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Esthetic and functional management of an ankylosed central incisor with a conservative restorative approach

Ritter, Andre V; Cunha, Leonardo Fernandes; Correr, Gisele M
In this case report, we share a conservative and simple restorative management approach for a relatively complex esthetic situation on an adult patient with an ankylosed maxillary central incisor in infra-occlusion. A 37-year-old healthy female patient presented for a consultation with a chief complaint of an unappealing smile. The intraoral exam revealed tooth #8 (FDI 11) was in obvious and significant infra-occlusion due to altered eruption. Periapical radiographs of this area were non-contributory and all teeth responded within normal limits to pulp vitality tests. After review of several treatment options, the patient opted for a conservative restorative approach in which a partial ceramic veneer was planned for the ankylosed tooth, while composite resin was used on the contralateral central incisor to achieve a symmetric and pleasant result. CLINICAL SIGNIFICANCE: A relatively complex clinical problem was satisfactorily resolved with a very conservative option in which composite resin and a ceramic veneer were used to restore an asymmetric smile.
PMID: 29399941
ISSN: 1708-8240
CID: 4144082

Digital smile design and mock-up technique for esthetic treatment planning with porcelain laminate veneers [Case Report]

Garcia, Paula Pontes; da Costa, Rogério Goulart; Calgaro, Murilo; Ritter, André Vicente; Correr, Gisele Maria; da Cunha, Leonardo Fernandes; Gonzaga, Carla Castiglia
The use of digital tools offers a new perspective to daily clinical activities. The digital information serves as a starting point for a wax-up and intraoral mock-up, which is widely reported in literature as an objective and efficient communication tool among dentist, patient, and technician. This case report of a maxillary anterior rehabilitation demonstrates esthetic planning with the digital smile design (DSD) system and a direct mock-up technique. After preoperative photographs were obtained, digital planning was created using DSD. However, due to differences in virtual simulation, a direct mock-up with composite resin was performed. Porcelain laminate veneers using feldspathic ceramics were used to restore the anterior teeth. Many times, the DSD simulation is not enough for the patient to understand and observe the changes that will be performed on the anterior teeth. This combination of techniques can offer predictability to results as well increasing the patient expectation satisfaction.
PMCID:6080190
PMID: 30122831
ISSN: 0972-0707
CID: 4144092

Effect of composite type and placement technique on cuspal strain

Ólafsson, Vilhelm G; Ritter, André V; Swift, Edward J; Boushell, Lee W; Ko, Ching-Chang; Jackson, Gabrielle R; Ahmed, Sumitha N; Donovan, Terence E
OBJECTIVE:To compare the cuspal strain in Class II restorations made with bulk-fill and conventional composite resins. MATERIALS AND METHODS:Fifty extracted maxillary premolars were mounted into phenolic rings and divided into five groups (n = 10). Specimens received standardized MOD preparations. A two-step self-etch adhesive was applied and the preparations were restored using a custom matrix as follows: Filtek Supreme Ultra in eight 2-mm increments (FSUI); Filtek Supreme Ultra in bulk (FSUB); SonicFill in bulk (SF); SureFil SDR flow in bulk, covered with a 2-mm occlusal layer of Filtek Supreme Ultra (SDR/FSU); Tetric EvoCeram Bulk Fill in bulk (TEBF). Strain gages bonded to the buccal and lingual cusps recorded cuspal strain during restorations. End strain values were determined and data were subjected to Kruskal-Wallis testing, followed by one-way ANOVA and Tukey´s post hoc test. RESULTS:Combined strain values and standard deviations (in µɛ) were: FSUI: 723 ± 102.8, FSUB: 929.2 ± 571.9, SF: 519.1 ± 80.2, SDR-FSU: 497.4 ± 67.6 and TEBF: 604.5 ± 127.1. A significant difference was found between group FSUI and groups SF, SDR-FSU, and TEBF. Group FSUB showed significantly higher mean strain and greater standard deviation than all other groups due to cuspal fractures, and was thus excluded from the statistical analysis. CONCLUSIONS:The tested bulk-fill composite resins exerted less strain onto tooth structure than the incrementally placed conventional composite resin, although the magnitude of generated strain was product-dependent. Bulk-filling with conventional composite resins is contraindicated. CLINICAL SIGNIFICANCE:Bulk-fill composite resins exerted less strain onto adjacent tooth structure than a traditional composite, even when that composite is was placed incrementally. Bulk-filling with traditional composite resins is unpredictable and contraindicated.
PMCID:5815887
PMID: 29034597
ISSN: 1708-8240
CID: 4144052

Physical-mechanical properties of orthodontic resins with different photoinitiators [Meeting Abstract]

Correr, GM; Roseira, PM; Ritter, Andre V; Cunha, LF; Gonzaga, CC; Moro, A; Alonso, RCB
ORIGINAL:0014358
ISSN: 0022-0345
CID: 4154882

Efficacy of resin cements in bonding of processed composite resin to dentin [Meeting Abstract]

Ritter, Andre V; Sulaiman, TA; Rodgers, B; Baratto, F; Nolasco, GM; Gonzaga, C
ORIGINAL:0014357
ISSN: 0022-0345
CID: 4154872

Optical and mechanical properties of different zirconia generations [Meeting Abstract]

Abd Alraheam, I; Donovan, TE; Boushell, L; Ritter, Andre V; Cook, R; Sulaiman, TA
ORIGINAL:0014356
ISSN: 0022-0345
CID: 4154862

Composite Repair Strength as a Function of Surface Treatment [Meeting Abstract]

Ritter, Andre V; Sulaiman, TA; Altitinchi, A; Baratto, Fo F; Correr, GM; Gonzaga, CC
ORIGINAL:0014355
ISSN: 0022-0345
CID: 4154852

CAD/CAM post-and-core using different esthetic materials: Fracture resistance and bond strengths

Falcão Spina, Denis Roberto; Goulart da Costa, Rogério; Farias, Isabelli Carolini; da Cunha, Leonardo Gonçalves; Ritter, André Vicente; Gonzaga, Carla Castiglia; Correr, Giselle Maria
PURPOSE/OBJECTIVE:To evaluate the fracture resistance (FR), and push-out bond strengths (BS) of custom-made CAD/CAM post-and-cores manufactured with different esthetic materials. METHODS:90 single-rooted extracted teeth were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three equal groups according to the material: hybrid ceramic Vita Enamic (HC); nano-ceramic resin composite Lava Ultimate (RC); and experimental epoxy-resin reinforced by glass-fiber (FG). The post-and-cores were manufactured using CAD/CAM and cemented using a self-adhesive resin cement (Rely X Unicem2). A subgroup of 30 specimens (n=10) was subjected to fatigue (1,000,000 cycles at 5 Hz) and then to the FR test. Another subgroup with 60 specimens was submitted to the BS test, with and without fatigue. Data were submitted to analysis of variance (FR - one-way ANOVA; BS - two-way ANOVA) and Tukey's test (α= 0.05). RESULTS:The FR values (mean±SD, in Newtons) were 414.5±83.9 (HC), 621.3±100.3 (RC), and 407.6±109.0 (FG), with RC showing significantly higher FR values (P< 0.05). For BS, there was no statistically significant difference among the materials, with and without fatigue (P> 0.05). The type of material used to obtain the CAD/CAM-customized post-and-cores had a significant effect on the FR, but not on the BS of the specimens. Fatigue did not influence the BS for the tested materials. CLINICAL SIGNIFICANCE/CONCLUSIONS:CAD/CAM custom-made esthetic post-and-cores showed good performance relative to fracture resistance and bond strength to root canal dentin walls. The CAD/CAM materials tested could be used as an alternative to restore wide flared root canals in esthetically compromised teeth.
PMID: 29251451
ISSN: 0894-8275
CID: 4144072

Accuracy evaluation of intraoral optical impressions: A clinical study using a reference appliance

Atieh, Mohammad A; Ritter, André V; Ko, Ching-Chang; Duqum, Ibrahim
STATEMENT OF PROBLEM/BACKGROUND:Trueness and precision are used to evaluate the accuracy of intraoral optical impressions. Although the in vivo precision of intraoral optical impressions has been reported, in vivo trueness has not been evaluated because of limitations in the available protocols. PURPOSE/OBJECTIVE:The purpose of this clinical study was to compare the accuracy (trueness and precision) of optical and conventional impressions by using a novel study design. MATERIAL AND METHODS/METHODS:Five study participants consented and were enrolled. For each participant, optical and conventional (vinylsiloxanether) impressions of a custom-made intraoral Co-Cr alloy reference appliance fitted to the mandibular arch were obtained by 1 operator. Three-dimensional (3D) digital models were created for stone casts obtained from the conventional impression group and for the reference appliances by using a validated high-accuracy reference scanner. For the optical impression group, 3D digital models were obtained directly from the intraoral scans. The total mean trueness of each impression system was calculated by averaging the mean absolute deviations of the impression replicates from their 3D reference model for each participant, followed by averaging the obtained values across all participants. The total mean precision for each impression system was calculated by averaging the mean absolute deviations between all the impression replicas for each participant (10 pairs), followed by averaging the obtained values across all participants. Data were analyzed using repeated measures ANOVA (α=.05), first to assess whether a systematic difference in trueness or precision of replicate impressions could be found among participants and second to assess whether the mean trueness and precision values differed between the 2 impression systems. RESULTS:Statistically significant differences were found between the 2 impression systems for both mean trueness (P=.010) and mean precision (P=.007). Conventional impressions had higher accuracy with a mean trueness of 17.0 ±6.6 μm and mean precision of 16.9 ±5.8 μm than optical impressions with a mean trueness of 46.2 ±11.4 μm and mean precision of 61.1 ±4.9 μm. CONCLUSIONS:Complete arch (first molar-to-first molar) optical impressions were less accurate than conventional impressions but may be adequate for quadrant impressions.
PMCID:5812952
PMID: 28222869
ISSN: 1097-6841
CID: 4144022

The quality of fixed prosthodontic impressions: An assessment of crown and bridge impressions received at commercial laboratories

Rau, Clayton T; Olafsson, Vilhelm G; Delgado, Alex J; Ritter, André V; Donovan, Terry E
BACKGROUND:The authors evaluated and quantified clinically detectable errors commonly seen in impressions sent to commercial laboratories and determined possible relationships between finish line errors and other factors involved. METHODS:The authors visited 3 large and 1 small commercial dental laboratories over a 12-month period. Three calibrated examiners evaluated the impressions. The examiners evaluated all impressions for errors by using ×2.5 magnification loupes under ambient room lighting without the aid of additional illumination. RESULTS:The authors evaluated 1,157 impressions; 86% of the examined impressions had at least 1 detectable error, and 55% of the noted errors were critical errors pertaining to the finish line. The largest single error categories evaluated were tissue over the finish line (49.09%), lack of unprepared stops in dual-arch impressions (25.63%), pressure of the tray on the soft tissue (25.06%), and void at the finish line (24.38%). The factors blood on the impression (odds ratio, 2.31; P < .001) and tray type (odds ratio, 1.68; P < .001) were associated significantly with finish line errors. CONCLUSIONS:Marginal discrepancies made up the largest category of error noted in impressions evaluated. The authors noted an increase in errors at the finish line with dual-arch impression techniques and in the presence of blood. PRACTICAL IMPLICATIONS:Dentists have ethical, moral, and legal obligations bestowed on them by the profession and need to evaluate critically the work they send to laboratories. The authors strongly recommend an improvement in technique and reviewing of all impressions and working casts.
PMID: 28601188
ISSN: 1943-4723
CID: 4144042