International Journal of Esthetic Dentistry (EN), 01/2023

Implants in the esthetic area are challenging for many reasons, all the more so when the hard and soft tissue are deficient at the beginning of the procedure. Numerous grafting techniques are available for the clinician, each one with its own strengths and weaknesses. It is important to understand these differences and to carry out a thorough diagnosis and case selection in order to make the right choice for each patient. The present article describes the treatment of a deficient maxillary central incisor site after extracting an ankylosed tooth. A palatal bone plate was utilized to reconstruct the missing buccal wall in the first place. Three months later, an implant was inserted and at the same time the soft tissue was augmented with a connective tissue graft. The case was successfully restored and finalized with a satisfactory esthetic outcome. The morbidity related to autogenous bone and soft tissue harvesting is discussed, but the shorter healing periods and optimal tissue quality obtained are highlighted.

Purpose: The present study aimed to assess fatigue resistance and color modifications of endodontically treated incisors (ETIs) submitted to internal bleaching and restored using three different techniques. Materials and methods: Forty-five maxillary central incisors received endodontic treatment and were internally bleached. After the completion of bleaching, the ETIs were divided into three groups (n = 15) according to the different restoration procedures: 1) glass-ionomer cement base covered with composite resin (GI); 2) short fiber-reinforced composite resin base with composite resin (SF); 3) composite resin restoration over a fiberglass post (FP). Specimens were subjected to accelerated fatigue testing: frequency of 5 Hz, beginning with a load of 100 N for 5000 cycles and a 25-N load increase applied every 1700 cycles until a load of 1200 N was reached. Samples were loaded until fracture. The Kaplan-Meier survival analysis with the log-rank post hoc test were performed (α = 0.05). Tooth color was measured 4 weeks after the bleaching treatment and again after the final restoration procedure using a spectrophotometer and the Commission Internationale de l’Eclairage (CIE) L*a*b* system. L* values of the specimens were analyzed using the Shapiro-Wilk and paired sample t tests (α = 0.05). Results: All groups showed similar survival mean cycles until failure (P = 0.332) and presented a major number of nonrestorable failures. The GI group presented the lowest number of nonrepairable fractures (GI = 68%, SF = 79%, FP = 86%) and showed the most stable L* value (P = 0.987). Conclusions: The fatigue survival of internally bleached ETIs was not affected by the restorative technique utilized. Retaining the glass-ionomer base and covering the surface with composite resin should provide optimal color stability.

The fracture strength of implant-supported monolithic CAD/CAM crowns under approximate clinical conditions and how their fracture strength is affected by cement type remain unclear. The present study investigated the fracture resistance of implant-supported polymer-infiltrated ceramic and zirconia-reinforced lithium silicate glass-ceramic crowns cemented with two different cement types after aging in a mastication simulator. RelyX Ultimate Clicker (3M ESPE) as adhesive resin cement, Panavia SA Cement Plus (Kuraray Noritake) as self-adhesive resin cement, and two monolithic materials (A1-T for Enamic and M1-HT for Suprinity; both Vita Zahnfabrik) were tested. Forty CAD/CAM-produced monolithic implant-supported crowns for a maxillary right second premolar were prepared, and crowns were cemented to the straight implant abutments with each cement, then subjected to dynamic load cycling (480,000 cycles) and thermocycling (about 4,000 cycles) in a mastication simulator. Crown fracture resistance was analyzed by the load-to-failure test. Crown–abutment samples were loaded until fracture. No significant difference was observed in the fracture load of the crowns among the groups. The results suggest that both monolithic restoration materials could be an alternative for implant-supported cement-retained restorations, regardless of cement type.

The accurate determination of tooth shade and its reproduction in modern restorations is often an arduous challenge in daily dental practice. The lack of objective methodologies in dental color estimation can make the work of dentists and dental technicians even more complex and frustrating. The purpose of the present article is to suggest shared clinical and laboratory workflows for digital image standardization to achieve an easy optical integration for posterior indirect composite restorations.

Background and aim: Dental implant patients are frequently required to undergo a second-stage/uncovery procedure to expose the implant fixture. The aim of the present prospective study was to evaluate the clinical outcomes of the vestibular split rolling flap (VSRF) versus the double door mucoperiosteal flap (DDMF) techniques at adjacent posterior implant sites during the second-stage procedure. Materials and methods: A total of 44 uncovered posterior dental implants in 10 healthy patients were treated at the second stage. All the mesial implants were assigned to the VSRF technique (group A) and the distal implants to the DDMF technique (group B). Soft tissue measurements were performed as vestibular keratinized mucosal width (KMW) and vestibular mucosal thickness (MT) over a period of 1 year, assessed at four different intervals. Results: Healing was uneventful at all sites. There were no patient dropouts in the entire study time frame. The clinical comparison of the adjacent implants showed overall higher MT measurements at 12 months for group A (2.5 ± 0.2 mm) compared with group B (1.00 ± 0.3 mm), and for KMW measurements for group A (2.5 ± 0.2 mm) compared with group B (2.0 ± 0.3 mm). Conclusions: The VSRF technique described in the present article is a reliable method for performing an implant uncovery. If the technique is applied according to the indication and with a minimally invasive protocol, it is preferable to other conventional exposure techniques due to its ability to provide enhanced soft tissue volume around the implant, which can in turn benefit the health, esthetics, function, and long-term stability of the peri-implant tissue.

Aim: The aim of the present preliminary study was to observe and make a histologic comparison of connective tissue grafts (CTGs) harvested from the lateral palatal mucosa through the use of two different harvesting techniques. Materials and methods: Three patients were enrolled in the study, providing six standardized CTGs. One well-experienced periodontist collected the replacement grafts using two different methods. After outlining the grafts to a fixed dimension, the graft on one side was deepithelialized by a round coarse bur intraorally before harvesting. The graft on the contralateral side was obtained by harvesting from the palate first; subsequently, deepithelialization was performed extraorally with the aid of a no. 15c blade. After finalization, histologic evaluation was performed. Results: No apparent differences were found between the two observed techniques in terms of graft thickness, proportion, and composition. After deepithelialization, epithelial remnants were clearly evident in five out of six cases. Despite being more technique sensitive, the removal of epithelium by bur scored better. Proper graft handling and graft regularity are described as advantages of the more conventional epithelial excision by blade. Conclusions: Despite the wide use and broad variety of commonly applied techniques of graft deepithelialization, the present authors assume that full excisions with the use of a blade are hardly ever achieved. Despite the unpredictable retrieval of epithelium by blade, graft handling and graft regularity can be proposed as the biggest advantages. On the other hand, the presented novel in situ deepithelialization with a round bur seems to be more predictable.