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Objective: To evaluate the effect magnitude of different parameters on smile attractiveness.Materials and methods: A reference and 13 images were produced by manipulating 13 parameters. Image rating was performed with a 4-point Likert scale from least attractive (1) to most attractive (4). Image raters included laypeople, dental students, dentists, and dental specialists. Friedman and Wilcoxon image were used for estimate of effect size. Parameters were classified into small (0.10-< 0.30), medium (0.30-< 0.5), or large (≥0.50).Results: A total of 1040 people participated with good consistency (α = 0.861), and moderate reliability (0.64-0.7). The reference image had the highest rank (laypeople:11.79, dental background: 12.55). For effect size; gingival margin level (À0.11, À0.01), teeth width proportion (À0.09, À0.10), inverted smile arch (À0.09, À0.21), commissure line cant (À0.15, À0.17) and low smile (À0.24, À0.23) had small effect size; occlusal plane cant (À0.36, À0.49), midline cant (À0.36, À0.48), and midline shift (À0.37, À0.49) had medium effect size; diastema (À0.55, À0.54) and color (À0.56, À0.56) had large effect size for the laypeople and dental groups. High smile (À0.42, À0.51), incisor edge symmetry (À0.46, À0.54) had medium effect size in laypeople group and large effect size in the dental group. Width to length tooth proportion (À0.26, À0.39) had small effect size in the laypeople group and medium effect size in the dental group. Conclusions: Smile parameters had different effect magnitude on smile attractiveness and were classified into small, medium, or large parameters. Neither laypeople nor professionals have a collective judgment on what constitutes a beautiful smile. Clinical significance: This study investigated the effect magnitudes of 13 smile parameters and presented a small, medium, and large smile parameters classification. It should provide the clinician with an insight into the expected effect each parameter has on the smile.

Monolithic zirconia and hybrid ceramic restorations have been widely used in the last decade for both anterior and posterior dental restorations. However, their use lacks sufficient scientific evidence in most cases, as the expeditious manufacturing of these versatile ceramic materials exceeds the limits of in vitro and/or in vivo validation. This study aimed to evaluate and compare the mechanical properties (flexural strength, fracture toughness, Vickers hardness, and brittleness index) of three CAD-CAM monolithic multilayer zirconia ceramics (GNX—Ceramill Zolid® Gen-X, ZCP—IPS e.max® ZirCAD, and UPC—Upcera® Esthetic Explore Prime) and one CAD-CAM monolithic multilayer polymer-infiltrated hybrid ceramic (ENM—Vita® Enamic) with a CAD-CAM monolithic lithium disilicate ceramic as a control (EMX —IPS e.max® CAD). A total of 160 discs (GNX = 32, ZCP = 32, UPC = 32, ENM = 32, and EMX = 32) were cut, polished, and fully sintered (except for the ENM). Half of the samples for each group were subjected to hydrothermal aging. Descriptive analysis and ANOVA tests were used to compare the groups. The zirconia groups showed significantly higher mechanical properties than the EMX group for both the non-aged and aged samples (p < 0.05). The ENM group showed the lowest brittleness index, while EMX showed the highest. The mechanical properties of monolithic multilayer zirconia ceramics were generally better than those of monolithic multilayer polymer-infiltrated hybrid ceramic and lithium disilicate ceramic. All groups showed, to some extent, a change in their mechanical properties after aging, with the ENM being the most affected.

Zirconia has generated tremendous interest in the esthetic materials used for dental restorations. However, using conventional zirconia has some limitations especially in highly esthetically demanding situations, as it lacks the translucency that other ceramic materials possess. This study aimed to evaluate and compare the optical properties (shade, translucency, and opalescence) of three CAD-CAM monolithic multilayer zirconia ceramics (GNX; Ceramill Zolid® Gen-X, ZCP; IPS e.max® ZirCAD, and UPC; Upcera® Esthetic Explore Prime) and one CAD-CAM monolithic multilayer polymer-infiltrated hybrid ceramic (ENM; Vita® Enamic) with a CAD-CAM monolithic lithium disilicate ceramic as control (EMX; IPS e.max® CAD). 200 discs (GNX = 40, ZCP = 40, UPC = 40, ENM = 40, and EMX = 40) were cut, polished, and fully crystallized. Half of the samples for each group were subjected to hydrothermal aging. Descriptive analysis and ANOVA tests were used to compare the groups. Zirconia GNX, ZCP, and UPC groups showed significantly lower optical properties than ENM and EMX groups for both the non-aged and aged samples (p < 0.05). UPC and ENM groups showed a significant decrease in translucency and opalescence after aging (p < 0.05). The optical properties of monolithic multilayer zirconia ceramics were lower than monolithic multilayer polymer-infiltrated hybrid ceramic and lithium disilicate ceramic. Polymer-infiltrated hybrid ceramic was significantly affected by aging.

PurposeTo compare the fracture resistance and failure modes of anterior cantilever resin‐bonded fixed partial dentures (RBFPDs) fabricated from high translucency zirconia with different intaglio surface treatments.Materials and methodsSound‐extracted canines (N = 50) were randomly divided into five groups (n = 10) to be restored with high translucency zirconia RBFBDs of different intaglio surface treatments. The RBFPD was designed using exocad software and fabricated using a CAM milling machine. The RBFPDs were treated differently: abrasion with 50 µm alumina particles (Group 1); abrasion with 30 µm silica‐coated alumina particles (Group 2); abrasion with silica‐coated alumina particles (30 µm) and silane application (Group 3); abrasion with silica‐coated alumina particles (30 µm) and 10‐methacryloyloxydecyl dihydrogen phosphate (10‐MDP) primer application (Group 4); abrasion with silica‐coated alumina particles (30 µm) and silane, and 10‐MDP primer application. All RBFPDs were cemented using dual‐cured resin cement. The RBFPDs underwent 6000 thermal cycles with distilled water at 5/55°C for 2 min per cycle and then mechanical cyclic loading with 1200,000 cycles of 50 N at a 1.7 Hz frequency at an angle of 135° to the abutment's long axis. Then, RBFPDs were loaded to fracture using a universal testing machine at 1 mm/min. Maximum fracture forces and failure modes were recorded. Fractured specimens and uncemented specimens were examined using a scanning electron microscope. Data was analyzed using ANOVA and Games–Howell post hoc tests at p < 0.05.ResultsMean fracture load results showed a statistically significant difference between the research groups (p < 0.0001) and it ranged from 69.78 to 584 N. Group 4 exhibited the highest fracture load mean (p < 0.0001) which was significantly different from all other groups. Group 2 recorded a significantly higher fracture load mean than Group 3 (p = 0.029). Three modes of failure were observed: prosthesis debonding, prosthesis fracture, and abutment fracture.ConclusionsAbrasion of zirconia surface with 30 µm silica‐coated alumina particles and application of 10‐MDP primer yielded the highest mean fracture loads of monolithic high translucency zirconia RBFPD. The mode of fracture of the RBFPDs was influenced by the type of surface treatments.

Immediate replacement of teeth designated for extraction is an appealing treatment rationale for both the patient and the operator. However, it has been associated with a greater risk of facial recession and compromised soft-tissue esthetics. Partial extraction therapy (PET) or synonymously socket shield technique (SST) or root membrane technique (RMT) has been proposed to conserve the facial alveolar contour and soft-tissue esthetics. In this article, a special case is described where a root membrane was used to prevent the modeling of the facial aspect of the extraction socket. Partial extraction was performed allowing the socket with the facial root membrane in situ to partially heal for 8 weeks before implant placement. Successful integration and restoration were achieved with very minimal hard- and soft-tissue changes, accentuating satisfactory esthetic results as dictated by objective esthetic assessment. PET with early implant placement may be considered a viable treatment option for selected cases.