Statement of problem. Long-term clinical data are lacking on the comparison of the survival of adhesively luted pressed e.max lithium disilicate glass ceramic complete and partial coverage restorations in posterior dentitions and the effect that different technical and clinical variables have on their survival. Purpose. The purpose of this clinical study was to examine and compare the 16.9-year survival of posterior pressed e.max lithium disilicate glass ceramic complete and partial coverage restorations and associated clinical parameters on the outcome. Material and methods. Patients requiring either single-unit posterior defect-specific partial coverage or complete coverage restorations were recruited in a clinical private practice. The participants were offered the options of direct restorations, partial coverage cast gold, or glass ceramic (lithium disilicate) restorations. Those requiring complete coverage restorations were given the options of complete cast gold, metal-ceramic, or glass ceramic restorations. Only participants who chose glass ceramic partial and complete coverage restorations were included in the study. The overall survival of the glass ceramic restorations was assessed by the clinical factors determined at recall. The effect of various clinical parameters (type of restoration, dental arch, tooth position in the dental arch, age and sex of participant, and ceramic thickness) was evaluated by using Kaplan-Meier survival curves to account for attrition bias and other reasons for failure. The statistical significance of differences between parameters was determined using the log rank test (a=.05). Results. A total of 738 participants requiring 2392 lithium disilicate restorations in posterior teeth were evaluated. The mean age of the participants at the time of restoration placement was 62 (range: 20-99 years, 302 men and 436 women). Of 2392 units, 1782 were complete and 610 were partial coverage restorations. A total of 22 failures (bulk fracture or large chip) requiring replacement were recorded with the average time to failure 3.5 (0.02-7.9) years. The total time at risk computed for these units was 13227.9 years, providing an estimated failure risk of 0.17% per year. The 16.9-year estimated cumulative survival was 96.49%. The estimated cumulative survival of posterior complete (n=1782) and posterior partial coverage restorations (n=610) was 96.75% at 10.5 years and 95.27% at 16.9 years (P<.05). Of the 22, 16 failures were recorded for the complete coverage restorations. The total time at risk for these restorations was 10144.5 years, providing an estimated risk of 0.16 per year. The other 6 failures recorded occurred for the partial coverage restorations. The total time at risk for these restorations was 3083.5 years, providing an estimated risk of 0.19% per year. No statistically significant difference was found in the survival of posterior complete and partial coverage restorations among men and women, different age groups, or posterior tooth position in the dental arch (P>.05). The thick...

Statement of problem. Long-term clinical data on the survival of pressed lithium disilicate glass-ceramic when used with partial coverage restorations and the effect that different technical and clinical variables have on survival are sparse.Purpose. The purpose of this clinical study was to determine the 10.9-year survival of pressed lithium disilicate glass-ceramic partial coverage restorations and associated clinical parameters on outcomes.Material and Methods. Individuals requiring single unit defect-specific partial coverage restorations in any area of the mouth were recruited in a clinical private practice. Participants were offered the options of partial coverage cast gold or glass-ceramic (lithium disilicate) restorations. Only participants that chose glass-ceramic partial coverage restorations were included in the study. The overall survival of the glass-ceramic restorations was assessed by the clinical factors (participant's age, sex, dental arch, tooth position in dental arch, type of partial coverage restoration, and ceramic thickness) determined at recall. The effect of this clinical parameters was evaluated by using Kaplan-Meier survival curves accounting for attrition bias and other reasons for failure. The statistical significance of differences between parameters was determined by using the log rank test (a=.05).Results. A total of 304 participants requiring 556 lithium disilicate restorations were evaluated. The mean age for the participant at the time of restoration placement was 62 with a range of 20 to 99 years, 120 were men and 184 were women. A total of 6 failures (bulk fracture or large chip) requiring replacement were recorded with the average time to failure of 2.4 (0.8-9.2) years. The total time at risk computed for these units was 1978.9 years providing an estimated failure risk of 0.3% per year. The 10-year estimated cumulative survival was 95.6%. The estimated cumulative survival of inlays (n=246) and onlays (n=305) were 93.9% and 98.3%, at 9.9 and 9.8 years, respectively (P<.05). Of the 6, there were 3 failures recorded for the partial coverage inlay restorations. The total time at risk for these inlays was 786.79 years providing an estimated risk of 0.38% per year. The other 3 failures recorded occurred for the partial coverage onlay restorations. The total time at risk for the onlays was 1032.17 years providing an estimated risk of 0.29% per year. The failures occurred in the molar region only. There were no failures recorded for the anterior partial coverage inlays (n=5). The total time at risk computed for the anterior units was 21.55 years providing an estimated risk of 0% per year. There was no statistically significant difference in the survival of partial coverage restorations among men and women, different age groups, or position in the dental arch. The thickness of the restoration had no influence on the survival of glass-ceramic partial coverage restorations.Conclusions. Pressed lithium disilicate defect-specific partial coverage restorations reported high survival rate o...

To assess the effect of implant abutment material and soft tissue thickness on the peri-implant soft tissue color using spectrophotometry and to evaluate gingival esthetics and patient satisfaction with three different abutments. Materials and methods: Twenty-five patients with a missing maxillary tooth in the esthetic area received an endosseous implant using a two-stage protocol. Gray titanium, pink anodized titanium, and hybrid zirconia custom abutments were fabricated for each participant and inserted for one week with a cross-over design in a randomized manner. Color measurements were made using a spectrophotometer comparing midfacial peri-implant soft tissue and marginal gingiva of the contralateral tooth. CIE Lab color scale was used following the formula: ΔE = [(∆L) 2 + (∆a) 2 + (∆b) 2 ] ½ . PES scores were recorded, and patient satisfaction questionnaires were completed at each abutment change visit and at 1-year follow-up. Statistical analysis was performed using Friedman's test and the Wilcoxon signed-rank test with Bonferroni correction as well as the Mann-Whitney U test (α = 0.05). Results: Abutment material type significantly affected the ΔΕ values of the periimplant mucosa when compared to the contralateral teeth. At baseline, the highest ΔΕ means ± standard deviation (SD) values were obtained with gray titanium (11.25 ± 2.98), followed by pink anodized titanium (9.90 ± 2.51), and zirconia abutments (6.46 ± 1.43). Differences were statistically significant irrespective of soft tissue thickness. The highest PES values were obtained with zirconia abutments (10.88 ± 0.88), followed by pink anodized titanium (10.12 ± 1.13) and the lowest with gray titanium (9.68 ± 1.41). PES differences were significant only for the thin soft tissue group. Regarding patient satisfaction, VAS scores for the pink anodized and zirconia hybrid abutment groups were higher than the gray titanium group for each question. Conclusion:The color difference between soft tissues around teeth and implants was significant in all groups regardless of tissue thickness. The hybrid zirconia abutments resulted in the least color difference, followed by pink anodized and gray titanium. Significantly different PES values were recorded only for the thin tissue group. There was no significant difference in patient satisfaction between zirconia and pink anodized abutments at the 1-year follow up. Pink anodized abutments represent a good esthetic alternative to zirconia hybrid abutments especially in mechanically challenging situations.

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