Background/Aims Adhesive fragment reattachment (AFR) is one treatment option for crown‐root fractured teeth. However, there are no studies investigating the long‐term outcome of this approach. The aim of this retrospective study was to evaluate the long‐term outcome of AFR and periodontal health in crown‐root fractured teeth by assessing complications and periodontal status. Materials and Methods Data regarding 41 patients with 51 traumatized teeth (TT) were included. Periodontal health was assessed by recording the pocket probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), gingival index (GI), and plaque index (PI) in the TT and in one unaffected control tooth (CT). Complications were classified as “restorative,” “endodontic,” and “additional root fracture.” Based on these complications, the outcome was graded as “success,” “partial success,” “survival,” and “failure.” Statistics was performed by t test, chi‐square test and logistic regression models. Results After 8.5 ± 4.6 years, 76.5% (39/51) of the TT had functionally survived. Functional survival of the reattached fragments was 66.7% (26/39) after 9.5 ± 3.7 years. PPD (TT: 4.11 ± 2.03; CT: 2.08 ± 0.65), CAL (TT: 4.78 ± 2.19; CT: 2.42 ± 1.03), and BoP values (TT: 77.4%; CT: 22.6%) were higher in TT than in CT. GI scores > 0 were found in 83.3% of the TT and in 27.8% of the CT. PI scores did not differ between TT and CT. Of the complications, 56.8% were “restorative,” 22.7% “endodontic,” and 20.5% “additional root fractures.” Eleven (27.5%) TT were without complications and rated as “success.” Conclusions AFR in crown‐root fractured teeth showed a high survival rate and occasionally compromised periodontal health. However, due to the high complication rate, it should be considered as a long‐term temporary treatment to postpone other invasive therapy options. AFR can be a valuable way to avoid early loss of crown‐root fractured teeth, especially in young patients. Moisture control and additional root fractures significantly influenced the outcome.

SUMMARY Objectives Modern adhesives and composites allow the restoration of deep defects. In such cases, the matrix technique is particularly challenging, and excess composite is a common problem. Removing such overhangs with a scalpel has already been described as a substance preserving or selective finishing technique. Clinically, restoration margins may appear as a white line after scalpel finishing, and it is unclear whether this line represents a marginal gap and/or whether scalpel finishing promotes marginal gap formation. Therefore, the aim of this study was to investigate the influence of scalpel finishing of deep Class II composite restorations on marginal gap formation. Methods and Materials Standardized mesioocclusal-distal (MOD) cavities were prepared and restored in 60 human molars randomly divided into six finishing protocol groups: G1, scalpels (SC); G2, oscillating files (OF); G3, finishing strips (FS); G4, scalpels and finishing strips (SC+FS); G5, scalpels and polishing discs (SC+PD); G6, polishing discs alone (PD, controls). The groups were additionally assigned to finishing and polishing in a phantom head (groups 1–4) or hand-held setting (groups 5–6) to simulate clinical and in-vitro research conditions, respectively. After restoration, artificial aging was performed by thermocycling (5–55°C, 2500 cycles) and mechanical loading (50 newtons (N) with 500,000 cycles) prior to scanning electron microscopy analysis of proximal restoration margin quality on the mesial and distal surfaces (n=120) of each tooth. Outcomes (perfect margin, marginal gap, overhang, marginal fracture) were statistically analyzed by t-test, Mann-Whitney U test, single-factor analysis of variance, post-hoc t-test, Kruskal-Wallis test and Dunn-Bonferroni correction for multiple group comparisons. Cohen’s effect size d(Cohen) was calculated to show the strength of the relationship between variables. Results Overall, marginal quality was significantly better in the hand-held setting (SC+PD and PD) than the phantom head setting (SC, OF, FS, SC+FS). The best marginal quality was achieved with oscillating files in the phantom head setting and with scalpels plus polishing discs in the hand-held setting. Marginal gaps occurred significantly more often with scalpels, but the proportion of gaps was very low and clinically insignificant. Finishing strips were the least effective instruments for removing overhangs but performed better in combination with scalpels. Conclusions Scalpel finishing can effectively and gently remove overhangs from enamel. However, blades should be used with caution as they can cut the dentin and cementum. Scalpel finishing does not lead to a clinically relevant increase in marginal gaps, but should be followed by polishing, whenever possible, to eliminate any marginal fractures that might be present.

Objectives To assess tooth discoloration induced by different hydraulic calcium silicate-based cements (HCSCs), including effects of blood and placement method. Materials and methods Eighty bovine teeth cut to a length of 18 mm (crown 8 mm, root 10 mm) were randomly assigned to 10 groups (n = 8), receiving orthograde apical plug treatment (APT). Apical plugs were 4 mm in length and made of ProRoot MTA (Dentsply), Medcem MTA (Medcem), TotalFill BC RRM Fast Set Putty (Brasseler), or Medcem Medical Portland Cement (Medcem) plus bismuth oxide (Bi2O3) with and without bovine blood. Further, orthograde (with or without preoperative adhesive coronal dentin sealing) and retrograde APT were compared. Teeth were obturated with gutta-percha and sealer, sealed with composite and stored in distilled water. Tooth color was measured on apical plug, gutta-percha/sealer, and crown surface before treatment versus 24 h, 1, 3, 6, 12, and 24 months after treatment by spectrophotometry. Color difference (ΔE) values were calculated and analyzed by Shapiro–Wilk test, ANOVA with post hoc tests, Friedman test, t test, and post hoc tests with Bonferroni correction (α = .05). Results Tooth discoloration occurred in all groups with no significant differences between HCSCs (p > .05). After 24 months, color changes were prominent on roots but insignificant on crowns. Blood contamination induced a significantly decreased luminescence (p < .05). Blood had a stronger impact on tooth color than Bi2O3. No relevant effects of retrograde placement (p > .05) or preoperative dentin sealing (p > .05) were detected. Conclusions Apical plugs of the tested HCSCs cause discoloration of bovine roots, but not discoloration of bovine tooth crowns within a 24-month period. Clinical relevance APT should be performed carefully while avoiding direct contact with the coronal dentin, and in that case no aesthetic impairments occur.

Background: To test the hypothesis that transparent matrices result in more continuous margins of bulk-fill composite (BFC) restorations than metal matrices. Methods: Forty standardized MOD cavities in human molars with cervical margins in enamel and dentin were created and randomly assigned to four restorative treatment protocols: conventional nanohybrid composite (NANO) restoration (Tetric EvoCeram, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (NANO-METAL) versus transparent matrix (NANO-TRANS), and bulk-fill composite restoration (Tetric EvoCeram Bulk Fill, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (BFC-METAL) versus transparent matrix (BFC-TRANS). After artificial aging (2500 thermal cycles), marginal quality was evaluated by scanning electron microscopy using the replica technique. Statistical analyses were performed using the Mann–Whitney U-test and Wilcoxon test. The level of significance was p < 0.05. Results: Metal matrices yielded significantly (p = 0.0011) more continuous margins (46.211%) than transparent matrices (27.073%). Differences in continuous margins between NANO (34.482%) and BFC (38.802%) were not significant (p = 0.56). Matrix type did not influence marginal gap formation in BFC (p = 0.27) but did in NANO restorations (p = 0.001). Conclusion: Metal matrices positively influence the marginal quality of class II composite restorations, especially in deep cavity areas. The bulk-fill composite seems to be less sensitive to the influence of factors such as light polymerization and matrix type.

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