International Journal of Esthetic Dentistry (EN), 01/2019

A healthy and adequate band of keratinized periimplant mucosa is key to long-term biologic and esthetic success. Yet in about one-third of implant patients, its formation requires connective tissue graft procedures. Such procedures may be considered impractical for patients who need retreatment of failures, those who are not willing to go through multiple surgical steps, or those receiving multiple implants that would thus involve multiple connective tissue grafts. This article introduces the buccal pedicle fl ap technique, a new surgical approach for boosting the soft tissue around dental implants without connective tissue grafting. The technique is a minimally invasive surgical approach that can be performed as one-stage or two-stage surgery and can be applied in anterior and posterior areas as well as at single and multiple adjacent implants.

Objective: This article assesses the esthetic opinion of the experts involved in dental restoration (general dentists, orthodontists, prosthodontists) and laypeople. Differences in esthetic opinion among the studied groups are assessed. Material and methods: A questionnaire was constructed based on four photographs. A quantitative esthetic appreciation using a numerical scale was requested from four groups of observers. The final sample consisted of 434 participants: 142 laypeople, 141 general dentists, 100 orthodontists, and 51 prosthodontists. The photographs presented were based on the same lips and modified from the same intraoral photograph with asymmetric canines: the right canine was smaller than the left canine and had a lower gingival margin. A mirror image of the right canine was digitally made to create symmetry. Results: There were statistically significant differences (P 0.05) in the assessments made across the different groups of observers. For all questions, the laypeople assigned significantly higher scores (P 0.05) than the orthodontists and prosthodontists. However, there was no significant difference between groups, and all the groups considered the photograph with the larger canines to be more esthetic. The dental professionals and the laypeople disagreed the most regarding their assessment of the least esthetic image. Conclusion: There were differences between the four observer groups in their scoring of the photographs from 0 to 10 relative to the more pleasing esthetics of closure of space with asymmetric canines. However, there were no differences in the results when evaluating each type of canine relative to the form. The canine with the most prominent shape was considered to be more esthetic by all the groups.

Aim: To compare the shear bond strength (SBS) after aging of two dual-curing composite resin cements to multiphase composite resin (experiment) and glass-ceramics (control). Methods: Seventy computer-aided design/computer-aided manufacturing (CAD/CAM) blocks were prepared: 24 multiphase composite resin blocks (Lava Ultimate; experiment), and 12 control blocks (groups 5 and 6: 6 IPS e.max CAD, 6 IPS Empress CAD). Surface treatments of the experiment groups were: 1) Al2O3 airborne particle abrasion; 2) bur-roughening; 3) silica-coated aluminum oxide particle abrasion; and 4) hydrofluoric (HF) acid etching. Per study group, Variolink II (a) and RelyX Ultimate (b) were used as cements. Per treatment group, four cement cylinders were adhered to the conditioned blocks (n = 12). After thermocyclic aging (10.000x, 5°C to 55°C), notch-edge shear testing was applied. Modes of failure were examined. A P value of 0.05 was considered significant. Results: Groups 1a (18.68 ± 3.81) and 3a (17.09 ± 3.40) performed equally to 6a (20.61 ± 4.10). Group 5a (14.39 ± 2.80) did not significantly differ from groups 1a, 3a, and 4a (15.21 ± 4.29). Group 2a (11.61 ± 3.39) showed the lowest bond strength. For the RelyX Ultimate specimens, mean bond strengths were: 1b (18.12 ± 2.84) > 4b (15.57 ± 2.31) > 2b (12.34 ± 1.72) = 3b (11.54 ± 2.45) = 6b (12.31 ± 1.87) > 5b (0.78 ± 0.89). Failure mode analysis showed a significant association between bond strength values and modes of failure (chi-square). Conclusion: The SBS of the composite cements to the multiphase composite resin that was treated by Al2O3 or silica-coated aluminum oxide particle abrasion is comparable to the bond of the control groups.

Purpose: This study evaluated the shear bond strength (SBS) of resin cement to dentin after applying two adhesive (A) systems with a combination of four different immediate dentin sealing (IDS) strategies, and two surface conditioning (SC) methods. Material and methods: Human third molars (n = 140) were collected and randomly split (n = 70 each) between the two A systems (Clearfil SE Bond; Kuraray [AC] and Optibond FL; Kerr [AO]). The A groups were further divided into four IDS strategies (2 x one adhesive layer (IDS-1L); 2 x two adhesive layers (IDS-2L); 2 x one adhesive layer and one flowable layer (IDS-F); 2 x no adhesive layer (delayed dentin sealing [DDS]). Finally, each strategy group was categorized into one of the two SC methods (only pumice [SC-P] or pumice and silica coating [SC-PS]), except the DDS group, where only SC-P was used. This resulted in 14 groups of 10 specimens each. The occlusal coronal third was removed from each molar crown with a diamond saw (Isomet 1000), and IDS was applied, followed by temporary restorations. These were removed after 2 weeks of water storage, and the IDS surfaces were subsequently conditioned. The standard adhesive procedure (Syntac Primer and Adhesive, Heliobond; Ivoclar Vivadent) was executed, followed by the application of a resin cement (Variolink II; Ivoclar Vivadent) and photopolymerization. All specimens were subjected to thermocyclic aging (10,000 cycles, 5°C to 55°C). Shear force was applied to the adhesive interface in a universal testing machine (1 mm/min). Fracture types and locations after loading were classified. The data were analyzed using analysis of variance (ANOVA) and independent samples t tests. Results: AO groups exhibited higher mean SBS values (14.4 ± 6.43) than AC groups (12.85 ± 4.97) (P = 0.03). ANOVA showed the main effect of the applications on the SBS in the different groups (P = 0.00). Both DDS groups showed significantly lower SBS values compared with all the IDS groups (IDS-1L, IDS-2L, IDS-F). No significant differences in SBS results were found between the IDS groups (P = 0.43) and between the SC methods (P = 0.76). Dentin-cement interface failures diminished with the application of IDS. Conclusion: IDS improves the SBS compared with DDS. No significant differences were found between the tested conditioning methods.

Objective: Facial appearance has been found to have an important social and psychological effect on the human personality. Hence, this cross-sectional analytic questionnaire-based study of dental patients assessed the satisfaction with dental appearance and personality traits among a group of dental patients. Materials and methods: The questionnaire sought information on the sociodemographic characteristics of the participants; satisfaction with teeth in general and with tooth color in particular; the presence of caries, tooth-colored fillings, and tooth fractures; and desired treatment to improve appearance. A visual analog scale (VAS) was used to determine satisfaction with appearance, and the 10-item version of the Big Five personality inventory data was subjected to analysis in the form of frequency distribution, descriptive statistics, cross tabulations, chi-square, and logistic regression, with P set at 0.05. Results: Those participants not satisfied with their tooth color were less likely to be satisfied with the general appearance of their teeth. A greater proportion of participants who were satisfied with the general appearance of their teeth had low scores on conscientiousness traits and neuroticism traits. Those who had high scores on conscientiousness traits tended to be dissatisfied with their tooth color. Conclusions: Personality traits affect the perception of satisfaction with tooth appearance, with patients with conscientiousness personality traits who tend toward perfectionism not readily satisfied, while those with neuroticism personality traits who are emotionally stable more readily satisfied with the appearance of their teeth. This information is important when providing esthetic dental treatment to patients, as expectations differ depending on individual personality traits.

Aim: The present work aims to compare a digital dental histoanatomical analysis method with chemical enamel dissolution for the study of dental morphology. Material and methods: Extracted maxillary anterior teeth were scanned under microcomputed tomography (μCT) (μCT 40; Scanco Medical), segmented, and reconstructed three-dimensionally (Amira, version 5.5.2; VSG). Following the digital acquisition of dental morphology, all specimens were acid treated with 5% formic acid for careful dissolution of the enamel layer. Six measurements (three buccopalatal and three mesiodistal) per specimen were performed, both digitally following the μCT scan and physically both before and after enamel dissolution. The obtained measurements were subjected to statistical analysis through concordance coefficient measurements and linear regression. Results: A straight line correlation behavior with no statistically significant difference was found between both methods, with a concordance correlation coefficient of 97%. Conclusion: The digital, nondestructive, μCT-layered, three-dimensional reconstruction method presented comparable results to acid-etched enamel dissolution, confirming that both options are reliable for the histoanatomical analysis of enamel and dentin morphologies.

The purpose of the present study was to evaluate the efficacy of a single dose of botulinum toxin (BTX) at the Yonsei point for the treatment of gummy smile (GS). A total number of 45 female patients were enrolled in the study at a private clinic over a period of 24 months. Three units of onabotulinumtoxinA (BTX-A) per site (90 hemifacies) were initially injected at the Yonsei point. The patients were then assessed at 2, 12, 24, and 36 weeks postinjection. The data were evaluated using mean standard deviation, analysis of variance (ANOVA), and Tukey's post hoc test. The results of the study revealed that a single dose of BTX-A injected at the Yonsei point was effective in the treatment of GS (P 0.05) and achieved better results than multiple injections at various sites.