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Purpose To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition. Materials and methods For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross-tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P Results A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials and locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003). Conclusion Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended.

Objectives The survival rate of indirect partial adhesive restorations on vital versus endodontically treated teeth is still controversial. The hypothesis is that there may be a difference in the survival rate of partial adhesive restorations performed on non-vital teeth compared to vital teeth. Materials and methods This systematic review was conducted following the PRISMA guidelines. The considered clinical studies investigated the outcomes of adhesive inlays, onlays, and overlays conducted over the past 40 years, focusing on Kaplan–Meier survival curves to calculate the hazard ratio (primary objective) and the survival rate (secondary objective) between vital and non-vital teeth. The risk of bias was assessed using the Newcastle–Ottawa Scale. Studies included in the review were identified through bibliographic research on electronic databases (“PubMed,” “Scopus,” “Cochrane Central Register of Controlled Trial,” and “Embase”). The K agreement between the two screening reviewers was evaluated. Results A total of 55,793 records were identified on PubMed, Scopus, and other bibliographic sources, and after the application of the eligibility and inclusion criteria, eight articles were included for qualitative analysis and six for quantitative analysis. The meta-analysis of the primary and secondary outcomes demonstrated that hazard ratios (HR = 8.41, 95% CI: [4.50, 15.72]) and survival rates (OR = 3.24, 95% CI: [1.76, 5.82]) seemed more favorable for indirect partial adhesive restorations on vital teeth than for those on endodontically treated teeth. Conclusions Within the limits of this study, these findings suggest that the risk of failure of indirect partial adhesive restorations on endodontically treated teeth is higher than on vital teeth. Clinical relevance The use of partial adhesive restorations on vital and endodontically treated teeth showed different long-term clinical outcomes.

STATEMENT OF PROBLEM Long-term clinical data on the survival of pressed lithium disilicate glass-ceramic when used with partial coverage restorations and the effect that different technical and clinical variables have on survival are sparse. PURPOSE The purpose of this clinical study was to determine the 10.9-year survival of pressed lithium disilicate glass-ceramic partial coverage restorations and associated clinical parameters on outcomes. MATERIAL AND METHODS Individuals requiring single unit defect-specific partial coverage restorations in any area of the mouth were recruited in a clinical private practice. Participants were offered the options of partial coverage cast gold or glass-ceramic (lithium disilicate) restorations. Only participants that chose glass-ceramic partial coverage restorations were included in the study. The overall survival of the glass-ceramic restorations was assessed by the clinical factors (participant's age, sex, dental arch, tooth position in dental arch, type of partial coverage restoration, and ceramic thickness) determined at recall. The effect of this clinical parameters was evaluated by using Kaplan-Meier survival curves accounting for attrition bias and other reasons for failure. The statistical significance of differences between parameters was determined by using the log rank test (α=.05). RESULTS A total of 304 participants requiring 556 lithium disilicate restorations were evaluated. The mean age for the participant at the time of restoration placement was 62 with a range of 20 to 99 years, 120 were men and 184 were women. A total of 6 failures (bulk fracture or large chip) requiring replacement were recorded with the average time to failure of 2.4 (0.8-9.2) years. The total time at risk computed for these units was 1978.9 years providing an estimated failure risk of 0.3% per year. The 10-year estimated cumulative survival was 95.6%. The estimated cumulative survival of inlays (n=246) and onlays (n=305) were 93.9% and 98.3%, at 9.9 and 9.8 years, respectively (P

Aim and objective To compare the fracture resistance in teeth managed by root canal treatment after restoring with different types of onlays, inlays, and endocrowns prepared with hybrid ceramics and pulp chambers restored with fiber-reinforced composite and resin composite that were radiopaque, light-cured, and flowable. Materials and methods The present study was carried out on 252 extracted mandibular molars. All the specimens were divided into six groups randomly. Each group consisted of 42 specimens. Group 1 consisted of intact teeth without any access cavity. It was the control group. Group 2 consisted of teeth with endocrown and empty pulp chamber. Group 3 consisted of teeth with mesio-occlusal-distal (MOD) onlay prepared with hybrid ceramics and pulp chamber filled with flowable, light-cured, radiopaque resin composite. Group 4 consisted of teeth with MOD onlay and pulp chamber filled with fiber-reinforced composite. Group 5 consisted of teeth with MOD inlay and pulp chamber filled with flowable, light-cured, radiopaque resin composite. Group 6 consisted of teeth with MOD inlay and pulp chamber filled with fiber-reinforced composite. Inlay, onlay, and endocrowns were prepared with computer-aided design (CAD) and computer-aided machine (CAM) using hybrid ceramics. Universal testing machine was used for the measurement of the fracture resistance of each specimen. Inferential statistics were performed by applying Fisher's exact test and chi-square test. Results Fracture strength was found to be maximum in the intact teeth group followed by the endocrown. The fracture strength was minimum in the inlay group. The fracture strength was intermediate in the onlay groups. Conclusion Endocrown showed maximum fracture resistance as compared to the inlay and onlay restorations. Clinical significance Proper management of root canal-treated teeth is one of the greatest challenges for endodontists. It has been observed that tooth preparation design and the material used for the restoration of root canal-treated teeth play a vital role in the resistance against fracture in the teeth.

PURPOSE To assess the short-term outcomes of two different conservative preparation designs for posterior zirconia inlay-retained fixed dental prostheses (IRFDPs) and to analyze the marginal integrity of such restorations. MATERIALS AND METHODS Thirty patients with a missing maxillary first molar participated in this study and were divided randomly into two groups: one that received abutment preparations for inlay retainers (ID group, n = 20), including a proximal box and an occlusal extension, and one that received only proximal box preparations (PB group, n = 10). Zirconia IRFDPs were bonded in position and followed up after 2 weeks, 6 months, 1 year, and then annually. The in situ restorations were duplicated utilizing a single-step putty/wash impression technique at the 2-week and 2-year follow-up visits. Restoration margins were evaluated under scanning electron microscopy, and marginal continuity was calculated as a percentage of the whole margin at the tooth-cement (TC) interface and the zirconia-cement (ZC) interface. RESULTS After a mean observation period of 26.2 months, all restorations were still in function. The only complication encountered was debonding of restorations; however, they were re-bonded back in place without issue. The cumulative Kaplan-Meier 2-year survival rate for the IRFDPs was 86.6%. There was a significant difference between the two groups regarding percentage of continuous margins (P < .05) after 2 years, with the percentage of continuous margins in the ID group at 92.8% and 91.5% at the TC and ZC interfaces, respectively, and in the PB group at 84.1% and 78.6% at the TC and ZC interfaces, respectively. CONCLUSION Zirconia-based monolithic IRFDPs can be recommended for short-term replacement of a single maxillary molar.

Background This study evaluates the mechanical performance of deep margin elevation technique for carious cavities by considering the shape designs and material selections of inlay using a computational approach combined with the design of experiments method. The goal is to understand the effects of the design parameters on the deep margin elevation technique and provide design guidelines from the biomechanics perspective. Methods Seven geometric design parameters for defining an inlay’s shape of a premolar were specified, and the influence of cavity shape and material selection on the overall stress distribution was investigated via automated modelling. Material selection included composite resin, ceramic, and lithium disilicate. Finite element analysis was performed to evaluate the mechanical behavior of the tooth and inlay under a compressive load. Next, the analysis of variance was conducted to identify the parameters with a significant effect on the stress occurred in the materials. Finally, the response surface method was used to analyze the stress responses of the restored tooth with different design parameters. Results The restored tooth with a larger isthmus width demonstrated superior mechanical performance in all three types of inlay materials, while the influence of other design parameters varied with the inlay material selection. The height of the deep margin elevation layer insignificantly affected the mechanical performance of the restored tooth. Conclusions A proper geometric design of inlay enhances the mechanical performance of the restored tooth and could require less volume of the natural dentin to be excavated. Furthermore, under the loading conditions evaluated in this study, the deep margin elevation layer did not extensively affect the strength of the tooth structure.

Background/Aim: The aim of this study was to evaluate the bond strength of glass ceramic inlay system using 2 antibacterial adhesive luting protocols with 2 cementation techniques to bur-cut dentin. Material and Methods: Class I inlay cavities with 6-degree occlusal divergence and size of 6-, 3and 2-mm in length, width and depth, were prepared on extracted human molars, randomly assigned to 2 main groups; each to 1 cementation technique, with or without immediate-dentin-bonding (IDB or NIDB) further divided into 3 subgroups; 2 to 2 antibacterial luting protocols, traditional (T) and experimental (E); and 1 to a control (C) group. In group IDBT, IDB-E and IDB-C dentin bonding was applied immediately after cavity preparation. In group NIDB-T, NIDB-E and NIDB-C dentin bonding was applied just before cementation of the restorations. The cavities in IDB-T and NIDB-T were treated with 2% chlorhexidine-digluconate (CHX) prior to dentin bonding application. The cavities in IDB-E and NIDB-E were treated only with dentin bonding system containing MDPB (12-methacryloyloxydodecylpyridinium bromide) active monomer featuring antibacterial effect. IDB-C and NIDB-C served as control. Dual-cure adhesive resin cement was used for the cementation of Lithium disilicatebased ceramic inlay restorations. Fourteen test specimens per group were prepared for microtensile testing and consecutively subjected to tensile load at a crosshead speed of 1 mm/min. The mode of failure was observed under SEM and evaluated for each group. The Kruskal-Wallis test was used to investigate the statistical difference between groups (a=0.05). Results: The microtensile load was 5.96 MPa (median: 5.99 MPa) for IDB-T, 7.23 MPa (median: 7.55 MPa) for IDB-E, 6.68 MPa (median: 6.56 MPa) for IDB-C, 7.24 MPa (median: 7.20 MPa) for NIDB-T, 6.98 MPa (median: 6.30 MPa) for NIDB-E, and 7.02 MPa (median: 6.99 MPa) for NIDB-C, with no statistical difference between the groups (p>0.05). SEM monitoring for mode of failure revealed either cohesive (within resin cement) or adhesivecohesive (mostly within resin cement along with partially involved areas between resin cement and ceramic restoration) character. Conclusions: Within the limitations of the current study, none of the tested antibacterial luting protocols with either cementation technique was found to be superior in terms of bond strength.

Clinical Relevance Composite resin or ceramic inlays, onlays, and overlays can achieve high long-term survival and success rates. SUMMARY Objective: This study evaluated the long-term clinical performance and complications of composite resin or ceramic inlays, onlays, and overlays, as well as identified the factors that might influence the clinical outcome of the restorations. Method: A systematic literature search was conducted in the Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases until April 30, 2019, without language restrictions. Randomized clinical trials, clinical retrospective, and prospective cohort studies with a mean follow-up period of five years were included. Two reviewers extracted the study data independently. Newcastle-Ottawa Scale was applied for quality assessment. Meta-analysis was performed by the random-effects model and fixed-effects model. Results: After removal of duplicates, 2818 studies were identified. Finally, 13 observational studies were included in the meta-analysis based on retrospective and prospective cohort studies. The cumulative survival rate and success rate of composite resin inlays, onlays, and overlays were 91% and 84% after five years of follow-up, respectively. The survival rates of ceramic inlays and onlays were 90% at 5 years, 89% at 8 years and 85% at 10 years, while the success rates of ceramic inlays and onlays were 88% at 5 years and 77% at 10 years. Secondary caries and endodontic complications were the predominant failures for composite resin inlays, onlays, and overlays, while restoration fractures and endodontic complications were the main failures for ceramic inlays and onlays. No direct association between parafuntional habits and bruxism and the fractures of restorations was found. Nonvital teeth and multiple-surface restorations tended to increase the risk of failure. Regarding other factors influencing the clinical outcome, no definite conclusion could be drawn due to inconsistent results. Conclusions: The long-term clinical outcomes have been demonstrated to achieve high survival and success rates based on 10-year data for ceramic inlays and onlays, as well as 5-year data for resin inlays, onlays, and overlays.

Alloplastic malar onlays have been used by surgeons to correct or enhance the midfacial skeleton for over 40 years. Case series have shown respectable results using different alloplastic materials in various maxillofacial subsites. However, these articles include small numbers of patients with limited follow up. We present a literature review specifically concentrating on porous polyethylene (Medpor, Stryker) and polyethyl ether ketone (PEEK) malar onlays. We illustrate the technique used by a single oral and maxillofacial surgeon for placement of 119 implants in 61 patients over a 14-year period, and show the results of this work with long-term follow up. A complication rate of 2.5% in this cohort was reported, with follow up of three years, demonstrating that this technique for midfacial correction is successful in both the short and the long term.

This clinical report presents the use of a modified polyetheretherketone (PEEK) Inlay Retained Resin Bonded Fixed Dental Prosthesis (IRRBFDP) framework, veneered with indirect high impact composite for the bilateral restoration of mandibular first molar teeth, as the most conservative treatment option for a medically compromised patient. When used as a framework, PEEK's elastic modulus (approximately 4 GPa), could result in the reduction of stresses transferred to the abutment teeth and the cementation interface accordingly, therefore it could result in lower de-bonding rates and higher success rates. Furthermore, the high bond strength with the veneering composite material and the luting cements permit its use for resin-bonded restorations. Preparation guidelines, indications and advantages for the fabrication of IRRBFDPs are described in this clinical report. No technical complications such as de-bonding of the framework, connector or retainer fracture of the adhesive frameworks or loss of retention were observed during the course of 8 years. Prosthetic replacement of single missing posterior mandibular teeth utilizing IRRBFDPs with high performance polymer materials could potentially offer long-term high survival rate outcomes. Further clinical evidence is required in order to justify the above statement.

PURPOSE This study was done to compare the survival rates of cast gold and ceramic onlays placed in a dental school setting. MATERIAL AND METHODS An electronic search was conducted in the patient records at Adams School of Dentistry, University of North Carolina at Chapel Hill for onlay codes that were in the database (From 1998 until 2018). Progress notes and radiographs were scrutinized to establish the survival time of the restorations. Any complications that occurred during the life time of the restorations were noted. The survival was summarized by categorization based on ranges of survival time in years; group 1: 1 to 5 years, group 2: 6 to 22 years. The mean survival time and standard deviation were calculated. One-way ANOVA was used to determine whether there was a statistically significant difference in the survival times between gold and ceramic onlays. RESULTS The mean survival rate of cast gold onlays (86.6%) was comparable to that of ceramic onlays (81.1%). The gold onlays in Group 1 had a higher mean survival time (2.43 years) than the ceramic onlays (2.03 years). This difference was statistically significant (p = 0.002). The ceramic onlays in Group 2 had a mean survival time of 19.75 years while gold onlays had a mean survival time of 17.63 years. This difference was not statistically significant (p = 0.91). CONCLUSION It was concluded that while the survival rate of ceramic onlays (81.1%) was inferior to that of cast gold onlays (86.6%), it was comparable.

To compare the 1-year clinical performance of lithium disilicate and resin composite CAD/CAM onlay restorations. Twenty patients that required two restorations in posterior teeth, with at least one cusp to be covered, received two onlays. One was made with IPS e.max CAD (Ivoclar-Vivadent) and the other with Lava Ultimate (3M Oral Care). Two blind observers evaluated the restorations at baseline and 1 year after the onlays were cemented, according to FDI criteria. At each recall, digital photographs, bite-wing radiographs and impressions of the restorations were taken for SEM evaluation of the interface. Results were analyzed by Mann–Whitney U and Wilcoxon tests (p p > 0.05). However, deterioration in surface lustre (p = 0.020) and color match/translucency (p = 0.039) were detected for IPS e.max CAD onlays after 1-year. Under SEM evaluation, there were no statistically differences in micromorphological criteria at baseline nor after a year between IPS e.max CAD and Lava Ultimate onlays. Conclusion: After 1 year of clinical service IPS e.max CAD and Lava Ultimate onlays showed a similar clinical performance that needs to be confirmed in long-term evaluations.

Clinical Relevance Preparation designs for bondable partial coverage restorations are varied. As little as 1 mm of thickness of a remaining buccal cusp can be kept when restoring maxillary premolars with bondable partial coverage restorations. SUMMARY Indirect partial coverage restorations have become increasingly popular in recent years as new and improved adhesive materials have been developed. These restorations can preserve substantial amounts of tooth structure. However, there are some aspects of indirect partial coverage restorations for which no clear protocol exists. This study investigated the minimal thickness of the nonfunctional cusp that must be left in a bondable ceramic partial coverage restoration in order to resist compressive force. Ninety sound human maxillary premolar teeth were obtained and used in one of the following three ways. Ten of the sound teeth were used as a control without further preparation. Forty other sound teeth had cavities designed and were tested as “unrestored teeth.” The remaining 40 sound teeth received not only cavities but also restoration and were tested as “restored teeth.” Both the restored group and the unrestored group were prepared either with an overlay or with varying buccal cusp thicknesses of 1, 2, or 3 mm. In total, there were nine experimental groups with 10 in each group (n=10). The prepared teeth were digitally scanned, and the restorations were designed and fabricated from IPS e.max computer-aided design (CAD) software using a CAD/CAM machine (CEREC MC XL, Dentsply Sirona, Bensheim, Germany). The restorations were cemented with resin cement (Panavia V5). All samples underwent thermocycling and dynamic fatigue simulating approximately one year of actual use. All the teeth were then subjected to compressive load until the point of fracture, and the mode of each fracture was analyzed. Results show that the fracture resistance of the restored groups was significantly higher than the nonrestored groups (p

Clinical Relevance Using the deep margin elevation technique in preparations extending beyond the cemento-enamel junction appears to be beneficial in maintaining structural integrity of CAD/CAM-fabricated feldspathic ceramic inlays. SUMMARY Objective: To evaluate the effect of deep margin elevation on structural and marginal integrity of ceramic inlays. Methods and Materials: Forty extracted human third molars were collected and randomly separated into four groups (n=10/group). In group 1 (enamel margin group), the gingival margin was placed 1 mm supragingival to the cemento-enamel junction (CEJ). In group 2 (cementum margin group), the gingival margin was placed 2 mm below the CEJ. In group 3 (glass ionomer [GI] margin group), the gingival margin was placed 2 mm below the CEJ, and then the margin elevated with GI to the CEJ. In group 4 (resin-modified glass ionomer [RMGI] margin group), the gingival margin was placed 2 mm below the CEJ, and then the margin elevated with RMGI to the CEJ. Standardized ceramic class II inlays were fabricated with computer-aided design/computer-aided manufacturing and bonded to all teeth, and ceramic proximal box heights were measured. All teeth were subjected to 10,000 cycles of thermocycling (5°C/55°C) and then underwent 1,200,000 cycles of vertical chewing simulation at 50 N of force. Ceramic restorations and marginal integrity were assessed with a Hirox digital microscope. The Fisher exact test (two-tailed) with adjusted p-values (α=0.05) and logistic regression were used for statistical analysis. Results: The cementum margin group had a significantly higher ceramic fracture rate (90%) compared to other groups (10% in enamel margin and GI margin groups, p=0.007; 0% in RMGI group, p Conclusion: Deep marginal elevation resulted in decreased ceramic fracture when preparation margins were located below the CEJ. There was no difference found between margin elevation with GI or RMGI. Increased heights of ceramic proximal box may lead to an increased probability of ceramic fracture.

PURPOSE To evaluate the clinical performance of endodontically treated (ET) teeth restored with two different marginal forms of lithium disilicate glass-ceramic (LDG ceramic) onlays. MATERIALS AND METHODS A total of 120 posterior teeth were prepared for onlays after ET. The occlusal surfaces of the teeth were removed 1.5 to 2 mm anatomically. Different marginal forms were employed depending on the thickness of the residual axis wall of each tooth: In Group S, a 1-mm shoulder was prepared when the remaining axis wall was > 2 mm (n = 50), and in Group B, a 20- to 30-degree bevel was prepared when the remaining axis wall was ≤ 2 mm (n = 70). The access of the pulp chamber was filled with resin, and 1.5 to 2 mm of the box morphology of the pulp chamber was preserved. The pressed LDG ceramic was applied to the fabricated onlays. The teeth and restorations were checked after 6, 12, and 24 months. All available restored teeth were assessed using modified United States Public Health Service criteria. RESULTS During the observation period, no tooth fracture occurred. Neither tooth cracks nor secondary caries were observed in Group S or Group B. The 2-year survival rate of the teeth was 100%. Five fractured onlays were observed in Group S in the molar region, while all onlays in Group B were intact (P < .05). The survival rate of the onlays was 95.83%. CONCLUSION The results demonstrate that LDG ceramic onlays can preserve ET posterior teeth with a highly satisfactory outcome, though the marginal form may affect the survival rate of the onlay.

Objective To evaluate the clinical performance of hybrid ceramic inlay-onlay restorations over a 2-year period. Clinical considerations A total of 30 lithium disilicate glass ceramic (LDC; control group) and 30 hybrid ceramic (HC; test group) inlay/onlay restorations were performed in 14 patients. Clinical evaluations were performed after 1 week, 6 months, 1 year, and 2 years of cementation according to the modified United States Public Health Service (USPHS) criteria, gingival index, and plaque index. The Friedman test was used for the significant difference in time and Wilcoxon signed-rank test was used for the determination of differences. The clinical parameters, gingival and plaque indexes differences in time were analyzed with Chi-square test. No statistically significant difference (P > .05) was found between the two groups in the modified USPHS, gingival index, and plaque index evaluations, whether statistically significant differences were found within groups. The total survival rate was 100% for both groups after 2 years. Conclusion Based on the 2-year data, the tested HC can be considered a reliable material for inlay/onlay restorations. Clinical significance The results of this in vivo study suggest that both resin nanoceramic materials and LDC materials have been successfully incorporated in treatments of inlay and onlay restorations. Short-term results showed that resin nanoceramic materials can be counted as a good choice in inlay and onlay restorations in an effort to reduce the treatment time associated with ceramic firing processes.

Objective The aim of this study was to evaluate the 2-year clinical performance of computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite inlay restorations in comparison with direct resin composite restorations. Materials and methods In 44 patients, 120 class II (mesio-occlusal/disto-occlusal) cavities were randomly assigned into two groups; CAD/CAM resin composite inlay group (Lava Ultimate), direct resin composite group (Clearfil Majesty Posterior). Clinical evaluations were performed after 1 week, 6 months, 1 year, and 2 years according to the FDI criteria. The data were analyzed using Friedman's ANOVA and Mann-Whitney U tests (α = .05). Results In 41 patients, 114 restorations were evaluated at the second year (recall rate 93.2%). All restorations were ideal or clinically acceptable. At the first year, considering all criteria, there were no statistically significant differences between the groups. However, there was a significant difference in terms of surface luster at second year, in favor of inlay restorations (P = .015). The marginal staining of resin composites increased after 2 years (P = .046), but there was no significant difference between the groups. Conclusions Except the surface luster, 2-year clinical performance of CAD/CAM resin composite inlay restorations was found similar to direct resin composite restorations according to FDI criteria CLINICAL SIGNIFICANCE: The clinical performance of CAD/CAM resin composite inlays was acceptable in class II cavities subsequent to 2-year evaluation.

Objectives This investigation was a longitudinal, randomized clinical trial to measure the clinical performance of a nano-ceramic material (Lava Ultimate/3M) for chairside Computer Assisted Design/Computer Assisted Machining (CAD/CAM) fabricated restorations. Materials and methods One hundred and twenty chairside CAD/CAM onlays were restored with a CEREC system randomly assigned to 60 leucite-reinforced ceramic (IPS EmpressCAD/Ivoclar Vivadent AGBendererstrasse 2FL-9494 SchaanLiechtenstein) onlays and 60 nano-ceramic (Lava Ultimate/3M) onlays. Equal groups of onlays were cemented using a self-etch and a total etch adhesive resin cement. The onlays were recalled for a period of 5 years. Results At 1 week postoperatively, 10% of the onlays cemented with both the self-etch and total etch adhesive resin cements were reported as slightly sensitive. However, all patients were asymptomatic by the 4th week without treatment. Four leucite-reinforced onlays and one nano-ceramic onlay fractured and required replacement. Conclusions Adhesive retention with a self-etch or total etch cementation technique resulted in a similar clinical outcome with no reported debonds. The nano-ceramic onlays had a lower incidence of fracture compared to the leucite-reinforced ceramic onlays with both having a very low risk of fracture. Nano-ceramic onlays performed equally as well as glass ceramic onlays over 5 years of clinical service. Clinical significance Ceramic materials have been a mainstay for chairside CAD/CAM restorations for the past 30 years and a new category of resilient ceramics with a resin matrix has been introduced reported to offer ceramic-like durability and esthetics with resin-like efficiency in handling. There are no long-term clinical studies on the performance of these materials. This is a 5-year randomized clinical trial on the performance of nano-ceramic onlays.

Treatment of gingival recessions associated with noncarious cervical lesions (NCCL) can be a challenging clinical situation for clinicians. Both periodontal and restorative treatment can be necessary for this kind of defect. By using both digitally precise computer-aided design/computer-assisted manufacture (CAD/CAM) procedures and natural inlay (NI) material for restoration of defects before the coronally advanced flap (CAF) surgery, attachment of soft tissues on the root surface can be achieved successfully. Seven nonsmoking patients with NCCL associated with gingival recessions in the maxillary esthetic zone were treated with NI restoration before CAF surgery. All of the included patients needed at least one tooth extraction, and extracted teeth were used for NI restoration for the CAD/CAM milling procedure. After application of the restorative material onto NCCL defects, CAF surgery was performed for root coverage. The primary outcome was increased mean root coverage percentage and clinical attachment gain after a 6-month follow-up period. Successfully restored NCCL defects were covered with CAF, and 91.67% mean root coverage was achieved with a 1.98-mm attachment gain. Additionally, 71.42% of the root surfaces covered completely. Application of NI restoration materials with CAD/CAM techniques can be a promising procedure for the restoration of NCCL defects before periodontal surgery. This method can achieve a better clinical attachment after root surface coverage.

SUMMARY Aims: To evaluate the effect of two composite restorative techniques (direct bulk fill vs indirect CAD/CAM) on the fracture resistance and mode of fracture of extended mesio-occlusal-distal (MOD) cavity preparations. Methods: Fifty-one sound human mandibular third molars were divided into three groups (n=17). Extended bucco-lingual MOD cavities were prepared. Teeth in group 1 were restored with a bulk-fill resin composite (Filtek Bulk-Fill Posterior Restorative), teeth in group 2 were restored with composite computer-aided design/computer-aided manufacturing (CAD/CAM) inlays (Lava Ultimate), and teeth in group 3 served as control and remained intact. All specimens were submitted to thermocycling, and a fracture resistance test was performed using a Universal testing machine (0.5 mm/min). Mode of fracture was classified into five types. One-way analysis of variance and the Duncan test were used to analyze the fracture load data at a significance level of α = 0.05. A chi-square test was used for the analysis of fracture mode between the restorative groups. Results: Statistical analysis showed significant differences in fracture resistance among the experimental groups. The teeth restored with the bulk-fill composite exhibited lower fracture resistance (1285.3±655.0 N) when compared to the teeth restored with the composite CAD/CAM inlays (1869.8±529.4 N) (p Conclusions: Although both types of restorations failed at loads larger than those found in the oral cavity, the CAD/CAM composite inlays increased the fracture resistance of teeth with large MOD cavities when compared to direct bulk-fill composite restorations. The majority of fracture types were intraorally repairable for both restorative techniques.

Definitive restorative management of young permanent molars affected with severe MIH is still elusive with a dearth of conservative restorative options. The present trial compared the 36 months clinical and radiographic performance of minimally invasive cast metal and indirect resin onlays for rehabilitation of permanent first molars affected with severe MIH. In this parallel group open label randomised trial, 42 vital molars affected with severe MIH in 30 children, aged 8–13 years were randomly allocated using stratified permuted block randomization to receive either a cast metal onlay or an indirect composite onlay (n = 21 each). Clinical and radiographic evaluations of these onlays were carried out at 9, 18 and 36 months using the USPHS criteria. Cumulative survival rate as well as the calculated clinical success rates of both types of onlays were also determined. The longevity of onlays was assessed using Kaplan–Meier survival analysis. At 36 months, overall retention rate was found to be 95% with complete elimination of any pre-existing sensitivity. Cumulative survival rates were found to be 95% vs. 100%, p = 0.67, while the calculated clinical success rates were 90% and 85.7% for metal and resin onlays, respectively, with no significant differences (p = 0.76). Mean survival rates based on Kaplan–Meier analysis were determined to be 85% vs. 100% for the metal and composite groups, respectively (p = 0.075). Irrespective of the type of material used, onlays offer a predictable and conservative restorative alternative for molars affected with severe MIH. The trial is registered under Clinical Trial Registry India (CTRI/2016/10/007379).

The purpose of this in-vitro study was to evaluate the fracture resistance and failure mode of non-invasively reinforced endodontically treated mandibular molars. Sixty freshly extracted defect-free mandibular molars were divided into four experimental groups with extensive MOD cavities on endodontically treated teeth with different restoration types and one control group with intact teeth (n = 12). The groups were as follows: “Normal”: direct resin composite; “Ring”: glass fiber-reinforced strip (Dentapreg) wrapped around buccal and lingual walls followed by direct resin composite; “Inlay”: indirect CAD/CAM resin composite inlay; “Onlay”: indirect CAD/CAM resin composite onlay; “Intact”: Intact teeth (Control). Tetric EvoCeram and Adhese Universal (Ivoclar Vivadent) were used for direct restorations and Tetric CAD (Ivoclar Vivadent) adhesively luted with Adhese Universal and Variolink Esthetic LC (Ivoclar Vivadent) were used for indirect restorations. All teeth were submitted to thermo-mechanical cyclic loading. All samples were then submitted to a compressive load until fracture. Fracture load was noted and teeth were analyzed to classify the failure mode as either catastrophic (C) or non-catastrophic (NC). No statistically significant difference was found between fracture strength of the five groups when all specimens were considered (p = 0.1461). Intact group showed the lowest percentage of catastrophic failures (41.67%). Ring group presents less catastrophic failures (75%) than Normal group (83.34%), and failures of indirect restorations—Inlay and Onlay—were almost all catastrophic (91.67% and 100%, respectively).

The present study was a prospective, controlled, randomized, clinical short-term trial aiming to evaluate the clinical performance of adhesively luted, lithium disilicate and feldspathic glass-ceramics onlays over a period up to 2 years. A total of 11 patients (7 female, 4 male; age range: 18-60 years, mean age: 39 years) were selected for this study. Each patient received a maximum of two restorations per group in a split-mouth-design. LD: Eleven onlays, performed with lithium disilicate-based ceramic (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein), and FP: Eleven onlays, performed with feldspathic ceramic (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Recalls were performed at 2 weeks (baseline = R1), 1 year (R2) and 2 years (R3) after the cementation by three calibrated blinded independent investigators using mirrors, magnifying eyeglasses, probes and bitewing radiographs. The postoperative sensitivity, secondary caries, marginal integrity, marginal discoloration, color match, surface roughness, tooth integrity, and restoration integrity were evaluated. The Friedman test was used to determine if there was a statistically significant difference in time-to-time comparison of the parameters in the ceramics restorations. A total of 95.4% of the restorations were clinically acceptable at the 2-year recall, without a difference for any evaluation parameter for both ceramic materials. Based on the 2-year data, the CAD-CAM onlays manufactured with feldspathic and lithium-disilicate based ceramics showed similar clinical performance. Resumo O presente estudo é um estudo clínico prospectivo, controlado, randomizado e de longo curto prazo, com o objetivo de avaliar o desempenho clínico de restauraç ões adesivas cerâmica vítrea reforçada com dissilicato de lítio e cerâmica feldspática por um período de até 2 anos. Um total de 11 pacientes (7 mulheres, 4 homens; faixa etária: 18-60 anos, idade média: 39 anos) foram inseridas para este estudo. Cada paciente recebeu duas restaurações por grupo em um delineamento de boca dividida. LD: Onze onlays, realizados com cerâmica à base de dissilicato de lítio (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein); e FP: Onze onlays, realizados com cerâmica feldspática (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Os retornos foram realizados em 2 semanas (linha de base = R1), 1 ano (R2) e 2 anos (R3) após a cimentação, por três investigadores independentes, cegos e calibrados, usando espelhos, óculos de aumento, sondas e radiografias interproximais. Foram avaliadas a sensibilidade pós-operatória, cárie secundária, integridade marginal, descoloração marginal, correspondência de cores, rugosidade da superfície, integridade dentária e integridade da restauração. O teste de Friedman (95%) foi utilizado para determinar se havia uma diferença estatisticamente significante na comparação periódica dos parâmetros nas restaurações cerâmicas. Um total de 95,4% das restaurações estava clinicamente aceitável no retorno de 2 anos, sem diferença para qualquer parâmetro de avaliação para ambos os materiais cerâmicos. Com base nos dados de 2 anos, as restaurações CAD-CAM fabricados com cerâmica feldspática e à base de dissilicato de lítio apresentaram desempenho clínico semelhante.