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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: closed (10 July 2023) | Viewed by 24395

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Prof. Dr. Rubén Agustín Panadero

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Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
Interests: fixed prosthesis; BOPT; dental implants; dental ceramics; white spots
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Predictable is a term used when you are certain that something can be predicted before it happens. In science, the use of this word is the objective sought by many scientists who seek to argue the whys and wherefores of their research. Extrapolating this situation to the dental clinic, dentists always try to find a predictable treatment for our patients, but this does not always happen. Dental treatments must meet a series of objectives: restore health, recover function, and achieve aesthetics. Aesthetics is currently a very important parameter in patient treatment. Due to the development of the industry, the incorporation of new restorative materials, the advancement of digital procedures, and the change in mentality of our society, the development of cosmetic dentistry is booming. The objectives of this Special Edition are the presentation of new restorative protocols with minimal intervention, fixed prosthesis treatments with aesthetic results for both teeth and implants, peri-prosthetic treatments with health results and gingival harmony, basic and surgical periodontal treatment to achieve gingival aesthetics, new tooth whitening therapies, treatment of developmental defects of the tooth, behavior analysis of new prosthodontic materials, and orthodontic treatment in improving the aesthetics of the smile.

The scope of this Special Issue is to provide an overview of recent advances in the field of aesthetic dentistry. Researchers in this field are therefore encouraged to submit an original article or review to this Special Issue (case reports and short reviews will not be accepted).

Prof. Dr. Rubén Agustín Panadero
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

gingival treatment
BOPT
dental implants
dental ceramics
orthodontics
teeth whitening
white spots
fixed prosthesis
dental aesthetics

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Published Papers (8 papers)

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Research

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14 pages, 5053 KiB

Open AccessArticle

Total Rehabilitation Using Adhesive Dental Restorations in Patients with Severe Tooth Wear: A 5-Year Retrospective Case Series Study

by Álvaro Ferrando Cascales, Salvatore Sauro, Ronaldo Hirata, Daniela Astudillo-Rubio, Raúl Ferrando Cascales, Rubén Agustín-Panadero and Andrés Delgado-Gaete

J. Clin. Med. 2023, 12(16), 5222; https://doi.org/10.3390/jcm12165222 - 10 Aug 2023

Cited by 3 | Viewed by 3210

Abstract

Introduction: Currently, there is little clinical evidence to support the medium- and long-term survival and clinical performance of ultraconservative approaches using adhesive restorations in full-mouth restorations. The aim of this case series study was to evaluate the medium-term clinical performance of anterior and posterior adhesive restorations applied with direct and indirect techniques using resin composites and glass-ceramic-based materials. Materials and Methods: The inclusion criteria were an esthetic problem as the main reason for consultation and severe generalized wear of grade 2 to 4 according to the Tooth Wear Evaluation System (TWES 2.0). In addition, at each follow-up appointment, patients were required to submit a clinical-parameter-monitoring record according to the modified United States Public Health Service (USPHS) criteria. Results: Eight patients with severe tooth wear were treated through full rehabilitation in a private dental clinic in Spain by a single operator (AFC). A total of 212 restorations were performed, which were distributed as follows: 66 occlusal veneers, 26 palatal veneers and 120 vestibular veneers. No signs of marginal microleakage or postoperative sensitivity were observed in any occlusal, vestibular and/or palatal restoration after the follow-up period. The estimated survival rate of the 212 restorations was 90.1% over 60 months of observation, with a survival time of 57.6 months. Only 21 restorations had complications, which were mostly resolved with a direct composite resin. The dichotomous variables of the restoration type (posterior veneer, anterior veneer) and the type of restored tooth (anterior, posterior) were the risk predictors with statistically significant influences (p < 0.005) on the survival of the restorations. Conclusion: According to the results of this study, there is a significantly higher risk of restorative complications in posterior teeth compared to anterior teeth. Also, it can be concluded that the indication of adhesive anterior and posterior restorations is justified in the total oral rehabilitation of patients with severe multifactorial tooth wear, as they are associated with a low risk of failure. Full article

(This article belongs to the Special Issue Clinical Advances in Cosmetic Dentistry)

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10 pages, 1237 KiB

Open AccessArticle

Influence of Different Bracket Adhesive Systems on Enamel Demineralization—An In Vitro Study

by Christoph-Ludwig Hennig, Simon Löhnert, Ann Nitzsche, Sandor Nietzsche, Frank Steiniger, Justus Marquetand, Konrad Tolksdorf, André Guellmar, Bernd Sigusch and Collin Jacobs

J. Clin. Med. 2023, 12(13), 4494; https://doi.org/10.3390/jcm12134494 - 5 Jul 2023

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Abstract

Background: enamel demineralization is a common side effect of orthodontic therapy with fixed braces. The aim of the present in vitro study was to compare a conventional adhesive system and a modern adhesive system (APC Flash-Free [FF] technology) with regard to the demineralization of enamel by Streptococcus sobrinus (S. sobrinus). Methods: this in vitro study included premolar teeth and compared APC FF adhesive brackets (Group A, n = 15) with conventional adhesive brackets (Group B, n = 15) from the same company. Specimens were incubated with a positive control group (PCG, n = 5) and a negative control group (NCG, n = 5) in an S. sobrinus suspension for three weeks. To evaluate the grade of enamel demineralization, the samples were analyzed using a polarizing microscope. Results: the test specimens of group B with conventionally bonded bracket adhesive showed significantly greater (+10.8 μm) demineralization with regard to the penetration depth of the demineralization than the PCG (p = 0.012). Thus, there was a difference from group A with the new bracket adhesive of the FF brackets (+7.29 μm). Significantly, demineralization was more pronounced cervically than coronally in both groups, and it occurred cervically more frequently than grade 3 demineralization (p = 0.001). Conclusions: it seems plausible that new orthodontic bracket adhesives and the modern FF adhesive system positively contribute to the reduction in enamel demineralization during orthodontic treatment. Full article

(This article belongs to the Special Issue Clinical Advances in Cosmetic Dentistry)

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10 pages, 1648 KiB

Open AccessArticle

Accuracy between 2D Photography and Dual-Structured Light 3D Facial Scanner for Facial Anthropometry: A Clinical Study

by Rocío Cascos, Laura Ortiz del Amo, Francisco Álvarez-Guzmán, José Luis Antonaya-Martín, Alicia Celemín-Viñuela, Diego Gómez-Costa, Mónica Zafra-Vallejo, Rubén Agustín-Panadero and Miguel Gómez-Polo

J. Clin. Med. 2023, 12(9), 3090; https://doi.org/10.3390/jcm12093090 - 24 Apr 2023

Cited by 9 | Viewed by 1845

Abstract

(1) Background: Facial scanners are used in different fields of dentistry to digitalize the soft tissues of the patient’s face. The development of technology has allowed the patient to have a 3-dimensional virtual representation, facilitating facial integration in the diagnosis and treatment plan. However, the accuracy of the facial scanner and the obtaining of better results with respect to the manual or two-dimensional (2D) method are questionable. The objective of this clinical trial was to evaluate the usefulness and accuracy of the 3D method (a dual-structured light facial scanner) and compare it with the 2D method (photography) to obtain facial analysis in the maximum intercuspation position and smile position. (2) Methods: A total of 60 participants were included, and nine facial landmarks and five interlandmarks distances were determined by two independent calibrated operators for each participant. All measurements were made using three methods: the manual method (manual measurement), the 2D method (photography), and the 3D method (facial scanner). All clinical and lighting conditions, as well as the specific parameters of each method, were standardized and controlled. The facial interlandmark distances were made by using a digital caliper, a 2D software program (Adobe Photoshop, version 21.0.2), and a 3D software program (Meshlab, version 2020.12), respectively. The data were analyzed by SPSS statistical software. The Kolmogorov–Smirnov test revealed that trueness and precision values were normally distributed (p > 0.05), so a Student’s t-test was employed. (3) Results: Statistically significant differences (p ≤ 0.01) were observed in all interlandmark measurements in the 2D group (photography) to compare with the manual group. The 2D method obtained a mean accuracy value of 2.09 (±3.38) and 2.494 (±3.67) in maximum intercuspation and smile, respectively. On the other hand, the 3D method (facial scanner) obtained a mean accuracy value of 0.61 (±1.65) and 0.28 (±2.03) in maximum intercuspation and smile, respectively. There were no statistically significant differences with the manual method. (4) Conclusions: The employed technique demonstrated that it influences the accuracy of facial records. The 3D method reported acceptable accuracy values, while the 2D method showed discrepancies over the clinically acceptable limits. Full article

(This article belongs to the Special Issue Clinical Advances in Cosmetic Dentistry)

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12 pages, 729 KiB

Open AccessCommunication

Clinical Evaluation of Bilateral Multiple Gingival Recession Treatment with Autogenous Connective Tissue Graft Associated with Low-Level Laser Therapy

by Ricardo Roberto de Souza Fonseca, Camila Pantoja Silva, Beatriz Leal de Senna Sastre, Erich Brito Tanaka, Tábata Resque Beckmann Carvalho, Paula Gabriela Faciola Pessôa de Oliveira, Silvio Augusto Fernandes de Menezes, Rogério Valois Laurentino, Renata Pimentel de Oliveira, Roberta Pimentel de Oliveira, Andréa Dias Neves Lago and Luiz Fernando Almeida Machado

J. Clin. Med. 2023, 12(6), 2349; https://doi.org/10.3390/jcm12062349 - 17 Mar 2023

Cited by 1 | Viewed by 2029

Abstract

Background: Gingival recession (GR) is described as an apical displacement of the gingival margin in relation to the cementoenamel junction, exposing the root surface to the oral cavity environment. This study aimed to evaluate the clinical results of a bilateral root coverage (RC) of GR associated with an autogenous connective tissue graft (aCTG) alone or combined with low-level laser therapy (aCTG + LLLT). Methods: This cross-sectional, split-mouth, double-blind, clinical pilot study featured three individuals who attended a periodontics post-graduate program with the main complaint of GR and dental hypersensitivity (DHS). Of these, only one patient met the inclusion criteria and the parameters evaluated were: DHS, the keratinized tissue’s thickness and width clinical attachment level (CAL), probing on depth (PD), and bilateral GR based on Cairo RT I. The patient was evaluated by a first clinical evaluator and the treatment was randomly divided into two groups, G1: aCTG only (control group, n = 3 teeth per side) and G2: aCTG + LLLT (test group, n = 3 teeth per side). LLLT used a diode laser (660 nm) with a dose of 3 J/cm² per point and 4 s per point was applied in four different periods, preoperatively; transoperatively and immediately postoperatively, the application was performed in three points (eight applications) on alternate days for 7 days and a 90-day follow-up was performed for clinical evaluations of the periodontal parameters and the collected data were analyzed by Kruskal–Wallis and Dunn tests. Results: the RC mean percentage was <95% in both groups after 90 days. Comparing treatment sides, G1 (n = 3/3, 100%) had a higher prevalence of RC than G2 had (n = 3/3, 95%). DHS significantly decreased after 90 days in both groups. Both groups showed an improvement in the other periodontal parameters evaluated during the short-term follow-up; mainly, PD had a statistically significant (p ˂ 0.05) increase after 90 days and a CAL decrease during this period; KTW and KTT also had a significant increase in both groups (p ˂ 0.05). Conclusions: the results indicated that aCTG + LLLT might have an additional benefit to GR root coverage within the evaluated time and this section also includes the within-study limitations. Full article

(This article belongs to the Special Issue Clinical Advances in Cosmetic Dentistry)

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13 pages, 1170 KiB

Open AccessArticle

Efficacy of Guided Tissue Regeneration Using Frozen Radiation-Sterilized Allogenic Bone Graft as Bone Replacement Graft Compared with Deproteinized Bovine Bone Mineral in the Treatment of Periodontal Intra-Bony Defects: Randomized Controlled Trial

by Aniela Brodzikowska, Bartłomiej Górski, Marcin Szerszeń and Mariano Sanz

J. Clin. Med. 2023, 12(4), 1396; https://doi.org/10.3390/jcm12041396 - 9 Feb 2023

Cited by 2 | Viewed by 2430

Abstract

(1) Background: The aim of this study was to compare the clinical and radiographic outcomes of guided tissue regeneration (GTR) using two biomaterials as bone replacement grafts in the treatment of periodontal intra-bony defects. (2) Methods: Using a split-mouth design, 30 periodontal intra-bony defects were treated with either frozen radiation-sterilized allogenic bone grafts (FRSABG tests) or deproteinized bovine bone mineral (DBBM, controls) combined with a bioabsorbable collagen membrane in 15 patients. Clinical attachment level gains (CAL-G), probing pocket depth reductions (PPD-R), and radiographic changes in linear defect fill (LDF) were evaluated 12 months postoperatively. (3) Results: The CAL, PPD, and LDF values improved significantly in both groups 12 months after the surgery. However, in the test group, the PPD-R and LDF values were significantly higher compared to the controls (PPD-R 4.66 mm versus 3.57 mm, p = 0.0429; LDF 5.22 mm versus 4.33, p = 0.0478, respectively). Regression analysis showed that baseline CAL was a significant predictor for PPD-R (p = 0.0434), while the baseline radiographic angle was a predictor for CAL-G (p = 0.0026) and LDF (p = 0.064). (4) Conclusions: Both replacement grafts when used for GTR with a bioabsorbable collagen membrane yielded successful clinical benefits in teeth with deep intra-bony defects 12 months postoperatively. The use of FRSABG significantly enhanced PPD reduction and LDF. Full article

(This article belongs to the Special Issue Clinical Advances in Cosmetic Dentistry)

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15 pages, 1327 KiB

Open AccessArticle

The Analysis of Facio-Dental Proportions to Determine the Width of Maxillary Anterior Teeth: A Clinical Study

by Naseer Ahmed, Mohamad Syahrizal Halim, Zuryati Ab-Ghani, Maria Shakoor Abbasi, Ayesha Aslam, Jawad Safdar, Gotam Das, Abdul Razzaq Ahmed and Nafij Bin Jamayet

J. Clin. Med. 2022, 11(24), 7340; https://doi.org/10.3390/jcm11247340 - 10 Dec 2022

Cited by 3 | Viewed by 3103

Abstract

The present study aimed to analyze mid horizontal facial third proportions, those being the interpupillary, inner intercanthal, and bizygomatic distance modified with golden proportion, The Preston proportion, golden percentage and 70% recurring esthetic dental proportion were used for determining maxillary anterior teeth width. A total of 230 participants took part in this study. The front dental and facial photographs along dental stone cast which were converted to three-dimensional (3D) models were used for evaluation. The mid horizontal facial third proportions showed no significant relationship with maxillary anterior teeth width without modification with dental proportions. Whereas, with modification, no statistically significant difference was found between inner-intercanthal distance by golden percentage and width of central incisors. The bizygomatic distance was greater than intercanine distance. While the interpupillary distance by golden proportion was found to be consistent with intercanine distance in female participants. The modified anterior teeth width was significantly different from measured values, when determined by using the three mid facial proportions with Preston and 70% recurring esthetic dental (RED) proportion. Furthermore, the measured width of maxillary anterior teeth showed no difference when plaster dental casts widths were compared with 3D models. The interpupillary, inner-intercanthal, and bizygomatic distance should not be directly used to determine maxillary anterior teeth width. While maxillary anterior teeth width can be determined by modifying the inner inter-canthal distance with golden percentage and interpupillary distance with golden proportion. Moreover, the midfacial third proportions modified with Preston and 70% recurrent esthetic dental proportion were found to be unreliable for the determination of maxillary anterior teeth widths. Full article

(This article belongs to the Special Issue Clinical Advances in Cosmetic Dentistry)

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12 pages, 734 KiB

Open AccessArticle

Comparison of Malocclusion Prevalence, Type and Severity between Cerebral Palsy and Healthy Subjects: A Prospective Case-Control Study

by Victoria Martínez-Mihi, Vanessa Paredes-Gallardo, Francisco-Javier Silvestre and Javier Silvestre-Rangil

J. Clin. Med. 2022, 11(13), 3711; https://doi.org/10.3390/jcm11133711 - 27 Jun 2022

Cited by 3 | Viewed by 3665

Abstract

Background: To analyze the prevalence, type and severity of malocclusions in a group of patients with cerebral palsy (CP) using a facial and occlusal analysis and the Dental Aesthetic Index (DAI). Methods: A prospective, case–control study was made of two groups, a cerebral palsy and a control group, with the determination of the facial and occlusion analysis in the three spatial planes. The Dental Aesthetic Index (DAI) was used to assess the severity of malocclusion. Results: The patients with CP presented a higher prevalence of increased facial lower third height and a greater tendency towards right-side canine and molar class II malocclusion, narrower transverse relationship and crossbite. The DAI scores were statistically significantly higher in the CP group. Increased physical impairment in the CP group was associated to greater DAI scores. Conclusions: The prevalence and severity of malocclusion were significantly greater in the CP group. The type of malocclusion predominantly found in these patients was molar class II, with open bite, increased overjet and a narrow arch. The CP group also presented mixed breathing with higher DAI scores and decreased facial lower third height. Full article

(This article belongs to the Special Issue Clinical Advances in Cosmetic Dentistry)

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Review

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15 pages, 965 KiB

Open AccessReview

White Spot Lesions (WSLs)—Post-Orthodontic Occurrence, Management and Treatment Alternatives: A Narrative Review

by Luminita Lazar, Alexandru Vlasa, Liana Beresescu, Anamaria Bud, Ana Petra Lazar, Larisa Matei and Eugen Bud

J. Clin. Med. 2023, 12(5), 1908; https://doi.org/10.3390/jcm12051908 - 28 Feb 2023

Cited by 15 | Viewed by 4880

Abstract

Although treatment with fixed or mobile appliances has become an important part of modern orthodontics, side effects such as white spot lesions (WSLs) have a negative impact on the aesthetic outcome of orthodontic treatment. The purpose of this article was to review current evidence on the diagnosis, risk assessment, prevention, management and post-orthodontic treatment of these lesions. Data collection was performed electronically, and the initial search using the keywords “white spot lesions”, “orthodontics”, “WSL”, “enamel” and “demineralization” in different combinations resulted in 1032 articles for the two electronic databases used. Ultimately, a total of 47 manuscripts were considered relevant to the aim of this research and included in this review. The results of the review indicate that WSLs remain a significant problem during orthodontic treatment. According to studies in the literature, the severity of WSLs correlates to the duration of treatment. Using toothpaste with more than 1000 ppm fluoride at home reduces the frequency of WSL separation and regular application of varnishes in the office reduces the frequency of the occurrence of WSLs only in the context of maintaining a strict hygiene regime. The old hypothesis that elastomeric ligatures retain more dental plaque than metal ones has been refuted. There are no differences in the appearance of WSLs between conventional brackets and self-ligating brackets. Clear aligner mobile devices develop fewer WSLs but are more extensive as opposed to conventional fixed devices, while lingual orthodontic appliances have a lower incidence of WSLs, and the most effective device for preventing these lesions is WIN, followed by Incognito. Full article

(This article belongs to the Special Issue Clinical Advances in Cosmetic Dentistry)

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