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Objectives: The aim of Working Group 4 was to address topics related to biologic risks and complications associated with implant dentistry. Focused questions on (a) diagnosis of peri-implantitis, (b) complications associated with implants in augmented sites, (c) outcomes following treatment of peri-implantitis, and (d) implant therapy in geriatric patients and/or patients with systemic diseases were addressed., Materials and Methods: Four systematic reviews formed the basis for discussion in Group 4. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary., Results: Bleeding on probing (BOP) alone is insufficient for the diagnosis of peri-implantitis. The positive predictive value of BOP alone for the diagnosis of peri-implantitis varies and is dependent on the prevalence of peri-implantitis within the population. For patients with implants in augmented sites, the prevalence of peri-implantitis and implant loss is low over the medium to long term. Peri-implantitis treatment protocols which include individualized supportive care result in high survival of implants after 5 years with about three-quarters of implants still present. Advanced age alone is not a contraindication for implant therapy. Implant placement in patients with cancer receiving high-dose antiresorptive therapy is contraindicated due to the associated high risk for complications., Conclusions: Diagnosis of peri-implantitis requires the presence of BOP as well as progressive bone loss. Prevalence of peri-implantitis for implants in augmented sites is low. Peri-implantitis treatment should be followed by individualized supportive care. Implant therapy for geriatric patients is not contraindicated; however, comorbidities and autonomy should be considered., (© 2018 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.)

Objectives: Working Group 2 was convened to address topics relevant to prosthodontics and dental implants. Systematic reviews were developed according to focused questions addressing (a) the number of implants required to support fixed full-arch restorations, (b) the influence of intentionally tilted implants compared to axial positioned implants when supporting fixed dental prostheses (FDPs), (c) implant placement and loading protocols, (d) zirconia dental implants, (e) zirconia and metal ceramic implant supported single crowns and (f) zirconia and metal ceramic implant supported FDPs., Materials and Methods: Group 2 considered and discussed information gathered in six systematic reviews. Group participants discussed statements developed by the authors and developed consensus. The group developed and found consensus for clinical recommendations based on both the statements and the experience of the group. The consensus statements and clinical recommendations were presented to the plenary (gathering of all conference attendees) and discussed. Final versions were developed after consensus was reached., Results: A total of 27 consensus statements were developed from the systematic reviews. Additionally, the group developed 24 clinical recommendations based on the combined expertise of the participants and the developed consensus statements., Conclusions: The literature supports the use of various implant numbers to support full-arch fixed prostheses. The use of intentionally tilted dental implants is indicated when appropriate conditions exist. Implant placement and loading protocols should be considered together when planning and treating patients. One-piece zirconia dental implants can be recommended when appropriate clinical conditions exist although two-piece zirconia implants should be used with caution as a result of insufficient data. Clinical performance of zirconia and metal ceramic single implant supported crowns is similar and each demonstrates significant, though different, complications. Zirconia ceramic FDPs are less reliable than metal ceramic. Implant supported monolithic zirconia prostheses may be a future option with more supporting evidence., (© 2018 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.)

This systematic review aimed to determine whether there is consensus for antibiotic prescription in healthy patients undergoing implant placement. A search of PubMed, Embase and Medline databases was conducted in January 2016 to find published journal articles on the use of antibiotics in implant placement, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were prospective human clinical trials investigating antibiotic usage during implant placement. Fifteen studies were deemed suitable. In 13 studies, no statistical difference was found between antibiotic use and the incidence of prosthetic failure, implant failure and early postoperative infections. These were rated as having low to high risk bias. Contrary results were reported in two studies, both of which were rated as having a high potential for bias. In conclusion, antibiotic use in healthy patients for the prophylaxis of surgical infection associated with dental implant placement does not appear to improve clinical outcomes. Practitioners should apply principles of antimicrobial stewardship and not use antibiotics as a routine measure in healthy patients., (© 2017 Australian Dental Association.)

The dentists must have solid knowledge in occlusology in order to obtain predictable long-term results for the implant-prosthetic treatment. The aim of our study was to verify if, with methods and materials currently used in any dental office for occlusal equilibration, the dentist can successfully integrate the implant-prosthetic restoration in the habitual occlusion of the patient. Using the T-Scan II system, we analyzed occlusion of three mandibular class III Kennedy edentulous male patients, from a private practice in Bucharest (Romania), all missing the first mandibular molar and all wearing a metal-ceramic crown on implant. In all these cases, the occlusion of the crowns was adjusted using articulating paper and vinyl polysiloxane biting material. The analysis of occlusion with the T-Scan II system in those three cases showed that the crowns were successfully integrated in the habitual occlusion. This study proves that those traditional methods, which are most frequently used in practice, are good enough to adjust the morphology and intensity of the occlusal contacts, if they are correctly and conscientiously used.

Ichraq Oulghazi, Amal El Yamani, Bouabid Morchad Prosthodontics Department, Mohammed V University, Rabat, MoroccoCorrespondence: Ichraq Oulghazi, Prosthodontics department, Mohammed V University, Rabat, 10112, Morocco, Tel +212707163587, Email ichraqoul98@gmail.comPurpose: The aim of this work is to conduct a literature review to highlight all the parameters involved in sub-prosthetic radicular fractures of teeth supported by metallic dental core.Materials and Methods: The following research was performed among published studies over the last 10 years in two PubMed/Medline and Scopus and supplemented by manual searching within the bibliographies. The search was restricted to publications in English and French.Results: Out of the 1464 articles initially identified, 18 studies met our inclusion criteria and were subsequently included in the literature review. These consisted of eight Finite Element Analysis Studies, two Retrospective Studies and one Randomized Controlled Trial. The results of this review show that radicular fractures are influenced by several variables, including predisposition, with maxillary premolars and mandibular molars being the most commonly affected teeth. Intracanal preparation can induce crack formation, leading to localized high stress concentrations. Increased ferrule height to 2 mm significantly enhances dental fracture resistance. Using high modulus of elasticity alloys results in nearly complete stress transmission to dentin due to their limited deformability and absorption capacity. The highest fracture resistance is achieved when posts are sealed using resin-modified glass-ionomer cement. Longer posts may be preferable to prevent vertical fractures. Additionally, occlusal factors, through repetitive stresses, contribute to crack propagation from surface defects, a phenomenon termed fatigue fracture.Conclusion: These findings have significant implications. Practitioners should be aware of the predisposition of certain teeth, the importance of preserving the ferrule effect, the choice of root post materials, post Cement Material and the role of occlusal forces in managing and preventing vertical root fractures.Keywords: endodontically treated teeth, root fracture, radicular fracture, tooth fracture, dental restoration failure, biomechanical factor, stress factor, cast post, metal post, post and core technique, dental posts, metallic coronoradicular restoration

Abstract Background While the concept of angled screw channels has gained popularity, there remains a scarcity of research concerning the torque loss and fracture strength of monolithic zirconia restorations with various screw channel angulations when exposed to thermomechanical cycling. This in-vitro study aimed to evaluate the reverse torque value and fracture resistance of one-piece screw-retained hybrid monolithic zirconia restorations with angulated screw channels after thermomechanical cycling. Methods One-piece monolithic zirconia restorations, with angulated screw channels set at 0°, 15°, and 25° (n = 6 per angulation) were fabricated and bonded to titanium inserts using a dual-cure adhesive resin cement. These assemblies were then screwed to implant fixtures embedded in acrylic resin using an omnigrip screwdriver, and reverse torque values were recorded before and after thermomechanical cycles. Additionally, fracture modes were assessed subsequent to the application of compressive load. One-way ANOVA and Bonferroni post hoc test were used to compare the groups (α = 0.05). Results The study groups were significantly different regarding the fracture resistance (P = 0.0015), but only insignificantly different in the mean percentage torque loss (P = 0.4400). Specifically, the fracture resistance of the 15° group was insignificantly higher compared to the 0° group (P = 0.9037), but significantly higher compared to the 25° group (P = 0.0051). Furthermore, the fracture resistance of the 0° group was significantly higher than that of the 25° group (P = 0.0114). Conclusions One-piece hybrid monolithic zirconia restorations with angulated screw channels can be considered an acceptable choice for angulated implants in esthetic areas, providing satisfactory fracture strength and torque loss.

Abstract Resin composites containing surface pre-reacted glass (S-PRG) have been introduced to reduce demineralization and improve remineralization of the tooth structure. However, water diffusion within the material is necessary for its action, which can impair its overall physicomechanical properties over time, including color stability. This study aimed to evaluate the color stability and related degree of conversion (DC) of four resin composites. Discs (6 x 4 mm, n = 5/group) of microhybrid (MH), nanofilled (NF), nanohybrid (NH), and S-PRG-based nanohybrid (S-PRG-NH) composites with two opacities (A2/A2E and A2O/A2D) were prepared. Color (CIELab and CIEDE2000) was evaluated with a spectrophotometer after aging in grape juice (2 x 10 min/10mL/7days). The DC was analyzed by using Fourier transform infrared spectroscopy before and after light-curing. Data were statistically analyzed by using two-way analysis of variance and post-hoc least significant difference tests (p

Abstract Objectives The term “cracked tooth” is used to describe an incomplete fracture initiated from the crown and progressing towards a subgingival direction. Despite the high prevalence of cracked teeth and their frequent association with symptoms and pulpal or periapical pathoses, there is still no consensus in the literature with regard to their restorative and endodontic management. Therefore, the aim of this narrative review was to evaluate the most relevant research and provide an up‐to‐date comprehensive overview regarding the treatment of cracked teeth. Materials and Methods An electronic literature search was carried out in MEDLINE (via Ovid), Embase (via Ovid), Scopus, and Web of Science as well as several “Grey literature” sources up to February 22nd 2022 using a combination of pre‐specified ‘free‐text' terms (keywords) and “subject headings.” The search process was supplemented by handsearching in relevant dental journals and reference lists. This narrative review focused on clinical follow‐up studies (observational or interventional studies, case series/reports), laboratory studies and systematic reviews written in English language that reported data on treatment of permanent cracked teeth. The selection of relevant studies was carried out by two reviewers (AK and DG) working independently in two consecutive stages: title/abstract screening and full‐text retrieval. Any discrepancies in the study selection were resolved by discussion between the reviewers. Results In total, 64 articles were selected for inclusion in this narrative review. Conclusions Cracked teeth with normal pulp or reversible pulpitis have exhibited high pulp and tooth survival rates by the provision of direct or indirect composite restorations. Besides, recent data favour monitoring, especially in the absence of symptoms or compromised tooth structure. When endodontic intervention is required, current evidence suggests that along with appropriate restorative management, outcomes of cracked teeth may be comparable to those of non‐cracked root filled teeth.

Introduction: This randomized clinical study aimed to evaluate the clinical performance of composite and compomer materials in primary molars over two years. Methods: Children aged five to six years with at least two carious proximal surface primary molars were screened for resin-hybrid composite (Kerr Herculite Classic) and compomer (Dyract XP and R&D Series Nova) restorations. The restorations were clinically evaluated after 3, 6, 9, 12, 15, 18, and 24 months using the modified United States Public Health Service criteria. Statistical analyses were performed using Chi-square, McNemar, z-tests, and Kaplan-Meier survival analysis. P0.05). No significant differences were observed between the three materials concerning retention, color matching, marginal discoloration, anatomic form, marginal integrity, secondary caries, and surface texture (P>0.05). No statistically significant differences were also found between the effects of the cavity type, the tooth position in the arch, the age of the patient, the restorative material, and the lining material on the survival rates of the teeth (P>0.05). Restoration loss was higher in males than females, and a statistically significant relationship was observed in terms of gender (P=0.017). Restoration loss in the first primary molars (8.3%) was greater than that in the second primary molars (6.7%) (P=0.041). Conclusion: Both composite and compomer restorations were clinically successful over two years.

Dental treatment after endodontic therapy is quite challenging in clinical practice. While multiple post-and-core systems emerged and disappeared in the dental field, the historical process was laborious and still requires several up to date scientific evidence. Furthermore, once considered the gold standard, rigid metallic post-and-cores might be considered a limited option. Moreover, the development of glass-fiber posts and the biomechanical principles for root preparation bring multiple advantages, but also raise concerns over guidelines and indications. This review examined the classic literature so that clinicians may understand the concepts behind post endodontic restorative treatments and the doubts that still remain in the daily practice before performing this restorative modality.

Abstract Objectives This is a double-blind, split-mouth, randomized clinical study that aims to evaluate the influence of bulk-fill composite packaging presented in syringes (BSy) and capsules (BCa), and the effect of selective enamel etching (SEE) on the clinical performance of class I and II bulk-fill resin composite restorations after 24 months. Methodology A total of 295 class I or class II restorations were performed on 70 patients. One universal adhesive was applied in all restorations. SEE was used in 148 restorations and self-etching mode (SET) in 147 restorations. After the adhesive application, cavities were restored with Filtek Bulk-fill Posterior Restorative in syringes (BSy), Filtek One Bulk-fill in capsules (BCa), or Filtek Supreme Ultra in syringes with the incremental technique (In). All restorations were evaluated using the FDI criteria after one week and after six, 12, and 24 months. Kaplan-Meier survival analysis and Pearson’s Chi-square test were used (α=0.05) for statistical analysis. Results After 24 months, 62 patients were evaluated and four restorations were lost due to fracture (one for SEEBSy, two for SEEIn, and one for SETIn). No significant differences in the fracture and retention rate were found between groups (p>0.05). SEE showed significantly fewer marginal adaptation defects than SET (p

Statement of problemConventional diagnostic aids based upon imagery and patient symptoms do not indicate whether restorative treatments have eliminated structural pathology.PurposeThe purpose of this clinical study was to evaluate quantitative percussion diagnostics (QPD), a mechanics-based methodology that tests the structural integrity of teeth noninvasively. The study hypothesis was that QPD would provide knowledge of the structural instability of teeth after restorative work.Material and methodsEight participants with 60 sites needing restoration were enrolled in an IRB-approved clinical study. Each participant was examined comprehensively, including QPD testing. Each site was disassembled and microscopically video documented, and the results were recorded on a defect assessment sheet. A predictive model was developed for the pathology rating based on normalized fit error (NFE) values using data from the before treatment phase of the study published previously. Each restored site was then tested using QPD. The mean change in NFE values after restoration was evaluated by the pathology rating before treatment. The model was then used to predictively classify the rating after restoration based on the NFE values after treatment. The diagnostic potential of the rating was explored as a marker for risk of pathology after restoration.ResultsAfter restoration, 51 of the 60 sites fell below an NFE of 0.04, representing a greatly stabilized tooth site sample group. Several sites remained in the high-risk category and some increased in pathologic micromovement. Two models were used to determine severity with indicative cutoff points to group sites with similar values.ConclusionsThe data support the hypothesis that QPD can indicate a revised level of structural instability of teeth after restoration.

Introduction: The goal of this study was to test the impact of both diabetes type and control via the hemoglobin A1C biomarker on oral health outcomes. Materials & Methods: In this observational study, data were extracted from the University of Pittsburgh Dental Registry and DNA Repository and analyzed. From 6,026 subjects, 414 ones with a diagnosis of diabetes were matched by sex, age and ethnicity with 414 individuals without diabetes. A number of statistical approaches (chi-square, Fisher’s exact, Student’s t, Wilcox, and Mann Whitney tests) were used and all comparisons were set with an alpha of 0.05. Results: Patients with type 1 diabetes experienced xerostomia more often compared to non-diabetic matched pairs (p=0.02). Patients with diabetes (n=414) experienced temporomandibular joint (TMJ) discomfort more often than their non-diabetic matched pairs, as did type 1 diabetic patients alone, in comparison to both their matched pairs and type 2 diabetic patients (p=0.01, p=0.004, and p=0.02, respectively). Among patients grouped by diabetic control, all patients reporting control (n=39) experienced xerostomia more often than their non-diabetic matched pairs (p=0.05). Patients in poor diabetic control experienced restoration failure more often than patients in good control (p=0.04). The experience of restoration failure was no different between patients in good diabetic control and their matched controls (p=0.26). The number of restoration failures was higher in patients in poor control, as compared to their matched non-diabetic controls (p=0.03). Conclusion: Patients with diabetes experienced xerostomia but not necessarily more severe caries experience, and may be protected from TMJ discomfort. Patients in good control of their diabetes were at no greater risk for restoration failure as compared to non-diabetic patients; however, the patients in poor control were at higher risk for failed restorations.

Objective: To assess the reproducibility of two clinical criteria for the evaluation of restorations in primary teeth and the impact on treatment decision. Material and Methods: A cross-sectional study was performed selecting 71 resin-based composite restorations placed in primary molars of children who had sought dental treatment at a dental school. Two trained examiners evaluated independently the restorations using modified FDI and USPHS criteria. All restorations were assessed separately with each system in random order to avoid memory bias. Kappa statistics were used to determine inter-examiner reliability considering each parameter of both criteria and score final about treatment decision. McNemar test was used to compare the treatment decision with two criteria. The significance level was set at 5%. Results: Kappa values ranged from 0.28 to 0.93 with USPHS and 0.28 to 0.88 with FDI, considering each parameter separately. Inter- examiner agreement for treatment decision was excellent for both criteria (Kappa: 0.85-0.90). For clinical decision-making, no difference between criteria was found, irrespective of examiner. Conclusion: Low inter- examiner agreement for evaluation of each parameter of USPHS and FDI criteria does not reflect on reproducibility for treatment decision. Both criteria may be suitable for evaluation of composite restorations in primary teeth.

Objective: To evaluate the influence of cavosurface vestibular bevel (CSVB) application on the clinical success (CS) of class IV restorations of traumatized permanent teeth, the influence of the number of fracture angles and dental trauma recurrence (DTR) on the restorations retention rate (RRR) and incidence of pulp necrosis (PN). Material and Methods: Fifty-seven children and adolescents with enamel and dentin fractures requiring C-IV restorations were randomly allocated in groups with CSVB and without CSVB. The primary outcomes were the CS of restorations, evaluated using modified USPHS criteria, and the incidence of PN after a 6-months follow-up. As secondary outcomes, the influence of the number of fractured angles and the DTR on the RRR and on the incidence of PN were evaluated (p>0.05). Results: Of 57 children and adolescents, 74 teeth were restored, and 71 completed the six-month follow-up analysis. Teeth restored with and without CSVB displayed similar CS as well as the same incidence of PN (p>0.05). The number of fractured angles did not influence the RRR and DTR was not associated with PN (p>0.05). DTR was associated with a lower RRR (p

Statement of problemIn patients with an altered skeletal maxillomandibular relationship and bone resorption, the rehabilitation of edentulous jaws by combining 4 implants, 2 straight medially and 2 tilted distally, may be preferred to avoid a bone augmentation procedure.PurposeThe purpose of this single cohort 1-year prospective study was to evaluate the clinical performance of a 4-implant overdenture fully supported by a computer-aided designed and computer-aided manufactured (CAD-CAM) titanium bar.Material and methodsThis single cohort prospective study included edentulous participants rehabilitated with a 4-implant overdenture in 1 of the 2 jaws. The outcomes were implant and prosthetic survival and success rates, any biologic and technical complications, periimplant marginal bone loss, changes in the oral health impact profile (OHIP), bleeding on probing, and the plaque index.ResultsEighteen participants received 72 implants. One year after implant placement, no implants or prosthesis had failed, and no biologic or technical complications had been observed. At the 1-year follow-up, the mean marginal bone loss was 0.29 ±0.16 mm. The OHIP summary scores demonstrated a significant improvement in oral health-related quality of life. At the 1-year follow-up, positive bleeding was found in 2 participants (11.1%) around 3 implants (4.1%). Three participants (16.6%), accounting for 5 implants (6.9%), showed a slight amount of plaque.ConclusionsA 4-implant overdenture supported by a CAD-CAM titanium bar may be a reliable option for the treatment of the edentulous mandible and maxilla over a 1-year period. Oral health-related quality of life significantly improved in all treated participants.

AimTo systematically scrutinise the scientific literature to evaluate the accuracy of computer-guided implant placement for single missing teeth, as well as to analyse the eventual clinical advantages and treatment outcomes.Material and methodsThe electronic and manual literature search of clinical studies published from January 2002 up to November 2015 was carried out using specified indexing terms. Outcomes were accuracy; implant and prosthetic failures; biological and mechanical complications; marginal bone loss (MBL); sulcus bleeding index (SBI); plaque score (PS); pink esthetic score [PES]; aesthetic and clinical outcomes.ResultsThe search yielded 1027 relevant titles and abstracts, found during the electronic (n = 1020) and manual (n = 7) searches. After data extraction, and screening of titles, abstracts, and full-texts, 32 studies fulfilled inclusion criteria and were included in the critical review: two randomised controlled clinical trials, six prospective observational single cohort studies, one retrospective observational study, three in vitro comparative studies, 10 case reports and 10 systematic reviews. A total of 209 patients (18 to 67 years old) were treated with 342 implants using computer-guided implant surgery. The follow-up ranged from 12 to 52 months. The cumulative survival rate ranged from 96.5% to 100%. Eleven implant planning softwares and guided surgery systems were used and evaluated.ConclusionsComputer-guided surgery for single missing teeth provides comprehensive treatment planning, reliable implant positioning, favourable clinical outcomes and aesthetics. A tooth-supported template for the treatment of single missing teeth results in greater accuracy of implant positioning than with mucosa-supported or bone-supported templates. The limited scientific evidence available suggests that guided surgery leads to implant survival rates as good as conventional freehand protocols. Computer-guided surgery implies additional costs, that should be analysed in terms of cost-effectiveness, considering the reduction of surgery time, postoperative pain and swelling, as well as, the potential increased accuracy. Long-term randomised clinical trials are eagerly needed to investigate the clinical performance of guided surgery in partially edentate patients.

Objectives: The aim of this retrospective study was to determine the frequency and localization of the overhanging restorations by observing patients’ routinely taken panoramic radiographs. Materials and Methods: The panoramic radiographs of 4,960 patients who applied to a dental clinic in University between 2015 and 2016 and had one or more previous restorations were retrospectively examined. The study group included 243 patients (133 females and 110 males) with a mean age of 39.7 ± 12.5 years. Superposed interdental areas were not evaluated. Frequency distributions and percentages were calculated for the categorical data as to the surface of the maxillary-mandibular premolar and molar teeth, also the presence or absence of root canal treatment. Chi-square tests were used to compare data relating to the localization and frequency of overhanging restorations. Results: In the radiological evaluation of 243 patients, a total of 280 overhanging restorations were detected. Root canal treatment was present in 45.4% of the teeth with an overhanging restoration. The frequency of overhanging restorations in the maxilla was significantly higher (60.4%) than that of the mandible (39.6%), (p

Aim: A retrospective, cross-sectional study was carried out to evaluate the performance of resin composite restorations placed by undergraduate dental students with 1 to 15 years of placement based on dental records. Methods: Four calibrated operators evaluated 498 restorations (anterior and posterior) of 120 patients according to Ryge’s validated criteria (USPHS). Results: The criteria that showed the smallest changes between the types of failures were color matching, marginal discoloration and surface texture. Regarding the longevity, the surface texture showed an increase in the frequency of failures from the second time interval (3.1 to 6 years). Higher prevalence of failure was found in class II and III restorations, with secondary caries being the main reason. No significant differences were found for anatomic form, marginal adaptation, and color matching. Class V restorations showed a higher fracture rate with total displacement of the restoration, with no increase in the frequency of fracture over time. Conclusion: High rate of restoration failure was observed, possibly due to the lack of experience and skills of the students. This outcome highlight the need for continuous revision and improvements of teaching practice regarding the development of clinical competences and skills by dental students.

Immediately loaded implant prostheses have been used to successfully rehabilitate completely edentulous arches. Risk factors for successful treatment have not included involuntary mandibular movements. The treatment was completed on a patient with a history of neuroleptic medications who had remaining mandibular teeth extracted and then developed involuntary mandibular movements. The patient was dissatisfied with a mandibular removable prosthesis and wanted a fixed prosthesis. The immediate implant loading of a complete arch fixed prosthesis was delivered, and the patient lost 3 of the 6 implants. The patient continued to have problems with her definitive prostheses as the symptoms of her involuntary mandibular movements worsened.

Background. Implant fractures can cause difficult problems for patients and dentists. This systematic review aimed to determine the influence of some implant parameters on the occurrence of their fracture and to determine the incidence of fractures reported in recent years. Methods. A search was conducted in Pubmed database, from which 12 studies published in the last 12 years were selected. Results. This review reported a 2% incidence of implant fracture. Most implants had been in function between 3 and 4 years until fracture. The studies did not provide necessary information to establish a relationship between the different parameters of implants and the incidence of fractures. Conclusion. Thus, the indication of type, diameter and length of an implant and the bone quality in the region receiving it should be studied and accurately examined for each individual case in order to avoid future failures.

Aim: To focus on clinical decision-making by dentists for defective restorations in the context of an overburdened healthcare system and a high caries rate. Materials and Methods: A cross-sectional study was conducted using mixed-methods. An online survey was administered to all members of the South African Dental Association followed by in-depth interviews of 15 purposefully selected dentists in the Western Cape. The online data included demographic data, education level, knowledge, attitudes, and practises related to dental amalgam use. The interviews consisted of two patient cases where dentist were asked to explain their treatment decisions. Quantitative data was analysed using statistical software SAS (SAS Institute Inc., Cary, NC, USA) and a Chi-square test and Spearman's correlation was used with P < 0.05. The interviews were coded, transcribed, and analysed using the Atlas.ti ® software. Responses were analysed using the framework method. Results: A significant relationship was found between dentists with more than 21 years of experience and the repair of defective restorations (P = 0.0027*). Remaining tooth structure and the presence of pain were the most important clinical factors influencing treatment decisions. Non-clinical factors such as fear, ethical conscience, cost to patient and dental school had an influence on their decisions. Conclusion: Clinical factors and non-clinical factors influence dentists' treatment decisions. There was a lack of translation of evidence-based information to everyday general practice dentistry in South Africa. These results have implications in changing current continuing professional education activities and motivating policy makers to incentivize preventive and minimally invasive dentistry. [ABSTRACT FROM AUTHOR]

PurposeTo test in a rat model whether quantitative percussion diagnostics provide reliable, reproducible indications of osseointegration.Materials and methodsTitanium implants were placed in femurs of 36 Sprague-Dawley rats. Each animal was assigned to one of six groups defined by one of three time points (2, 4, or 8 weeks postplacement) and one of two treatments (matrix metalloproteinase [MMP] inhibitor GM6001 or control). Percussion testing was conducted three times per subject at implant placement and before sacrifice at one of the time points. For each time point, there was an experimental group that received daily intraperitoneal injections of GM6001, and a control group that received no MMP inhibitor. The percussion data consisted of loss coefficient (LC) values that characterize energy dissipation. Statistical analysis was performed on the LC values for the two animal groups using the paired Student t test to assess differences as a function of time, and the independent t test to compare mean LC for the study groups at sacrifice (α = .05). Histologic evaluation using the osteogenic CD40 protein marker was also performed.ResultsA nearly significant difference in mean LC at the 2-week time point was observed between the two treatments with the GM6001 group having the higher value (P = .053). There was a greater difference between the mean LC values for the 4-week GM6001 and control groups (P = .001). The histologic evidence for subjects in these two groups confirmed reduction of osteogenesis at the implant interface after administration of the MMP inhibitor.ConclusionsLower control LC values relative to the GM6001 therapeutic group were observed, consistent with the effect MMP inhibition has on matrix remodeling at the implant bone interface. This finding in conjunction with histologic observations confirms that osseointegration can be monitored using percussion diagnostics.

Abstract This study evaluated the effect of selective carious tissue removal on the fracture strength and failure mode of composite restorations in molars presenting only the buccal cusps. Deep cavities were prepared on the occlusal surface, and the lingual cusps were removed. Carious lesions in the middle of the pulpal wall were artificially induced with acetic acid (pH = 4.5) for 35 days. The demineralized dentin was left intact or was completely removed prior to restoration with a bulk-fill composite (n = 10). Images of the specimens were obtained by optical coherence tomography (OCT) before and after the caries induction/removal. The mechanical resistance to fracture by axial compressive loading and the failure type and extension were determined. The pulpal wall/composite interface of the fractured specimens was analyzed by OCT. The data were analyzed for significance with t-tests (α = 0.05). The deepest cavities and a more frequent occurrence of pulpal exposure were observed more often for non-selective carious tissue removal. The protocol of carious tissue removal did not affect the fracture strength (p = 0.554). An increased occurrence of catastrophic failures involving the roots was observed for non-selective carious tissue removal. Some occurrences of restoration displacement or cracks throughout the resin-dentin were observed only for the selective carious tissue approach. Selective carious tissue removal is a feasible approach to extensively damaged teeth since it reduced the occurrence of pulpal exposure and root fractures, without compromising the fracture strength.

Objective: To examine the potential association between patients’ characteristics that experienced implant failure and those who had successful implant treatment. Materials and methods: This retrospective case-control study is based on 186 dental records of implant failure and 186 age and gender matched successful treatments for a total of 372 patients. Age at the time of the procedure, gender, medical history, tobacco use, dental insurance status, ZIP code and type of treatment provided (implant failure/successful implant treatment) were recorded. Results: The population consisted of 47.6% females, 48.9% individuals with dental insurance and 9.7% self-reported tobacco users. A statistically significant association (p≤0.05) was found between implant failure and successful implant treatment in regards to tobacco use, socio-economic status and medical history. Insurance status and implant location (region, arch) did not affect significantly (p>0.05) the outcome of implant therapy. Conclusions: Within the limitation of this retrospective case-control study, individuals with high socio-economic status, no history of tobacco use and history of heart attack were more likely to have a successful implant treatment than those with a low socio-economic status, tobacco users and without history of heart attack.

The study aimed to compare the repair bond strength of aged composite and amalgam repaired with resin composite after various mechanical and adhesive surface treatments. Specimens were aged by thermal cycling (10,000 cycles, 5-55°C) and randomly subjected to one of three surface treatments: diamond bur abrasion, aluminum oxide air abrasion, or silica coating. Conventional bonding or a universal adhesive with incorporated silane was applied afterward (each n = 16) and resin composite was attached. In the control groups (each n = 16), resin composite was attached using one of the above adhesives without prior mechanical surface conditioning. After further thermal cycling, the shear bond strength (SBS) and failure modes were assessed. Statistical analyses were performed using ANOVA, Weibull statistics, two sample t-tests, and Chi2-test (P < 0.05). The SBS of the repaired amalgam was significantly lower than that of the composite and mechanical pretreatment significantly increased SBS. The universal adhesive significantly improved the SBS of the repaired amalgam compared to the conventional bonding agent and mechanical pretreatment increased the number of cohesive/mixed failures. Amalgam restorations may be repaired using resin composites, but the resulting SBS is lower than that obtained with composite. [ABSTRACT FROM AUTHOR]

Background: Coronal restoration of endodontically treated teeth (ETT) with mesio-occluso-distal (MOD) cavities is of a great importance in long-term success of the treatment. This study evaluated the effect of fiber reinforcement on the fracture resistance (FR) of ETT restored with flowable or paste bulk (PB)-fill composite resin compared to conventional composite (CC) resin. Materials and Methods: In this in vitro experimental study, eighty maxillary premolars were divided into eight groups (n = 10). The first group was left intact (G1) and the other groups received MOD cavities along with endodontic treatment. G2: Remained unrestored while the other experimental groups were restored with three types of composite resin with or without fiber insertion. G3: CC resin, G4: PB fill, G5: Flowable bulk fill (FB). G6: Fiber + CC, G7: Fiber + PB, and G8: Fiber + FB. FR was tested at crosshead speed of 1 mm/min and recorded in Newton. Data were analyzed using one-way analysis of variance and Tukey's tests at significance level of P < 0.05. Results: G1 and G2 revealed the highest and the lowest FR, respectively. The mean FR of the testing groups in Newton was as follows: G1 = 1204.8 A, G2 = 352.1 C, G3 = 579.6 BD, G4 = 596.7 BD, G5 = 624.9 BDE, G6 = 858.3 E, G7 = 529.6 CB, and G8 = 802.5DE. Different uppercase letters indicate the significant difference between the groups. Conclusion: The effect of fiber insertion on FR depended on the type of composite resin; the highest reinforcing effect was obtained in the CC resin + fiber, followed by bulk-fill flowable + fiber, and flowable bulk (FB)-fill composite resin. The strength of the former was significantly higher than the conventional and PB fill with and without fiber.

Abstract: Adhesive procedures have changed the way to restore endodontically treated teeth (ETT). It started with the shift from cast post-and-core to fiber post. The original focus on strength also shifted towards failure modes, revealing that catastrophic failures are still a concern when restoring endodontically-treated teeth even with fiber posts. As an alternative, postless approaches have been proposed in order to improve the chances of repair. The goal of this critical review is to present a survey of the current knowledge on adhesive approaches to restore endodontically treated teeth with and without extensive coronal tissue loss. The preservation of tooth structure of endodontically treated teeth is paramount. Partial versus full coverage of ETT, the role of the ferrule, the post type effect on catastrophic failures and postless alternatives as endocrowns and postless build-ups are reviewed. There is a consensus that the remaining tooth structure plays an important role in ETT survival, although the current literature still is contradictory on the influence of post type on root fractures as well as the benefits of avoiding a post or partially restoring a tooth. More clinical studies should be carried out with the modern postless adhesive alternatives to conventional approaches.