Domenico Cascione

Immediate dentin sealing supports delayed restoration placement

STATEMENT OF PROBLEM Immediate dentin sealing (IDS) is a new approach in indirect restorations. Dentin is sealed immediately following tooth preparation, prior to impression making. It is not known whether it is still possible to obtain an efficient bond between the resin-coated dentin and the restoration after 2 to 4 months of placement of provisional restorations. PURPOSE The purpose of this study was to determine if there were differences in microtensile bond strength to human dentin using the IDS technique when comparing 2, 7, and 12 weeks of delay until restoration placement, using 2 different dentin bonding agents (DBAs). Previously published preliminary IDS data were included for comparison. MATERIAL AND METHODS Fifty freshly extracted human molars were obtained and divided into 10 groups. A 3-step etch-and-rinse DBA (Optibond FL) and a 2-step self-etching DBA (SE Bond) were used. For each DBA, the control (C) specimens were prepared using a direct immediate bonding technique and composite restoration (Z100). Preparation of the other specimens used an indirect approach without dentin prebonding (delayed dentin sealing, DDS) or with immediate dentin sealing (IDS), immediately following preparation. IDS teeth had provisional restorations (Tempfil inlay) placed for 2 weeks (IDS-2W), 7 weeks (IDS-7W), or 12 weeks (IDS-12W) before restoration placement. All teeth were prepared for a nontrimming microtensile bond strength test (MTBS) 24 hours after definitive restoration with composite overlays (Z100). Ten to 11 beams (0.9 x 0.9 x 11 mm) from each tooth were selected for testing. MTBS data obtained from the 10 experimental groups were analyzed with a 2-way analysis of variance (ANOVA, dentin bonding system, and sequence of application) with each tooth (mean MTBS from the 10-11 beams) used as a single measurement. The Tukey HSD post hoc test was used to detect pairwise differences among experimental groups (alpha=.05). Fractured beams were also analyzed under stereoscopic microscope (x 30) and SEM. RESULTS For both adhesives, the mean microtensile bond strengths of C and all IDS groups were not significantly different and exceeded 45 MPa. DDS groups exhibited lower bond strength than all others sequences (P<.001) with SE Bond at 1.81 MPa significantly lower (P=.026) than Optibond FL at 11.58 MPa. The highest mean microtensile bond strength values were found with Optibond FL at 7 weeks (66.59 MPa) and 12 weeks (59.11 MPa). These were significantly higher than SE Bond in the same conditions with values of 51.96 MPa and 45.76 MPa (P=.001 and P=.003), respectively. Failures in DDS groups were all interfacial and purely adhesive. Both C and IDS-2W groups demonstrated interfacial failure that was typically mixed with both areas of failed adhesive resin and areas of cohesively failed dentin while IDS-7W and IDS-12W failed consistently between the existing resin coating (used during IDS) and the overlaying composite resin. CONCLUSIONS When preparing teeth for indirect bonded restorations, IDS with a 3-step etch-rinse or a 2-step self-etching DBA (prior to impression making) results in microtensile bond strength similar to that obtained with a freshly placed adhesive. The bond strength is not affected by up to 12 weeks of elapsed time prior to placement of the definitive restoration.

Diagnostic mock-ups as an objective tool for predictable outcomes with porcelain laminate veneers in esthetically demanding patients: A clinical report

This clinical report demonstrates how a clinician can objectively overcome some of the barriers associated with providing patients with predictable esthetics, in a mutually satisfactory manner. Two such barriers are identified and discussed. The first is related to psychology and patient attitude to treatment. The second is related to the actual clinical procedure. A direct mock-up technique is described which serves as an effective communication tool between the dentist, patient, and dental laboratory technician.

Simulated tissue using a unique pontic design: a clinical report.

Unfavorable relationships between the residual edentulous ridge, pontic, and gingival papilla may compromise the definitive result of a restoration. Different procedures have been described and developed to improve the relationship between esthetics and functionally acceptable fixed partial dentures. This article describes a unique pontic design as well as the application of pressure during insertion of the pontic to achieve proper tissue displacement. Controlled pressure enhances the interdental papilla and creates the illusion of pontics emerging from the soft tissue, providing the restoration with a natural-looking effect.

Restoration using gingiva-colored ceramic and a ridge lap pontic with circumferential pressure: A clinical report

Achieving an optimal esthetic result when replacing missing teeth with implant-supported restorations in the esthetic zone is a demanding surgical and restorative challenge. This clinical report describes the use of a cantilevered, cemented, implant-supported restoration with gingiva-colored ceramics and a circumferential pressure-ridge lap pontic to replace 2 incisors and the adjacent tissue.

Fabrication of the mandibular implant-supported fixed restoration using CAD/CAM technology: A clinical report

The mandibular implant-supported fixed restoration is an appropriate treatment choice for patients with inadequate bone volume in the posterior mandible. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has broadened the scope and application for this treatment option. A milled titanium bar retaining individual all-ceramic zirconium oxide crowns, with composite resin replicating gingival tissues, is recommended as an acceptable variation for this type of prosthesis. An alternative method for fabricating a mandibular implant-supported fixed restoration using CAD/CAM technology is described.

Anterior Provisional Restorations Used to Determine Form, Function, and Esthetics for Complex Restorative Situations, Using All-Ceramic Restorative Systems

A technique is proposed for the restoration of a large and visible maxillary anterior defect. The importance of proper diagnosis, treatment planning, and communication is emphasized. Irreversible treatment should only be rendered once patient approval has been obtained through objective evaluation with provisional restorations. The techniques presented in this article use a combination of ceramic systems currently available to satisfy functional demands while achieving acceptable esthetics. A controlled series of steps, where the provisional restorative components are being replaced by the definitive ones is planned. The only difference between the provisional and definitive restorative components is the material used. The definitive restorations consisted of an implant-supported zirconium oxide framework. Individual pressed porcelain restorations were luted to the framework and a natural tooth. CLINICAL SIGNIFICANCE Provisional restorations allow an objective form of communication. Vertical and horizontal transitional lines can be effectively masked with appropriate treatment planning and a skilled ceramist. Many traditional dental laboratory steps may be eliminated or simplified without compromising the definitive restorations.