#14/#24 and #16/#26) and a reference cube was scanned with four different IOS (i700 (Medit), Primescan (Dentsply Sirona), Trios 4 and Trios 5 (3Shape) ten times each. Datasets were compared with a reference dataset of IMM that was generated with x-ray computed tomography in advance. 3D deviations for the implant-abutment-interface points (IAIPs) were calculated. Statistical analysis was performed by multifactorial ANOVA (p < .05). Results: Overall deviations for trueness (mean) ± precision (SD) of the IAIPs ranged from 88±47 μm for the Primescan, followed by 112±57 μm for the i700, 121±42 μm for the Trios 4 and 124±43 μm for the Trios 5 with decreasing accuracy along the scan path. For trueness, one significant difference between the Primescan and the T4 was detected for one implant position. For precision, no significant differences were noticed. Conclusions: Although the latest IOS showed a significant improvement in transfer accuracy, the accumulating deviation along the scan path is not yet resolved. Considering the Trios system, the innovation seems to be limited as no improvement could be detected between Trios 4 and 5.

Purpose: The aim of this study was to evaluate the influence of restoration bonding and type of preparation on load bearing capacity of a tooth restored with indirect glass ceramic or hybrid ceramic occlusal veneer restoration. Materials and Methods: Occlusal surfaces of extracted human molar teeth were prepared for indirect occlusal veneers with or without circumferential chamfer. The occlusal veneers were milled either from CAD/CAM hybrid ceramic (HC) Cerasmart (GC), or lithium-disilicate glass ceramic (LDGC) IPS e.max CAD (Ivoclar Vivadent) blocks. Finalized veneers were bonded to teeth following manufacturers’ instructions or according to the technique for the intended deteriorated bonding using n-hexane wax solution preconditioning on restorations (n=8/group). The ultimate fracture load was recorded, and fracture types were analyzed and classified visually. Statistical analysis was performed using one-way ANOVA. Results: The highest fracture load was recorded in teeth with bonded LDGC veneer (p≤0.0007). The bonded HC veneers had only marginally higher fracture load compared to non-bonded veneers. In all groups with deteriorated bonding, veneers loosened without tooth fracture whereas in the bonded veneer groups tooth fractures were observed, especially in teeth restored with LDGC material. Conclusions: Bonded LDGC occlusal veneers have high load bearing capacity which exceeds the fracture resistance of tooth structure. Circumferential chamfer preparation for an occlusal veneer has no influence on fracture load of a restored tooth.

Purpose: To compare the fracture load of two framework materials, zirconia and a new fiber-reinforced composite (FRC), for full-arch implant-supported rehabilitations using various cross- sections. Material and Methods: A cobalt-chromium metal model simulating the all-on-four concept and including 2 anterior straight and 2 posterior 45- degree angled multi-unit digital implant analogs was manufactured. 4 straight multi-unit abutments were screwed onto the implant analogs. The metallic model was scanned, and 18 frameworks were fabricated, consisting of 9 made of zirconia and 9 made of fiber-reinforced composite (FRC). The frameworks were then divided into 6 groups, with each group consisting of 3 frameworks  (n=3). Group division was based on material type (Zirconia or FRC Trilor) and framework cross-section: 3.5 x 6 mm2, 5.5 x 6 mm2, or 7.5 x 6 mm2. All specimens underwent thermocycling in 2 baths (5 ͦ c- 55 ͦ c for 2350 cycles). Subsequently, the frameworks were cemented to the abutments of the metal model and subjected to a load-to-failure bending test at 3 different points using a universal testing machine (crosshead speed: 1 mm/min) until complete fracture occurred (according to ISO/TS 11405:2015). Descriptive statistics were used to present quantitative variables as means ± standard deviations. To compare two means, Student's t-test or Mann-Whitney test was utilized, and for three means, ANOVA test was used. Results: The FRC group with a 7.5 x 6 mm2 cross-section exhibited the highest load-to-failure values (ranging from 1020 N to 2994N) , while the zirconia group with a 3.5 x 6 mm2 cross-section recorded the lowest values (ranging from 212 N to 1287 N). The material type and framework cross-section significantly affected the mean load-to-fracture values (p< 0.05). Regardless of the framework cross-section, the FRC group exhibited higher fracture loads than the zirconia group. In both materials, fracture load values were increased with larger framework cross-sectional areas, with the highest values observed at the inter-implant midpoint. Conclusion: The FRC Trilor demonstrated a fracture load that make it a suitable alternative to zirconia for all-on-four implant prosthetic frameworks.

Purpose. The aim of this study was to determine and compare color differences of pressed lithium disilicate ceramic specimens after repeated firing cycles. An additional objective was to determine and evaluate correlation of CIEDE2000 values analyzed by X-Rite Color i5 Spectrophotometer, VITA EasyShade Advance 4.0 and Adobe Photoshop. Material and methods. Tile specimens (N=36) with 8 x 10 x 1.5mm dimensions were prepared by IPS e.max Press lithium disilicate MT Monochromatic ingots and IPS e.max Multi Press lithium disilicate Multichromatic ingots. Specimens were exposed to 7 repeated firing cycles. Color analysis was performed after the 1st, 2nd, 3rd, 5th, and 7th firing cycles. CIE L*a*b* values were measured by X-Rite Color i5 Spectrophotometer, VITA EasyShade Advance 4.0 and Adobe Photoshop. CIE DE*2000 (ΔE*00) was calculated to estimate color differences. Results. Linear regression and multiple comparison analysis (Tukey’s HSD test) showed a statistically significant (p<.001) color difference ΔE*00 after multiple firing cycles. Statistically significant differences (p<.05) were also noted in different shade groups and between different instruments used for shade evaluation. Moreover, significant differences (p<.05) were found in interactive effects between different shades tested by different instrument, different shades tested after multiple firing cycles and different instruments after multiple firing cycles. Conclusions. Lithium disilicate material shows significant color differences after repeated firing cycles tested by three color analysis instruments. Measuring instruments used to evaluate CIE L*a*b* color values showed significant differences in color values analysis, which may lead to altered level of interpretation, particularly to determine perceptibility and clinical acceptability thresholds.

Purpose: To investigate the medium-term survival of Dalbo-Rotex retention elements, identify potential risk factors for complication or loss, and to consider economic factors. Materials and Methods: Patients treated with Dalbo-Rotex retention elements in a university setting were retrospectively identified and examined. Clinical data comprised assessments of the dental, periodontal, endodontic, and prosthetic situation, including radiographic analysis. Patient satisfaction was quantified with visual analog scale questionnaires. Five-year Kaplan-Meier plots for relative survival and success rates were calculated. Results: The 45 included patients had a total of 76 Dalbo-Rotex retention elements. Twelve Dalbo-Rotex elements failed and complications occurred in 42.1% of elements, equating to a survival rate of 84.2% and a success rate of 47.4% after a mean observation period of 49.2 months (SD 52.4, range 6–219 months). The 5-year cumulative survival and success rate was 62.4% (95% CI 44.0–88.4%) and 35.6% (95% CI 23.8–53.2%), respectively. Patients’ self-assessment of prostheses retention was rated at 82 (IQR 40–92.2) with low pain perception at 4.5 (IQR 0–30). Probing pocket depth levels were significantly reduced in patients adhering to a regular recall interval compared with those with longer intervals. Conclusions: Chairside Dalbo-Rotex retention elements are a straightforward chairside method for prostheses retention that achieve good survival over medium-term follow up with high patient satisfaction. This technique is therefore a viable alternative to cast post copings that may be particularly valuable for patients with limited financial resources.

Purpose: To develop a system for assessment of the status of a tooth to receive a full coverage crown and depict it on a measurable scale, and to validate its use by assessing examiner reproducibility. Methods: The index was developed based on the inputs from experts in the field with a consensus on factors (4 periodontal, 2 endodontic, and 4 prosthodontic), stages of severity (stage 1 to stage 4), assigned scores, and relative weights pertaining to varied clinical scenarios. Based on the selection of factor-stage combination, an overall tooth crownability index (TCI) score along with three-factor scores were computed. The validation study included clinical and radiological assessment of cases based on the index criteria by four independent examiners (periodontist, prosthodontist, endodontist, and general practitioner). Results: Forty teeth were assessed. The distribution of repeated selection by the examiners was quite identical to the initial (kappa = 0.93). There was no statistically significant difference in the mean scores of examiners in TCI and factorial scores. An excellent agreement between the measurements was observed among the examiners (ICC =0.993; Crohnbach α = 0.993). Conclusions: A tooth crownability index has been developed for a tooth to receive a full coverage crown which has an excellent agreement and good reproducibility among the examiners. TCI will serve as a baseline tool in treatment plan decision-making based on the status of the teeth and in research for evaluating the efficacy of various treatment options available (standard criteria for outcome assessment).

Purpose: The purpose of this work is to observe the effect of the cavity design of the direct composite restoration on a real case of the patient's tooth structures after applying his mandibular kinematics with finite element analysis. Materials and Methods: Four complex maxillomandibular models of teeth 17 and 47 were constructed from the patient's cone-beam acquisition and the patient's kinematic data recorded with Modjaw® were added. Different shapes and sizes of mesio-occluso-distal (M.O.D.) composite restorations were simulated, including the polymerization shrinkage of this material. Finite element analyses were used to observe the Von Mises stresses occurring during polymerization and mastication. Results: The stresses were observed at the cavity margin and the amplitude of the stresses was higher when the enamel volume was lower. The reduction in occlusal enamel volume with the open-angle vestibular and palatal walls resulted in a greater increase in stresses observed on the structures. Conclusions: The occlusal enamel is the area that bears the maximum masticatory stress, the loss of this enamel volume generates a much greater concentration of stress on the underlying structures. It is important to preserve as much enamel tissue as possible when designing a cavity for a direct composite restoration.

Purpose: To determine the frequency of insert changes for combined maxillary and mandibular implant overdentures (IOD) using the Locator Legacy system. A secondary objective was to assess the survival of dental implants with IODs. Materials and Methods: This retrospective audit reviewed clinical records with up to 12 years follow up from 785 patients who received IODs using the Locator system at a dental hospital. From these, 151 had a combined maxillary opposed by a mandibular IOD and from this, 37 had data retrieved using a minimum data set. The frequency of insert change was recorded and descriptive analysis was provided by means and standard deviations for continuous variables. Frequencies of categorical values were reported as percentages. Results: 222 implants were placed on 21 men, 16 women with a mean age 67.5 years (SD 8.8). All patients were reviewed at least once. Maxillary and mandibular IODs experienced 1.9 (SD 2.0) and 1.2 (SD 1.2) mean insert changes per patient, respectively. The mean time (SD) between initial and first insert change for maxillary and mandibular IODs was 3.4 months (SD 3.2) and 6.4 months (SD 7.2) and between the first and second insert change was 9.9 months (SD 9.0) and 10.0 months (SD 8.3), respectively. Implant failure was 21.6% and 2.7% in the maxilla and mandible respectively.Conclusions: Clinicians should anticipate the first insert change around 3 months for maxillary IOD and 6 months for mandibular IOD. Subsequently, the second insert change to be around 10 months for both maxillary and mandibular IODs.

Background: Maxillary premolars have a unique anatomical location. This is an CBCT based study where the suitability of maxillary premolars for immediate implant placement (IIP) is evaluated. Based on prosthetically driven treatment treatment planning a simple classification system is put forth. Materials and Methods: 150 CBCTs of maxillary first premolars were analysed in BlueskyBio software. The topographic position of the tooth was determined by analysing the dimensions of the buccal and lingual cortical plates, the distance between the bucco-lingual plates and the residual bone height from the root apex to the floor of the sinus. Virtual placement of an implant was carried out such that the implant would be positioned 1 mm apical to the buccal bone crest, would engage 3 mm of bone apical to the root apex, and would have a trajectory so that the abutment access was from the central fossa. Four categories were identified and the classification was proposed. Results: It was observed that 74% of cases had buccal bone<1mm,26% had buccal bone >1mm. 79% cases had an average distance >3mm between root apex and maxillary sinus, 21% had an average distance of root apex and maxillary sinus <3mm. The categorizations of implant placement were as follows -Type 1- 24%, Type 2- 56.6%, Type 3-43.3%, Type 4- 0%. Conclusions: In majority of maxillary 1st premolars an IIP is possible with the implants to be placed in the palatal sockets or the furcation area. In cases were the buccal plate thickness is inadequate, simultaneous grafting should be considered between the implant position and buccal plate.

Purpose: Several procedures are performed to achieve optimal esthetic results in single-tooth implants. However, there is discordance regarding the potential benefit and risks of immediate implant loading/provisionalization. The aim of this prospective case series is to investigate the effect of immediate provisionalization of single-tooth implants at healed sites for periimplant soft-tissue conditions, focusing on papilla formation around single implants. Materials and Methods: Twelve patients received a total of 12 implants in the incisor, canine or premolar region of the upper and lower jaw at healed sites with immediate chair-side provisionalization. Four months later, the temporary crown was replaced by the permanent crown. After 40±13.1 months, clinical follow-up was conducted, assessing Probing pocket depth (PPD); Bleeding on Probing(BoP); Mucosal recession (MR) and Width of Keratinized Mucosa (KM). Papilla index (PI) was determined immediately after implant placement  (baseline), before removing the temporary crown (t1), 4 weeks after insertion of the definitive crown (t2) and at the final follow-up examination (t3) to evaluate papilla formation and its change over time. Results: None of the implants were lost. The mean PPD was 2.5±0.39 mm, BoP of 25% and 3.5 mm of KM were observed at the final follow-up. No implants showed MR. PI increased in all patients from 1.5±0.45 at baseline to 2.4±0.56 at t1, 2.6±0.47 at t2 and 3.02.6±0 at t3. The increase in PI between t0 and each individual timepoint from t1-t3 showed statistical significance. Conclusion: The present results indicate the suitability and benefit of immediate provisionalization to achieve favorable peri-implant soft-tissue conditions and papilla formation.

Purpose: To evaluate the circumferential bone level and the morphological changes in posterior mandibular ridge of mandibular overdenture wearers submitted to conventional and immediate loading through cone beam computed tomography (CBCT) at 1 and 3 years. Material and Methods: Twenty participants who received 2 NDI (Facility - 2.9x10 mm) were randomly allocated to the conventional loading (CL: n=10) or immediate loading (IL: n=10) groups. CBCT scans were performed in each group to analyze the vertical (VBL) and horizontal (HBL) bone level around the implants, analyzed together with the posterior bone remodeling of the mandible measured at distances of 5, 10, 15, and 20 mm from the mental foramen (L1-L4). Differences between groups were verified using the student t test at a significance level of 5%. Results: The IL group showed a significantly higher HBL in the first year (P=.028) and a significantly higher VBL in the third year  (P=.032), with HBL of -0.22 mm and VBL of -0.59 mm, respectively. After the third year, measurements of the percentage of cortical and medullar height indicated that the IL group presented a significantly higher percentage of cortical bone height (40.1 ± 9.3) compared to the CL group (31.8 ± 5.8) at position L1 (P=.05). No difference was found for posterior ridge remodeling (P>.05). Conclusions: IL group showed slightly higher values of HBL and VBL, and locally displayed more replacement of medullary by cortical bone. However, circumferential bone level values in the IL group are still clinically acceptable and the posterior resorption rate remained stable after 3 years of function, irrespective of the loading type.

Purpose: To evaluate the surface characteristics, accuracy (trueness and precision), and dimensional stability of tooth preparation dies fabricated using conventional gypsum and direct light processing (DLP), stereolithography (SLA), and polymer jetting printing (PJP) techniques. Materials and Methods: Gypsum preparation dies were replicated according to the reference data and imported into DLP, SLA, and PJP printers, and the test data were obtained by scanning after 0, 1, 3, 7, 14, 28, and 42 days. After analyzing the surface characteristics, a best-fit algorithm between the test and the reference data was used to evaluate the accuracy and dimensional stability  of the preparation dies. The data were analyzed by one-way analysis of variance and Tukey test or Kruskal-Wallis H test (α = .05). Results: Compared with the gypsum group (3.61 ± 0.59 μm), the root mean square error (RMSE) values of the SLA group (5.33 ± 0.48 μm) was rougher (P < .05), the PJP group (2.43 ± 0.37 μm) was smoother (P < .05), and the DLP group (2.92 ± 0.91 μm) had no significant difference (P > .05). For trueness, the RMSE was greater in the PJP (34.90 ± 4.91 μm) and SLA (19.01 ± 0.95 μm) groups than in the gypsum (16.47 ± 0.47 μm) group (P < .05), and no significant difference was found between the DLP (17.10 Å} 1.77 μm) and gypsum groups. Regarding precision, the RMSE ranking was gypsum = DLP = SLA < PJP group. The RMSE ranges in the gypsum, DLP, PJP, and SLA groups at different times were 6.79 to 8.86 μm, 5.44 to 10.17 μm, 10.16 to 11.28 μm, and 10.94 to 32.74 μm, respectively. Conclusion: Although gypsum and printed preparation dies showed statistically significant differences in surface characteristics, accuracy, and dimensional stability, all tooth preparation dies were clinically tolerated and used to produce fixed restorations.

Epidermolysis bullosa hereditaria (EBH) is a group of rare diseases characterized by a cutaneous-mucosal fragility with the formation of bullae, including the oral mucosa. Therapeutic choices, especially prosthetic rehabilitation, must anticipate the worsening of the limitation of oral opening while respecting the functional and aesthetic expectations of the patients. This review on the oral prosthetic rehabilitation of patients with epidermolysis bullosa hereditaria (EBH) to study the level of evidence and quality of the presented available articles and establish clinical recommendations for the prosthetic management of these patients. Materials and methods. An electronic search was done in July 2022 in five databases following PICOTS elements. The quality of the reports was established using the modified Pierson, Bradford Hills, and Ottawa Newcastle scale. Results. Data extracted from 19 case reports for protocolized analysis corresponded to 64 patients and 80 dental prostheses with almost 9 out of 10 patients being completely edentulous. The distribution of EBH types was 84% dystrophic, 10.5% junctional, and 5.5% simplex. The difficulties encountered by the authors synthetized in this review characteristically reflected those most likely encountered in dental practice. Most rehabilitations were implant-supported prostheses (85%) followed by removable dentures (10%) and finally dental-supported rehabilitations (5%). Fixed full-arch implant-supported prostheses represented 76.4% of implant-supported prostheses and this last prosthetic solution described showed the highest scientific quality. Conclusions. In an individualized approach to treatment, we recommend that in cases of total edentulism, fixed full arch implant-supported prostheses are the most appropriate, as they allow the best computer-aided planning, design, manufacture, and fitting of the prosthesis in such a complex clinical context. Keywords: Epidermolysis bullosa, dentistry, dental prosthesis, rare disease, microstomia, systematic review

Purpose: The aim of this study was to evaluate the effect of toothbrushing on the surface roughness (Sa), roughness profile (Rv), gloss units (GU) and surface morphology of three glazed ceramics. Materials and Methods: Specimens (n=7) from different CAD/CAM materials 1- Lithium disilicate-based glass ceramic (IPS e.max CAD); 2- Zirconia-reinforced lithium silicate glass ceramic (Celtra Duo) and 3- 6 mol% yttria partially-stabilized zirconia (InCoris) were evaluated. IPS e.max CAD and InCoris specimens were sintered and all the groups were pre-polished and glazed according to the manufacturer's recommendations: IPS Ivocolor Glaze Paste (Ivoclar Vivadent) or Universal Overglaze High Flu (Dentsply/Sirona). Sa, Rv, GU and morphology were analyzed before and after brushing at 30.000, 120.000 and 180.000 cycles. The data of Sa and GU were analyzed by ANOVA two-way and post-hoc Tukey’s test (α=0.05). Rv was analyzed by Kruskal-Wallis and Student-Newman-Keuls. The surface morphology was analyzed qualitatively. Results: The Sa decreased significantly after 180.000 toothbrushing cycles for all materials tested. CE showed higher Rv than EM and IN, and IN showed the highest GU after 180.000 toothbrushing cycles, which promoted a polishing effect for all materials. Conclusion: Long-term toothbrushing was not able to jeopardize the glazed-surface of all tested materials compared to unbrushed.

Purpose: This study aimed to evaluate the effects of an ergonomic dentist stool design on muscle activity and fatigue in dentists. Materials and methods: Fourteen dentists were recruited, and electrodes were attached to the arm, neck, and shoulder muscles of these dentists according to the Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles protocol. After measuring the maximal voluntary contraction, eight-channel surface electromyography was performed during simulations of two dental procedures (intraoral scanning and tooth preparation) while the dentists were using two types of dentist stools. Furthermore, muscle activity and fatigue were determined based on the eight-channel surface electromyography data, and ergonomic risk levels were evaluated according to the muscle activity. The Shapiro–Wilk test was used to confirm that all data were normally distributed, and the Mann–Whitney U test was used to compare the two types of dentist stools (α = 0.05). Results: There was a significant difference between the conventional and ergonomically designed dentist stools in terms of the activity of trapezius descendens muscle (p < 0.05). Notably, the activity of the trapezius descendens muscle was lesser when the dentists used ergonomically designed dentist stools than when they used a conventional dentist stool. The activity of all muscles, except for the sternocleidomastoid, indicated moderate ergonomic risk. Conclusion: A dentist stool that enables dentists to maintain ergonomic posture should be used to prevent musculoskeletal disorders. 

Purpose: This study aimed to evaluate the prevalence of biological and technical/mechanical complications in edentate elders rehabilitated with complete removable dental prostheses (CDs) and overdentures [tooth-retained (ODs), implant-retained (IODs)]. Materials and Methods: Patient records of adults (>60y) rehabilitated with CDs, ODs, and IODs were included. Demographic information (age, sex), information on the prostheses type, number/type of biological/prosthetic complications, along with the number/time of the complications, were extracted.Kaplan-Meier model was used for the statistical analyses. Results: 162 patients (mean age: 74.5±9.45y; prostheses: n=224, CD=172; OD=21; IOD=31) were included. The average period of function in situ was 19.70±27.66, 32.72±27.84, and 31.73±32.67 months, for the CDs, ODs, and IODs, respectively. 5 prostheses failed. Survival analysis revealed an overall survival rate (SR) of 97.8%, with individual five-year cumulative survival probability of 96.1% for CDs, 94.1% for ODs, and 100.0% for IODs. There were no significant survival differences between maxillary and mandibular prostheses within each type of rehabilitation. In the maxilla, no significant differences were found in maintenance visit times due to prosthodontic complications among the different types of prostheses. Patients with mandibular CDs required maintenance visits earlier compared to mandibular ODs (p<0.001) and IODs (p<0.001). Patients with mandibular ODs also required maintenance visits earlier than those with mandibular IODs (p=0.005). Conclusions: Rehabilitation of the edentate jaws, whether with CDs, ODs, or IODs, is a predictable treatment modality with high survival rates. Differences in maintenance visit times were observed, with CDs and ODs in the mandible requiring earlier visits compared to IODs.

Immediate non-functional loading of an implant in the anterior region is a documented treatment modality with high success rates. This therapeutic approach is frequently used to overcome esthetic and functional problems during the provisionalization period, but also because it provides better support of the peri-implant soft tissues. For that purpose, an implant-supported resin restoration, either traditionally or digitally made, is used. This clinical report describes the modification of patient's natural tooth, that was previously fractured, used as an implant-supported provisional restoration to obtain better esthetics and preservation of the soft tissues in their original, pre-extraction, position. 

Purpose: To describe a digital workflow for the management of the emergence profile and restoration’s finishing line on vertical prepared teeth, utilizing a digital data set. Material & methods: The scan of the prepared teeth the day of the preparation, the scan of the provisional restoration placed on the preparation after soft tissue maturation and the scan of the provisional restoration outside of the oral cavity, are combined under a common data set, that can provide all the necessary information in order to design the final restoration. Results: The presented digital technique can facilitate the implementation of the vertical preparation, as the desired finish line can be defined by the clinician and be transferred predictable to the dental lab. Current approach provides also, an alternative gingival management method, taken advantage of the displacement of soft tissue in the appointment of vertical preparation. Conclusions: The positioning of the final finishing line on vertical prepared teeth, the management of the soft tissue and the fabrication of the final restoration, can be facilitated combining digital data sets, that have been obtained during a distinct phase of the treatment. 

Purpose: Evaluating the facial esthetics of complete denture (CD) treatment using a 3D analysis of the lower third of the face before (T1) and after (T2) treatment by comparing and correlating measurements. Material and Methods: Thirty-one edentulous patients were enrolled, and three-dimensional (3D) images were captured before (T1) and after (T2) CD delivery. Twelve landmarks were established in the face. Linear, angular, surface, and perimeter measurements were evaluated and compared with the paired t test. The delta (Δ) values (T2-T1) were assessed by the Spearman correlation to verify the associations between all measurements according to the facial parameters (α=.05). Results: Statistical differences were identified in the lower third of the face in the linear measurement Sn-Gn (P = 0.006), the angular measure Tright-Pg-Tleft (P = 0.004), and at the surface of the lower third of the face (P = 0.001). All measurements were statistically different in the labial protrusion area: the nasolabial angle (Prn-Sn-Ls), the surface, and the perimeter (P = 0.001). In the lip evaluation, statistical differences were observed in the linear (Ls-Li), surface, and perimeter measurements (P = 0.001). Conclusion: The facial esthetic proportions of the linear and perimeter measurements increased, and the angles of sealed lips and nasolabial and lower facial convexity decreased after CD delivery. The present study showed a clinical important correlation between linear and angular measurements that should help restore facial esthetics, providing metrics that can aid the clinician in facial composition. 

Purpose: To investigate the influence of milling parameters on the durability during in-vitro aging-simulation, and fracture force of resin-based composite crowns. Materials and Methods: Identical molar crowns (n=8 per group) were milled from resin-based composite crowns (Grandio, VOCO, Germany) with different processing speed (soft, normal, fast) or level of details (very high, high, low) form 98mm discs. To investigate the influence of cooling, one group was milled wet. The influence of polishing was tested in two groups. All crowns were adhesively bonded on standardized resin-based composite molars. Aging was performed with thermal cycling and mechanical loading (2x3000x5°C/55°C, 2min, H20 dist., 1.2x106 force 50N). Fracture forces were determined (v=1mm/min, Z010, Zwick, Germany). Statistics: Pearson-correlation, one-way ANOVA, Bonferroni post-hoc-tests (α=0.05). Results: All crowns survived TCML without any failures. The fracture values varied between 1237.3 +/- 326.7N and 3308.6 +/- 655.8N. Significant (p<0.001) differences between the individual manufacturing approaches were detected. Failure was categorized as a fracture of the crown and partial loosening of the crown. No different failure pattern was observed between the tested systems. Conclusion: A medium level of detail seems to be ideal to achieve highest fracture forces. No relationship existed between machining speed and fracture force. Fracture force was not affected by wet grinding. In individual cases, polishing reduced crown fracture values, due to reduced wall thickness. 

Purpose: To investigate the microscopic structure and fracture toughness of two pressable glass-ceramics comprising GC Initial LiSi Press (LiSi) and IPS e.max Press (e.max) with different levels of translucency.  Materials and methods: Four groups of LiSi and e.max with medium opacity and high translucency levels were examined. The crystal morphology of acid-etched specimens was observed under a scanning electron microscope (SEM). Six specimens in each group were fabricated in square shape (12 mm ´12 mm ´ 1.5 mm) to measure translucency parameters (TP) using a spectrophotometer. Ten bar-shaped specimens each group with dimension of 23 mm ´ 2 mm ´ 4 mm were determined the fracture toughness (K_Ic) by a surface crack in flexure (SCF) using a universal testing machine. One-way ANOVA and Scheffe post-hoc tests were used for statistical analysis. Results: LiSi showed fine dense crystals 1 – 1.5 µm in size, while e.max showed long rod-shaped crystals 3 – 4 µm in size. The TP values of all specimens were coincided with their translucency levels.There was no statistical difference in the K_Ic between different translucency for both ceramics (p<0.05). However, the K_Ic of e.max was significantly higher than that of LiSi at both translucency levels. As a result of larger and longer crystals in e.max, it could provide better crack deviation mechanism to resist the fracture. Conclusion: Within the limitations of this study, the translucency levels of both lithium disilicate ceramics did not affect the fracture toughness of the materials. The fracture toughness of e.max was statistically higher than LiSi.

Disconnection and reconnection of abutments multiple times have known to affect the mucosal barrier around implants leading to marginal bone loss. This clinical report describes a novel technique that amalgamates the benefits of digital technologies encompassing the fabrication of surgical guides for implant placement, customized hybrid zirconia abutments and all ceramic lithium disilicate crowns prior to implant placement. A correct 3-dimensional implant positioning along with immediate placement of the definitive hybrid customized abutment and a lithium disilicate crown has the potential to reduce treatment time, visits and costs while delivering optimal esthetic outcomes.

Statement of problem: 5Y-PSZ-based zirconia dental restorations exhibit high translucency and good esthetics but have a higher fracture risk compared to 3Y-TZP. Objectives: To investigate the effect of BruxZir SteelTM treatment on the fracture resistance of zirconia three-unit bridges prepared using 5Y-PSZ-based zirconia blanks. Methods: Three-unit zirconia bridges were milled using CAD/CAM from homogeneous bisque zirconia blanks (5Y-PSZ-based) supplied by various manufacturers and sintered. Their fracture resistance was analyzed by dynamic loading. For each zirconia blank, the fracture resistance of the sintered test restoration (cementation surface treated with BruxZir SteelTM) was compared with the sintered control restoration (untreated cementation surface). Finite Element Analysis (FEA) was used to analyze the stress distribution on the three—unit bridge under an axial load. Results: The fracture resistance of the test restorations was significantly higher than that of the control restorations for all the manufacturers considered in this study (P < 0.05). Furthermore, the restoration made of BruxZirⓇ Esthetic treated with BruxZir SteelTM had the highest fracture resistance compared to the other restorations. In addition, the three-unit bridge restorations prepared from 5Y-PSZ-based zirconia blocks exhibited differences in grain size and fracture toughness depending on the presence or absence of BruxZir SteelTM treatment. The locations of high stresses under FEA correlated well with the fracture locations in the corresponding experimental test. FEA also demonstrated the improved performance of BruxZir Steel-treated sample compared to the control. Significance: The fracture resistance of 5Y-PSZ-based BruxZir SteelTM-treated three-unit bridges was significantly higher (min. 30%, max. 198%) than control. Keywords: Fracture Resistance, Three-unit Bridge, 5Y-PSZ, Fracture Toughness, grain size, critical loads

Purpose: To investigate the effect of recycling of lithium disilicate (LD), surface treatment and thermocycling (TC) on the bond strength (SBS) to resin cement. Materials and Methods: Blocks of LD were made according to the recycling cycle, with 24 blocks for each strategy: Control-conventional sintering; 1R (1 recycling cycle) and 3R (3 recycling cycles). For the recycling groups, blocks were waxed (10x10x3mm), mounted in a silicone ring, poured with investment material, and then residues of sintered LD blocks were pressed by the lost wax technique. The residual LD was reused as described until reach 3R. Afterwards, the blocks were embedded in acrylic resin, sanded and divided (n=15) according to the factors “surface treatment” (HF20s+Silane and HF120s+Silane and Monobond Etch&Prime- MEP) and TC (with/10.000 cycles and without). After surface treatment, cylinders (Ø:2mm) of resin cement were made and submitted to SBS test (100KgF,1mm/min). Data (MPa) were analyzed by 3-way ANOVA, Tukey's test (5%) and Weibull analysis. Failure analysis was performed with stereomicroscope. Results: ANOVA revealed that all factors were significant (P=.000*). The group 3RMEP(105.09±19.49) presented the highest SBS among the experimental groups. 1RHF20sTc(7.50±1.97) group had the lowest SBS, similar to the CHF20sTc(15.69±3.77), 1RHF20s(15.12±3.03), 1RHF120sTc(14.60±3.43) and 3RHF20sTc(15.65±0.97). The Weibull modulus and characteristic strength varied among the experimental groups (P=0.0). Failure analysis revealed adhesive and mixed types. Conclusion: The recycling of DL ceramics increases the SBS to resin cement when the ceramic is treated with HF120s+S or MEP. Keywords: Shear Strength, lithium disilicate, recycling.

Purpose: The association of Temporomandibular disorder (TMD) and somatic symptoms with the psychological variables of personality, coping, and distress were analyzed in young adults. Physical and psychological correlates were also explored along with the risk factors for TMDs/somatization. Materials and Methods: Participants were enlisted from a local university and the presence of TMDs and somatic symptoms was determined with the Short-form Fonseca Anamnestic Index and Patient Health Questionnaire-15. The psychological variables of personality, coping, and distress was assessed with the Big-Five Personality Inventory-10, brief-COPE Inventory, and Depression, Anxiety, Stress Scales-21 accordingly. Statistical evaluations were performed with the Mann-Whitney U test, Spearman’s correlation, and logistic regression analyses (α = 0.05). Results: Among the 455 participants (mean age 22.7 ± 1.2 years), 18.2% and 5.7% had TMDs and medium-to-high somatization respectively. Participants with TMDs exhibited substantially higher somatization and psychological distress scores than those with no TMDs. Significant differences in TMD, conscientiousness, extraversion, and psychological distress scores were observed between participants with no-to-mild and medium-to-high somatization. The association between TMD and somatization scores, albeit significant, was weak. Neuroticism and dysfunctional coping style were moderately correlated to general distress, depression, anxiety, and stress (rs = 0.44-0.62). Conclusions: Findings suggest that anxiety is the main risk factor for the presence of TMDs and medium-to-high somatization in non-clinical young adults while conscientiousness is a protective factor for somatization. Keywords: Temporomandibular disorders, somatization, personality, coping behavior, psychological distress.

Objectives To evaluate and compare bacterial growth on zirconia versus titanium healing caps. Material and methods S. sanguinis (Ss) and F. nucleatum (Fn) were grown on titanium and zirconia healing caps that were fixed to the cover of a 96-well microtiter plate. A drop (10 μL) of bacterial suspension was placed on each healing cap and allowed to dry for 1h at 37°C. After this time, the cover was replaced on the plate such that the caps were completely immersed in fresh liquid medium. Each plate contained only one bacterial strain, with 2 control groups. Bacterial growth was monitored over 18h by following the optical density at 650nm. A one-way ANOVA comparison test was used for statistical analysis. Scanning electron microscope (SEM) images of healing caps of each material were taken after a 48h incubation with Ss or Fn to assess bacterial attachment and with no bacteria as control. Results Ss growth was similar in both types of healing cap with no significant differences between these groups and the control (P=0.990). However, there was significantly less growth of Fn on the zirconia caps than on the titanium samples (P<0.0001) or the control (P<0.0001). SEM imaging revealed obvious differences in the surface characteristics of the titanium and zirconia caps. The number of bacteria attached to the rough apical area was particularly high. Conclusions The use of zirconia healing caps may reduce the growth of some bacterial species compared to that seen on titanium healing caps. Keywords: Implants, healing caps, Bacterial growth, titanium, zirconia

Purpose: This study aimed to evaluate the tensile strength of five different thicknesses of two resin cements placed between two titanium surfaces, before and after ageing. Materials and Methods: One hundred titanium 5 grade models composed of two surfaces simulating a semiprecision attachment for overdenture and its housing in the framework, were used. Samples were cemented using two different resin cements (SoloCem and OT-Cem). Five groups representing five different cement thicknesses (from 50 to 250μm) were created by varying the housing diameter. A half of the sample underwent to a tensile strength test 24h after luting, while the other half after 30000 thermic cycles from 5°C to 55°C. Shapiro-Wilk and ANOVA with post-hoc tests were performed to relate the tensile strength to the variables: cement type, thermal ageing and cement thickness (p <0.05).   Results: Statistical differences were found between the cements both at T0 and T1; the mean values of tensile strength of SoloCem were three times higher than those of OT-Cem. The thermic cycles determined a reduction of the tensile force values for both cements; statistical evidence was found only for the SoloCem except for the 100μm thickness group. Significant differences were also found between the cement thicknesses of both cements, with 50µm and 100μm expressed the best tensile strength. Most of the fractures were of cohesive nature. Conclusion: SoloCem showed a higher tensile strength than OT-Cem but has been more stressed by the ageing. For each group the cement thickness influenced the tensile strength values with an inverse relationship.

Purpose: The objective of the study was to determine the values of 15 craniofacial linear distances in the Serbian ethnic group and the correlations between them that are predictive or can serve as proxy for OVD using and compare two methods of face-anthropometric and digital 2D face-photogrammetric measurement. Material and methods: A total of 90 adults were selected. Facial distance as a tool to measure the OVD was Sn-Gn - distance between septum of the nose (Sn) and tip of the chin (Gn). Face-anthropometric measurements were made with a Boley Gauge (Buffalo Dental Manufacturing Co.NY,USA). Digital 2D photogrammetric facial measurements were performed using the computer program DrCeph (FYI Technologies, USA). Results: Determined mean value for the distance Sn-Gn by face-anthropometric was Sn-Gn(f) X=63.55 and by face-photogrammetric was Sn-Gn(ph) X=63.56. Multivariate regression analysis revealed that Sn-Gn(f) depended on ExL-ExR(f)  p<0.001, ZyL-ZyR(f) p=0.077, N-Sn(f) p=0.096, Sn-Sto(f)  p=0.043 and gender and that Sn-Gn(ph) depended on ExL-ExR(ph) p<0.001, EnL-EnR(ph) p=0.029, N-Sn(ph) p=0.013, Sn-Sto(ph) p=0.001 and gender. Conclusions: A comparison of facial anthropometry and digital 2D facial photogrammetry reveals no statistical significance differences in the values obtained and shows that facial photogrammetry could be a reliable method as a facial anthropometry.

Purpose: The aim of the current study is to evaluate inlay and onlay marginal adaptation of two different ceramic materials using two intra-coronal preparation designs. Materials and Methods: An examination of the marginal adaption of two materials, lithium disilicate (IPS e.max CAD) (EX) and polymer infiltrated ceramic network material (PICN; Vita Enamic) (EN), and two preparation designs where D1 represents MOD inlay preparation with no cusp reduction and D2 in addition of the basic MOD preparation, the buccal cusps (functional cusps) were reduced by 1.5 mm. 4 sub-groups (EX-D1), (EX-D2), (EN-D1), (EN-D2) were  conducted. Forty (n=40) mandibular molars were used. A stereomicroscope was used to assess the marginal gap before, after cementation and after thermocycling. Values were calculated for the mean, median, standard deviation (Sd), minimum, maximum, and 95% confidence interval. Pair-wise comparisons using Tukey's Post-Hoc test were performed following a significant analysis of variance (ANOVA) P ≤ 0.05. Results: The results revealed that lithium disilicate (IPS e.max CAD) showed statistically significantly higher mean gap distance than polymer infiltrated ceramic network material (PICN; Vita Enamic) (61µm to 99µm). Pair-wise comparisons showed that D2 design has statistically significant higher mean gap values than D1. Conclusions: Both lithium disilicate (IPS e.max CAD) or polymer infiltrated ceramic network material (PICN; Vita Enamic) provided marginal adaptation within clinical accepted range. Polymer infiltrated ceramic network material restorations provided better fit than lithium disilicate restorations. Cusp coverage has a greater marginal gap compared to conventional Preparation. 

Purpose: To assess wear, fatigue, and fracture resistance of different CAD/CAM onlays, milled from monolithic Zirconia (Zr), hybrid ceramic (EN), and lithium disilicate (LS), when used as abutments for removable partial denture frameworks fabricated from acetal resin (AR) or cobalt-chromium (Co-Cr). Methods: Standard onlays and RPD framework were designed and milled using CAD/CAM. Onlays were cemented with resin cement to identical teeth models. The RPD’s occlusal rest surface and the ceramic onlays’ rest seats were both 3D scanned before and after 750,000 mechanical load cycles (50 N) and 8,000 thermal cycles (5-55°C) in a chewing simulator. The volumetric loss was measured using 3D image processing software, and the failure of the samples was detected using a stereomicroscope. The fracture resistance was tested by loading to failure in a universal testing machine. The fatigue failure results were analyzed with Fisher's exact probability test and the wear and fracture resistance data were analyzed using two-way ANOVA and Bonferroni Post-hoc test (P<0.05). Results: A significant difference (p<0.05) was found between the tested experimental groups in wear, fatigue, and fracture resistance. Zr/Co-Cr combinations exhibited the least wear and the highest fatigue and fracture resistance (P<0.05), while the highest wear and least fatigue and fracture resistance were recorded for EN/AR group (p<0.05). Conclusions: Zr onlays demonstrated a conservative treatment option with superior mechanical behavior when used as an onlay abutment, regardless of the RPD framework material used. The AR framework is not recommended in the posterior region for removable partial dentures. Keywords: CAD/CAM, Onlay, RPD, Fatigue, fracture, wear, Lithium Disilicate, Zirconia, Hybrid Ceramic.

Purpose: To evaluate radiographic changes around six implants (Two posterior zygomatic and four conventional implants) used with fixed detachable restorations in patients with severe maxillary posterior resorption with either Polyether ether ketone (PEEK) or titanium frameworks. Materials and methods: Twelve maxillary edentulous patients were rehabilitated with six implants, including two posterior zygomatic and 4 conventionally placed implants for each patient following all-on-six distribution, and opposing mandibular all-on-four implant retained fixed detachable prostheses. A two-stage surgical unloaded healing protocol was performed. According to framework and teeth materials, there were two groups; Group I: CAD-CAM milled framework from modified BioHPP PEEK, bonded to polymethylmethacrylate crowns. Group II: screw-retained CAD-CAM milled framework from titanium, bonded to zirconium crowns. Bone loss evaluation for six implants was performed using cone beam computed tomography at the time of insertion (T0), after one year (T1), and after three years (T2). Results: There was a statistically significant difference in bone loss between PEEK and titanium groups. Less bone loss in PEEK groups around anterior conventional implants at buccal surfaces (P =0.01), at mesial surfaces (P <0.001), at distal surfaces (P <0.001), and zygomatic implants at buccal surfaces (P =0.004), and at palatal surfaces (P =0.003). Conclusions: Within the limitations of the study, the full-arch PEEK and titanium frameworks of fixed-detachable prostheses used with an All-on-Six distribution using zygomatic implants for rehabilitation of maxillary edentulous atrophied posterior arches was a promising treatment approach. Less bone loss was observed with the PEEK framework restorations combined with the PMMA crowns group.

Purpose: To report on the follow-up of two earlier published RCTs on the performance of screw-retained monolithic zirconia restorations on Ti-base abutments based on intraoral optical scanning or conventional impressions. Materials and Methods: A total of 54 patients receiving 89 restorations (44 single crowns [SC]), 21 splinted crowns [2-FDP], and 24 three-unit fixed partial dentures (3-FDP)] were included in the 1- to 3-year follow-up period. The restoration survival and technical complications were documented. Results: A total of 50 patients with 84 restorations completed the 3-year follow-up. One 3-FDP from the IOS group was lost. This resulted in survival rates of 97.9% for the test and 100% for the control restorations and an overall survival rate of screw-retained monolithic zirconia restorations on implants of 98.8% after 3 years. There was no statistically significant survival difference between the test and control groups (P = .362). When evaluated separately, a 100% survival rate for SCs and 97.7% rate for 2-FDPs was reported. One decementation and three occurrences of screw loosening occurred over the 1- to 3-year follow-up. The multiple-implant restorations showed higher (23.3%) complication rates at the restoration level than the SCs (4.9%) after 3 years of function (P = .026). Conclusion: Screw-retained monolithic zirconia restorations on Ti-base abutments show promising survival rates after 3 years of function. Restorative complications of screw-retained monolithic zirconia restorations on Ti-base abutments are more likely to happen in the first year of function and are more common in multiple-implant restorations than solitary crowns. The impression (IOS or conventional) does not seem to influence these results.

Purpose: To determine the average time it takes for patients to adapt to mandibular complete dentures and the factors associated with this critical period. Materials and methods: A total of 108 completely edentulous patients were rehabilitated using complete dentures. Adaptation was evaluated based on the following criteria: mastication, comfort, speech, and swallowing with dentures. Kaplan-Meier analyses were used to estimate the average time to adaptation. Log-rank test was used to assess the adaptation period and associated factors. Results: Of the 108 rehabilitated patients, 89 had adapted to mandibular complete dentures at the 6-month follow-up. The mean time to adaptation estimated from the Kaplan-Meier curve was 78.54 days (95% CI: 71.04 to 86.04). The factors associated with the adaptation period were previous experience with a mandibular denture (P = .032), the professional who made the previous complete dentures (P = .034), frequency of appearance of traumatic lesions after 15 days of rehabilitation (P = .023), posterior mandibular ridge height (P = .005), and regular use of the new dentures (P = .002). Conclusion: Most patients adapted to mandibular dentures after 2.6 months. No prior mandibular denture experience, use of old dentures made by a dental technician, occurrence of traumatic injuries 15 days after complete denture delivery, presence of a resorbed posterior mandibular ridge, and nonregular wear were associated with longer adaptation time to the new mandibular complete dentures.

This case report describes a novel approach combining orthodontic and implant digital treatment planning workflows to enable prosthetically driven implant placement before orthodontic treatment is performed or completed. The computer-assisted implant placement is performed using a static surgical guide based on the future positions of the teeth after completion of orthodontic treatment. This innovative approach allows for select partially edentulous patients to undergo fixed prosthetic rehabilitation before orthodontic treatment is completed.

Purpose: To evaluate the effect of tooth brushing and dentifrice fluoride (F^-) concentration on changes in color and translucency (ΔE₀₀ and ΔT₀₀, respectively), surface gloss (GS), surface roughness (Sa), and microstructure of a glazed CAD/CAM ceramic. Materials and methods: Ceramic blocks (e.max/CAD) were sectioned into rectangular plates (14 x 12 x 1 mm), and one surface of each sample was glazed. Samples were divided into three groups according to the F- concentration in the dentifrice (0, 1,100, and 5,000 μg/g) and were then subjected to 60,000 tooth brushing cycles. Luminosity and color were measured using a spectrophotometer at baseline and after every 20,000 cycles to obtain their ΔE₀₀ and ΔT₀₀ values. Another set of samples was prepared to measure the GS with a gloss meter and the Sa with a confocal laser microscope. The GS and Sa results were subjected to analysis of variance, Tukey test, and Dunnett test (α = .05). Results: After 60,000 tooth brushing cycles, all of the variables were clinically acceptable, and there were no significant differences in the ΔE₀₀, ΔT₀₀, GS, or Sa among the fluoridated dentifrices. The GS values decreased significantly as the number of tooth brushing cycles increased. Conclusion: The ΔE₀₀, ΔT₀₀, GS, and Sa values were all clinically acceptable after the glazed e.max/CAD ceramic had been subjected to 60,000 tooth brushing cycles with dentifrices containing up to 5,000 μg/g of F^-.

Purpose: To compare the CIE L*a*b* values of two different dental shade guides using two shade-matching spectrophotometers. Materials and methods: SpectroShade Micro (MHT) and Easyshade (VITA Zahnfabrik) were tested. One calibrated operator performed 30 measurements of each tab from three batches of two guides, VITA Classical (VC) and VITA 3D-Master (VM). Receiver operating characteristic (ROC) curves and intraclass coefficients (ICC) between the different batches were calculated. Results were given as mean and SD of the L*a*b* values and the respective color differences according to the CIEDE 2000 formula (ΔE₀₀) for each of the shade tabs in the two spectrophotometers, then analyzed with independent student t test (α = .05). Results: A total of 1,440 and 2,610 measurements for VC and VM, respectively, were performed per spectrophotometer. There were statistically significant differences between the two devices for all L*a*b* values, with the exception of: L* for 3R1.5; a* for 2R1.5, 3L1.5, 2L2.5, 3M2, 3L2.5, 4L1.5, and 4L2.5; and b* for D3, 1M2, and 3M2. When assessing the same shade guide, differences in ΔE₀₀ were detected between devices above the acceptability threshold (ΔE₀₀ ≥ 1.8) for all shade tabs except for VC (C1, C2, D3, A3.5, C3, and A4) and VM (4M1, 3R2.5, 4L2.5, and 4M3). The overall mean of the inter-device ΔE₀₀ was 2.2 ± 1.0 for VC and 2.5 ± 1.0 for VM. Conclusion: The two dental spectrophotometers presented high ICC and ROC values, which validates their indication as auxiliary tools. However, there are discrepancies in the hues D (VC) and R (VM) with interdevice variability when evaluated for the L*a*b* component.

Purpose: To measure the influence of postpolymerization condition (dry or submerged in water) and time (2, 10, 20, and 40 minutes) on the accuracy of additively manufactured model material. Materials and methods: A bar standard tessellation language file was used to manufacture the resin specimens (E-Model Light, EnvisionTEC) using a 3D printer (Vida HD, EnvisionTEC). Two groups were created based on the postpolymerization condition: dry (D group) or submerged in water (W group). Each group was divided into four subgroups (D1 to D4 and W1 to W4) depending on the postpolymerizing time (2, 10, 20, and 40 minutes; n = 20 each; N = 160). The specimen dimensions were measured using a low-force digital caliper (Absolute Low Force Caliper Series 573, Mitutoyo). The volume was calculated: V = l × w × h. Shapiro-Wilk test revealed that the data were not normally distributed. Data were analyzed using Kruskal-Wallis and pairwise Mann-Whitney U tests (α = .05). Results: Significant differences in length, width, height, and volume values were found among the subgroups (P < .0018). In all groups, the width dimension (x-axis) presented the worst accuracy compared to height (z-axis) and length (y-axis) (P < .0018). The D2 and D4 subgroups obtained the closest dimensions to the virtual design; additionally, no significant differences were found between the two subgroups (P < .0018). Dry condition showed higher manufacturing accuracy compared to the water-submerged condition. In the water-submerged subgroups, the highest accuracy was obtained in the W2 and W4 subgroups (P < .0018). Conclusion: Postpolymerization conditions and time influenced the accuracy of the material tested. Dry postpolymerization condition with a time of 10 and 40 minutes obtained the highest accuracy.

Purpose: To develop an instrument for the assessment of perception of orofacial appearance and psychologic issues that can affect peoples' judgments. Materials and methods: A panel composed of five members (one psychologist, two prosthodontists, one orthodontist, and one final-year dental student) generated 31 items that could draw specific hypothetical dimensions. The questionnaire was self-administered by individuals attending local high schools and university (N = 261; 26.4% men) in the 14- to 28-year age range. Internal consistency, construct validity, responsiveness, and temporal stability were assessed. Results: Factorial analysis and Cronbach's alpha identified four dimensions (self-esteem, perfectionism, body image, and smile appearance concern) that could be best fitted by 17 items. Internal consistency was good (α in the 0.70 to 0.80 range). The dimensions were correlated with existing instruments that measure similar constructs. In responsiveness testing, tooth whitening did not induce changes in perfectionism or body image; however, it did increase self-esteem and decreased esthetic concern (P < .05). Conclusion: The newly created questionnaire is a consistent and reliable short instrument that measures psychologic issues related to the perception of orofacial appearance.

Purpose: To assess the retention and adaptation of milled and printed denture bases and to compare them to conventional ones. Materials and methods: A total of 24 completely edentulous patients were selected. For each patient, three maxillary denture bases were constructed. Three groups were defined according to fabrication technique: group I = denture bases were constructed by a conventional technique; group II = denture bases were milled from prepolymerized blocks of polymethyl methacrylate; and group III = denture bases were fabricated by a 3D printing technique. A digital force gauge was used for measuring the retention of the denture bases intraorally, while Geomagic Control X 64 software was used to evaluate the adaptation of the denture bases with their corresponding master casts. Analysis of variance for repeated measures was used for comparison among the groups, followed by pairwise comparison with Bonferroni correction as a post hoc test. The significance level was set at α = .05. Results: Statistical analysis showed significant differences among the three groups regarding retention and adaptation. The highest values of retention and adaptation of denture bases were found in group II (milling group). Conclusion: Within the limitations of this study, the following could be concuded: milled denture bases demonstrated better retention and adaptation than the conventional heat-polymerized and the printed denture bases; and printed denture bases showed better adaptation but similar retention to conventional heat-polymerized denture bases.

Purpose: To evaluate the performance of fully (Celtra Duo, Dentsply Sirona) and partially (VITA Suprinity, VITA) crystallized zirconia-reinforced lithium silicate and partially sintered lithium disilicate (IPS e.max CAD, Ivoclar Vivadent) glass-ceramics submitted to polishing, glazing, or no surface treatment after aging. Materials and methods: Specimens of each glass-ceramic were subjected to polishing with rubber cups (POL), glazing (GL), or control (C; no treatment) and afterwards aged with 18,000 thermal cycles (5°C to 55°C). The average roughness (Ra), 2D and 3D morphology, contact angle, multispecies biofilm formation (Streptococcus mutans and Candida albicans), and mechanical strength were evaluated by atomic force microscopy (AFM, n = 5), sessile-drop goniometry (n = 5), spectrophotometry (n = 5), and flexural strength test (n = 10), respectively. Data were analyzed using two-way analysis of variance and Tukey test (α = 5%). Results: POL promoted lower Ra than glazing, and Celtra Duo presented higher Ra than IPS e.max CAD (P < .05). Surfaces without polishing promoted higher Ra than the POL group (P < .001), greater contact angle (P < .001), and significant morphologic changes, regardless of the glass-ceramic. Irrespective of the treatment, the contact angle was higher in Celtra Duo, and regardless of the material, there was higher biofilm formation and lower flexural strength of unpolished compared to POL or GL ceramics. Conclusion: Polishing with rubber cups promoted lower roughness and minor morphologic surface alterations, but biofilm formation and flexural strength were similar to the glazed surface. In general, Celtra Duo and VITA Suprinity showed similar behavior to IPS e.max CAD, which makes zirconia-reinforced lithium silicate glass-ceramics a good option for indirect restorations.

Purpose: To investigate the physical and mechanical behavior of polyether ether ketone (PEEK) before and after thermocycling and its potential use as a more durable prosthetic component for implant-supported and -retained removable dental prostheses (I-RDP). Materials and methods: Roughness and surface hardness were evaluated in specimens obtained using the subtractive method (n = 20) with Ø 9 mm and 2 mm of thickness, and retention force was measured in attachments with Ø 4 mm and 3 mm of height. For fatigue resistance test, a polyurethane matrix with two ball-abutment implants (MDL, Intra-Lock International) was used to simulate the mandibular alveolar ridge. A total of 40 attachments (n = 20 pairs) were captured in acrylic resin blocks using a technique analagous to the direct clinical pick-up of overdenture female attachments and submitted to 2,900 insertion/removal cycles to simulate 24 months of overdenture use. Physical analyses were performed by Fourier transform infrared spectroscopy (FTIR), x-ray diffraction (XRD), and differential scanning calorimetry (DSC) before and after thermocycling (5° C to 55°C for 10,000 cycles). After normal distribution was verified by Shapiro-Wilk test, one-way analysis of variance (ANOVA) was applied to analyze the surface roughness and hardness, and two-way ANOVA with Bonferroni adjustment was used to assess the retention force (α = .05). Results: Thermocycling did not change the PEEK surface roughness or hardness (P > .05). As for the retention force, the highest average was observed after the thermocycling test (P = .006). Conclusion: Based on the FTIR, XRD, and DSC results, PEEK crystallinity decreased after thermocycling, and the physical and mechanical behavior of this polymer was compatible with the proposed application, attesting that it is a component of greater durability for I-RDPs.

Purpose: To assess whether implant-retained prostheses produced with a laser-sintering technique present accuracy and passive fit comparable to their milled counterparts. Materials and methods: Two Regular Neck Straumann analogs were placed in a block of polymethyl methacrylate (PMMA) at 15 mm of distance and parallel to one another. The PMMA block was then scanned, and two groups of cobalt-chromium (Co-Cr) screw-retained, three-unit implant prostheses were fabricated using milling (control) and laser sintering (test) techniques. The prostheses were then screwed on the PMMA block, and the vertical marginal gap between the prostheses and the analogs at the implant-abutment junction was measured twice: (1) when only one screw was tightened, and (2) when both screws were fully tightened. The mean marginal gap measurements were compared to assess the difference in terms of passive fit between the laser-sintered and milled prostheses. Results: The mean marginal gap of the milled and laser-sintered groups was 23.18 μ (SD = 6.2) and 23.71 μ (SD = 19.5), respectively. Conclusion: Laser-sintered prostheses presented a marginal fit comparable to milled.

Purpose: To clinically evaluate oral implant restorations placed by undergraduate students in the dental clinical curriculum at KU Leuven (Belgium) in terms of function and esthetics. Materials and methods: A retrospective observational cohort study was designed. The esthetic and functional evaluations of implant-supported restorations placed in the framework of the undergraduate implant dentistry clinical training program using White/Pink Esthetic Score (WES/PES) and visual analog scale (VAS) scoring was performed. Furthermore, complications were registered based retrospectively on the patient's medical file. The following research questions were stipulated: (1) How well do implant-supported restorations placed by undergraduate students perform esthetically? and (2) Which complications occurred and how were these managed? Results: Between August 2008 and July 2014 (6 academic terms), 251 implants (Brånemark System Mk III, Nobel Biocare) were placed in 113 patients by 155 students (> 40% of all students enrolled in the training program). Of these implants, 228 were restored in 101 patients by 118 students with varying restoration types. Esthetic scoring of the restorations in 83 of these patients revealed a satisfying mean WES of 8.14 ± 2.09 (out of 10) and PES of 9.56 ± 3.14 (out of 14). Complications were registered in 18.9% of the cases. Discussion: Clinical training in implant dentistry for undergraduates contributes to the development of advanced skills in the dental student's Master education. Overall, patients were satisfied with their implant-supported restorations. Implant and restoration success rates and complication incidence were confirmed by long-term data in the oral implant literature.

Purpose: To evaluate the efficacy of cleaning protocol in decontamination of organic compounds from polished zirconium oxide samples. Materials and methods: A total of 24 rectangular plate specimens were sintered from zirconium oxide. All samples were polished with commercially available polishers (course, fine, and superfine) and polishing paste. During the first step of the protocol, all specimens were cleaned with steam. After that, samples were randomly assigned to one of three groups (n = 8 each): A, B, and C. In group A, no additional cleaning was performed, while specimens of group B underwent an ultrasonic cleaning in distilled water. Group C specimens were cleaned in an ultrasonic bath with a special detergent solution. After washing, samples were subjected to energy-dispersive x-ray spectroscopy (EDX) and scanning electron microscope examination. In order to detect organic materials, the level of carbon atoms was measured. Results: EDX analysis revealed that samples in group A had the highest percentage levels of carbon atoms (9.57 ± 3.67) on the surface compared to the other cleaning protocols. The group B cleaning protocol resulted in lower carbon levels (4.73 ± 3.56), but the difference was not significant from only steam-blasted ones (P = .439). All specimens in group C had no detectable carbon atoms (0), which implies that all wax molecules had been removed (P < .05). Conclusion: Only following the group C cleaning protocol can total decontamination of the polished zirconium surface from organic compounds be expected. Therefore, it is advised to employ an ultrasonic bath with detergent solution for cleaning procedures of zirconium abutments before delivery.

Purpose: To evaluate the application of chitosan as a cleanser in the control of biofilm formation on cobalt-chromium (Co-Cr) alloy and acrylic resin surfaces. Materials and Methods: In total, 172 Co-Cr discs and 172 acrylic resin discs (14 mm x 3 mm) were contaminated with Streptococcus mutans, Staphylococcus aureus, Candida albicans, or Candida glabrata and incubated for 48 hours. Then, specimens were randomly divided into groups and immersed in the following solutions for 15 minutes: WC = solution without chitosan (control); CH = chitosan solution (5 mg/mL); CN = chitosan nanoparticle solution (3.8 mg/mL); and ET = effervescent tablet. Biofilm recovery rates (n = 9) were evaluated by counting the colony-forming units (CFU/mL). Biofilm morphology was evaluated using scanning electron microscopy. Data were compared with Kruskal-Wallis or analysis of variance followed by Tukey post hoc tests. Results: For acrylic resin, ET showed the lowest number of CFU for S aureus and S mutans (P < .001). CH exhibited intermediate values for S mutans, S aureus, and C albicans, and CN exhibited intermediate values for S mutans and S aureus. For C glabrata, there was no statistical difference between the solutions (P = .264). For Co-Cr, ET showed the highest level of antimicrobial action against all microorganisms (P < .001), and CH showed an intermediate level of action against S mutans and S aureus. Against C albicans and C glabrata, there was no significant difference among CH, CN, and WC. Conclusion: Although ET had a broader spectrum of antimicrobial action, the chitosan solution showed promise as a denture cleanser. Int J Prosthodont 2021.

Purpose: To evaluate the fracture behavior of monolithic crowns made of lithium disilicate (IPS e.max CAD, Ivoclar Vivadent; and Initial LiSi Block, GC) and zirconia-reinforced lithium silicate (Celtra Duo, Dentsply Sirona; and Suprinity, VITA) materials before and after cyclic fatigue aging. Materials and methods: Four groups (n = 22 per group) of CAD/CAM-fabricated maxillary incisor crowns were produced. All crowns were luted on metal dies with an adhesive dual-curing resin cement (G-CEM LinkForce [GC]). Half of the crowns in each group (n = 11) were statically loaded to fracture without aging. The remaining half were subjected to cyclic fatigue aging for 120,000 cycles (F_max = 220 N) and then loaded statically to fracture. Fracture mode was then visually examined. Scanning electron microscopy and energy-dispersive spectroscopy were used to evaluate the microstructure of the CAD/CAM ceramic materials. The data were statistically analyzed with two-way analysis of variance followed by Tukey honest significant difference (HSD) test (α = .05). Results: Before cyclic aging, there was no statistically significant difference in load-bearing capacity among the four groups (P = .371). After cyclic aging, the load-bearing capacity significantly decreased for all groups (P = .000). While the e.max CAD blocks had significantly higher load-bearing capacity (1,061 ± 94 N) than both monolithic ceramic crowns (P < .05), no significant difference was obtained compared to the Initial LiSi Block group (920 ± 140 N) (Tukey HSD P = .061). Conclusion: The mechanical performance of monolithic ceramic crowns fabricated from lithium disilicate was better than zirconia-reinforced lithium silicate after cyclic fatigue aging.

Purpose: To evaluate the effect of cavity tapering on the marginal and internal adaptation of endocrowns fabricated from two different ceramic materials. Materials and methods: Two mandibular molar model teeth were prepared with two different cavity tapers (5 and 10 degrees). Forty endocrowns in four groups (n = 10 each) were milled using lithium disilicate and zirconiareinforced lithium silicate ceramics for each cavity taper. The marginal and internal adaptation were measured with a stereomicroscope (×30) at 18 different points. The data were statistically analyzed using independent t test (P < .05). Results: A statistically significant difference was shown among the tested groups at 10 degrees of taper (P < .001). At 5 degrees of taper, the difference was insignificant. The greatest internal gap was observed on the pulpal floor in all tested groups. Conclusion: All materials had clinically acceptable internal and marginal gaps; however, lithium disilicate ceramic had significantly better adaptation at 10 degrees of taper.

Purpose: To evaluate the dimensional discrepancy between the diagnostic wax-up and the resulting mock-up. Materials and methods: A maxillary model with misaligned teeth was scanned, and an initial cast was 3D printed. A total of 60 identical casts were 3D printed from the initial one after scanning, and based on a digital additive veneer wax-up on the 6 anterior teeth, 10 more casts were 3D printed. The specimens were allocated to seven groups (n = 10 each). Group 1: transparent silicone matrix with a flowable light-curing composite resin; group 2: same as group 1, with the addition of a prefabricated transparent tray; group 3: silicone impression putty (65 on the Shore A hardness scale) and light-body silicone impression material with a dual-curing bis-acryl resin; group 4: same as group 3 without light-body silicone; group 5: silicone laboratory putty (92 Shore A) with a dual-curing bis-acryl resin; group 6: silicone laboratory putty (92 Shore A) with PMMA; and group 7: wax-up casts (control). Scans from the mock-ups were co-registered, segmented, and superimposed with the scans from the wax-up. The difference of the mock-up compared to the wax-up was quantified using morphologic operations. The results were analyzed with Kruskal-Wallis test and Dunn post hoc test (P < .05). Results: All mock-ups were larger in size in comparison to the wax-up. Significant differences were found for every labial surface third. The incisal third was the most inaccurate third, while the middle third was the most accurate. The most accurate groups were 2 and 5, and the largest discrepancy was observed in group 6. Conclusion: The analog mock-up differed dimensionally from the wax-up, irrespective of the technique/materials used.

Purpose: To investigate the influence of occlusal interference in dental prosthetics using finite element analysis (FEA). Materials and methods: The FEA model designed for this study centered on an all-ceramic, bi-layered, fixed partial denture (FPD) retained on the maxillary first premolar and molar, with the second premolar replaced by a pontic. The surrounding structures, such as the neighboring teeth, antagonists, and periodontium, were modeled. Four different load cases were designed at occlusal interferences of 0, 8, 12, and 24 μm, loaded by a simulated bite force of 300 N. Principal and von Mise stresses, as well as strain, were evaluated for all included structures. Results: For interferences of 12 and 24 μm, failure-relevant tensile stresses in the veneering layer were observed at the occlusal surfaces. Stress found in the zirconia FPD did not reach fatigue or flexural strength for any test load. Conclusion: Peak tensile stress was observed in close proximity to occlusal contact points, increasing with increasing occlusal interference. The FEA results suggested that the majority of occlusal stress is absorbed by the deformation of the periodontal ligament. Framework failure caused by the simulated interferences was not expected. Surface defects may ultimately lead to failure due to fracture or chipping, especially in cases of weaker ceramics or veneering.

Purpose: To evaluate the fracture strength of endodontically treated molars filled with different composite resins, with or without fiber reinforcement. Materials and methods: A total of 60 intact mandibular molars were selected and endodontically treated. A standardized mesio-occlusal-distal cavity was prepared with cervical margins 1 mm above the cementoenamel junction and oral and buccal walls with 1.5-mm remaining thickness. Universal adhesive was used in all specimens in etch-and-rinse mode. Specimens were divided into four groups (n = 15 each) according to restoration technique: CSM group, adhesive overlay with hybrid ceramic (CeraSmart, GC); EXP group, direct composite restoration (Essentia U, GC) and everX Posterior (GC) as core material; ESU group, direct composite restoration (Essentia U); and EST group, direct composite restoration (Essentia U) reinforced with horizontal bidirectional glass fibers placed over the pulpal chamber floor (everStick-Net, GC). After 7 days of water storage, samples were loaded until fracture using a universal testing machine. The maximum breaking loads were recorded in Newtons (N), and statistical analysis was then conducted with two-way analysis of variance and post hoc Tukey test. Fragments were analyzed using scanning electron microscopy. Results: Mean fracture resistance was: CSM = 1,428.9 ± 316.90 N; EXP = 1,874.57 ± 299.47; ESU = 1,557.44 ± 355.65; and EST = 1,870.27 ± 145.11. CSM and EXP showed the highest strength values when compared to the other groups. The variable "fiber insertion" did not significantly alter the fracture resistance. Origins of the fractures were always located on the occlusal surface, mainly from the major contact loading area. Conclusion: The use of everX Posterior showed great improvement in fracture resistance, similar to cuspal coverage restoration. However, only short fiber-reinforced composite resins showed a favorable fracture pattern.

Purpose: To compare in a randomized controlled trial the 5-year clinical outcomes of (1) 3-unit fiber-reinforced resin-bonded fixed dental prostheses (RBFDPs) to 3-unit metal-ceramic RBFDPs; and (2) 3-unit fiber-reinforced RBFDPs to 2-unit cantilevered metal-ceramic RBFDPs. Materials and methods: A consecutive sample of 50 young adult patients with tooth agenesis or trauma in the anterior region was included. The recruitment period was from 2005 to 2009, during which a total of 62 RBFDPs were inserted. In group A, 27 participants were randomly treated with 18 metal-ceramic 3-unit RBFDPs and 15 3-unit fiber-reinforced RBFDPs. In group B, 23 participants were randomly treated with 16 metal-ceramic 2-unit RBFDPs and 13 3-unit fiber-reinforced RBFDPs. All patients were followed up at baseline registration and at 1, 3, and 5 years. The primary outcome parameter was survival rate of the RBFDPs, and the secondary outcome parameters were periodontal and technical/esthetic outcomes and patient-reported evaluation of the RBFDPs. Results: Seven patients dropped out of the study during the 5-year observation period. In group A, the fiber-reinforced RBFDPs had a cumulative survival rate of 23% after 5 years, which was significantly less than for the 3-unit metal-ceramic RBFDPs. In group B, the cumulative 5-year survival rate was 36% for the fiber-reinforced RBFDPs and 91% for the 2-unit cantilevered metal-ceramic RBFDPs. Conclusion: The 3- and 2-unit metal-ceramic RBFDPs had a significantly higher 5-year survival rate than the 3-unit fiber-reinforced RBFDPs. The accessibility for oral hygiene practice was better with 2-unit compared to 3-unit RBFDPs, and the degree of gingivitis was lower. The esthetic outcome was better for the RBFDPs with ceramic pontics than the composite ones.