Periodontal Health among Type 2 Diabetes Patients Treated with Different Dental Restorations

Background: Diabetes increases periodontal disease risk and its complications, which are worsened with age or faulty restorations. Aim: Evaluate periodontal health among patients with diabetes treated with different dental restorations. Materials and Methods: This comparative cross-sectional study was conducted at the faculty of dentistry, Najran University, KSA, from March 2018 to February 2020. It included 260 diabetics, treated with different dental restorations, divided into four groups, each comprising 65 patients aged 45 - 60 years: Group 1 (G1), no restorations (control group);Group 2 (G2), Class II amalgam restorations;Group 3 (G3), Class II composite resin restorations;and Group 4 (G4), three-unit posterior metal ceramic prostheses. The Ages of all restorations ranged from 8 to 10 years. All groups were assessed for the Plaque Index (PI) and Gingival Index (GI), Overhangs Rate (OR), Alveolar Bone Loss (ABL) (the latter two using panoramic X-ray). HbA1c and duration of participants were also assessed and compared. Results: The mean HbA1c results of the groups ranged from 8.1% to 9.5%, and their mean diabetes durations ranged from 7.2 to 12 years. All the groups showed worse periodontal scores, ranging from 2.45 - 2.95 for PI and 2.25 - 2.8 for GI. G2 had higher scores than G1 and G3 (p < 0.001). G4 had the highest two recorded scores (p < 0.001). G2 had a higher rate of overhangs than G3 (p < 0.037). The mean ABL was 44% (SD 6.4) for G1, 56.0% (SD 6.7) for G2, 46.5% (SD 5.8) for G3, and 74.5% (SD 6.4) for G4. The lowest values were recorded in G1 and G3 (p = 0.987). The highest value was observed in G4, which was significantly higher than other groups (p < 0.001). Conclusion: The worse periodontal parameters among subjects treated with either three-unit metal ceramic or Class II amalgam restorations indicated severe periodontal destruction. Untreated subjects and subjects treated with Class II composite resin had relatively better periodontal status.

Insightful Understanding of the Role of the Mechanical Properties in Defining the Reliability of All-Ceramic Dental Restorations: A Review

Since the last two decades, restorative dentistry has been witnessing an increased acceptance of the use of the well-known all-ceramic materials for the fabrication of single dental restorations, such as inlays, onlays, crowns, anterior and posterior fixed partial dentures (PFPDs). These restorations certainly offer the potential for better biocompatibility coupled with superior aesthetic qualities, especially when compared with the conventional prostheses made from porcelain that is fused with metal ceramic restorations. However, brittleness and extreme sensitivity of all-ceramic materials to micro-like defects or cracks that are inherently present, or may grow, in their microstructure during different laboratory fabrication steps, during necessary clinical adjustments, or from post-placement chewing activity, remain major shortcomings of these dental restorations. In fact, many researchers are of the opinion that the improved mechanical properties can significantly improve the lifetime of all-ceramic restorations and result in enhanced reliability. Therefore, efforts of researchers, as well as manufacturers, have been directed towards the improvement of the mechanical properties in order to overcome such limitations. This article reviews the characterization of the most important mechanical properties that can delineate the behavior of all-ceramic dental materials upon loading. These include fracture mechanics, the brittle nature of ceramics, the relationship between microstructural features and fracture behavior, sources of cracks and flaws that may initiate a fracture and the effect of different fabrication procedures and/or clinical adjustments on the mechanical behavior of dental ceramics are also reviewed and discussed.