Retrospective evaluation of fiber-reinforced periodontal splints and resin bridges in the anterior region

Aim: The aim of this study was to evaluate the clinical performance of fiber-reinforced periodontal splints (FRSs) and adhesive bridges (FRBs) in treating anterior single-tooth defects. Methodology: Sixty-five patients who received FRSs and FRBs from 2001 to 2012 were recalled and evaluated clinically. The FRS and FRB restorations of the patients were clinically evaluated in terms of anatomical form, marginal adaptation, marginal coloration, secondary caries, and retention, according to the modified United States Public Health Service (USPHS) criteria. The current restoration statuses of the patients from 5 to 10 years post-treatment were photographed and recorded. Patient satisfaction level was assessed using a visual analogue scale (VAS), and periodontal pocket depth was measured. Clinical follow-up data were obtained and analyzed with the Chi-squared test (p<0.05). Results: When each of the modified USPHS criteria was compared with the baseline values, statistically significant differences were observed between the groups. There were statistically significant differences when the categories were evaluated according to initial values (p<0.05). When the clinical evaluation criteria were compared with each other, no statistically significant differences were found (p>0.05). While the most successful results were obtained in the FRB group, most of the restoration losses and repairs occurred in the FRS group. According to the data obtained, 38% of restorations were lost and all restorations had been intact for at least 5 years. All lost restorations were in FGS restorations. The recall rate was 49% (n=32). Twenty (62.5%) of 32 patients rated their satisfaction with the restorations as being between 90 and 100, 8 (25%) as being between 80 and 90, and 4 (12.5%) as being between 70 and 80 on the VAS scale. The pocket depths of the patients at 5- and 10-years post-restoration were 2.3–3.8 mm and 2.4–5.2 mm, respectively. Conclusion: Fiber-reinforced restorations performed due to the loss of anterior single teeth and periodontal tissue can serve patients clinically for at least 5 years. FGK and FGS restorations can be considered alternative treatments that can further delay the more expensive implant and prosthetic treatment options for years. How to cite this article: Ünlü N, Altınbilek N, Velioğlu MS. Retrospective evaluation of fiber-reinforced periodontal splints and resin bridges in the anterior region. Int Dent Res 2021;11(Suppl.1):122-7. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.19 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Clinical Outcome of Class II direct composite restorations using total-Cetch versus selective etch adhesives

Background: The composite restoration of anterior is always a challenging job. Aim: To compare the clinical outcome of class 2 direct composite restorations using total-etch and selective etch adhesives, according to USPHS criteria. Methods: One hundred patients were included in this randomized controlled clinical trial study at Operative Dentistry department of LMDC, Lahore. They were divided in two groups. Group 1 for total etch technique, group 2 for selective etch technique enamel was etched with 37% phosphoric acid for 20 second and then washed thoroughly with water for 5-10 seconds and was dried with air for 5 seconds till frosty white and bond with self etch. Results: The majority of patients were in the age range of 25-31 years, 25 (50%) patients used total etch technique and 22 (44%) patients used selected etch technique. When compare the overall rating for restorations, 38 patients (76%) have acceptable restoration in total etch technique and 46 patients (92%) in selected etch technique. Statistically the difference was significant (P<0.05). Conclusion: Selected etch technique presented a successful clinical performance over total etch technique for Class II restorations. Keywords: Class II direct composition restoration, Total etch technique, Selected etch technique.

Clinical Evaluation of Resin Composite CAD/CAM Restorations Placed by Undergraduate Students

To evaluate the clinical outcomes of resin composite CAD/CAM restorations in a prospective cohort study, and to assess patient and operator satisfaction after restoration placement, 59 indirect resin composite were placed by supervised undergraduate students, of which 43 restorations were followed over a mean period of 28 months (14–44 months) and evaluated using USPHS criteria. Patient and operator satisfaction levels were assessed using a visual analogue scale (VAS) after restoration placement. A total of 37 patients and 47 restorations were included for further study. Four teeth were extracted—three due to extensive drug-induced secondary caries in the same patient, and one tooth due to large periapical periodontitis after 44 months of service. The overall survival rate was 91.4%, and success rate was 87.2%. Differences between baseline and endpoint scores were significant for marginal discoloration (p < 0.05) and adaptation (p < 0.001). Color match (p < 0.05) and surface texture (p < 0.001) differed significantly, affecting all restoration types. VAS scores for patient and operator satisfaction showed a significant rank correlation (p < 0.01), and pairwise comparison showed significant differences for mean overall patient and operator VAS scores (p < 0.001). Lava Ultimate CAD/CAM may be considered a suitable material for overlays and endocrown restorations when combined with IDS, air abrasion, and MDP-containing adhesive systems. Marginal disintegration may present in inlays and onlays over time.

Efficacy of conventional fluoridated toothpastes containing arginine and high-fluoride toothpastes on the control of root caries in patients undergone radiotherapy of head-and-neck: a randomized controlled trial

This parallel, triple-blind RCT evaluated the restorative performance of a resin-modified glass-ionomer-cement (RMGIC) in irradiated patients and the prevention of root caries lesions adjacent to restoration, comparing the effect of conventional (control) concentration, high-fluoride (F) containing fTCP and arginine-based toothpastes. A total of 63 lesions was screened and 60 were included into randomized distribution into three groups (N- participants in baseline/n- root caries lesions): G1 = 1,450 ppm F (N = 10/n = 17); G2 = 5,000 ppm F + fTCP (N = 7/n = 18) and G3 = 1,450 ppm F + arginine + CaCO3 (N = 6/n = 25). Based on eligibility criteria, all patients were mandatory enrolled after completed 3-month of radiotherapy of head-and-neck. Two calibrated operators performed the restorative procedures (RMGIC - Vitremer) and two calibrated examiners (Kappa = 0.94) evaluated the restorations based on modified USPHS criteria at baseline, 1, 3 and 6-month follow-up. Data was collected and statistically assessed with Kruskal-Wallis test (p < 0.05). There were no statistically significance differences among the performance of the restoration among the three groups regarding the criteria retention, marginal adaptation, marginal staining, post-operative sensitivity, adjacent caries, color alteration, anatomic form and surface texture (p > 0.05). Even with oral complications caused by radiation-therapy, if the restorations are properly performed and patients are under professional supervision, high-F presented similar efficacy of arginine and conventional-containing toothpastes to prevent secondary caries. Clinical relevance: This clinical trial brings new evidences about the regular use of high-F, arginine-based and conventional-F containing toothpastes in irradiated patients under supervision of a multidisciplinary team and the encouragement of self-cooperation.

Vertical Bite Rehabilitation of Severely Worn Dentitions with Direct Composite Restorations: Clinical Performance Up To 11 Years

Our aim was to evaluate the clinical performance of direct composite restorations placed in patients with severely worn dentitions at an increased vertical dimension of occlusion, after up to 11 years. One hundred and sixty-four teeth in 13 patients with severely worn dentitions had been reconstructed with either microhybrid (first cohort; n = 59) or nanofilled (second cohort; n = 105) composite restorations at increased vertical dimension of occlusion using a wax-up-based template-aided placement technique. From the dental records, information about repair and replacement of restorations was obtained. Patients were clinically examined after a mean follow-up time of 10.7 years (first cohort) or 5.2 years (second cohort) using United States Public Health Service (USPHS) criteria. Subjective patient satisfaction was also recorded using visual analogue scales (VAS). The overall quality of the restorations was good with predominantly ‘Alpha’ and ‘Bravo’ scores, respectively. Nanofilled composite showed less surface degradation and better margin qualities than microhybrid composite. Of the 59 restored teeth in the first cohort, 13 restorations showed unfavorable events after 10.7 years, of which ten could be repaired. In the second cohort, 23 of 105 restorations showed unfavorable events, which could all be repaired. VAS scores revealed high patient satisfaction with the treatment approach. In conclusion, direct composite restorations placed at an increased vertical dimension of occlusion show good clinical long-term performance in patients with severe tooth wear.

Evaluation of single crowns using USPHS criteria during cementation - A retrospective study

The modern era is seeing an incline in dental health issues namely dental caries, missing teeth, etc. causing an increased use of prosthetics to replace the function of such teeth or provide esthetics. This has led to various studies in this field to improve the quality and lifespan of the crowns. An important aspect of this is to consider the cementation process and luting material used, which are crucial in determining the result. A retrospective study was done on patients reporting to Saveetha Dental College and Hospitals. A sample size of 1055 was obtained and data tabulated using the Excel sheet. SPSS software was used to analyze the data statistically. Chi-square test was done to evaluate the association between tooth type and cement used, USPHS scores for adaptation, colour match, marginal discoloration and surface roughness. The study revealed that GIC was the most common luting material used which was statistically significant and lower molars were the most involved sites for cementation. The most common USPHS score for adaptation, marginal discoloration and surface roughness for all types of tooth was Score 0. For color match, the most common USPHS score was Score 1.

Influence of different application protocols of universal adhesive system on the clinical behavior of Class I and II restorations of composite resin – a randomized and double-blind controlled clinical trial

Background Multimode adhesives incorporate the versatility of adapting to various clinical situations by its capacity to be used in different protocols. This study aimed to evaluate the clinical behavior of composite resin direct restorations (Class I and II) performed with different universal dentin adhesive application protocols comparing adapted FDI and adapted USPHS criteria. Methods The current study is a randomized, double-blind, split-mouth, and convenience sample controlled clinical trial. The participants (age ≥ 18 years) had restorative need of Class I and/or II due to the presence of carious lesions and/or unsatisfactory restorations in at least three dental elements. Each participant received three application protocols for Scotchbond Universal adhesive (3M ESPE), one in each tooth to be restored: ER = etch-and-rinse + adhesive (n = 50); SEE = selective enamel etch + adhesive (n = 50) and SE = self-etch adhesive (n = 50). All teeth were restored in a similar way using Filtek™ Supreme composite resin (3M ESPE). Restorations were evaluated using the adapted FDI and adapted USPHS criteria, at baseline after 7 to 21 (12.02 ± 5.68) days (T1; n = 50 per group) and after 12 to 20 (15.8 ± 2.7) months (T2; n = 46 per group) by two previously calibrated evaluators (Kappa > 0.80). The statistical tests were performed between groups (Friedman), intragroup (Wilcoxon), and between the criteria considering acceptable and not acceptable restorations (McNemar), α = 0.05. Results A statistically significant difference was observed only for the property “superficial staining”, between groups at T2 (p = 0.01) for ER (n = 13 with score 2 or more) and SEE (n = 3 with score 2 or more) and intragroup for ER (T1, n = 1 with score 2 or more; T2, n = 13 with score 2 or more, p = 0.001) and SE (T1, n = 0 with score 2 or more; T2, n = 8 with score 2 or more p = 0.007). For the other comparisons between groups, intragroup, and between the adapted FDI and adapted USPHS criteria, there were no statistically significant differences (p ≥ 0.05). Conclusions It can be concluded that the different application protocols of the universal adhesive resulted in clinically “acceptable” restorations after 15.8 ± 2.7 months of follow-up. Adapted FDI and adapted USPHS criteria provided similar results to each other. Trial registration. Number in Brazilian Registry of Clinical Trials (ReBEC): RBR-9p3hdp. Registered 24 May 2015.

Repair or Observation of Resin Margin Defects: Clinical Trial After Five Years

SUMMARY Objective: To assess the effectiveness of repair/resealing of stained composite margins as an alternative to controlled observation without treatment in a randomized clinical trial after five years. Methods and Materials: Each patient recruited had from one to three composite restorations with visible margin discoloration. Initially, the characteristics of each defect were recorded with direct vision through a surgical microscope at 20× magnification. Clinical evaluation was done by two independent examiners using modified USPHS criteria for color, margin discoloration, and margin adaptation. Each restoration was then randomly assigned to a control or treatment group. Control restorations were observed yearly for the presence of recurrent caries; treatment restorations were resealed by exposing the margin with a ¼ round bur, removing all interfacial stain, acid etching, placing an adhesive bonding agent, and a flowable composite to restore margin integrity. There were 152 patients recruited, with 360 restorations (180 control and 180 treatment). Results: At five years, 104 patients were recalled (68%) with 271 restorations (76%): 136 untreated control and 135 resealed restorations. At that time, 61 restorations had been lost or replaced for nonrelated reasons. Clinical evaluation of the remaining 210 restorations determined penetrating discoloration (control = 81%, resealed = 46%) and margin crevice formation (control = 21%, resealed = 11%). Recurrent caries was diagnosed cumulatively in only six control and five treatment restorations (&lt;5%). Microscopically, 49 control restorations (49%) and 36 resealed restorations (33%) had crevice formation. Discoloration was distributed as follows: 9% vs 47% with no discoloration, 30% vs 33% in the composite, 49% vs 18% in the interface, and 12% vs 2% in tooth structure. Conclusions: Resealing of restorations with margin discoloration reduced the occurrence of penetrating stain from 81% in controls to 46% in resealed margins and crevicing from 21% to 11% after five years. Both controlled observation and resealing of margins resulted in a similar very low incidence (&lt;6%) of recurrent caries.

Evaluation of patient satisfaction and shade matching of Vita Suprinity versus lithium disilicate (E-max) ceramic crowns in the esthetic zone: a randomized controlled clinical trial

Background: Optical impairments of teeth in the esthetic zone constitute a problem for many dentists and patients as several studies concluded that patients were dissatisfied of their dental appearance because of their restorations' color. The purpose of this study was to assess patient satisfaction combined with shade matching of VITA SUPRINITY versus lithium disilicate (IPS e-max CAD) all-ceramic crowns in esthetic zone. Methods: 26 patients with teeth problems indicated for full coverage restoration on one tooth in the esthetic zone (from upper central incisor to 1st premolar) were randomized into 2 equal groups (n=13) for which different CAD-CAM ceramic materials were used; (VITA SUPRINITY) a zirconia reinforced lithium silicate ceramic and (IPS e.max CAD) lithium disilicate glass ceramic. The crowns were fabricated to match the shade of the contra-lateral/ adjacent tooth and assessed using the modified USPHS criteria. Also patient satisfaction was assessed. The data obtained by evaluating each assessment criteria were statistically analyzed using the Chi-square test that was performed in categorical data. Results: According to the modified USPHS criteria, 100% of the patients were Alpha score with 0% for Bravo, Charlie and Delta scores in both groups. While according to the visual analogue scale (VAS), 100% of the patients were satisfied while 0% were dissatisfied by the restoration in both groups. Conclusions: The results for both materials in terms of patient satisfaction and shade matching were Alpha. This indicated that both materials are clinically accepted to be used as full coverage restorations for excellent esthetic outcome. Registration: NCT0284611.

Evaluation of Three Esthetic Restorative Materials Used for Carious or Noncarious Cervical Lesion Restoration

Background: Cervical lesions appear on the cervical surface of the lingual or buccal side of the tooth and are classified into carious and non-carious lesions. Aim: The present study evaluates the performance of three different types of aesthetic restorative materials, used for the restoration of carious or non-carious cervical lesions. Materials and methods: The study comprised 195 cervical lesions in 45 patients. The restorations were carried out for non-carious cervical lesions in 34.62% of the cases, for primary carious lesions in 40.00% of the cases, and to replace a previous restoration in 25.38% of the cases. The restorations were evaluated at 2 weeks (the reference line), and then at 1 and 2 years after placement. The following have been assessed: restoration retention, color harmonization, surface texture, margin discoloration, anatomical contour, margin integrity, and the presence of secondary caries. The characteristics were registered in conformity with the modified USPHS criteria. Results: At the one-year evaluation, we noticed the loss of 12 restorations, and after 2 years, the loss of 19 restorations. The results showed significant differences between restorative materials regarding color, margin adaptation, margin coloration, surface texture, as well as criteria regarding the anatomical contour (p <0.05). Conclusions: The evaluation of the success of restorative material retention must consider the location of the cervical lesion. A successful treatment depends particularly on a full understanding of the factors that caused the lesions and on the method of their treatment.