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Influence of the ferrule effect on the failure of fiber-reinforced composite post-and-core restorations: A systematic review and meta-analysis

Published online: June 18, 2019

Abstract

Statement of problem

The survival and/or success of post-retained restorations is influenced by the amount of residual coronal structure, known as the “ferrule effect.”

Purpose

The purpose of this systematic review and meta-analysis was to evaluate whether the presence or absence of the ferrule effect influences the failure rate of fiber-reinforced composite post-and-core restorations.

Material and methods

A comprehensive review of the literature was performed using the PubMed/Medline, Embase, Scopus, and Cochrane Library databases for articles published up to May 2018. The risk ratio with 95% confidence interval was estimated using the Mantel-Haenszel method. Potentially eligible studies were selected based on the reading of the abstracts and full text of prospective clinical trials, randomized clinical trials, or prospective randomized studies, all with a minimum of 10 participants in each group, with a follow-up period longer than 6 months, and published in English.

Results

Of the 380 studies retrieved, 4 were included in this meta-analysis. A total of 297 teeth were evaluated, 157 with a ferrule and 140 without a ferrule. The mean survival rate was 88.35% in the ferrule group and 78.05% in the nonferrule group. No statistically significant difference was noted in the general failure analysis (risk ratio: 0.71 [95% confidence interval: 0.47 to 1.06]; P=.09), although a higher number of failures occurred in nonferrule restorations. More controlled and randomized clinical trials are needed to establish a clinical protocol for the use of post-retained restorations.

Conclusions

Despite the limited number of available studies, the results of this meta-analysis suggest that the ferrule effect does not significantly reduce the failure rate in fiber-reinforced composite post-and-core restorations.
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The 3-P’s of Composite Bonding: Potential, Predictability and Profitability

Dr. Buddy Mopper will be presenting “The 3-P’s of Composite Bonding: Potential, Predictability and Profitability” at a new location, The University of Chicago’s Gleacher Center in downtown Chicago on September 27, 2019.
Dr. Mopper is one of the pioneers of direct resin bonding who has taught thousands of clinicians how to successfully incorporate direct resin bonding into their practices. In this 7 CE-credit course, you will understand how to utilize bonding in ways you never expected.
Join this class and discover how to treat more patients chairside.  Learn all the composite dentistry that you may be missing in your practice and how doing more of it can benefit you financially and professionally. This full-day lecture will teach you how to make long-lasting, seamless and invisible restorations of all types. Learn an in-depth direct approach technique for Class III, Class IV, Class V, diastema closure, direct resin veneer, masking dark teeth, incisal reinforcement, repairs and more. From simple techniques to advanced techniques, this course covers it all.
Call Erika at 800-837-2321or visit www.CEEchicago.com to register.  Hurry, seating is limited, and this lecture will fill-up fast!
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CS 3600 Intraoral Scanner Tested to Have Highest Accuracy in Latest Implantology Study

FOR IMMEDIATE RELEASE: June 19, 2019
When it comes to placing implants accuracy matters, and the CS 3600 intraoral scanner was found to give the most accurate results during a new study, “Trueness and Precision of Five Intraoral Scanners in the Impressions of Single and Multiple Implants: A Comparative In-Vitro Study.”1
With few peer-reviewed studies evaluating the clinical efficacy of intraoral scanners in implantology, these latest findings from Drs. Francesco Guido Mangano, Uli Hauschild, Giovanni Veronesi, Mario Imburgia, Carlo Mangano and Oleg Admakin compared the trueness and precision of five intraoral scanners and determined which have both accurate and consistent results.
According to the study, the CS 3600 had the best accuracy, while having the fewest triangles making up the meshes in all applications.
“The number of triangles is often misinterpreted to be a measure of acquisition resolution or mesh quality,” Victor Wong, Ph.D., director, research and innovation, Carestream Dental, said. “In fact, by having the best trueness with the smallest number of triangles, the CS 3600 demonstrates the most efficient/optimal mesh generation by placing more triangles in areas with more details, and vice versa, with minimized mesh file size while maintaining accuracy.”
To put the scanners to the test, 10 scans were performed by a single digital dentistry expert per indication per intraoral scanner with a zig-zag technique in the same environmental conditions. Two maxilla plaster models were used as a reference: One partially edentulous and one totally edentulous.
In this study, trueness is defined by the difference between the scanned model and the reference model; precision is quantified by the difference between repeatedly scanned models. In both cases, smaller values indicate greater trueness and/or precision. A scanner needs both trueness and precision to be considered accurate.
When scanning a single crown, the CS 3600 was found to have the best trueness (15.2 ±0.8 μm) and the best precision (11.3 ±1.1 μm). The CS 3600 also had the best trueness (23 ±1.1 μm) and the best precision (21 ±1.9 μm) when scanning a partial prosthesis. While scanning a full arch, the CS 3600 had the best trueness (44.9 ±8.9 μm) and had the second-best precision (35.7 ± 4.3), which very closely follows the best precision result (35.6 ± 3.4).
This is not the first time that studies have confirmed the CS 3600’s high performance. In a 2018 study,2 the CS 3600 outperformed other scanners, as well as traditional impressions, in finish line accuracy. Its trueness was confirmed by a 2017 study that tested the accuracy of four intraoral scanners in oral implantology.3
To learn more about the CS 3600, or any of Carestream Dental’s innovative solutions, visit carestreamdental.com.
1Mangano F, Logozzo S, Hauschild U, Veronesi G, Imburgia M, Mangano C, Admakin O. June 6, 2019. Trueness and precision of 5 intraoral scanners in the impressions of single and multiple implants: a comparative in vitro study. BMC Oral Health. 19(101): DOI 10.1186/s12903-019-0792-7
2Nedelcu R, Nystrom I, Olsson P, Thor A. Feb. 26, 2018. Finish Line Distinctness and Accuracy in 7 Intraoral Scanners versus Conventional Impression: An In-vitro Descriptive Comparison. BMC Oral Health.18(27): DOI 10.1186/s12903-018-0489-3
3Imburgia M, Logozzo S, Hauschild U, Veronesi G, Mangano G, Mangano FG. June 2, 2017. Accuracy of Four Intraoral Scanners in Oral Implantology: A Comparative In-Vitro Study. BMC Oral Health. 17(92): DOI 10.1186/s12903-017-0383-4
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Monolithic CAD-CAM lithium disilicate versus monolithic CAD-CAM zirconia for single implant-supported posterior crowns using a digital workflow: A 3-year cross-sectional retrospective study

Published online: June 12, 2019

Abstract

Statement of problem

Dentistry has evolved significantly with the introduction of digital technologies and materials; however, clinical evidence for the performance of the complete digital workflow for single implant–supported posterior crowns is lacking.

Purpose

The purpose of this cross-sectional retrospective clinical study was to compare the clinical outcomes of 2 types of implant-supported crown used to replace a single missing posterior tooth in a completely digital workflow: transocclusal screw-retained monolithic lithium disilicate crowns versus transocclusal screw-retained monolithic zirconia crowns.

Material and methods

A total of 38 participants who had been provided with dental implants and transocclusal screw-retained monolithic lithium disilicate or zirconia single crowns were evaluated in the study. Clinical and esthetic outcomes were recorded after a 3-year follow-up.

Results

Both groups had comparable clinical outcomes with a survival rate of 100%. In the lithium disilicate group, 89% of the participants were free of technical complications, and 95%, in the zirconia group. Only 1 patient experienced minor chipping affecting a lithium disilicate crown. All complications were considered minor and were easily resolved, and none of the participants required replacement of a crown. No biological complications were recorded in either group.

Conclusions

Within the limitations of this cross-sectional retrospective clinical study, monolithic lithium disilicate and zirconia screw-retained single crowns fabricated using computer-aided design and computer-aided manufacturing (CAD-CAM) and a fully digital workflow were found to be reliable and suitable clinical options for restoring a posterior missing tooth on a dental implant.
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Recommended treatment of cracked teeth: Results from the National Dental Practice-Based Research Network


Published online: June 12, 2019

 

Abstract

Statement of problem

Despite the high prevalence of posterior cracked teeth, questions remain regarding the best course of action for managing these teeth.

Purpose

The purpose of this clinical study was to identify and quantify the characteristics of visible cracks in posterior teeth and their association with treatment recommendations among patients in the National Dental Practice-Based Research Network.

Material and methods

Network dentists enrolled patients with a single, vital posterior tooth with at least 1 observable external crack. Data were collected at the patient, tooth, and crack levels, including the presence and type of pain and treatment recommendations for subject teeth. Frequencies according to treatment recommendation were obtained, and odds ratios (ORs) comparing recommendations for the tooth to be restored versus monitored were calculated. Stepwise regressions were performed using generalized models to adjust for clustering; characteristics with P<.05 were retained.

Results

A total of 209 dentists enrolled 2858 patients with a posterior tooth with at least 1 crack. Mean ±standard deviation patient age was 54 ±12 years; 1813 (63%) were female, 2394 (85%) were non-Hispanic white, 2213 (77%) had some dental insurance, and 2432 (86%) had some college education. Overall, 1297 (46%) teeth caused 1 or more of the following types of pain: 1055 sensitivity to cold, 459 biting, and 367 spontaneous. A total of 1040 teeth were recommended for 1 or more treatments: restoration (n=1018; 98%), endodontics (n=29; 3%), endodontic treatment and restoration (n=20; 2%), extraction (n=2; 0.2%), and noninvasive treatment, for example, occlusal device, desensitizing (n=11; 1%). The presence of caries (OR=67.3), biting pain (OR=7.3), and evidence of a crack on radiographs (OR=5.0) were associated with over 5-fold odds of recommending restoration. Spontaneous pain was associated with nearly 3-fold odds; pain to cold, having dental insurance, a crack that was detectable with an explorer or blocked transilluminated light, or connected with a restoration were each weakly associated with increased odds of recommending a restoration (OR<2 .0="" p="">

Conclusions

Approximately one-third of cracked teeth were recommended for restoration. The presence of caries, biting pain, and evidence of a crack on a radiograph were strong predictors of recommending a restoration, although the evidence of a crack on a radiograph only accounted for a 3% absolute difference (4% recommended treatment versus 1% recommended monitoring).
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Comparison of nonscheduled, postinsertion adjustment visits for complete dentures fabricated with conventional and CAD-CAM protocols: A clinical study

 

Publication History

Published online: June 12, 2019

Abstract

Statement of problem

Unscheduled denture-adjustment visits may disrupt both patients and clinicians. Denture-adjustment visits have not been correlated with denture-processing methods.

Purpose

The purpose of this clinical study was to identify differences in the number of unscheduled postinsertion-adjustment visits of patients with complete dentures fabricated by injection molding (IM) versus dentures fabricated by computer-aided design and computer-aided manufacturing (CAD-CAM).

Material and methods

One hundred six participants were evaluated in the study. They were consecutively treated in a private practice setting and followed up for 1 year after the insertion of new complete dentures. The first 33 received dentures fabricated using an IM system, and the other 73 were milled using a CAD-CAM system. All participants had been edentulous for at least 1 year. Participant ages ranged from 29 to 83 years. IM dentures were fabricated by a commercial dental laboratory; CAD-CAM dentures were milled by a commercial manufacturer. All participants were scheduled for 1- or 2-week postinsertion office visits. Further adjustment visits were scheduled according to participant request. The results were tabulated, and univariable tests of association were performed including chi-square and the Fisher exact tests for categorical comparisons and the Wilcoxon rank sum test for comparison of ordinal continuous data. A multivariable logistic regression model was used to control for the influence of multiple predictor variables on the outcome of interest.

Results

Edentulous years ranged from 1 to 60. Approximately one half (n=56) of all participants returned for scheduled postinsertion visits approximately 1 to 2 weeks after insertion of the dentures. No significant demographic or clinical differences were noted between participants receiving CAD-CAM or conventional dentures. Return visits for unscheduled adjustments were not associated with the method of denture fabrication or any other demographic features (P=.55).

Conclusions

Based on the results of this study, there were no significant differences in the number of unscheduled, postinsertion visits for participants whose dentures were fabricated following IM or CAD-CAM milling protocols. Clinicians may choose to fabricate complete dentures with either protocol and expect similar clinical results in terms of the number of unscheduled postinsertion visits.
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