A novel procedure for symmetric and consistent layer thickness management in esthetic direct restoration of anterior teeth is presented. For the purpose of obtaining a satisfactory final outcome of an esthetic direct restoration, it is crucial to standardize either margin preparation design and dentin and enamel layer thickness. Leaving too much space for the final translucent layer may lead in fact to “low value—gray” restorations if not correctly managed. The most common tool used to check layer thickness is the sagittal silicone index, which is reliable but involves planning; therefore, it requires two stages appointments. In this clinical case, a novel procedure is used to prepare, to model and to check thickness of composite shades in a single appointment, thus providing a symmetric esthetic outcome. A healthy 21-year-old woman referred to our dental office for the esthetic rehabilitation of both maxillary central incisors. The correct composite bilateral and symmetric layer thickness management provided a predictable esthetic outcome of the restorations. The main objective of this case presentation is to describe a novel technique that is able to save chair-time and dental laboratory costs during direct restorations in anterior teeth.

Objectives: To conduct a systematic review assessing quantitative enamel loss occurring after orthodontic debonding and clean-up procedures. Materials and Methods: A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed on different databases (Embase, Medline, Scopus, Web of Science) for papers investigating volumetric enamel loss due to bracket and clear aligner attachment debonding and/or clean-up procedures. Studies investigating in vivo and in vitro articles published in the English language until 16 July 2022 were included. The study selection was then performed by two authors who screened the abstracts independently. Results: Of 421 screened abstracts, 41 articles were selected for full-text analysis. Finally, nine studies were included in this review. No in vivo papers were retrieved. In vitro papers investigated volumetric loss caused by the removal of metal brackets (n = 7), ceramic brackets (n = 1), and both (n = 1). The clean-up procedure varied among all investigations. Impressions at baseline and after debonding/clean-up were superimposed, and the volumes were subtracted using different 3D digital analysis software. Among all included studies, the volumetric loss of enamel ranged from 0.02 ± 0.01 mm³ to 0.61 ± 0.51 mm³ per tooth. Conclusions: Debonding and clean-up procedures produce enamel loss. The debonding/clean-up procedure that is able to cause the least enamel volume loss has yet to be identified.

In esthetic restorations of anterior teeth the clinician has to manage several aspects in order to have a predictable outcome. A deep knowledge of the anatomy as well as the adhesive procedures and the optical properties of resin-based composites are mandatory to achieve esthetic results. Contemporary restorative materials present either several shades and different translucency properties and therefore they are able to mimic teeth’s optical behavior thus providing a natural aspect to anterior restorations. The wrong thickness of different composite layers may provide unpleasant results such as low value (grayish) restorations that often requires reintervention. A precise step-by-step procedure is therefore mandatory to provide the proper shade at the correct place. There is therefore the need of some corrections and adjustments during the layer procedure in order to avoid errors in shade positioning that could affect final result. The authors present a case series (six clinical cases) treated with the proposed technique with up to five years follow-up.

The use of lubricants during restorative procedures is a clinically common practice to alleviate the stickiness of resin-based composite (RBCs) materials and to improve its handling. This study evaluated the effects of three modeling liquids (ML) and one universal adhesive (UA) used as lubricants during composite layering on the color stability and translucency of RBCs. Methods. The following materials were applied between every 1 mm RBC layer (total restoration height of 4 mm): GC modeling liquid (GCML, GC Corporation, Tokyo, Japan), composite wetting resin (UPWR, Ultradent Products, South Jordan, UT, USA), Bisco modeling resin (BSMR, Bisco Inc., Schaumburg, IL, USA) as an ML and Clearfil Universal Bond Quick (KUBQ, Kuraray Noritake Dental, Tokyo, Japan) as a UA. Lubricant-free specimens were used as the control. Color coordinates (L*, a* and b*) were recorded at baseline and after a simulation of 1 month of coffee consumption. Data were analyzed using ANOVA and a post hoc Tukey test (p < 0.05). Results. All lubricants induced a color change higher than the perceptibility threshold (ΔE00 > 0.81). GCML showed the highest color stability. The use of KUBQ resulted in significantly higher a* values (p = 0.001) at baseline and after staining. KUBQ and UPWR significantly influenced the color stability (ΔE00, p = 0.0001) after staining, overcoming the clinical acceptability threshold (ΔE00 > 1.77). Conclusions. The use of lubricants may affect color stability at baseline and after simulation of staining. Translucency was not affected at baseline nor after staining. Clinical Significance. Clinicians should be aware that some lubricants may affect color stability, even at baseline.

Background and Objectives: To evaluate the influence of proximal box design on primary stability and adhesive bond strength of indirect partial bonded restorations (IPBR) in posterior teeth. Materials and Methods: Thirty extracted human third upper molars were randomly assigned to three groups (n = 10 each): Group A, butt joint overlay-type restorations with proximal box (height-to-depth ratio 1:2–1:3); Group B, proximal box with height-to-depth ratio 1:1; and Group C, flat bevel preparation as control. Specimens underwent standardized preparation: immediate dentin sealing, restoration with overlays, and cementation with Panavia V5 adhesive resin cement. Mechanical measurements were performed to assess the tensile bond strength 48 h post-cementation using a universal testing machine. Finite element analysis (FEA) was also carried out to evaluate stress distribution at the adhesive interface. Data were analyzed by ANOVA with the Bonferroni post hoc tests. Results: Group A exhibited significantly higher bond strength values (403.7 ± 37.5 N) compared with Group B (340.4 ± 32.7 N; p < 0.01) and Group C (324.8 ± 33.3 N; p < 0.01). No significant difference was observed between Groups B and C. FEA corroborated the experimental findings, showing more homogeneous stress distribution for Group A and higher stress concentrations in Groups B and C. Conclusions: Proximal box design significantly affects the primary stability and bond strength of IPBR in vitro. A deeper proximal box with favourable geometric features enhances adhesive performance and stress distribution. Within the limitations of this study, these findings suggest potential clinical benefits, although further in vivo studies under dynamic conditions are needed to confirm long-term restoration performance.

Le anomalie di forma e di volume, che possono interessare la corona, la radice o solo l’endodonto, si configurano più frequentemente in un difetto anatomico della corona clinica dove gli elementi dentali interessati appaiono di dimensioni ridotte (microdontia) rispetto alla condizione di normalità. Questo tipo di difetto, che interessa generalmente gli incisivi laterali superiori, si … Continued