Purpose: The aim of this review is to investigate the current state of knowledge on the incorporation of antifungal agents into the tissue conditioners for the treatment of denture induced stomatitis. Study selection: Studies reporting the incorporation of antifungal/antimicrobial agents in to tissue conditioners were included in the review. In order to search the studies on the topic ‘‘incorporation of antifungal agents in tissue conditioners for the treatment of denture induced stomatitis'' ISI web of science, PubMed/MEDLINE, and Google-Scholar databases were searched from 1970 up to and including July 2015 using various keywords such as antifungal agents, tissue conditioners, Candida albicans, denture stomatitis, etc. Results: Various studies reported the efficacy and effectiveness of adding conventional organic antifungal medicines (nystatin, azole group derivatives and chlorhexidine, anti- microbials/antifungals other than organic (silver zeolite, silver nano-particles, photo-cat- alysts and metallic oxides) and natural and herbal antimicrobials (tea tree oil, lemongrass essential oil and origanum oil) into various tissue conditioners. The review literature reported that incorporation of antifungal agents into tissue conditioners is effective with minimal or no effects on physical and mechanical properties of tissue conditioners. Conclusions: Incorporation of different antifungal medicaments to commercially available tissue conditioners can be recommended for the management of denture induced stomatitis.

Purpose: The aim of this article is to review available literature on the clinical procedure of immediate dentine sealing for indirect bonded restorations. Study selection: More than 40 articles reporting the technique, studies, outcomes, etc. were reviewed after PUBMED/MEDLINE search, most of them addressing the specific situation of dentin bonding for indirect restorations. Results: It is known that tooth preparation for indirect bonded restorations can result in significant dentin exposures. Immediate application and polymerization of the dentin bonding agent to the freshly cut dentin, prior to impression making is therefore recom- mended by some authors. Literature indicates that this procedure, immediate dentine sealing (IDS), appears to achieve improved bond strength, fewer gap formations, decreased bacterial leakage, and reduces post-cementation sensitivity. This rational approach to adhesion is also reported to have a positive influence on tooth structure preservation, patient comfort, and long term survival of indirect bonded restorations. Conclusion: In the extensive literature regarding advantages of using IDS technique signifi- cant differences have been shown when compared to Delayed Dentine Sealing. Although more research is required in this field, presently there are NO scientific reasons not to recommend IDS in routine practice.

Purpose: Self-reported measures have been widely used to indicate the presence of possible and probable sleep bruxism (SB) in both research and clinical situations. However, few studies have attempted to assess the diagnostic validity of this approach. The aim of this study was to estimate the diagnostic validity of self-reported measures of SB using an ambulatory single-channel electromyographic (EMG) device. Methods: A total of 115 participants were enrolled and examined by standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) including two questions related to SB: self-reported SB and morning-jaw symptoms. An ambulatory single-channel EMG device (GrindCare3^TM, Medotech A/S) was used for measuring jaw-muscle EMG activity during sleep for seven consecutive nights. Cut-off values for different measures of EMG activity (average, maximum and minimum) and the coefficient of variation (CV) were selected to divide participants into two groups, with higher or lower EMG activity or CV values. The sensitivity and specificity for each question and combination of them were calculated. Results: Self-reported SB had the highest sensitivity (compared with morning-jaw symptoms) for all measures of EMG activity and CV, although the values were low to modest (average: 76.0%, maximum: 76.9%, minimum: 77.3%, CV: 61.0%). The specificity was low for both the questions related to the different measures of EMG activity and CV (35.1-52.4%). Conclusions: This study indicated that the diagnostic validity of self-reported measures of SB was low to modest using an ambulatory EMG device assessment as a reference. Using only self-reported measures for the assessment of SB may not have a high validity, which should be taken into consideration in the clinical evaluation of patients.

Purpose: The aim of this prospective study was to evaluate the changes in oral health-related quality of life (OHRQoL) during implant treatment for partially edentulous patients, and to evaluate the influence of the type of partially edentulous arch. Methods: Twenty patients with a small number of lost teeth (fewer than 4 teeth) who underwent implant treatment were selected. Chronological QOL change during implant treatment was measured. The subjects completed the shortened Japanese version of the Oral Health Impact Profile (OHIP-J14) before the surgery (T0), 1 week after the surgery (T1), 1 week after interim prosthesis placement (T2), and 1 week after definitive prosthesis placement (T3). Complete data of the twenty subjects were analyzed with the Wilcoxon signed-rank test. Results: The total OHIP-J14 score was significantly reduced only at T3 (P < 0.05). ‘‘Physical pain'' and ‘‘Physical disability'' scores significantly decreased at T3, and ‘‘Psychological discomfort'' scores also significantly dropped at T2. However, ‘‘Functional limitation'' scores significantly increased at T1. ‘‘Psychological disability'', ‘‘Social disability'', and ‘‘Handicap''scores remained the same. On the other hand, in the comparison depending on the type of partially edentulous arch, the total OHIP-J14 score significantly decreased at T3 in the unilateral free-end edentulous space, whereas no significant difference was observed in the bounded edentulous space. Conclusion: Although there is a temporary functional limitation after implant placement in overall OHRQoL improvement was observed after the definitive prosthesis placement. Moreover, implant treatment was more effective in the unilateral free-end edentulous space.

Purpose: The aim of this study was to evaluate the effects of hydrofluoric acid treatment on bond strength of resin cements to three different types of ceramic/glass containing CADCAM block composite materials. Methods: CAD-CAM block materials of polymer infiltrated (Vita Enamic), resin nanoceramic (Lava Ultimate) and nanoceramic (Cerasmart) with a thickness of 1.5 mm were randomly divided into two groups according to the surface treatment performed. In Group 1, specimens were wet-ground with silicon carbide abrasive papers up to no. 1000. In Group 2, 9.6% hydrofluoric acid gel was applied to ceramics. Three different resin cements (RelyX,Variolink Esthetic and G-CEM LinkAce) were applied to the tubes in 1.2-mm thick increments and light-cured for 40 s using LED light curing unit. Half of the specimens (n = 10) were submitted to thermal cycling (5000 cycles, 5-55 8C). The strength measurements were accomplished with a universal testing machine (Lloyd Instruments) at a cross-head speed of 0.5 mm/min until the failure occurs. Failure modes were examined using a stereomicroscope and scanning electron microscope. The data were analyzed with multivariate analysis of variance (MANOVA) and Tukey's post hoc tests (a = 0.05). Results: There were significant differences between ceramics and resin cements ( p < 0.001). However, hydrofluoric acid gel treatment had no effect on bond strength values ( p = 0.073). In addition, thermal cycling significantly decreased bond strength values of resin cements to ceramics ( p < 0.001). Conclusions: Use of appropriate resin cement systems with different ceramic/glass-polymer materials might promote the bonding capacity of these systems.

Purpose: The aim of this in vitro study was to evaluate tensile bond strengths and corrosion resistance of CoCr alloys joined with gold cylinder by a soldering system in comparison with the conventional cast-joining system. Methods: CoCr alloys joined with gold cylinder by a soldering system using a high-fusing gold solder (CoCr/Solder/Gold cylinder), gold alloy joined with gold cylinder by a cast joining system (Gold alloy/Gold cylinder) and CoCr castings were fabricated. The tensile bond strength and corrosion resistance in 0.9% NaCl solution (pH 7.4 and pH 2.3) were evaluated. Scanning electron microscopy (SEM) of the fractured surface and electron probe microanal- ysis (EPMA) of the joined interfaces were also performed. Results: The tensile bond strengths of the CoCr/Solder/Gold cylinder specimens showed similar values as the Gold alloy/Gold cylinder specimens. SEM observation and EPMA analyses suggested firm bonding between the CoCr alloy and gold cylinder. The released elements from the CoCr/Solder/Gold cylinder specimens were similar to ones from CoCr castings. Conclusions: Results showed that superstructures made of CoCr alloys joined with the gold cylinder using a high-fusing gold solder had sufficient bond strength and high corrosion resistance. These hybrid frameworks with cobalt-chromium alloy and gold cylinder are promising prosthesis for implant superstructures with the low cost and favorable mechan- ical properties instead of conventional high-gold alloys.

Purpose: The aim of this study was to evaluate the effect of implant location on load distribution in the abutment tooth, implant and residual ridge with a distal-extension implant-supported removable partial denture (ISRPD). Methods: A mandibular unilateral distal-extension edentulous simulation model was used. Implants were inserted at the second premolar (mesial implant) and second molar (distal implant) positions in the edentulous area. An experimental ISRPD was fabricated of acrylic resin with a cobalt-chromium alloy framework. Loads on the implants and abutment tooth were measured with piezoelectric force transducers. The load on the residual ridge was measured with pressure-sensitive film. A vertical load of 100 N was applied at the first molar region. Measurements were made under the following three conditions: with conventional removable partial denture (CRPD), with mesial-implant-supported removable partial den- ture (MISRPD), and with distal-implant-supported removable partial denture (DISRPD). In each condition, the unused implants were made inactive by eliminating contact with the inner surface of the denture. Results: The load on the abutment tooth was greatest with DISRPD, followed by CRPD and MISRPD (P < 0.01). The load on the implant was greater with DISRPD than with MISRPD (P < 0.01). The load on the residual ridge was lowest with DISRPD, followed by MISRPD and CRPD (P < 0.01). Conclusions: This experimental study provided quantitative data regarding the effect of implant location on load distribution with ISRPDs. Further investigation regarding the effect of denture design on the load distribution is needed for determining the proper implant location of ISRPD.

Purpose: Zirconia exhibits excellent strength and high biocompatibility in technological applications and it is has therefore been investigated for clinical applications and research. Before setting prostheses, a crown prosthesis inner surface is sandblasted with alumina to remove contaminants and form small cavities. This alumina sandblasting causes stressinduced phase transition of zirconia. Atmospheric-pressure low-temperature plasma has been applied in the dental industry,particularly for adhesives, as a surface treatment to activate the surface energy and remove contaminants. The purpose of this study was to examine the influence of atmospheric-pressure lowtemperature plasma treatment on the shear bond strength between zirconia and adhesive resin cement. Methods: The surface treatment method was classified into three groups: untreated (Cont group), alumina sandblast treatment (Sb group), and atmospheric-pressure lowtemperature plasma treatment (Ps group). Adhesive resin cement was applied to stainless steel and bonded to zirconia. Shear adhesion tests were performed after complete hardening of the cement. Multiple comparisons were performed using a one-way analysis of variance and the Bonferroni method. X-ray diffractometry was used to examine the change in zirconia crystal structure. Results: Statistically significant differences were noted between the control and Sb groups and between the control and Ps groups. In contrast, no statistically significant differences were noted for the Ps and Sb bond strength. Atmospheric-pressure low-temperature plasma treatment did not affect the zirconia crystal structure. Conclusions: Atmospheric-pressure low-temperature plasma treatment improves the bonding strength of adhesive resin cement as effectively as alumina sandblasting, and does not alter the zirconia crystal structure.

Purpose: Zirconia and cobalt-chromium can withstand a similar degree of loading. There- fore, using a zirconia base for removable dentures could allow the thickness of the palatal area to be reduced similarly to metal base dentures. We hypothesized that zirconia palatal plate for removable dentures provides a high level of participants' perception without influencing taste thresholds. The purpose of this study was to evaluate the participants' perception and taste thresholds of zirconia palatal plate. Methods: Palatal plates fabricated using acrylic resin, zirconia, and cobalt-chromium alloy were inserted into healthy individuals. Taste thresholds were investigated using the whole- mouth gustatory test, and participants' perception was evaluated using the 100-mm visual analog scale to assess the ease of pronunciation, ease of swallowing, sensation of tempera- ture, metallic taste, sensation of foreign body, subjective sensory about weight, adhesive- ness of chewing gum, and general satisfaction. Results: For the taste thresholds, no significant differences were noted in sweet, salty, sour, bitter, or umami tastes among participants wearing no plate, or the resin, zirconia, and metal plates. Speech was easier and foreign body sensation was lower with the zirconia plate than with the resin plate. Evaluation of the adhesiveness of chewing gum showed that chewing gum does not readily adhere to the zirconia plate in comparison with the metal plate. The comprehensive participants' perception of the zirconia plate was evaluated as being superior to the resin plate. Conclusions: A zirconia palatal plate provides a high level of participants' perception without influencing taste thresholds.

Purpose: The aim of this study was to evaluate, by CBCT superimposition, bone changes (cortical bone intactness, sclerosis and subchondral cyst) in the glenoid fossa related to stabilization splint (SS) therapy for temporomandibular joint osteoarthritis (TMJ OA) patients and to compare the effects for two groups, one that had undergone SS therapy and the other that had not. Methods: This case-control study included 36 TMJ OA patients, 10 that had undergone SS therapy (the SS group) compared with 26 that had not (the non-SS group). Osseous changes in the glenoid fossa were evaluated based on superimposed CBCT images before and after treatment. Results: Improvements ranging from 57.5 to 100% were achieved in cortical bone integrity, sclerosis, and subchondral cyst for both groups, SS and non-SS. However, there were no statistically significant difference between the two groups ( p > 0.05). The non-SS group showed a significant decrease in the distances from the point of inflexion and the lowest point of the articular eminence to the reference line ( p < 0.05). On the other hand, the SS group showed an increase for the point of inflexion. The other measures showed no statistically significant differences in distance before treatment and after treatment, even though the average distance after treatment showed an overall increasing tendency. Conclusion: SS therapy relieved excessive loading on the TMJ in the TMD OA patients, who showed, via CBCT superimposition, less bone resorption in the glenoid fossa.

Purpose: Low-intensity pulsed ultrasound (LIPUS) is widely used in medical fields because it shortens the time required for biologic wound healing in fracture treatment. Also, in dental fields, LIPUS should be effectively employed for implant treatment. However, most of the relevant reports have been published on its effects on bone formation around implants, and the effects of LIPUS on soft tissue healing remain unclear. In the present study, we examined the effects of LIPUS on soft tissue healing using gingival epithelial cells. Methods: Gingival epithelial cells were cultured on a dish, followed by LIPUS exposure at a frequency of 3 MHz for 15 min. The cells were counted with a hemocytometer, and a scratch assay was conducted by measuring the closing area of the scratch wound using a micro- scope. Following LIPUS exposure, total RNA was collected for microarray analysis. In addition, real-time PCR was performed to examine the mRNA expression level of integrin a6b4. Furthermore, total protein was collected to examine the protein expression level of integrin a6b4 by western blotting. Results: The cell count and scratch assay demonstrated that LIPUS exposure promoted cell proliferation and scratch-wound closure. Microarray analysis demonstrated the increased expression levels of adhesion-related genes, including integrin. Real-time PCR analysis demonstrated that LIPUS exposure significantly up-regulated the mRNA expression level of integrin a6b4. Western blotting showed intense staining of integrin a6b4. Conclusion: LIPUS exposure promotes wound closure in the scratch assay and up-regulates the expression level of integrin a6b4 as compared with the control.

Purpose: To compare the impact of canine guided vs. bilateral balanced occlusion on oral health related quality of life (OHRQoL) as a patient-reported outcome measure. Methods: In this randomized single-blind crossover trial, 19 patients have been provided with new complete dentures in the maxilla and mandible. OHRQoL was assessed using the 49-item Oral Health Impact Profile (OHIP-49) before the start of the prosthodontic treatment (B), 3 months after insertion of the new dentures (T1), and 3 months after rework into the alternative concept (T2). Multilevel mixed-effect linear regression models were computed to determine the effect provided by the new set of dentures and the specific impact of the occlusal concept on OHRQoL using summary scores of the OHIP-49 and of a 19-items subset specific for edentulous patients (OHIP-EDENT). Results: At baseline, participants' OHRQoL was substantially impaired indicated by an average OHIP-49 score of 42.1 points and an OHIP-EDENT score of 21.1 points. The effect of provision of a new set of complete dentures was a statistically significant decrease of 8.3 points (OHIP-49) and 4.0 points (OHIP-EDENT), respectively, representing a clinically rele- vant improvement in OHRQoL. When wearing dentures with bilateral balanced occlusion, participants showed on average 1.6 points higher OHIP-49 scores and 0.9 points higher OHIP- EDENT scores compared to canine guided dentures. This effect of the occlusal concept was neither statistically nor clinically significant. Conclusions: Both investigated occlusal concepts for complete dentures were comparable in their effect on patients' perceptions with none being considerably superior in terms of OHRQoL.

Purpose: The purpose of this report is to propose a computer assisted mandibular reconstruction procedure, utilizing a custom-made Ti-mesh tray with particulate cancellous bone and marrow, and a removable denture. This procedure was based on the top-down treatment technique, and reviews the case of a representative patient with mandibular continuity defect. Methods: The patient was a 74-year old female with a chief complaint of facial asymmetry and masticatory dysfunction. Due to gingival carcinoma, she underwent a segmental mandibulectomy on the left mandibule. On the VR space, using 3-D reconstructed computer tomography data, the residual rightside mandibular fragment was repositioned based on the condylar position and the occlusal relation. The mandibular fragment was then mirrored for a central sagittal plane. The position of the mirrored object was slightly arranged with the occlusal relation. Through the above operations, the landmark configuration, for the custom-made Ti-mesh tray as a virtual simulation model, was fabricated. On the physical model, we produced a custommade Ti-mesh tray with a commercial Ti-mesh sheet. Surgical treatment was carried out using the tray. The denture pattern was designed by a dental technician on the VR space, fabricated using a 3D printer, and modified to create an impression tray with resin. Using the impression, the temporary removable denture was fabricated. Conclusions: We propose a computer assisted design for a custom-made Ti-mesh tray and a removable denture, based on the Top-down treatment concept. We feel this technique is advantageous in reconstructing functional occlusion, and in accurately regaining dental and facial esthetics.

Patient: A fifty-year-old man received embolization for mandibular hemangioma two years ago, and the surgeon had placed four implants in his mandible and made a removable denture upon the implants. His denture however fractured repeatedly in the past years. After examination and communication with the patient, an implant-assisted overdenture incorporating bar attachment combined ERA attachment and Locator abutment was re- fabricated. A sixteen months follow-up showed acceptable outcome. Discussion: There are some guidelines on design of implant over-denture, the site of implant will affect the final result. The unfavorable bone structure of mandibular hemangioma restricts the number and the site of implant, modification of design is essential to improve the final result. Conclusion: Multi-disciplinary cooperation should be established for extensive edentulous case. Overlay type prosthesis incorporating several types of attachments can be suitable for complex case because of acceptable results and easy maintenance.

Patient: A 69-year-old Japanese male visited Nihon University Dental Hospital for refabrica- tion of his mandibular implant-supported complete fixed prosthesis (ISCFPD) and maxillary ^{complete denture, which had been fabricated 15 years previously. In this case, Ce-TZP/Al}2^O3 nanocomposite (Ce-TZP/A) was applied to the framework of the mandibular ISCFPD and maxillary complete denture. Three years after deliver of the framework, no particularly notable biological or prosthetic complications were observed, and a high level of patient satisfaction had been achieved. Discussion: Conventional ISCFPD frameworks were fabricated by casting gold alloys; how- ever, with the recent advancement of CAD/CAM technology, titanium (Ti) or yttria tetrago- nal zirconia polycrystal (Y-TZP) frameworks have become more common. In contrast, the main fabrication method for Ti or Co-Cr frameworks of removable dental prostheses has shifted from the conventional casting method to CAD/CAM fabrication. Ce-TZP/A, which was chosen as the framework material this time, shows higher strength and greater toughness than Y-TZP. However, since it has a low light-transmitting property and exhibits an opaque white color, the range of its application in fixed prostheses, particularly in the esthetic area, is limited. Conclusion: We described a case in which Ce-TZP/A was applied to the frameworks of a mandibular ISCFPD and a maxillary complete denture. No particularly notable biological or prosthetic complications were observed in the mandibular ISCFPD or the maxillary com- plete denture, and a high level of patient satisfaction was achieved. Medium- and long-term observations with a greater number of cases are essential to obtain information concerning various phenomena related to this procedure.