Smile Dental Journal 

About: Smile Dental Journal is an academic journal. The journal publishes majorly in the area(s): Crown (dentistry) & Dental implant. It has an ISSN identifier of 2072-473X. Over the lifetime, 57 publications have been published receiving 350 citations.

Interventions for Replacing Missing Teeth : Management of Soft Tissues for Dental Implants

Abstract: BACKGROUND Dental implants are usually placed by elevating a soft tissue flap, but in some instances, they can also be placed flapless reducing patient discomfort. Several flap and suturing techniques have been proposed. Soft tissues are often manipulated and augmented for aesthetic reasons. It is often recommended that implants are surrounded by a sufficient width of attached/keratinized mucosa to improve their long-term prognosis. OBJECTIVES To evaluate whether (1a) flapless procedures are beneficial for patients, and (1b) which is the ideal flap design; whether (2a) soft tissue correction/augmentation techniques are beneficial for patients, and (2b) which are the best techniques; whether (3a) techniques to increase the perimplant keratinized mucosa are beneficial for patients, and (3b) which are the best techniques; and (4) which are the best suturing techniques/materials. SEARCH STRATEGY The Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials, an internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCTs). The last electronic search was conducted on 15 January 2007. SELECTION CRITERIA All RCTs of root-form osseointegrated dental implants comparing various techniques to handle soft tissues in relation to dental implants. Outcome measures were: prosthetic and implant failures, aesthetics evaluated by patients and dentists, biological complications, postoperative pain, patient preference, ease of maintenance by patient, and width of the attached/keratinized mucosa. DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Authors were contacted for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS Eight potentially eligible RCTs were identified and five trials including 140 patients in total were included. Two trials (100 patients) compared flapless placement of dental implants with conventional flap elevation, two trials (20 patients) crestal versus vestibular incisions, and one trial (20 patients) Erbium:YAG laser versus flap elevation at the second-stage surgery for implant exposure. On a patient, rather than per implant basis, implants placed with a flapless technique and implant exposures performed with laser induced statistically significant less postoperative pain than flap elevation. There were no other statistically significant differences for any of the remaining analyses. AUTHORS' CONCLUSIONS Flapless implant placement is feasible and has been shown to reduce patient postoperative discomfort in adequately selected patients. There is insufficient reliable evidence to provide recommendations on which are the best incision/suture techniques/materials, or whether techniques to correct/augment perimplant soft tissues or to increase the width of keratinized/attached mucosa are beneficial to patients or not. Properly designed and conducted RCTs are needed to provide reliable answers to these questions.

The Pulpal Anesthetic Efficacy of Articaine Versus Lidocaine in Dentistry : A Meta - Analysis

Abstract: Background The authors evaluated published evidence from controlled clinical trials regarding the efficacy of two local anesthetic solutions in providing successful pulpal anesthesia. Methods The authors searched MEDLINE and Embase databases to identify peer-reviewed randomized controlled trials in which researchers directly compared articaine and lidocaine local anesthetic solutions in adult participants. They extracted study characteristics and outcomes data as a basis for meta-analysis. They completed subgroup analyses for both infiltration and mandibular inferior alveolar block anesthetic techniques. Results Articaine solutions had a probability of achieving anesthetic success superior to that of lidocaine, with an odds ratio of 2.44 (95 percent confidence interval [CI], 1.59–3.76; P P P = .009), and no difference when the authors considered only symptomatic teeth. Clinical Implications Research evidence supports using articaine versus lidocaine for achieving pulpal anesthesia when the infiltration mode of administration is used. It is premature to recommend articaine for mandibular block anesthesia in cases involving irreversible pulpitis.

A Systematic Review and Meta - Analysis of the Survival of Non - Feldspathic Porcelain Veneers over 5 and 10 Years

Abstract: Purpose: This systematic review aimed to report and explore the survival of dental veneers constructed from non-feldspathic porcelain over 5 and 10 years. Materials and Methods: A total of 4,294 articles were identified through a systematic search involving all databases in the Cochrane Library, MEDLINE (OVID), EMBASE, Web of Knowledge, specific journals (hand-search), conference proceedings, clinical trials registers, and collegiate contacts. Articles, abstracts, and gray literature were sought by two independent researchers. There were no language limitations. One hundred sixteen studies were identified for full-text assessment, with 10 included in the analysis (5 qualitative, 5 quantitative). Study characteristics and survival (Kaplan-Meier estimated cumulative survival and 95% confidence interval [CI]) were extracted or recalculated. A failed veneer was one which required an intervention that disrupted the original marginal integrity, had been partially or completely lost, or had lost retention more than twice. A meta-analysis and sensitivity analysis of Empress veneers was completed, with an assessment of statistical heterogeneity and publication bias. Clinical heterogeneity was explored for results of all veneering materials from included studies. Results: Within the 10 studies, veneers were fabricated with IPS Empress, IPS Empress 2, Cerinate, and Cerec computer-aided design/computer-assisted manufacture (CAD/ CAM) materials VITA Mark I, VITA Mark II, Ivoclar ProCad. The meta-analysis showed the pooled estimate for Empress veneers to be 92.4% (95% CI: 89.8% to 95.0%) for 5-year survival and 66% to 94% (95% CI: 55% to 99%) for 10 years. Data regarding other non-feldspathic porcelain materials were lacking, with only a single study each reporting outcomes for Empress 2, Cerinate, and various Cerec porcelains over 5 years. The sensitivity analysis showed data from one study had an influencing and stabilizing effect on the 5-year pooled estimate. Conclusion: The long-term outcome (> 5 years) of non-feldspathic porcelain veneers is sparsely reported in the literature. This systematic review indicates that the 5-year cumulative estimated survival for etchable non-feldspathic porcelain veneers is over 90%. Outcomes may prove clinically acceptable with time, but evidence remains lacking and the use of these materials for veneers remains experimental. Int J Prosthodont 2013; 26: 111-124. doi: 10.11607/ijp.3202

Cumulative Effects of Successive Restorative Procedures on Anterior Crown Flexure : Intact versus Veneered Incisors

Abstract: Objective When successive restorative procedures (e.g., porcelain veneers, interdental resin composite restorations, and endodontic treatment) are carried out on the same tooth, significant effects on crown flexure can be expected. Method and materials Dentin-bonded porcelain veneers (experimental group) were assessed in vitro using functional and cyclic thermal loads. They were compared to natural teeth (control group) with respect to 2 parameters: coronal flexure (investigated using experimental strain gauges) and morphology of the tooth-restoration interface (scanning electron microscopic evaluation). For both veneered and natural teeth, crown deformation was recorded at 5 sequential experimental steps: intact tooth (baseline), Class III cavities, Class III resin composite restorations, endodontic treatment, and endodontic restoration (without posts). Results No significant differences in crown flexure were found between natural and veneered incisors when compared across experimental steps. The main effect for experimental steps was highly significant. When averaged across all specimens (natural and veneered teeth), the endodontic treatment step resulted in the highest crown flexure (1.55x the baseline value). The unrestored Class III cavities and the endodontic restoration were next highest (1.30x and 1.28x the baseline value, respectively). The lowest crown flexures were found after restoration of the Class III cavities (1.13x the baseline value). No measurable microleakage or gaps were detected at the ceramic-resin, resin-enamel, or resin-dentin interfaces (Optibond FL, Kerr). Conclusion Each subsequent reduction in tooth structure resulted in a substantial increase in crown flexibility, even after restoration. Endodontic procedures were responsible for most of the loss in crown stiffness. Extensive proximal cutting and restorations seemed to minimally affect crown flexure. Porcelain veneers showed perfect biomimetic behavior, because cumulated restoration procedures had the same effect on natural and veneered incisors.

Survival and Complications of Zirconia - Based Fixed Dental Prostheses : A Systematic Review

Abstract: Statement of problem Evidence is limited on the efficacy of zirconia-based fixed dental prostheses. Purpose The purpose of this systemic review was to assess zirconia-based FDPs in terms of survival and complications. Material and methods Searches performed in PubMed databases were enriched by hand searches to identify suitable publications. The keywords used were: "zirconia" and "fixed dental prosthesis," "zirconia" and "crown," "zirconia" and "fixed partial denture" and "humans," "zirconia" and "crown" and "humans," "crown" and "all-ceramics," and "fixed partial denture" and "all-ceramics". Titles and abstracts were read to identify literature that fulfilled the inclusion criteria. Only peer reviewed clinical studies published in the English language from January 1999 through June 2011 were included. Results Twelve clinical studies based on zirconia, framework design, and porcelain veneering technique met the inclusion criteria. Of the studies identified, 1 was a randomized clinical study with 3-year follow-up results; the others were cohort prospective studies. Clinical complications included chipping of veneering porcelain, abutment failure, and framework fracture. One study investigated pressed ceramics as the veneering material and found no chipping of veneering porcelain after 3 years. Conclusions Short term clinical data suggest that zirconia-based fixed dental prostheses may serve as an alternative to metal ceramic fixed dental prostheses in the anterior and posterior dentition.