Asher Zabrovsky

The growing demand for re-treatment of existing implant supported restorations in the anterior area due to esthetic complications poses a clinical challenge. One-piece implant supported restoration adds to the clinical complexity. Single implant crown restorations appear short as a result of expected cranio-facial changes. In the presented clinical case, a minimally invasive approach is offered as a solution for such an esthetic difficulty. The clinical old crown was prepared to receive an anterior incisal onlay (AIO) made from lithium disilicate and felspathic porcelain. The manufactured addition was adhesively cemented, presenting a simple prosthetic solution for an esthetic complaint, with no need for surgical procedure, while not challenging the one-piece implant body. As the variety of materials and methods for predictable adhesion increases, non-surgical and non-invasive treatment options will receive high priority. When correctly diagnosed and meticulously performed, the presented solution will meet the patient expectations and provide a satisfying result.

Enamel demineralization is a common problem found in patients using orthodontic devices, such as orthodontic braces. It was found that Streptoccocus mutans growth increases adjacent to orthodontic devices, which may result in caries development. Incorporated antibacterial quaternary ammonium polyethylenimine (QPEI) nanoparticles were previously shown to be highly efficacious against various bacteria. Combining antibacterial materials in orthodontic cement may be advantageous to prevent bacterial outgrowth adjacent to orthodontic brackets. The aim was to evaluate the efficiency of orthodontic cement containing QPEI nanoparticles in reducing S. mutans and Lactobacillus casei outgrowth adjacent to orthodontic brackets. Orthodontic brackets were bonded to the buccal surfaces of extracted lower incisors. The antibacterial effect on S. mutans and L. casei outgrowth of Neobond bracket adhesive orthodontic cement with and without QPEI nanoparticles was compared. The antibacterial effect was evaluated using crystal violet staining and bacterial count (CFU/mL). The teeth in the experimental group, with the QPEI nanoparticles cement, showed significantly lower optical density (OD) values and CFU counts of S. mutans and L. casei than the teeth in the control group (p < 0.05). Based on the results, it can be concluded that orthodontic cement containing QPEI nanoparticles significantly inhibits S. mutans and L. casei growth around orthodontic brackets.