Purpose: The purpose of this study was to assess the longevity of the indirect fiber-reinforced composite resin-bonded-bridges (FRC RBBs) by new preparation design and digital impression, and compare it to the traditional preparation and impression. Materials and methods: The present study was a randomized controlled trial. Thirty patients were included in this study and were divided into two main groups (15 patients in each group, 1:1 allocation ratio). Group I received FRC RBBs with traditional minimal preparation and making impressions with additional silicone. While in group II FRC RBBs with a new preparation design were employed and intraoral scan impression was done for the patients. Both groups were designed and manufactured by computer-aided design and computer-aided manufacturing (CAD/CAM). Success and survival rates were evaluated for up to 2 years of the follow-up period. Kaplan–Meier survival curves and a logrank test were employed to analyze the data, with a 95% confidence interval. Results: Both groups were accompanied by a 100% survival rate after 2 years of follow-up. Nevertheless, the FRC RBBs (with traditional preparation) tended to show a better success rate of about 93.3% compared to 80% for the FRC RBBs (with new preparation technique), for 24 months. However, groups lacked statistical significance differences (p = 0.267). Conclusions: The study showed that indirect FRC RBBs in both groups performed well, with high success and survival rates for 2 years. Thus, it could offer a longer-term treatment solution taking into consideration the limitation of a short follow-up time and a small sample size.

Purpose: To compare the fracture resistance of three-unit (3-unit) provisional fixed dental prostheses (FDPs) fabricated using conventional, computer-aided design and computer-aided manufacturing (CAD/CAM) and three-dimensional (3D) printing methods. Materials and methods: Mandibular right second premolar and second molar typodont teeth were prepared and a metal die was fabricated. Five specimens of each 3-unit FDP were fabricated using self-cure (conventional), with 3D printing and CAD/CAM techniques. Specimens were placed on the universal testing machine and subjected to an axial load. The maximum force which led to the fracture of the FDP was recorded. Tukey's test for pairwise comparison of fracture strength was used and a one-way analysis of variance (ANOVA) was used for intergroup. Results: Maximum fracture resistance was seen in the CAD/CAM group (2510.3 N), followed by 3D printed (2182.9 N), and least in the self-cure group (1940.9 N). ANOVA for intergroup comparison showed a statistically significant difference in fracture resistance between the three groups (p < 0.001). A statistically significant difference in fracture resistance via post hoc Tukey's was seen in group I and group II (p < 0.001), and between group II and group III (p = 0.015). There was no significant difference found in between group I and group III (p > 0.05). Conclusion: Computer-aided design and computer-aided manufacturing milled and 3D printed 3-unit provisional FDP showed significantly better fracture resistance compared to the conventional FDP. Interim restorations fabricated using these advanced techniques provide stronger, more reliable, and conservatively produced provisional restorations.

Purpose: The purpose of this article was to evaluate and analyze the stress distribution in multiple single-piece dental implants before and after syncrystallization using finite element models. Materials and methods: Two maxillary three-dimensional (3D) finite element models were constructed using Creo elements software, with each model consisting of eight single-piece implants. Implants were positioned in the central incisor, canine, second premolar, and second molar regions, respectively, in both quadrants. In model A, no syncrystallization was done, and in model B, syncrystallization was done. Acrylic provisional restoration was constructed using 3D over the implants in both models A and B. Axial loading forces of 300 N in the anterior region (incisor to canine) and 800 N in the posterior region (premolar to molar) were applied using analysis of systems (ANSYS) software to analyze and compare the stress distribution between two finite element models. Results: Model B with syncrystallization showed less stress at implant, hard bone, and soft bone levels when compared to model A. A significant stress reduction of about 23% at the implant level, 47% at the hard bone level, and 42% at the soft bone level was seen. When compared at the provisional acrylic level, model B showed reduced stress compared to model A. Conclusion: Immediate loading after syncrystallization of multiple single-piece dental implants to titanium bars of sufficient thickness showed uniform and reduced stress distribution and aids in osseointegration when compared to conventional immediate loading of multiple single-piece dental implants.

Purpose: To evaluate and compare peri-implant tissue esthetics of single tooth implants in the anterior maxillary region using the pink esthetic score (PES) over a period of 1 year for different surgical and prosthetic treatment protocols. Materials and methods: This cross-sectional descriptive study was conducted on 30 patients (eight women and 22 men) aged 20–55 years who had undergone rehabilitation with an implant-supported prosthesis in the anterior maxilla region—two screw-retained prostheses (SP) and 28 cemented prostheses (CP), corresponding to 22 central incisors, five lateral incisors, and three canine teeth. The prosthetic restorations were placed and had been followed up for a minimum of 12 months. Assessment of PES was made on seven variables vs a natural reference tooth and a numerical scoring system with numerical values; 0–2 was used, Intergroup comparison was done using a t-test to find any significant difference. Results: The mean PES in this study was 8.97 ± 1.691 (range 7–13), which translated into an acceptable esthetic outcome. The mean PES score with the thick biotype was 9.62 ± 1.596 and 7.44 ± 0.527 with the thin biotype, and the difference is statistically significant. The mean PES score with a surgical technique involving flap exposure was 8.56 ± 1.315 and 9.43 ± 1.989 in flapless surgical technique, but the difference was insignificant. The mean PES score with immediate placement protocol was 9.60 ± 1.77 and 8.69 ± 1.59 in delayed placement protocol and the difference was statistically insignificant. The mean PES score with the immediate loading protocol was 10.14 ± 1.77 and 8.61 ± 1.53 in the delayed loading protocol and the difference was significant. The mean PES score for cement-retained prosthesis was 8.96 ± 1.753 and 9.00 ± 0.000 for SP, but the difference was insignificant. Conclusion: A thicker biotype does produce favorable esthetics, but an interplay of placement protocol, loading protocol, type of restoration, and material also contributes to the outcome. The assessment of peri-implant tissues serves as a guide to deciding the surgical approach, implant placement, and loading protocol depending on the gingival biotype. Hence, it is recommended that PES be used as a mandatory evaluation tool in implant prosthodontics.

Purpose: To assess the influence of different veneering techniques on the mechanical failure of tooth-supported veneered zirconia crowns. Materials and methods: An electronic literature search of PubMed, MEDLINE, SCOPUS, and Web of Science databases for relevant publications up to December 2021 was performed using the following MeSH combinations: zirconia, veneers, layering, pressing, computer-assisted design-on (CAD-on), clinical, in vitro, and crown. The focus of this study was to determine which layering technique in a single zirconia crown has the least mechanical complications according to the well-established PICO strategy. Titles and abstracts were screened to select studies based on the set criteria. Results: Of the 1,834 studies, 42 were selected for full-text reading and 12 of these met the inclusion criteria. All selected articles were in vitro studies. Among the veneering techniques, controversial findings were noted for pressed vs layered ceramic, whereas the CAD-on group showed significantly less chipping. The CAD-on technique using fused lithium disilicate layering ceramic exhibited superior mechanical performance with single crown-layered zirconia restorations over all other materials and techniques. Conclusions: Veneering techniques influence the mechanical performance of tooth-supported veneered zirconia restorations, with the advantage of the CAD-on-fused lithium disilicate technique. The findings are mainly supported by in vitro studies on single-crown restorations. Nevertheless, the clinical evidence regarding which veneering technique has better performance was inconclusive, and it suggests that all methods were adequate for clinical use.

Cranial defects are caused by certain congenital anomalies like Crouzon syndrome, or they may be acquired due to surgery, trauma, or pathological diseases. These cranial defects lead to disfigurement, mechanical vulnerability, social stigma, and neurological complications. Cranioplasty is the procedure to restore the natural esthetics, provide a mechanical barrier to protect the brain, and maintain cerebrospinal fluid (CSF) pressure. But the outcome of this technique will mainly depend on a large number of factors like case selection, the timing of surgery, implant material to restore the defect, snuggly fitting cranial plate, and biocompatibility of the graft material used. Out of these, the most important factor of a successful cranioplasty is the fabrication of an artificial cranial plate following accurate impression and fabrication principles. Different materials like metals, heat-polymerizing polymethyl methacrylate (PMMA) resin, polyethylene, and silicone have been used to fabricate cranial plates. Recently, polyether ether ketone (PEEK) and titanium have also been used with great success. This article presents three case reports showing three techniques of fabrication of cranial prosthesis with basic to latest materials and modalities.

Intrinsic tooth stains are more permanent in nature than extrinsic stains and can be divided into two types systemic and local. Erythrodontia is reddish-brown or reddish-black discoloration of teeth caused due to congenital erythropoietic porphyria (CEP) or Gunther disease. It is the rarest type of porphyria and is usually perceived in infancy. An 8-year-old girl with erythrodontia was referred to a private clinic in the United Arab Emirates with a chief complaint of discolored primary teeth with a medical history of CEP and severe right sensorineural hearing loss. A complete esthetic rehabilitation was done.

Maxillofacial defects can be congenital or acquired. Reconstruction and augmentation of maxillofacial defects are quite challenging due to the multidisciplinary approach and the complex anatomy of the region. Meticulous rehabilitation of such defects requires detailed shaping and sculpting of the autologous graft or the manufactured implants, which are often associated with complications such as resorption, infection, or displacement which might result in appalling prosthetic rehabilitation. Recent advances in computer-aided design/computer-aided manufacturing (CAD/CAM) have developed alternatives for fabricating patient-specific implants (PSIs), which allow for the accurate and efficient restoration of complex maxillofacial defects with improved contour and outcomes. This article presents the rehabilitation of maxillary continuity defect using PSI followed by prosthetic rehabilitation of missing dentate segments, restoring esthetics, function, and self-confidence of the patient.