Gabriele Augusti

Inlay-retained fixed dental prosthesis: a clinical option using monolithic zirconia.

Different indirect restorations to replace a single missing tooth in the posterior region are available in dentistry: traditional full-coverage fixed dental prostheses (FDPs), implant-supported crowns (ISC), and inlay-retained FDPs (IRFDP). Resin bonded FDPs represent a minimally invasive procedure; preexisting fillings can minimize tooth structure removal and give retention to the IRFDP, transforming it into an ultraconservative option. New high strength zirconia ceramics, with their stiffness and high mechanical properties, could be considered a right choice for an IRFDP rehabilitation. The case report presented describes an IRFDP treatment using a CAD/CAM monolithic zirconia IRFDP; clinical and laboratory steps are illustrated, according to the most recent scientific protocols. Adhesive procedures are focused on the Y-TZP and tooth substrate conditioning methods. Nice esthetic and functional integration of indirect restoration at two-year follow-up confirmed the success of this conservative approach.

Effect of different dental articulating papers on SEMG activity during maximum clenching.

This study evaluated the influence of two different occlusal indicators (articulating papers of 40μm and 200μm) on muscular activity of the temporalis anterior (TA) and superficial masseter (MS) during maximum voluntary clenches (MVC), using surface electromyography (SEMG). It was hypothesized that an articulating paper positioned between dental arches during MVC elicits a different muscular activity compared with the occlusion on natural dentition (without the occlusal indicator). 30 healthy adult subjects with a complete, natural dentition were recruited; SEMG activity was recorded in the following experimental conditions: MVC with cotton rolls for standardization purposes; MVC on natural dentition; MVC onto the 40μm or 200μm paper indicator positioned on right or left side of the dental arch. Percentage Overlapping Coefficient (POC; separate values obtained for TA and MS), antero-posterior coefficient (APC) and total muscle activities (IMP) were the analyzed SEMG parameters. The use of an occlusal indicator statistically changed POC_TA, POC_MS and IMP median values (p<0.05). Both 40μm and 200μm occlusal papers did not significantly affect APC values (P=0.86). A pronounced asymmetric muscular activity has been recorded with the introduction of an interocclusal media. All indices of muscular activity did not differ between sexes (Kruskal Wallis test, P>0.05). In conclusion, the examined articulating papers affected two specific SEMG parameters (POC and IMP); the recorded muscular activity with the occlusal indicator varied regardless left or right side positioning, and independently from tested paper thicknesses.

Removal of temporary cements following an immediate dentin hybridization approach: a comparison of mechanical and chemical methods for substrate cleaning

Abstract This study evaluated the microshear bond strength (μSBS) of a composite resin cement to a pre-hybridized dentinal substrate exposed to two kinds of temporary materials; the influence of different cleaning techniques was investigated. Dentinal surfaces were conditioned with an etch-and-rinse adhesive system to obtain an immediately-sealed (IDS) layer. Each surface was divided into quadrants and covered (1) with an eugenol-free (NE_Group) or (2) with a resin-based provisional agent (CL_Group). After storage, the temporary cement was removed by using one of the following methods: (1) Hand-scaler [S]; (2) Alumina air-abrasion [SB]; (3) Glycine-powder air-abrasion [Gly]; (4) D-Limonene chemical solvent [Or]. A new IDS layer was then created; polyethylene tubes were placed on dentin surfaces and filled with a dual-cure resin cement. A universal testing machine was used for the μSBS tests; conditioned surfaces were analyzed at SEM. Means and SD were calculated; a two-way ANOVA (a: 0.05) was performed to detect significant differences among groups. For NE groups, mean μSBS values (MPa) were: 21.6 ± 6.6 [NE_NoT]; 20.7 ± 4.5 [NE_Or]; 20.1 ± 6.6 [NE_SB]; 19.1 ± 5.3 [NE_S]; 17.8 ± 2.2 [NE_Gly]. No significant differences were found among tested treatments within NE (p: 0.5493). For CL groups, mean μSBS values (MPa) ranged from 15.8 ± 2.8 (CL_S50) to 19.4 ± 2.9 (CL_Gly). Cleaning of the substrate with glycine air-abrasion statistically improved μSBS values with respect to aluminum-oxide (CL_SB: 15.8 ± 2.8) or scaling (CL_S: 16.0 ± 2.4). The application of the IDS technique was effective for preservation of freshly-cut dentin from adverse effects of temporary materials. Glycine air-abrasion is suggested when a temporary resin cement is adopted.

Unexpected Complication Ten Years after Initial Treatment: Long-Term Report and Fate of a Maxillary Premolar Rehabilitation

Full-coverage restorations represent a well-known rehabilitation strategy for compromised posterior teeth; in the last years, new ceramic materials like zirconia have been introduced and widely adopted for the prosthetic management of molar and premolar areas. A long-term follow-up of a maxillary premolar rehabilitation using a veneered zirconia crown is presented; after ten years of uneventful clinical service of the tooth-restoration complex, a serious complication—namely, a vertical root fracture (VRF)—occurred. An extended time lapse (9 years) between the end of restorative procedures and development of symptoms due to VRF has been observed. On the other hand, a complete functional and esthetic integrity of the zirconia crown (without chippings or crack development) is documented along the follow-up period. Due to periodontal breakdown and severity of fracture, the premolar was extracted. The illustrations of our late failure, aetiological factors, and available data on the literature regarding VRF are addressed. Patients and clinicians should be aware of potential occurrences of some long-term, serious complications when dealing with previously treated and/or structurally weakened teeth. The development of a VRF might be unexpected and might occur many years after the end of tooth rehabilitation, despite adoption of contemporary restorative protocols and techniques.

Effect of thermal cycling and low pressure sandblasting on the bond strength of a self-adhesive cement to Y-TZP zirconia

The aim of this investigation was to assess the influence of several surface treatments on the shear bond strength (SBS) of a self-adhesive resin cement containing 10-methacryloxydecyl-dihydrogenphosphate monomer to densely sintered zirconia ceramic, before and after thermal cycles. Hundred densely sintered zirconia cylinders were divided into five groups (n = 20). Each of them received a different surface treatment: (1) control [No_T], with the zirconia surface unconditioned, (2) low pressure air abrasion [Sand_S], (50 μm, 1 bar), (3) standardized air abrasion [Sand_H], (50 μm, 2.8 bar), (4) standardized Rocatec™ Plus (silica-coated alumina oxide) air abrasion (2.8 bar) and silanization [Roc_H], (5) low pressure Rocatec™ Plus (silica-coated alumina oxide) air abrasion (1 bar) and silanization [Roc_S]. Five more surface-treated specimens were addressed to scanning electron microscope for qualitative observations. After specimen fabrication, subgroups of 10 bonded samples were stored in water either for 24 h (T1) or subjected to 5000 thermal cycles (T2); SBSs were determined with a universal testing machine at a crosshead speed of 1 mm/min. At T1, mean SBSs (MPa) obtained for the examined groups were: [Sand_H] 16.24 ± 2.95; [Sand_S] 16.01 ± 2.68; [Roc_H] 17.17 ± 1.64; [Roc_S] 15.92 ± 1.99. All surface treatments positively affected (p < 0.05) the initial self-adhesive cement adhesion to zirconia with respect to No_T (13.29 MPa). Artificial aging decreased the bond strength in all test groups significantly, but no spontaneous debonding was observed in [No_T]: at T2, SBS values ranged from 7.76 ± 2.37 (No_T) to 8.89 ± 1.74 (Sand_S), with no statistically significant difference between groups (p = 0.5293). Both air abrasion with alumina oxide and Rocatec™ universal bonding system, used with hard or low air pressure, produced comparable effects on cement–zirconia interface before and after thermal cycles. After artificial aging, minimal differences in bond strength values between sandblasted and control groups were not of statistical significance.