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Objective: To map the evidence regarding the clinical performance of posterior restorations with bulk-fill resin composites and identify research gaps., Materials and Methods: This mapping review was conducted following PRISMA-ScR guidelines for scoping reviews, and its protocol was registered on the Open Science Framework platform. Systematic searches were conducted, considering studies published between 2013 and February 2024 in the PubMed, Embase, and Cochrane databases. Clinical studies investigating the performance of bulk-fill resin composite restorations in class I and/or class II preparations with increments of 4 to 5 mm were included., Results: A total of 147 articles were identified, and based on the eligibility criteria, 26 studies were selected for descriptive analysis. Of the reviewed studies, 73% (n = 19) investigated high-viscosity bulk-fill composites, while 30% (n = 8) focused on low-viscosity bulk-fill composites. Evaluation periods ranged from 1 week to 10 years. Reported annual failure rates varied from 0% to 3%, with survival rates between 78.9% and 100%., Conclusions: Bulk-fill resin composites of high viscosity were the most analyzed in the published studies, with evaluation periods of up to 10 years. The review of available scientific evidence showed clinically acceptable performance for composite bulk-fill restorations, with high survival rates and minimal annual failure rates. There is a need for long-term clinical studies on bulk-fill resin composites., Clinical Significance: This review demonstrates that both high and low-viscosity bulk-fill resin composites exhibit satisfactory clinical performance, which can help clinicians optimize chairside time. However, it is important to highlight the need for further studies with longer follow-up periods., (© 2024 Wiley Periodicals LLC.)

Objectives: To evaluate clasp-retained removable partial dentures (C-RPDs) with a metal framework for survival, maintenance requirements, and biologic implications., Method and Materials: C-RPDs were retrospectively analyzed based on patient records. Treatment failure was defined as fracture of a framework component (metal base or connector) or loss of an abutment tooth. Other outcome variables included factors that might conceivably impact C-RPD survival (maxilla vs mandible, Kennedy classes, opposing dentitions, treatment by students vs certified dental practitioners), mobility and caries of abutment teeth (in relation to clasp designs), and maintenance requirements (relining, clasp or resin fractures). Differences were evaluated by appropriate statistical tests at the P ≤ .05 level., Results: A total of 612 patients (339 men, 273 women) 60.0 ± 11.5 years old at delivery were included, covering 842 C-RPDs and a mean observation period of 42.1 ± 33.2 months. Kaplan-Meier C-RPD survival was 76.2% after 5 years and 49.5% after 10 years. Biologic complications (ie, loss of abutment teeth) accounted for the vast majority (95.6%) of C-RPD failures, and Kaplan-Meier C-RPD survival was significantly better in the mandible (P = .015). Some clasp designs contributed significantly to caries and removal of abutment teeth (both P .05). No other significant differences were noted., Conclusion: Tooth loss both emerges as the main cause of C-RPD failure and might be amenable to careful selection of clasp designs. Overall, better C-RPD survival should be expected in the mandible. A noncontributory role of Kennedy classes and opposing dentitions is tentatively suggested based on numerically heterogenous subgroups.

Background: The materials used in root canal filling and radiotherapy (RT) application can affect the load-to-failure of the teeth. This study aimed to compare the load-to-failure of the teeth filled with AH Plus (AHP) or AH Plus bioceramic (AHPB) before or after 60 Gy- and 70 Gy-dose radiotherapy., Materials and Methods: One hundred and ten maxillary incisors were endodontically prepared up to ProTaper Next X4 instruments. The teeth were randomly divided into 5 main groups as: non-irradiated, root canal treatment (RCT) before 60 Gy radiotherapy, RCT before 70 Gy radiotherapy, RCT after 60 Gy radiotherapy, RCT after 70 Gy radiotherapy. These groups were divided into 2 subgroups for filling material: AHP ve AHPB. After filling and radiotherapy procedures, the teeth were fixed on the thermoplastic mask plane. The plane were placed in the middle of a rectangular prism shaped glass phantom, and irradiated via a linear accelerator device. The teeth were then embedded in cylindrical acrylic blocks and the force (N) that caused the fracture was recorded under the Universal testing device. Student t-test was used for statistical comparisons. Statistical significance level was determined as p < 0.05., Results: After 70 Gy dose radiotherapy, the group filled with AHPB showed statistically significantly lower fracture strength than the group filled with AHP (p < 0.05). In the control group, before 60 Gy RT group, after 60 Gy RT group, and before 70 Gy RT group, the sealers had statistically significantly similar load-to-failure. (p > 0.05)., Conclusion: The group filled with AHPB caused a lower fracture strength than the group filled with AHP following a 70 Gy dose of RT. The sealers in the control group, before 60 Gy RT group, after 60 Gy RT group, and before 70 Gy RT group exhibited comparable load-to-failure values., (© 2024. The Author(s).)

Purpose: This study investigated the fracture resistance of 0.5-mm-thick restorations for minimally invasive therapy. Anterior partial-coverage crowns composed of three-dimensional (3D)-printed 3-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP; Lithacon 3Y210, Lithoz) and 3D-printed composite (Varseo Smile Crown plus, Bego) were compared with a control group made from milled 3Y-TZP (Cercon ht, DentsplySirona)., Methods: Three groups each with 27 restorations were produced. For milled 3Y-TZP partial-coverage crowns, drill compensation was needed so the milling bur could access the inner surface at the incisal edge. Restoration fit was verified by cross-sectioning 12 specimens in each group. The remaining 15 restorations were sandblasted (Al2O3, 0.1 MPa) and adhesively cemented (Panavia SA, Kuraray) onto CoCr teeth. Static load-to-failure tests were performed. The load was induced on the incisal edge. The forces needed to fracture the specimens were analyzed using the Welch analysis of variance and post hoc Dunnet-T3 tests. The Weibull parameters were also calculated., Results: Drill compensation increased cement thickness at the loading area by 200 µm in milled 3Y-TZP restorations compared with the 3D-printed partial-coverage crowns. Fracture resistance was the highest in 3D-printed 3Y-TZP restorations (1570±661N) followed by milled 3Y-TZP (886±164N) and 3D-printed composite partial-coverage crowns (570±233 N). Milled 3Y-TZP was associated with a substantially higher Weibull modulus (m=6) than the 3D-printed materials (m=2), suggesting greater reliability., Conclusions: Fracture resistance increased with tighter fit, demonstrating the benefit of the geometric freedom associated with 3D-printing. Future research should focus on making 3D-printed 3Y-TZP more reliable to increase its safety in clinical use.

Purpose: This in vitro study investigated the influence of material selection, crown morphology, and vertical crown height on the biomechanical behavior of screw-retained monolithic hybrid abutment crowns (HACs)., Methods: Ninety implants were embedded in accordance with ISO standard 14801; ninety HACs were mounted (N=90). Monolithic crowns with varying group-specific designs were luted using titanium bases. HACs were fabricated from monolithic lithium disilicate ceramic (LD) or zirconia-reinforced lithium silicate ceramic (ZLS). The crown morphology was either maxillary premolar (LD&#95;PM, ZLS&#95;PM) or molar (LD&#95;MO). The three groups were further divided into three subgroups of ten specimens, each designed with a small (7.5 mm), middle (10.5 mm), and high (13.5 mm) configuration of crown heights (N=10). A load-to-failure test at 30° off-axis was conducted using a universal testing machine until failure. For statistical analysis, Kolmogorov-Smirnov and Mann-Whitney U tests were conducted (P < 0.05)., Results: All LD&#95;MO groups presented the highest failure values (808.7 to 947.9 N), followed by the LD&#95;PM (525.8 to 722.8 N) and ZLS&#95;PM groups (312.6 to 478.8N). A comparison between LD and ZLS materials (P < 0.001) as well as the crown morphology (P < 0.001) showed significant differences in failure values. The values in the subgroups of ZLS&#95;PM (low, middle, high) decreased as the crown height increased. The fracture modes showed no consistent patterns across the test groups., Conclusions: Material selection, crown morphology, and vertical crown height appear to be important factors that may influence the clinical failure values and patterns of screw-retained single implant crowns.

Purpose: To compare the influence of immediate loading (IL) and non-immediate loading (NIL) protocols on overdentures retained by reduced-diameter implants (≤ 3.5 mm)., Materials and Methods: Electronic databases including MEDLINE (via PubMed), Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) comparing clinical outcomes of immediately loaded and non-immediately loaded reduced-diameter implants supporting overdentures. The risk of bias within and across the studies and the certainty of evidence were assessed by RoB 2.0 and GRADE, respectively. A sensitivity analysis was performed by eliminating studies at high risk of bias and repeating the data synthesis employing the random effects model. Subgroup analyses were conducted based on the implant diameter and the length of follow-up., Results: Overall, six RCTs with 255 patients were included in this systematic review. The meta-analyses found similar implant survival rates between immediately loaded and non-immediately loaded implants in the mini-implant (RR &#61; 0.98; 95% CI &#61; 0.95, 1.01; P &#61; .12) and narrow-diameter implant subgroups (RR &#61; 0.99; 95% CI &#61; 0.94, 1.03; P &#61; .56) as well as in short-term (RR &#61; 0.98; 95% CI &#61; 0.97, 1.00; P &#61; .11) and long-term (RR &#61; 0.97; 95% CI &#61; 0.93, 1.01; P &#61; .09) follow-up subgroups. Additionally, marginal bone loss (MBL) showed no statistically significant difference between the loading protocols in the subgroup of long-term follow-up (MD &#61; 0.03; 95% CI &#61; -0.16, 0.23; P &#61; .74). Three RCTs investigating peri-implant parameters found relatively higher modified plaque index (PI) and probing depth (PD) in reduced-diameter implants under IL., Conclusions: Compared with NIL, the IL protocol can achieve comparable survival rates and MBL in reduced-diameter implants supporting overdentures.

Purpose: This study aimed to evaluate the 10-year outcomes of partial fixed dental prostheses (P-FDPs) fabricated using metal-free fiber-reinforced composite (FRC) resin frameworks veneered with composite resin and supported by short and extra-short implants., Methods: This study included 28 patients with 38 FRC prostheses supported by 96 implants. Implant and prosthesis survival and success rates were evaluated using Kaplan-Meier analysis., Results: The 10-year implant survival and success rate, as determined by Kaplan-Meier analysis, was 96.9%, and the prosthesis survival and success rates were 94.7% and 92.0%, respectively. None of the parameters under investigation were significantly correlated with prosthetic survival or successful outcomes, but three parameters were correlated with higher peri-implant bone levels: implant placement in the mandible as opposed to the maxilla, shorter P-FDP spans, and natural teeth on the opposing arch., Conclusions: FRC P-FDPs supported by short and extra-short implants presented high, up to 10-year, survival and success rates, when used to restore partially edentulous arches.

Aim: The aim of the present in vitro study was to investigate the effects of different sintering procedures on the fit, color parameters, and fracture load of monolithic fixed partial prostheses (FPPs)., Materials and Methods: A metal master model was scanned and FPPs were designed. Groups were created by fabricating FPPs using four different sintering procedures (n &#61; 10): Prettau-Standard (PST); Prettau-Slow (PSL); Ice-Speed (ISP); Ice-Standard (IST). PST-PSL (Group P; N &#61; 20) and ISP-IST (Group I; N &#61; 20) were colored with different coloring liquids. The marginal and internal fit were measured using the silicone replica method. CIELAB values of the samples were measured using a spectrophotometer. Then, for each sample, the die was obtained from polymethyl methacrylate. The specimens were cemented into dies and tested in a universal testing machine for fracture load. One-way ANOVA was performed to assess the effect of the sintering procedure on the marginal and internal fit; fracture load; and ∆E00, ∆L', ∆C', and ∆H' values of the FPPs., Results: The PSL and PST groups showed significantly smaller internal and marginal fit values compared with the ISP group. Additionally, the internal fit values of the IST group were significantly higher than those of Group P. Sintering time reduction led to a decrease in ∆E00 values. Fracture load values were not statistically significantly affected by the different sintering procedures for both brands., Conclusion: Different sintering procedures did not have a clinically significant effect on fit and fracture load. Different sintering procedures were found to have an impact on the color change of monolithic zirconia restorations.

Aim: The objective of the present study was to investigate the effect of using different materials for the fabrication of implant abutments and crowns on the mechanical behavior of implant-supported single crowns after artificial aging. The materials were tested in different combinations to reveal whether using stiff or resilient materials as an abutment or a crown material might influence the fracture strength of the whole structure., Materials and Methods: A total of 40 implants (blueSKY) were restored with identical custom-made CAD/CAM abutments milled out of lithium disilicate or ceramic-reinforced polyetheretherketone (PEEK) and divided into five test groups (n &#61; 8). Forty crowns made of three different materials (zirconia, lithium disilicate, and ceramic-reinforced PEEK) were used to restore the abutments. Specimens were subjected to mechanical loading up to 1,200,000 cycles in a chewing simulator (Kausimulator) with additional thermal cycling. The surviving specimens were subjected to quasi-static loading using a universal testing machine (Z010)., Results: The PEEK abutments with zirconia crowns showed the highest median failure load (3890.5 N) while the PEEK abutments with lithium disilicate crowns exhibited the lowest (1920 N). Fracture and deformation occurred in both the crowns and abutments., Conclusion: The failure load of the restorations was influenced by the material of the abutment and crown. Restoring PEEK abutments with zirconia crowns showed a high failure load and no screw loosening.

Background: Bioactive surface modifications have been proposed to enhance osseointegration and longevity of dental implants. This study aimed to systematically review and perform a meta-analysis on the effectiveness of various bioactive coatings in promoting bone integration and improving implant longevity., Methods: A systematic review was conducted, including studies that investigated bioactive surface modifications on titanium dental implants. Outcomes of interest were bone-to-implant contact (BIC) and implant longevity over a 30-day period. Data were extracted and analyzed using RevMan 5 (version 5.4.1), with forest plots generated to represent the mean difference (MD) and 95% confidence intervals (CI) under a random effects model., Results: The meta-analysis showed a significant improvement in BIC for surface-modified implants, with an overall MD of 7.29 (95% CI [2.94, 11.65]). Heterogeneity analysis indicated moderate heterogeneity (Tau² = 18.57, Chi² = 16.08, df = 8, P = 0.04, I² = 50%). The test for overall effect yielded Z = 3.28 (P = 0.001). For implant longevity, the overall MD was 7.52 (95% CI [3.18, 11.85]), with moderate heterogeneity (Tau² = 17.28, Chi² = 14.95, df = 8, P = 0.06, I² = 47%). The test for overall effect yielded Z = 3.40 (P = 0.0007)., Conclusion: Bioactive surface changes significantly improved osseointegration and lifespan of dental implants. Collagen-based coatings consistently encouraged early bone integration, while BMP-2 combinations were effective for osseointegration. Optimizing bioactive agent doses and combinations was critical for achieving desired outcomes., (© 2024. The Author(s).)

Background: This study evaluates the fracture strength and patterns of feldspathic porcelain restorations made using CAD/CAM technology for lower first molars with extensive crown destruction. The restorations include post-core and full-contour crown, composite resin core and full-contour crown, and endocrown. This research provides insights into effective restorative options to address tooth fracture risk, supporting minimally invasive procedures and CAD/CAM integration in dental practices., Methods: This study utilized 80 permanent mandibular first molars, which were divided into four groups: Group I (Post-Core-Full-contour crown), Group II (Core- Full-contour crown), Group III (Endocrown), and Group IV (Control). Root canal treatment was performed on all samples except for the control group. Following access cavity preparation, restorations for each tooth were fabricated using the CAD/CAM system and cemented with resin cement. The specimens were embedded in acrylic blocks. After undergoing thermomechanical aging, the samples were subjected to fracture resistance testing using a universal testing machine, which applied force until fracture occurred. The fracture patterns were subsequently analyzed, and the data were statistically evaluated using the Kruskal-Wallis and Chi-Square tests (p < 0.05)., Results: A significant difference in fracture values under axial forces was observed (p < 0.05). The control group had the highest fracture strength (1830 ± 277 N), while the Core- full-contour crown group showed the lowest (1532 ± 371 N). Failure types varied significantly among the groups (χ2 = 26.886, df = 9, p = 0.001). The most common failure type was Type-2 (33.75%), characterized by restorable fractures, while Type-3 fractures, unrestorable, were the least common (12.5%)., Conclusions: The findings underscore the significance of technological advancements in CAD/CAM for effectively restoring endodontically treated teeth with extensive crown damage. This study contributes valuable insights, emphasizing the clinical relevance of selecting appropriate restorative options to mitigate the risk of tooth fracture associated with coronal restoration failures., (© 2024. The Author(s).)

Background: Occlusal veneer had been evaluated for mechanical properties using lithium disillicate. However, studies evaluating the mechanical properties of occlusal veneer with different preparation designs and ceramic materials are lacking. So, this in vitro study aimed to evaluate the fracture resistance of occlusal veneers with two designs fabricated from two different ceramic materials., Material and Methods: Fourty mandibular third molars were distributed to 2 groups (n = 20) according to preparation design: group (O) anatomical occlusal reduction and group (OA) anatomical occlusal and 1 mm axial reduction. Each group was additionally subdivided into two subgroups (n = 10) according to ceramic materials; in subgroup X, lithium disilicate (e.max CAD, Ivoclar AG, Schaan, Liechtenstein) was used, and in subgroup S, zirconia-reinforced lithium silicate (ZLS) (Vita Suprinity, VitaZahnfabrik, Bad Säckingen, Germany) was used. All specimens were cemented with a light-cure resin cement (Choice 2, Bisco, Schaumburg, USA). 5000 thermocycles were applied to all specimens with both temperatures of 5 °C and 55 °C in two water baths; the dwell time was 30s at each bath, and the transfer time was 10s. Then all specimens were subjected to a fatigue simulation under dynamic loading of 200 N for 250,000 cycles. A universal testing machine (5500R/1123, Instron, Norwood, USA) was used to evaluate the fracture strength with a crosshead speed of 1 mm/min. All data were analyzed statistically by using a two-way ANOVA, and for some violations of assumptions, these results were compared with those obtained by the nonparametric test (Scheirer Ray Hare) (α = 0.05)., Results: A statistically significantly higher fracture resistance in the 'OA' (3389 N) compared to the 'O' (2787 N) group regardless of the ceramic material (P < .001) and a statistically significantly higher fracture resistance in the 'X' (3295 N) compared to the 'S' (2881 N) regardless of the preparation design (P = .015)., Conclusions: For occlusal veneers, all preparation designs and materials (such as Vita Suprinity and e.max CAD) had clinically acceptable fracture resistance values that were greater than the maximal biting forces. On the other hand, the e.max CAD with occlusal veneer, including axial reduction design, demonstrated the maximum fracture resistance value. Finally, no relationship between fracture strength and mode of failure was found., (© 2024. The Author(s).)

Clinicians who place and restore implants are always concerned about the success and longevity of the same. There are several local and systemic factors that affect osseointegration and the health of the peri-implant tissues. In this study, we review the systemic factors that can affect implant survival, osseointegration, and long-term success. The study highlights the importance of delineating, and taking into consideration these systemic factors from the planning phase to the restorative phase of dental implants. A thorough medical history, including prescription and over-the-counter medications, is vital, as there may be numerous factors that could directly or indirectly influence the prognosis of dental implants., Competing Interests: Disclosure D. C. Thomas, D. Bellani, J. Piermatti, and P. Kodaganallur Pitchumani declare no conflict of interest. There was no funding for this study. Statement of institutional review board approval or waiver: Institutional review and approval were not necessary for this study., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Broken screw removal from the implant connection is a common but challenging process. Several proposed methods and technical solutions may result in unsuccessful removal; thus, a novel, more conservative, risk-free method is proposed as a first attempt. The proposal is to use a silicon restoration holder to be twisted counterclockwise on the dried surface of the broken fragment inside the implant connection. This method, within the limitations of a minimal case series, yielded 100% results; however, despite previous attempts with less conservative techniques, this approach showed no efficacy. This article aims to promote the use of silicon restoration holders as a minimally invasive first attempt at broken screw retrieval treatment before considering other options.

Objectives: The objective of this review was to assess clinical trials that have examined the materials, design, and bonding of ceramic cantilevered resin-bonded fixed dental prostheses (RBFDPs) as a potential option for replacing missing anterior teeth. The evaluation primarily focuses on the rate of restoration failure and clinical complications., Materials and Methods: A thorough search of databases including PubMed/MEDLINE, Scopus, and the Cochrane Library, was conducted. The most recent search was performed in October 2023. Clinical studies that compared ceramic cantilevered RBFDPs with double retainers or cantilevered RBFDPs using different ceramic materials or bonding systems were included. The outcome measures considered were restoration failure and complication rates., Results: Twelve studies met the eligibility criteria. The pooled data showed a statistically significant decrease in complication events when using cantilever designs compared with double retainer designs (p < 0.05); however, there were no differences found between the two designs in terms of restoration failure. The complication and failure rate of cantilever RBFDPs did not show a statistically significant difference with or without ceramic primer application before luting with phosphate monomer-containing luting resin (p > 0.05)., Conclusions: Ceramic cantilevered RBFDPs have lower complication rates compared with those with double retainers. The use of a ceramic primer prior to luting composite resin for ceramic cantilevered RBFDPs decreases the occurrence of complications and failures, although this effect was not statistically significant. Additional research is required to confirm these findings. Glass ceramic cantilever RBFDPs showed a decrease in success after 6 years, requiring ongoing monitoring, but both zirconia and glass-infiltrated alumina cantilever RBFDPs have demonstrated durability with excellent long-term success and survival rates for up to 10 and 15 years., Clinical Significance: Cantilever ceramic RBFDPs in the anterior region are a less invasive and valuable treatment option, providing good esthetic results., (© 2024 Wiley Periodicals LLC.)

Objectives: The aim of this study was to predict the risk of dental implant loss by clustering features associated with implant survival rates., Materials and Methods: Multiple clinical features from 8513 patients who underwent single implant placement were retrospectively analysed. A hybrid method integrating unsupervised learning algorithms with survival analysis was employed for data mining. Two-step cluster, univariate Cox regression, and Kaplan‒Meier survival analyses were performed to identify the clustering features associated with implant survival rates. To predict the risk of dental implant loss, nomograms were constructed on the basis of time-stratified multivariate Cox regression., Results: Six clusters with distinct features and prognoses were identified using two-step cluster analysis and Kaplan‒Meier survival analysis. Compared with the other clusters, only one cluster presented significantly lower implant survival rates, and six specific clustering features within this cluster were identified as high-risk factors, including age, smoking history, implant diameter, implant length, implant position, and surgical procedure. Nomograms were created to assess the impact of the six high-risk factors on implant loss for three periods: 1) 0-120 days, 2) 120-310 days, and 3) more than 310 days after implant placement. The concordance indices of the models were 0.642, 0.781, and 0.715, respectively., Conclusions: The hybrid unsupervised clustering method, which clusters and identifies high-risk clinical features associated with implant loss without relying on predefined labels or target variables, represents an effective approach for developing a visual model for predicting implant prognosis. However, further validation with a multimodal, multicentre, prospective cohort is needed., Clinical Significance: Visual prognosis prediction utilizing this nomogram that predicts the risk of implant loss on the basis of clustering features can assist dentists in preoperative assessments and clinical decision-making, potentially improving dental implant prognosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To assess radiographic, clinical and patient-reported outcomes of single zirconia implant-supported crowns on titanium base abutments (TBA) over a 7.5-year period., Methods: Twenty-four patients received bone-level titanium implants and screw-retained zirconia implant crowns utilising TBA. Marginal bone level (MBL), clinical parameters (probing depth-PD, bleeding on probing-BoP, plaque control record-PCR), technical complications (USPHS criteria) and patient satisfaction were assessed at crown delivery (baseline), 1 year (FU-1) and at 7.5 years (FU-7.5) of follow-up., Results: Eighteen patients were available for re-examination at 7.5 years. The mean MBL at FU-7.5 (0.35 ± 0.20mm) did not significantly change compared to baseline (0.54 ± 0.39, p=.352) and to FU-1 (0.54 ± 0.45mm, p=0.524). From baseline to 7.5 years, the mean PD increased significantly, from 3.0 ± 0.6mm to 3.7 ± 0.8mm (p=0.005). However, BoP and PCR did not significantly change; (BOP: from 27.1 ± 20.7% to 25.0 ± 20.0%, p=0.498; PCR: from 11.1 ± 21.2% to 25.0 ± 25.1%, p=0.100). Nine patients presented with more than one bleeding site. This denoted a peri-implant mucositis prevalence of 50%, whilst none of the implants presented peri-implantitis. One incidence of minor and major ceramic chipping were reported on 2 out of the 18 crowns, resulting in a prosthetic survival rate of 94.4%. Seventeen patients were highly satisfied with their result., Conclusion: Single implant-supported zirconia crowns on TBA displayed: (i) minor number of technical complications, (ii) high prosthetic survival rate, (iii) stable marginal bone level and (iv) high patient satisfaction at 7.5 years., Clinical Implications: Titanium base abutments despite their high use in clinical practice, lacked medium- and long-term studies. The presented findings highlight their clinical performance at 7.5 years as they display satisfying radiographic, clinical and patient-related outcomes. TBA appear to be a suitable abutment choice for medium-term implant-supported restorations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To investigate the long-term implant survival rate and marginal bone loss (MBL) of implants with different variables associated over an observational period of at least 20 years., Materials and Methods: Patients with at least one implant placed prior to 2001 were recalled and visited. Data on implant macro-design, prosthetic aspects, site distribution, and patient-related factors were collected. MBL was evaluated on intraoral X-rays and peri-implant soft tissue parameters were recorded. The patients were asked to fill out a questionnaire to evaluate their satisfaction with the treatment received. Descriptive statistics indicators were estimated. Analysis of variance and analysis of covariance models were used to investigate any differences in the MBL and peri-implant probing depth (PPD) among the variables. A chi-square analysis was performed to investigate any association between different types of prosthetic implant-supported rehabilitations and survival/success outcomes., Results: Forty-one (41) patients and 174 implants were included with a mean observational period of 23.3 ± 2.8 years. The implant survival and success rates were 96.5% and 83.3% respectively, while 3.5% of early failures were detected. The lowest success rates were observed for implants supporting fixed full-arch rehabilitations (71.05%) and overdenture rehabilitations (86.11%). A mean MBL of 1.81 ± 0.71 mm and a mean PPD of 3.38 ± 1.62 mm were recorded. The interaction between the collected data with MBL and PPD did not reveal any statistically significant differences between the variables (p > 0.05). A statistically significant difference was recorded when analyzing the association between the different types of prosthetic implant-supported rehabilitations and success rates (p = 0.014), with fixed and removable full-arch rehabilitations presenting with lower success rates. Answers to the questionnaire showed a generally high level of satisfaction., Conclusions: Within the limits of this retrospective study and based on the results, an implant survival rate higher than 96% was observed after a mean observational period of 23.3 ± 2.8 years. Both the implant survival rate and MBL seemed stable after a mean observational period of 23.3 ± 2.8 years. Implants supporting fixed and removable full-arch rehabilitations seemed to present lower success rates over time. Implant rehabilitation seemed to provide patients with optimal long-term outcomes in terms of functional and psychological aspects., (© 2024 by the American College of Prosthodontists.)

Although transcrestal sinus floor elevation (TSFE) is widely used for cases of insufficient residual bone height in the posterior maxilla, few studies focus on the risk factors of early implant failure associated with TSFE procedures. This study aimed to identify and summarize the possible risk factors of implant failure associated with TSFE to ensure a more predictable implant survival rate using TSFE. We report the treatment of a patient with implant failure following TSFE and discuss this case's possible associated risk factors. A standard implant with a diameter of 4.8 mm and length of 10 mm was used after the TSFE procedure. Implant loosening was suddenly observed 6 weeks after the initial surgery. Factors that could result in early implant failure included patient-related risk factors, anatomical factors of the operational area, and operation- and implant-related factors. Within the current study's limitations, the graft material particles between the implant surface and socket could be considered a direct risk factor resulting in implant failure. Therefore, more attention should be paid to socket cleaning during the TSFE procedure, and loose particulate grafting materials should be discouraged. Another significant consideration for implant loss is the possibility of fractures in the buccal or palatal cortical plates during the site preparation and implant insertion. Thus, these factors should be studied further and receive more clinical attention.

Objectives: Conventionally and digitally manufactured removable complete dentures with different dentition forms were examined for manufacturing accuracy (trueness, precision), fracture forces under torsional loading and subsequent repairability., Methods: A total of 90 mandibular prostheses were manufactured. Ten were made using the injection molding technique and finished with prefabricated teeth. 40 bases each, were manufactured subtractively and additively. Digitally the prosthesis' dental arch was divided either into two quadrants or three sextants, or kept as full arch. Afterwards, ten additive and subtractive bases were finished with prefabricated teeth and ten of each with milled quadrants, sextants and full arches. After manufacturing, all specimens were rescanned for accuracy comparisons using the Root Mean Square (RMS). Lastly, all specimens were tested to failure under torsional loading., Results: Conventionally manufactured dentures showed the greatest deviation in accuracy. The type of base manufacturing did not determine the fracture resistance of the prostheses. The dentition form had a significant influence. While prefabricated teeth (86.01 ± 19.76 N) and quadrants (77.89 ± 9.58 N) showed a low fracture resistance, sextants (139.12 ± 21.41 N) and full arches (141.05 ± 17.14 N) achieved the highest fracture forces. Subtractive bases with prefabricated teeth or quadrants were assessed to be repairable, digital dentures with full arch were assessed as not repairable., Significance: The presented testing set-up is suitable to determine the fracture behavior of dentures rather than of standards. With the possibility of digital design and individual manufacturing, dentures' mechanical stability can be significantly increased, especially with suitable dentition forms., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The effect of antiplatelet and anticoagulant medications on the outcomes of sinus floor augmentation remains unclear., Methods: This retrospective cohort study analyzed data from electronic medical records of consecutive patients undergoing sinus floor augmentation at a single medical center. Patients were categorized into three categories: patients under antiplatelet medications, patients under anticoagulation medications, and healthy individuals. Data collected included tobacco smoking, residual alveolar bone height, timing of implant placement, materials used, vertical bone gain, early implant failure (EIF), and complications such as Schneiderian membrane perforation and postoperative bleeding. Multivariable analysis was performed to assess risk factors for EIF. Statistical significance was considered below 5%., Results: Among 110 patients with 305 implants, EIF occurred in 10% of patients and 4.65% of implants. No significant difference in postoperative bleeding or EIF was found between study groups. Univariate and multivariable analyses highlighted tobacco smoking (odds ratio [OR] = 7.92), lower residual alveolar ridge height (OR = 0.81), and staged implant placement (OR = 4.64) as significant EIF risk factors in this cohort., Conclusions: Anticoagulant and antiplatelet therapies do not significantly elevate the risk of EIF or postoperative bleeding following sinus floor augmentation. Tobacco smoking, residual alveolar ridge height and staged sinus floor augmentation were risk factors for EIF in patients using antiplatelet or anticoagulation medications undergoing sinus floor augmentation., (© 2024 The Author(s). Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Objectives: To evaluate the fracture resistance (FR) of polyetheretherketone (PEEK) abutments produced by additive and subtractive methods compared to milled zirconia abutments., Methods: Custom abutments were designed on Ti-base abutments and produced from three different materials, namely additively manufactured PEEK (PEEK-AM), subtractively manufactured PEEK (PEEK-SM), and zirconia (N = 60). PEEK-AM abutments were printed using PEEK filaments (VESTAKEEP®i4 3DF-T, Evonik Industries AG) on a M150 Medical 3D Printer (ORION AM) by fused filament fabrication (FFF). All surface treatments were carried out according to the manufacturer's instructions. All abutments were cemented on Ti-bases with hybrid abutment cement and then restored with milled zirconia crowns. Each subgroup was divided into non-aged and aged subgroups (n = 10). The aged groups were subjected to thermomechanical aging (49 N, 5-55 °C, 1.2 million cycles). FR tests were performed by using an universal testing machine. Data were statistically analyzed with one-way and two-way ANOVA and t-test., Results: The survival rate of the specimens after aging was determined as 100%. It was found that both the material and aging had a significant effect on the FR (p<.001). There was a statistical difference among the fracture values of the groups (p<.001). In both the aged and non-aged groups, PEEK-AM showed the statistically lowest FR, while the highest FR was seen in the zirconia group, which was significantly higher than the PEEK-SM (p<.001)., Conclusion: Hybrid abutments were successfully manufactured, and extrusion-based processed PEEK seems to be a good alternative to subtractive processed PEEK. However, since subtractive manufacturing still appears to be superior, further developments in additive manufacturing are needed to further improve the quality of 3D-printed PEEK parts, especially in terms of accuracy and bonding between adjacent layers., Clinical Significance: Additively manufactured PEEK abutments have the potential to be an alternative for implant-supported restorations in the posterior region., Competing Interests: Declaration of competing interest All other authors have no conflicts of interest to declare. The authors do not have any financial interest in the companies whose materials are included in this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study aimed to identify the ideal interimplant distance for optimum outcome on immediately loaded implant supported prosthesis. Hence this study was taken up to analyze the effect of varying interimplant distance on fracture resistance of implant supported provisional fixed dental prosthesis (FDP). A total of 24 bis-acrylate composite resin samples were prepared. Interimplant distance was present in the metal die for placement of dummy implants at distances of 14 mm, 21 mm, and 30 mm respectively. Wax-up for 3-unit, 4-unit, and 5-unit implant-supported provisional restoration was made. Silicone molds were used for making multiple interim prostheses using bis-acrylate composite material. All samples were subjected to fracture test in the universal testing machine with a crosshead speed of 1 mm/min. All samples were loaded with gradual force starting from 100 N until it fractured. The load was applied at the center of prosthesis. Data was analyzed by one-way analysis of variance and Bonferroni post hoc test. Mean fracture resistance of 3-unit provisional FDP at 14 mm of interimplant distance showed 1342.61 ± 179.15 N. Mean fracture resistance of 4-unit provisional FDP at 21 mm of interimplant distance showed 1420.44 ± 170.37 N. Mean fracture resistance of 5-unit provisional FDP at 30 mm of interimplant distance showed 791.61 ± 203.59 N. Both 14 mm and 21 mm of interimplant distance are suitable span lengths to be considered for the optimum outcome during immediately loading with implant-supported provisional restorations. Limitations of the study were that force application was static in nature and not dynamic and the arch form was not "U" shaped but longitudinal using Bis-Acryl material only with no cantilever. Future studies can be done to evaluate the fracture resistance of bis-acrylate material considering biomechanics and arch form of natural dentition. Distal cantilever should be considered along with different material for fabricating provisional restoration.

Objectives: To evaluate the effect of different cement types on the incidence of failure and loss of retention of zirconia and metal-ceramic single crowns (SCs) cemented on implant abutments., Methods: We placed 567 implant-supported SCs in 358 patients and retrospectively evaluated long-term retention for up to 12.8 years. The frameworks were made from metal alloy (n = 307) or zirconia (n = 260). SCs were cemented with permanent (glass-ionomer cement; n = 376) or semipermanent cement (zinc oxide non-eugenol cement; n = 191) on standardized (n = 446) or customized (n = 121) abutments. Kaplan-Meier curves were used to calculate the incidence of decementation. Differences between survival curves were assessed with log-rank tests. Cox-regression analysis was performed to evaluate multiple risk factors., Results: Of the 567 SCs, 22 failed because of technical complications and four because of implant loss. Loss of retention was observed in 50 SCs. Analysis revealed a 7% probability of loss of retention for zirconia and 16% for metal-ceramic SCs after 10 years (p = .011). After 5 years, loss of retention was higher for standardized abutments than for customized abutments (p = .014). The probability of loss of retention was higher with semipermanent than with permanent cement (p = .001). Cox-regression analysis revealed semipermanent cement as the only significant risk factor for SC failure (p = .026)., Conclusions: In contrast to semipermanent cement, permanent cement provides acceptable long-term retention of cemented implant-supported SCs. These possible positive effects of customized abutments have to be controlled with larger sample sizes., (© 2024 The Author(s). Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Background: Two intra-coronal preparation designs with varying extensions of cuspal coverage can perform differently regarding their fracture resistance against introral forces., Methods: Two materials (IPS e-max CAD [EX], VITA ENAMIC [EN]), and two different preparation designs (EX-D1), (EX-D2), (EN-D1), and (EN-D2) were investigated to compare their fracture resistance. A total of 40 (n = 40) caries free human mandibular molars were used. All the prepared samples were scanned using CEREC Omnicam scanner and the preparations were checked by the software for any sharpness and undercuts before restoration designing and fabrication. All restorations were milled using Cerec MCXL 4.4 milling machine. Duo-Link resin cement was used for cementation. After thermocycling and chewing simulation, all samples were loaded in the Universal testing machine in order to evaluate fracture resistance of all samples., Results: Fracture resistance testing revealed that e-max CAD (2134 N) showed statistically significantly higher mean fracture resistance values than Vita Enamic (1728 N). On the other hand, there was no statistically significant difference between mean fracture resistances between the two tested designs., Conclusions: Within the confines of this investigation, it can be said that although preparation design had no appreciable impact on fracture resistance, the CAD/CAM ceramic material utilized did., Clinical Significance: When restoring compound cavitties indirectly; a conservative defect oriented approach should be used. Glass Ceramic are prefered as restorative material., (© 2024 Wiley Periodicals LLC.)

Statement of Problem: Studies investigating the survival of implant-supported crowns provided in a dental school setting are sparse., Purpose: The purpose of this retrospective study was to evaluate the success and reasons for failure of single unit and splinted implant-supported crowns provided in a dental school., Material and Methods: Using the axiUm dental management software program and paper charts, all single unit and splinted implant-supported crowns provided between September 1989 and January 2020 were included for evaluation. Success, survival, and failure were recorded as well as reasons for failure. A Kaplan-Meier survival estimate with an associated P value, a life table analysis, and a log-rank test comparing the survival of single unit and splinted implant-supported crowns were performed., Results: Over 30 years, 678 implant-supported crowns (586 single unit and 92 splinted) had been provided. Of these crowns, 17 (2.90%) single unit crowns and 5 (5.43%) splinted crowns failed, with most being prosthetic failures for both single units (64.7%) and splinted (80%), rather than biologic failures. A total of 371 single unit (63.3%) and 46 splinted (50.0%) implant crowns were a complete success, and 215 single unit (36.7%) and 46 splinted (50.0%) crowns survived but had some type of complication. The overall implant-supported crown survival rate was 96.8%. The survival distribution of the single unit and splinted implant-supported crowns was not statistically significantly different [χ2(2)=1.285, P=.257]., Conclusions: Both single unit and splinted implant-supported crowns had high success rates and showed similar survival rates. The most common causes of complications were also similar, with debonding and screw loosening of crowns being the most common complication for both single unit and splinted crowns., (Copyright © 2024 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Completely veneered zirconia ceramic (ZC) fixed partial dentures (FPDs) have been reported to have a higher incidence of ceramic chipping than the standard metal-ceramic FPDs. However, data from comparative long-term studies are sparse., Purpose: The purpose of this retrospective study was to compare the long-term survival, chipping-free survival, and success of ceramic-veneered high noble metal alloy (HN), base metal alloy (cobalt-chromium alloy) (CC), and ZC FPDs and to isolate risk factors for the incidence of failure, veneer chipping, and overall complications., Material and Methods: Data from 289 study participants (58.7% women; mean age, 57.97 ±11.51 years) provided with a total of 400 FPDs comprising 197 (49.3%) HN FPDs, 121 (30.3%) CC FPDs, and 82 (20.5%) ZC FPDs fabricated from presintered 3 mol% yttria-stabilized zirconia (mean time of service, 6.85 ±3.25 years) were evaluated. Of these, 278 (69.5%) FPDs were provided by dentists and 122 (30.5%) by dental students. Five- and 10-year survival, chipping-free survival, and success rates were calculated using the Kaplan-Meier method and compared with the log-rank test. Risk factors were assessed using Cox regression analysis. The study was exploratory, so all P values were considered exploratory and descriptive., Results: The 5- and 10-year survival rates were 94.7% and 77.8% for HN, 93.7% and 81.2% for CC, and 92.9% and 53.3% for ZC FPDs, respectively, indicating no clear difference in survival among the framework materials. The 5- and 10-year chipping-free rates were 94.1% and 82.8% for HN, 96.1% and 78.9% for CC, and 82.6% and 62.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The 5- and 10-year success rates were 83.7% and 55.3% for HN, 86.5% and 51.4% for CC, and 68.9% and 30.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The Cox regression model indicated framework material as an influencing risk factor for success, and this influence persisted when chipping was investigated. Compared with zirconia, the use of a metal alloy reduced the risk of chipping or the occurrence of complications by up to one-third., Conclusions: All FPDs showed high 5-year survival rates and acceptable 10-year survival rates with no strong differences among the materials. Higher success and chipping-free rates were observed for both HN and CC restorations compared with ZC restorations. Metal frameworks had a lower risk for complications or veneer chipping than zirconia frameworks., (Copyright © 2022 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Current designs of fiber-reinforced composite (FRC) resin-bonded fixed dental prostheses (RBFDPs) have a limited lifespan, failing mainly through veneer-fiber delamination, debonding, and fracture., Purpose: The purpose of this in vitro study was to validate a new inlay-retained 2-unit cantilevered RBFDP with an optimized cavity and fiber layout proposed in a previous study by using simulated occlusal loading., Material and Methods: Two groups of specimens (n=20), 1 with and 1 without glass fibers, were used to test the influence of the cavity design and that of the fiber layout on their load capacity, respectively. The specimens without fibers were directly cut from a resin-ceramic block by using a computer-aided manufacturing system, while those with fibers were manually fabricated with unidirectional glass fibers and composite resin in a silicone mold. The specimens with and without fibers were attached to abutments made of the same resin-ceramic with a cyanoacrylate-based adhesive and a resin-based dental cement, respectively. An increasing compressive load was applied on the mesial fossa of the premolar pontic until failure. Cracking in the specimens during loading was monitored with a 2-channel acoustic emission (AE) system., Results: All the specimens without fiber reinforcement debonded from the abutments. Those using the optimized shovel-shaped cavity design had a mean ±standard deviation failure load (50.0 ±17.3 N) that was 193% higher than that of those with the conventional step-box design (17.1 ±6.2 N; P<.001). No significant difference was found between the groups for the mean number of AE events per specimen (step-box: 49 ±34 versus shovel-shaped: 63 ±34; P=.427), the mean amplitude of each event (58.4 ±1.3 dB versus 59.5 ±2.4 dB; P=.299), or the mean time to failure (283.2 ±122.3 seconds versus 297.5 ±66.7 seconds; P=.798). Between the groups of specimens with reinforcing fibers, the mean failure load of the conventional design was approximately half that of the optimized one. Again, no significant difference was found for the mean number of AE events per specimen (conventional: 28 ±18 versus optimized: 52 ±53; P=.248) or the mean amplitude for each AE event (64.9 ±4.2 dB versus 61.7 ±5.2 dB; P=.187). The connectors of 8 fiber-reinforced specimens with the conventional design fractured; the other 2 debonded from the abutments. Half of the shape-optimized fiber-reinforced specimens had fractured abutments, but the cantilevers remained intact, 4 specimens fractured at the connector, and only 1 debonded from its abutment., Conclusions: The shape-optimized 2-unit cantilevered FRC RBFDP had a higher load capacity than the conventional design., (Copyright © 2022 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Objective: Endocrowns can be fabricated from various materials as a treatment option for endodontically treated teeth. This mixed cohort study aimed to demonstrate the clinical efficacy of Endocrowns made of feldspathic, zirconia lithium silicate, and lithium disilicate ceramics using a chairside CAD/CAM system., Methods: The present study compared the clinical outcomes of 141 Endocrown restorations in posterior teeth of 85 patients in a two-year follow-up. The efficacy of restorations was evaluated in three aspects: esthetics, biological response, and function, with the aid of the FDI guideline, and presented as descriptive analyses. Additionally, the data were analyzed using Chi-square and Spearman correlation tests. The significance level was set at p = 0.05., Results: The study findings revealed that the type of restorations (feldspathic ceramic, zirconia lithium silicate, and lithium disilicate) (p > 0.05) and underlying teeth (molars and premolars) (p > 0.05) play no part in restorations' failure. Caries' recurrence is primarily responsible for the failure of the endocrowns. Secondary caries and radiolucency were observed in four teeth (2.83 %). The clinical efficacy of 126 restorations (89.36 %) fell into the category of "clinically excellent" and "clinically good." Ten restorations (7.09 %) were classified as "clinically sufficient/satisfactory," and only five restorations (3.54 %) needed replacement due to having "clinically unsatisfactory" and "clinically poor" quality., Conclusions: Endocrowns showed a high success rate and durability in the short term, therefore can be considered a safe choice for restoring endodontically treated teeth. It is worth noting that caries were the most common reason for the failure of the restorations., Clinical Significance: Endocrowns made of different ceramics have been proven reliable restorations for endodontically treated molars and premolars., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This prospective clinical trial evaluated the clinical performance of ceramic partial coverage indirect adhesive restorations (PCIARs) in posterior teeth luted with a light-cured composite resin., Methods: From April 2016 to January 2017, a total of 60 patients (27 males, 33 females; mean age: 42.2 ± 10.86 years old) received 83 glass-ceramic PCIARs (26 onlay, 57 overlay) made of IPS Emax CAD (Ivoclar Vivadent). All restorations were luted with a light-cured composite resin (Filtek Z250, 3 M ESPE) by two operators. Two independent calibrated examiners blinded to the operators performing the treatment evaluated the restorations at baseline, 1-year, and 5-year following FDI World Dental Federation criteria including esthetic, functional, and biological properties. Data were analyzed with the Friedman test and the Wilcoxon sign test (p < 0.05)., Results: None of the restorations failed due to fracture or retention loss. One restoration was clinically unsatisfactory because of secondary caries. Marginal staining (p:0.000), marginal adaptation (p:0.018) showed significant differences between 1-year and 5-year recall., Conclusions: The PCIARs demonstrated excellent clinical performance at 1-year period. The degradation parameters appeared as minor staining and minor irregularities after 5-year, without any affect on the clinical performance., Clinical Significance: Our findings provide evidence that the clinical performance of PCIARs luted with a light-cured composite resin was clinically acceptable after a five-year evaluation period. Due to secondary caries, only one restoration was considered clinically unsatisfactory., Clinicaltrials Registration Number: NCT04838483., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: To assess the fracture resistance and failure mode of endodontically treated premolars reconstructed by different preparation approaches: cervical margin relocation (CMR) and crown lengthening (CL) with complete ferrule (CLF) and partial ferrule (CLPF) with three different post and core systems., Materials and Methods: In this in vitro study, 100 maxillary premolars were assigned to the following 10 groups according to their preparation approach and type of post and core system (n = 10): (I) control (intact teeth), (II) prefabricated fiber post (PFP) and composite core with CMR (PFP-CMR), (III) polyethylene fiber-reinforced composite (PEFRC) with CMR (PEFRC-CMR), (IV) casting post (CP) and core with CMR (CP-CMR), (V) PFP-CLPF, (VI) PEFRC-CLPF, (VII) CP-CLPF, (VIII) PFP-CLF, (IX) PEFRC-CLF, and (X) CP-CLF. After thermomechanical loading, the fracture resistance and failure mode were assessed. Data were analyzed statistically (α = 0.05)., Results: In all post and core systems, the CLPF approach had lower fracture resistance than CMR (p < 0.05); CLF showed higher fracture resistance than CLPF only in the PFP system (p = 0.038). In PEFRC and CP systems, the difference between CLF and CLPF was not significant (p > 0.05). No significant difference was found in fracture resistance of different post and core systems with the same preparation approach (p > 0.05). CLPF showed the highest frequency of favorable, and CLF showed the highest frequency of unfavorable fractures., Conclusion: CLPF yielded lower fracture resistance than CMR. The difference in fracture resistance was not significant between CLF and CMR but the frequency of unfavorable fractures was higher in CLF than in other groups., (© 2023 by the American College of Prosthodontists.)

Statement of Problem: Long-term data are sparse on the use of metal-acrylic resin implant-supported fixed complete dentures., Purpose: The purpose of this retrospective clinical study was to assess the prosthetic survival and complication rate in patients treated with metal-acrylic resin implant-supported fixed complete dentures (ma-IFCDs)., Materials and Methods: The patient record system at the Dental College of Georgia was searched from 2006 to 2020 to identify all patients treated with ma-IFCDs by the graduate prosthodontic and general practice residents during this time. Variables collected were date of delivery of the prosthesis, arch treated (maxilla, mandible), date of the last visit, status of the opposing arch (complete arch fixed implant-supported prosthesis, complete denture, removable implant-supported overdenture, teeth and removable partial denture, teeth and implants, teeth only), date of replacement, and reason for replacement. Reasons for replacement were grouped as fracture of the framework, implant loss, patient-related concerns, catastrophic acrylic resin fracture (judged to be beyond predictable repair by the clinician), and extensive occlusal wear (judged to have worn to the point of requiring replacement)., Results: A total of 84 arches in 55 patients who met the inclusion criteria were identified from the electronic health review. Of the 84 complete arch prostheses, 43 were maxillary and 41 were mandibular. The median follow-up time was 2.8 years (interquartile range [IQR] 0.95, 4.65). A total of 31 of the 84 arches were identified as having failed, requiring replacement. The most frequent reason for replacement was catastrophic fracture of the acrylic resin (61%), followed by excessive occlusal wear (19%). It was found that 13% of the failures were associated with patient-related concerns, and 7% with the loss of an implant. Survival rates were analyzed based on the opposing arch. The combined survival rate (Kaplan-Meier, log-normal modeling) for ma-IFCDs was 54% at 5 years (95% confidence interval [CI] 42%, 66%) and 32% at 10 years (95% CI 20%, 47%)., Conclusions: Mid- to long-term survival rates for ma-IFCDs are concerningly low. The findings suggest that the status of the opposing arch plays a role in the survival rate of ma-IFCDs. The most common complication was catastrophic fracture of the acrylic resin superstructure, followed by wear of the acrylic resin denture teeth., (Copyright © 2022 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to determine the survival of class II composite restorations in premolars and molars with and without base bulk-fill composite in general dental practice., Materials and Methods: We collected data from the electronic patient files of the Public Dental Services in the City of Oulu, Finland. The timespan of data collection was from August 15th, 2002, to August 9th, 2018. The data consisted of class II composite restorations both with and without base bulk-fill composite. We compared the survival of these restorations using Kaplan-Meier survival curves, the log-rank test, survival rates, and the Wilcoxon signed ranks test., Results: We observed 297 restorations in 96 patients. The five-year survival rates for restorations with and without base bulk-fill composite were comparable in premolars (77.5% and 77.4%, respectively) but different in molars (69.9% and 57.8%, respectively, p = 0.069). In molars, the restorations with base bulk-fill composite exhibited a higher survival rate in 14 patients, whereas in 11 patients the restorations without base bulk-fill composites exhibited a higher survival rate. In 24 patients the survival rates were similar for restorations with and without the base bulk-fill composite (p = 0.246)., Conclusions: The restorations with and without base bulk-fill composite had similar longevity., Clinical Relevance: Base bulk-fill composites are safe to use in general practice due to their similar survival rates compared to conventional composites., (© 2024. The Author(s).)

The purpose of this study was to investigate the fracture behavior of endodontically treated (ET) deciduous molar when directly restored with different restorative materials in Class II (MO) cavities in comparison with permanent teeth. MO cavities were prepared with 2.4-2.5 mm and 1.9-2.0 mm in buccolingual width, and mesiodistal width of each cavity walls, respectively, followed by direct restoration with different materials: resin-modified glass ionomer cement (RMGIC), composite resin (CR), and composite resin containing 25% short glass-fiber (SFRC). All specimens were subjected to mechanical loading tests at a speed of 1 mm/min and evaluated fracture resistance and fracture modes. A one-way ANOVA followed by a Tukey multiple comparisons analysis was used. Deciduous-SFRC (3,310.5±396.2 N) were significantly higher fracture resistance than permanent-RMGIC (1,633.8±346.8 N) (p<0.001), and permanent-CR (1,400.0±381.3 N) (p<0.001). For the direct restoration of MO cavity after endodontic treatment, SFRC demonstrated its promising performance in load-bearing capacity and failure mode, especially in ET deciduous molars.

This study evaluated fracture resistance of monolithic fixed dental prostheses (FDPs) fabricated using different placement strategies of various connector designs in multilayered zirconia disc. Monolithic FDPs were placed in translucent and dentin layers of multilayered zirconia disc and fabricated with V-shaped and U-shaped connector designs gained by sharp and blunt millings. The FDPs were cemented on abutment models made of polymer material, underwent thermal cycles, and loaded to fracture using the universal testing machine. Fracture loads and modes were analyzed using two-way ANOVA, Tukey's post hoc test, and Fisher exact test (p≤0.05). The chosen placement strategy and connector designs gained by different milling procedures in computer-aided design/computer-aided manufacturing technology affect fracture resistance of monolithic FDPs made of multilayered zirconia materials. Placing the connector in translucent layer rather than dentin layer of multilayered zirconia disc and using sharp milling significantly reduces fracture resistance of monolithic multilayered zirconia FDPs.

Purpose: To evaluate the behavior of hybrid abutment crowns fabricated from monolithic lithium disilicate ceramic (LDC) and to compare the influence of different in vitro artificial aging protocols., Materials and Methods: A total of 32 monolithic hybrid abutment crowns of monolithic LDC were fabricated. Of these, 24 were artificially aged using three different protocols up to a 20 year simulation (1.2 × 106, 2.4 × 106, 4.8 × 106 chewing cycles, thermocycling), a control group underwent no artificial aging (n &#61; 8, N &#61; 32). Load-to-failure tests were conducted for all specimens, and failure values were compared (P < .05)., Results: All specimens passed in vitro aging. Mean failure load values between 532.6 and 562.8 N were found but did neither differ significantly among the test groups nor from the control group., Conclusions: Within the limitations of this in vitro pilot study, hybrid abutment crowns manufactured from monolithic LDC seem to offer appropriate long-lasting mechanical stability over a simulation period up to 20 years. The failure values and complication pattern seem to be independent of several aging protocols in this test set-up.

Objective: This meta-analysis aims to investigate the long-term survival rates of dental implants over a 20-year period, providing a practical guide for clinicians while identifying potential areas for future research., Materials and Methods: Data were sourced from recent publications, focusing exclusively on screw-shaped titanium implants with a rough surface. Both retrospective and prospective studies were included to ensure an adequate sample size. A systematic electronic literature search was conducted in the databases: MEDLINE (PubMed), Cochrane, and Web of Science. The risk of bias for all studies was analyzed using a tool by Hoy et al. RESULTS: Three prospective studies (n = 237 implants) revealed a mean implant survival rate of 92% (95% CI: 82% to 97%), decreasing to 78% (95% CI: 74%-82%) after imputation (n = 422 implants). A total of five retrospective studies (n = 1440 implants) showed a survival rate of 88% (95% CI: 78%-94%). Implant failure causes were multifactorial., Conclusion: This review consolidates 20-year dental implant survival data, reflecting a remarkable 4 out of 5 implants success rate. It emphasizes the need for long-term follow-up care, addressing multifactorial implant failure. Prioritizing quality standards is crucial to prevent overestimating treatment effectiveness due to potential statistical errors. While dental implantology boasts reliable therapies, there is still room for improvement, and additional high-quality studies are needed, particularly to evaluate implant success., Clinical Relevance: Never before have the implant survival over 20 years been systematically analyzed in a meta-analysis. Although a long-term survival can be expected, follow-up is essential and shouldn't end after insertion or even after 10 years., (© 2024. The Author(s).)

To evaluate the fracture load of bilayer ceramic crowns manufactured by Rapid Layer Technology (RLT) after different cementation protocols of the veneering ceramic to the zirconia infrastructures. Sixty epoxy resin preparations simulating a molar tooth were obtained and 60 zirconia infrastructures and feldspathic crowns were manufactured by RLT and divided into 6 groups according to the cementation protocol at the interface to veneering ceramic (n=10): Ctr- control: conventional resin cement; Al- Al2O3 sandblasting 50µm + conventional resin cement; Al/MDP- Al2O3 sandblasting (50µm) + resin cement with MDP; Sil- silicatization 30µm + conventional resin cement; Gl/HF- glaze + hydrofluoridric acid (5%,60s) + silane + conventional resin cement; Gl- glazing as bonding agent. The feldspathic ceramic internal surface was etched with fluoridric acid (5%) + silane followed by cementation according to respective protocols. All samples were mechanically cycled (200N and 4.5x105 Pa, 37°C, 2x106 cycles, 3.4Hz) and submitted to axial compressing fracture load test (10kN, 0.5mm/min). The results(N) were submitted to descriptive and analytical statistical analysis with 1-way ANOVA, Weibull, and the Tukey test (α=0.05). ANOVA revealed that there was a significant difference among the tested groups (p<0.0001). The group Al/MDP presented the higher resistance to fracture (1972.46A N), followed by the Ctr group (1584.41B N). The characteristic strength(σ0) was significantly different (p=0.000). The crack and chipping were the predominant failures. The air-abrasion at the external surface of zirconia with Al2O3 followed by cementation with MDP resin cement, should be selected to Rapid Layer Technique when felspathic ceramic is used as veneer ceramic.

This study aimed to assess the fatigue resistance of molars lacking a coronary remnant, using zero, one, two, or three fiberglass posts. Forty caries/crack-free human molars with coronal portions removed at the pulp chamber floor were randomly allocated into four groups (n=10). Following endodontic treatment, posts (Whitepost DC/DC.E 0.5, 1.0, FGM) were silanized (silane agent, Angelus) and cemented with a resin cement (RelyX U200, 3M ESPE). Resin composite cores (Z350, 3M ESPE) were built, and metal crowns were fabricated and cemented using the same luting system. Samples underwent cyclic fatigue testing at 45°, applying load in the occlusal surface at 10 Hz and 100 N initial load for 10,000 cycles, with 50 N increments every 10,000 cycles until failure. Fatigue failure load and cycles for failure data were recorded and subjected to survival analysis through Kaplan-Meier and Mantel-Cox post hoc tests, and Weibull analysis. Fractography patterns of failed crowns were qualitatively analyzed. The group without posts exhibited the lowest fatigue performance (p < 0.05) for both fatigue failure load and cycles to failure. Superior fatigue performance was observed in the three-post group, followed by groups with one or two posts, corroborated by the Weibull characteristic strength parameter. Weibull moduli were similar among conditions. All specimens exhibited failure involving detachment of the restorative set (posts/core/crown) with a portion of the dental remnant, without tooth fracture. Thus, when restoring mandibular molars without crown remnants, the use of fiberglass posts promotes greater fatigue resistance to oblique loads.

Background: Partial coverage concepts have met the main goal of conservative dentistry. Vonlays, which combine features of veneers and onlays, are a recent alternative to full coverage designs and overlay partial coverage restorations. This in vitro study was conducted to compare the fracture resistance of the newly introduced pressable zirconia-reinforced lithium silicate with pressable lithium disilicate ceramic and to determine the optimal preparation design for partial coverage on upper premolars., Methods: Fifty-two duplicated epoxy resin dies were prepared following vonlay and overlay preparation guidelines. For each preparation (n = 26), the specimens were divided into two subgroups to be restored with lithium disilicate (IPS e.max Press) or zirconia-reinforced lithium silicate (Vita Ambria) (n = 13 each). Ceramic vonlays and overlays were bonded using dual cure resin cement, subjected to thermomechanical fatigue, and the load to fracture was tested by using a universal testing machine. The specimens were fractographically analyzed via scanning electron microscopy (SEM). The normality of the fracture resistance data was checked using the Shapiro‒Wilk test and Q‒Q plots, and two-way ANOVA was used to assess the effect of the type of preparation and ceramic material on the fracture resistance., Results: The group of overlays restored with zirconia-reinforced lithium silicate showed the highest mean fracture load (1218.69 N), while the group of vonlays restored with lithium disilicate had the lowest mean fracture resistance (967.15 N). The effect of preparation design and material type on fracture resistance was significant for both factors, p = 0.003 and p < 0.0001, respectively. Different features of the fracture surfaces, such as arrest lines, hackles, and directions of crack propagation, were observed., Conclusions: Zirconia-reinforced lithium silicate exhibited greater resistance to fracture compared to lithium disilicate, making it a potential substitute for partial coverage restorations. Additionally, the overlay showed superior fracture resistance when compared to the vonlay preparation design., (© 2024. The Author(s).)

Background: Recently, prosthodontic approaches involve more conservative procedures that include less invasive finish line preparations that use less ceramic thickness., Aim of the Study: This in vitro study aimed to evaluate the effect of vertical preparation and modified vertical preparation designs on the marginal adaptation and fracture resistance of two types of ceramic crowns using CAD/CAM technology., Materials and Methods: Two typodont maxillary first premolars were embedded in acrylic resin. Forty positive replicas of epoxy resin dies were used that were divided into two groups depending on the preparation design (n = 20); Group V (Vertical): dies with feather edge finish line and Group MV (Modified vertical): dies with feather edge finish line, where a reverse shoulder of 1 mm depth was placed on the buccal surface 1.5 mm from the occlusal surface. Each group was further subdivided into two subgroups according to the type of ceramic material (n = 10): Subgroup Va and subgroup MVa for lithium disilicate (e.max CAD) and subgroup Vb and subgroup MVb for zirconia (zolid ht+). Crown restorations were made with CAD-CAM technology. The marginal adaptation was assessed using a stereomicroscope both prior to cementation and after cementation and aging. Fracture resistance was tested with a universal testing machine, and the data were statistically analyzed., Results: Marginal adaptation showed no significant differences between subgroups before or after cementation and aging. Three-way ANOVA indicated that preparation design (p = 0.516) and material (p = 0.269) had no significant effect, but cementation had a significant effect (p < 0.0001) on the marginal adaptation. According to two-way ANOVA test, Subgroup (MVb) showed the highest result followed by subgroup (Vb) and subgroub (MVa) and the least was subgroub (Va). Fracture modes showed no significant differences among the subgroups (p = 0.982)., Conclusions: Marginal adaptation of lithium disilicate and zirconia crowns remained clinically acceptable regardless of preparation design. While the modified vertical preparation with a reverse shoulder notably enhanced the fracture resistance of both materials, with zirconia demonstrating superior fracture resistance compared to lithium disilicate with average values exceeding premolar biting force., (© 2024. The Author(s).)

Dental implant restoration shows an effective method for the rehabilitation of missing teeth. The failure rate of periodontal implants in patients with chronic periodontitis is associated with periodontal flora, inflammation, and long-term periodontal bone resorption caused by chronic periodontitis. However, the therapeutic effects of dental implant restoration on inflammation in patients with chronic periodontitis have not addressed. The purpose of this study is to evaluate the risk indicators for inflammation, bone loss and implant failure in patients with chronic periodontitis. A total of 284 patients with dental implant restoration were recruited and divided into periodontally healthy patients (n = 128) and chronic periodontitis patients (n = 156). Periodontal indices including probing depth (PD), sulcus bleeding index (SBI), plaque index (PLI), gingival bleeding (GIL) and bleeding on probing (BOP) were compared in two groups. Inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1 (IL-1), matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) levels at baseline, 6 and 12 months after surgery, and the implant survival rate at 12 months after surgery, as well as the risk factors associated with failure of dental implant were also assessed. Outcomes demonstrated that patients in the chronic periodontitis group had higher values of periodontal indices than those in the periodontally healthy group. All inflammatory parameters in the chronic periodontitis group were higher than those in the periodontally healthy group and negatively associated with the chronic periodontal index (CPI) in chronic periodontitis patients. Chronic periodontitis patients had higher the prevalence of mucositis and peri-implantitis than patients with healthy periodontium. Implant diameter, length and design was associated with the risk of implant failure for chronic periodontitis patients receiving dental implant. The cumulative implant failure rate and incidence of implant fractures for chronic periodontitis patients at 12 months after surgery were 12.10% and 7.23% (p < 0.05), respectively, while were lower in the heathy periodontitis patients. Location, diameter, implant design, immediate loading and bone defect were risk indicators for bone loss for dental implant patients. The risk factors associated with failure of dental implant was higher in chronic periodontitis patients than patients in the periodontally healthy group (14.25% vs. 4.92%, p < 0.05). In conclusion, data in the current study indicate that inflammation is a risk indicator bone loss, implant fracture and implant failure in patients with chronic periodontitis., (© 2024. The Author(s).)

In recent years, a wide variety of materials have been used in dental implant treatment. In selecting the superstructures and abutments to be used it is important to consider their potential effect on the stability and durability of the planned implant. Excessive force applied to an implant during maintenance commonly results in complications, such as fracture of the superstructure or abutment, and loosening or fracture of the screws. This report describes a case of implant treatment for a 23-year-old man with esthetic disturbance due to trauma to the maxillary anterior teeth. The left maxillary central incisor could not be conserved due to this trauma, which had been caused by a traffic accident. After extraction, the tooth was restored with an anterior bridge. The crown of the left maxillary lateral incisor was fractured at the crown margin and, at the patient's request, implant treatment was selected as the restorative treatment for the missing tooth. A thorough preoperative examination was performed using placement simulation software. One titanium screw-type implant was placed in the maxillary left central incisor under local anesthesia. An all-ceramic crown with a zirconia frame was placed as a screw-fixed direct superstructure. At one year postoperatively, however, the superstructure and abutment became detached due to trauma. The fractured zirconia abutment was removed and replaced with a remanufactured abutment and superstructure. The patient has reported no subsequent dental complaint over the last 11 years. In this case, a surface analysis of the fractured zirconia abutment was performed. The scanned images revealed a difference in the fracture surfaces between the tensile and compressive sides, and electron probe microanalysis demonstrated the presence of titanium on the fracture surface. It was inferred that the hard zirconia abutment had scraped the titanium from the internal surface of the implant.

Purpose: The present study evaluated osteopenia (OPN) and osteoporosis (OP) as risk factors for dental implant failure and repeat failure., Methods: We performed a retrospective study on over 100 randomly selected patients per analysis to determine the effect of health status, smoking status, sex, implant location and operative conditions on first and second (re-implantation) implant survival. Analyses were conducted first using chi-squared test, followed by multiple logistic regression for significant variables., Results: In the cohort examining the effect of myriad risk factors on second implant survival, it was found that OPN and OP greatly impacted implant survival, wherein patients with osteoporosis or osteopenia had significantly more implant failures (p = 0.0353). Sex and operative conditions had no effect on implant survival, while implant location showed a notable effect wherein significantly more failures occurred in the maxilla vs mandible (p = 0.0299). Upon finding that OPN and OP have a significant effect on second implant survival, we conducted an additional study focusing on the impact of health status. Based on the multiple logistical regression analysis, we found that OPN and OP are the most significant factor in first implant survival (p = 0.0065), followed by diabetes (p = 0.0297). Importantly, it was observed that early implant failure is also significantly correlated with osteoporosis (p = 0.0044)., Conclusion: We show here a marked relationship in which the risk of first and second implant failure are significantly higher in patients with osteoporosis and osteopenia., (© 2024. The Author(s).)

Aim: Dental caries is a common oral disease in children with special needs such as those with autism spectrum disorders (ASDs). The aim is to assess whether the type and survival of three caries management, conventional resin restorations (CR), ART technique (ART) and SDF application without caries removal (SDF), in primary teeth carried out at the Pediatric Dentistry Department of San Paolo Hospital (University of Milan) differed between children with ASDs and unaffected peers., Methods: Data from a convenience sample of children with and without ASDs, who have received dental care for caries in primary teeth from January 2019 to June 2022, were analysed. Medical history, age, sex, teeth treated, and type of treatment were collected from dental charts. Data on success and minor and major failures of each treatment were also collected. Two survival analysis were performed, one considering both major and minor failures, a second considering only major failures. Cox Proportional Hazards multivariate logistic models were run to assess factors associated with failures. The statistical significance was set at 5% (p< 0.05)., Conclusion: In children with autism, the different techniques for approaching caries lesions seem to have the same probability of success. Therefore, the choice of treatment should be patient-oriented rather than lesion-oriented. In unaffected children, the gold standard always seems to be traditional restorative treatment.

Statement of Problem: The impact of various preparation designs on the fracture resistance and fracture type of mandibular premolars restored with 3 dimensionally (3D) printed, 1-piece endodontic crowns remains unclear., Purpose: The purpose of this study was to investigate the effect of different preparation designs on the fracture resistance and fracture patterns of mandibular premolars restored with 3D printed 1-piece endodontic crowns after thermal aging., Material and Methods: Forty-five freshly extracted mandibular premolars received 3 different preparation designs: with at least 2 intact cuspal walls (2CW), with only 1 intact cuspal wall (1CW), and no cuspal wall present (NoCW). One-piece endodontic crowns were designed by using a computer-aided design (CAD) software program, 3D printed, cemented to the prepared teeth with self-adhesive resin cement, and thermocycled between 5 °C and 55 °C in artificial saliva. Subsequently, all specimens were subjected to a fracture test. The results were statistically analyzed using 1-way ANOVA (α=.05), and fracture types of all specimens were examined using a light microscope., Results: The analysis of fracture resistance values across separate designs revealed no statistically significant differences (P>.05). Mean fracture resistance values were 724.5 N in 2CW, 713 N in 1CW, and 861 N in NoCW. In 2CW and 1CW, the 1-piece endodontic crowns mostly displayed Type III fractures, whereas those in NoCW exhibited a combination of Type II and Type III fractures., Conclusions: The mandibular premolar 1-piece endodontic crowns tested in this study exhibited similar fracture resistance and type of fracture with different preparation designs., (Copyright © 2024 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

A conservative approach to restoration assists in preserving the remaining tooth structure of extensively destroyed vital teeth. This case report describes a single-appointment chairside technique for placement of ceramic restorations in posterior teeth. A patient presented for treatment of her mandibular right first molar, which had a fractured resin-based composite restoration. Due to the presence of vital pulp, extent of the restoration, and presence of caries in the tooth, the following treatment plan was proposed: placement of a lithium disilicate glass-ceramic onlay fabricated with a computer-aided design/computer-aided manufacturing workflow. After the dentist removed the restoration and performed selective caries removal, structural analysis guided the reduction of the buccal cusps. Immediate dentin sealing was performed with a 2-step self-etching adhesive system, and a 1-mm-thick layer of flowable resin-based composite was placed as a resin coating. A digital impression was obtained, the onlay restoration was designed, and a lithium disilicate block was milled and subsequently crystallized. When the onlay was completed, the tooth preparation was sandblasted, selectively etched, and coated with a universal adhesive. The intaglio surface of the onlay was cleaned and primed, the onlay was bonded with dual-cure resin cement, and occlusal adjustments were completed. Follow-up examinations at 1 and 4 months revealed the clinical success of the case. From start to finish, it takes approximately 2.5 hours to produce a single-appointment chairside restoration. The technique used in this case offers a fast-paced workflow that is comfortable and practical for the patient and provides a predictable clinical outcome without the need for a temporary restoration., Competing Interests: No conflicts of interest reported.

This report of four clinical cases aims to illustrate the use of a lateral implant as a solution for implant overdentures in the mandible in different clinical situations. The first two cases describe the clinical situations of patients wearing two-implant mandibular overdentures until the failure of one of the implants, one due to implant loss and the other due to a fracture of an abutment screw, and how the conditions were managed. The third case illustrates the placement of a single implant to retain an overdenture, where a midline implant, as originally planned, was not feasible due to anatomic reasons. The final case describes the use of a lateral implant to support and retain a single-implant mandibular overdenture. The four cases demonstrate that a single lateral implant can be utilized as sole retention in cases of a failing contra-lateral implant and as an alternative to a single implant in the midline., (© 2024 The Authors. Journal of Prosthodontics published by Wiley Periodicals LLC on behalf of American College of Prosthodontists.)

Purpose: To identify the factors affecting the risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment., Methods: The study protocol followed the best practices of evidence-based medicine and was registered in PROSPERO. A comprehensive literature search was performed electronically in six databases (PubMed, Embase, SCOPUS, Web-of-Science, Lilacs, and Cochrane) on 18-09-2023. It was saved in EndNote-online and duplicates were removed. Selection of articles was performed in two stages, followed by data-extraction, risk of bias assessment, data-analysis, and meta-analysis. The quality of evidence for the outcomes was assessed by the GRADE-approach., Results: The study included six articles that had similar selection protocols with variations in duration from trauma to treatment and the observation period. Only one study employed pre-attachment fragment preparation and three performed post-attachment reinforcements. Overall loss of fragment was 20% (95%CI-13,30%). When the risk ratio for loss of restoration or fragment was compared, it was found to be 2.21 (95%CI-1.52,3.21) in uncomplicated crown fractures, 2.54 (95%CI-1.35,4.79) in complicated crown fractures. The risk of bias was found to be low in two and moderate in four studies. Grade of evidence for all the outcomes was very low., Conclusion: Fragment loss was lowest in uncomplicated crown fractures where reinforcement had been performed, and highest when bonding was done in complicated crown fractures without reinforcement. The risk of fragment loss was higher than the loss of composite restorations., (© 2024. The Author(s), under exclusive licence to British Dental Association.)

Objective: To evaluate the mechanical performance of patient-specific prefabricated temporary shell versus laboratory-fabricated CAD/CAM provisional restorations on titanium temporary abutments, with and without thermo-mechanical ageing., Materials and Methods: Implants with a conical connection were divided into four groups (n = 24) and restored with temporary shell or laboratory-fabricated central or lateral incisor PMMA restorations that were relined or bonded on titanium temporary abutments. The diameter of the central and lateral incisor groups' implants was regular (ϕ 4.3 mm) or narrow (ϕ 3.5 mm), respectively. Half of each group's specimens were subjected to ageing, simultaneous thermocycling (5-55°C) and chewing simulation (120,000 cycles, 50 N, 1.7 Hz) resulting in eight groups in total (n = 12). The aged specimens were evaluated with optical microscopy, and survival and complication rates were determined according to modified USPHS criteria. The non-aged specimens and those that had survived ageing were loaded until failure, whereupon bending moments were calculated., Results: Survival rates after ageing were 100% for all groups. Apart from wear facets (ϕ 2-3 mm) on the palatal restoration surface, no complications were observed. The mean fracture load and bending moments ranged between 597.6-847.1 N and 433.3-550.6 Ncm, respectively, with no significant differences between the eight groups (p = .25; p = .20)., Conclusions: As patient-specific temporary shell central and lateral incisor provisional implant-supported restorations are mechanically stable enough to withstand clinical bite forces, even after thermo-mechanical ageing, they may serve as an alternative to laboratory-fabricated provisional restorations., (© 2024 The Author(s). Clinical Oral Implants Research published by John Wiley & Sons Ltd.)