Objectives: The primary objective of this systematic review is to compare the fracture resistance of lithium disilicate (LDS)-based endocrowns and resin-based (RB) endocrowns of in-vitro studies, and the secondary objective is to compare their catastrophic failures. Materials and Methods: The review protocol was registered in the P ROSP ERO database (CRD42020166201). A comprehensive literature search was done in PubMed, Cochrane, EBSCOhost and Google Scholar using key terms. Only in-vitro studies that compared fracture resistance of LDS-based endocrowns and indirect RB endocrowns in molars were included. Data extraction, risk of bias assessment and qualitative analysis of the included studies were performed. Results: Five studies were included in this systematic review. The overall risk of bias for the included studies was moderate. Under axial loading, RB endocrowns showed similar fracture resistance when compared with LDS endocrowns. However, they showed better fracture resistance when compared with zirconia reinforced lithium silicate (ZLS) endocrowns. Furthermore, RB endocrowns showed fewer catastrophic failures than LDS-based endocrowns. Conclusions: RB endocrowns have similar or better fracture resistance and fewer catastrophic failures when compared to LDS-based endocrowns.
Introduction: A subgingivally extending proximal carious defect can be adequately restored with an adhesive indirect aesthetic restoration only when the proximal margins can be raised coronal to the Cementoenamel Junction (CEJ) using various Margin Elevation Materials (MEM). This approach is commonly referred to as the Proximal Box Elevation (PBE) technique. However, there is a lack of evidence in the literature regarding the quality of the marginal seal at the root dentine- MEM interface when using PBE technique. Aim: The purpose of this systematic review was to summarise the available evidence on the the quality of the marginal seal at the root dentine- MEM when using the PBE technique during the placement of adhesive indirect aesthetic restorations. Materials and Methods: Comprehensive electronic search was performed in PubMed Central, Cochrane Library and Google Scholar from their inception to January 2021 at the Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research (SRIHER) between May 2020 to January 2021. Full text articles published in english language which have performed an indirect restoration with and without PBE technique were included in the review. A total of 249 articles were screened initially in the review. The main keywords used were: “PBE”, “Cervical Margin Relocation (CMR)”, “Deep Margin Elevation (DME)” and “coronal margin relocation”. The review protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias assessment of the included studies was performed independently. Results: A total of 9 in-vitro studies were included in the present systematic review. Resin based composites of different viscosities seemed to perform adequately as MEM. It may be prudent to perform the margin elevation in multiple layers. Self etch adhesives had a better marginal seal than the total etch adhesives. Regarding the effect of indirect restoration on the marginal seal at the root dentine- MEM interface, there was no conclusive evidence. PBE may provide a congenial environment for predictable and efficient bonding of indirect adhesive aesthetic restorations. Conclusion: Based on the moderate quality of evidence from the included articles in this systematic review, it can be concluded that while performing a PBE technique, the quality of marginal seal at root dentine- MEM interface is satisfactory under in-vitro conditions.
Aim: The aim of the present study was to analyze the morphological variations and complexities in root canal systems of the maxillary second molars in South Indian population, using cone beam computed tomography (CBCT). Subjects and Methods: The CBCT images of 500 participants were examined at different slice thickness of 125 micrometers. Root canal systems of the 500 maxillary second molars were analyzed according to Vertucci, HMA Ahmed et al., and Kim et al. classifications in the Indian subpopulation. Statistical Analysis Used: Interobserver variability was analyzed using Kappa statistics. Results: Among the tooth analyzed, 63% had three roots, with a single canal in each root in 65.2% tooth. About 41.8% of the tooth had fusion of mesiobuccal and distobuccal roots. The most commonly found root canal configuration was Type I (65%) according to Vertucci's classification. According to HMA Ahmed et al. classification, 67.9% tooth had the configuration of 327 MB1 DB1 P1/317 MB1 DB1 P1. Nearly 20.8% tooth had MB2 canal. The most common isthmus type was Type II (55.2%) according to Kim's classification, and the prevalence of isthmus was 2–5 mm from the root apex. Conclusions: The number of roots, canals, their configuration, and occurrence of isthmus has not been reported in the South Indian population. The importance of understanding the knowledge of the anatomy of teeth during the treatment of maxillary second molars would contribute to successful endodontic outcomes.
Diastema between the teeth negatively affects the patients' smile, psychology and daily activities by creating a disharmony in the patients' face. The development of diastema has been attributed to several factors such as labial frenulum, microdontia, mesiodens, peg-shaped lateral incisors, agenesis, cysts, habits such as finger sucking, tongue thrusting, or lip sucking, dental malformations, genetics, proclinations, dental-skeletal discrepancies, and imperfect coalescence of interdental septum. Patients often present with complex problems that require a multidisciplinary treatment approach which includes determination of the aetiological factors, soft tissue morphology, occlusion, patient demands and aesthetic consideration to achieve satisfactory outcomes. Lack of current literature on classification of diastemas and multi-disciplinary approach of management led to the proposal of a new classification the ATAC (Anatomic and Therapeutic Classification) for management of the diastema. This case report highlights the use of the proposed classification for management of diastemas, requiring a perio-restorative intervention using a Chu's proportion gauge to achieve ideal aesthetics.
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