Academic literature on the topic 'Restorative and prosthodontics margins'

Advances in computer-aided design (CAD) / computer-aided manufacturing (CAM) technologies and their ease of application enabled the development of novel treatment concepts for modern prosthodontics. This recent paradigm shift in fixed prosthodontics from traditional to minimally invasive treatment approaches is evidenced by the clinical long-term success of bonded CAD/CAM glass-ceramic restorations. Today, defect-oriented restorations, such as inlays, onlays, and posterior crowns, are predominately fabricated from glass-ceramics in monolithic application. The variety of CAD/CAM ceramic restorative systems is constantly evolving to meet the increased demands for highly aesthetic, biocompatible, and long-lasting restorations. Recently introduced polymer-infiltrated ceramic network CAD/CAM blocks add innovative treatment options in CAD/CAM chairside 1-visit restorations. The material-specific high-edge stability enables the CAD/CAM machinability of thin restoration margins. Full-contour zirconia restorations are constantly gaining market share at the expense of bilayered systems. Advancements in material science and bonding protocols foster the development of novel material combinations or fabrication techniques of proven high-strength zirconia ceramics. CAD/CAM applications offer a standardized manufacturing process resulting in a reliable, predictable, and economic workflow for individual and complex teeth-supported restorations. More evidence from long-term clinical studies is needed to verify the clinical performance of monolithic polymer-infiltrated ceramic network and zirconia teeth-supported minimally invasive and extensive restorations.

ABSTRACT This case report demonstrates sequential Periodontic, Orthodontic and Prosthodontic treatment modalities to save and restore deep horizontally fractured maxillary central incisor. The location of fracture was deep in the mucosa which reveals less than 2 mm of tooth structure to receive the crown. The procedures like surgical crown lengthening, endodontic post placement, orthodontic forced eruption, core build-up and metal-ceramic crown restoration were sequentially performed to conserve the fractured tooth. Forced eruption is preferred to surgical removal of supporting alveolar bone, since forced eruption preserves the biologic width, maintains esthetics, and at the same time exposes sound tooth structure for the placement of restorative margins. How to cite this article Patil PG, Nimbalkar-Patil SP, Karandikar AB. Multidisciplinary Treatment Approach to Restore Deep Horizontally Fractured Maxillary Central Incisor. J Contemp Dent Pract 2014;15(1):112-115.

Abstract Introduction Provisional restoration is a critical component of fixed prosthodontics treatment, which must satisfy many inter-relative factors such as biological, mechanical, and esthetic. These restorations should have accurate marginal adaptation and optimum strength to maintain functional demands. The present “in vitro” study was conducted to evaluate the effect of water temperature and duration of immersion, on the marginal adaptation and microhardness of four different commercially available provisional restorative materials. Materials and Methods The 240 specimens were then seated on the stainless-steel die which simulated the prepared tooth, and evaluated for the marginal gap for four different provisional restorative materials and divided into four different groups A, B, C, and D. Each group was further divided into six subgroups according to temperature of water and time of immersion. In each group the samples were immersed in water at 20, 30, and 40 degrees, respectively for 5 and 10-minutes duration. Four different temporary restorative materials for crown fabrication were loaded each time to make temporary crowns. Results Each sample was placed under travelling stereoscopic microscope (20× magnification) and photographed. Results for each surface were obtained, and the average of three surfaces was calculated. Knoop hardness was measured using a microhardness tester. The study was subjected to statistical analysis, to know the statistical significance, of the effect of difference in time and temperature changes at the time of final polymerization on surface microhardness and marginal integrity of four different provisional restorative materials. Discussion The mean marginal discrepancies of bis-GMA (group B) at 20, 30, and 40°C for 5 and 10 minutes in water were smaller than the results of other groups. Microhardness evaluation showed that the poly ethyl methacrylate (PEMA) type resin exhibited significantly lower microhardness than the bis-acryl resin composites (Protemp 4 and Systemp.c&b) at both time and temperature intervals. Conclusion The bis-acryl composites material has the least marginal discrepancy in comparison with PEMA and polymethyl methacrylate (PMMA). The bis-acryl composites materials exhibit superior surface microhardness followed by PEMA and PMMA.

Fabrication of a clinically successful dental prosthesis requires clear and effective communication between dentists and dental technicians. Adequate completion of work authorization by dentists provides a means for increased professional quality assurance and satisfaction in dental prosthesis. The aim of this study was to evaluate the quality of communication between dentists and dental technicians via work authorization for fixed and removable dental prosthesis in Pakistan. This cross-sectional study was conducted for a period of 6 months to assess the quality of communication between dentists and dental technicians. A well-constructed questionnaire regarding work authorization of removable and fixed prostheses was used as a tool to collect data from 453 dentists. A linear regression analysis was performed to evaluate the relationship of the independent and dependent variables. A p value of ≤0.05 was considered statistically significant. It was observed that 92.1% of the dentists leave removable partial denture design to the dental technicians. About 56.5% of the dentists indicated information about base retention of partial dentures in work authorization. The majority of the dentists (56.5%) mentioned the material to be used for the construction of casting partial dentures. Nearly 66% of the dentists indicated the design of margins, and 44.6% of the dentists did not select the shade for fixed prostheses. Nearly 43% of the dentists did not draw the design of restoration, 21.9% chose to draw the design on paper, and 32.2% of the dentists drew the design on the cast. Meanwhile, 76.8% of the participants chose to directly communicate with their dental technicians personally. Nearly 41% of the dentists were satisfied with the restoration design, and 13.5% of the participants were not satisfied with the designs. Poor communication between dentists and technicians was observed, as the majority of the design decisions were left to the dental technicians. Therefore, communication between dentists and dental technicians should be improved by conducting combined workshops for the successful construction of dental prostheses.

(1) Background: Intraoral optical scanning (IOS) has gained increased importance in prosthodontics. The aim of this in vitro study was to analyze the IOS accuracy for treatment with full crowns, considering possible influencing factors. (2) Methods: Two tooth morphologies, each with four different finish-line designs for tooth preparation and epi- or supragingival locations, were digitally designed, 3D-printed, and post-processed for 16 sample abutment teeth. Specimens were digitized using a laboratory scanner to generate reference STLs (Standard Tessellation Language), and were secondary-scanned with two IOS systems five times each in a complete-arch model scenario (Trios 3 Pod, Primescan AC). For accuracy, a best-fit algorithm (Final Surface) was used to analyze deviations of the abutment teeth based on 160 IOS-STLs compared to the reference STLs (16 preparations × 2 IOS-systems × 5 scans per tooth). (3) Results: Analysis revealed homogenous findings with high accuracy for intra- and inter-group comparisons for both IOS systems, with mean values of 80% quantiles from 20 ± 2 μm to 50 ± 5 μm. Supragingival finishing lines demonstrated significantly higher accuracy than epigingival margins when comparing each preparation (p < 0.05), whereas tangential preparations exhibited similar results independent of the gingival location. Morphology of anterior versus posterior teeth showed slightly better results in favor of molars in combination with shoulder preparations only. (4) Conclusion: The clinical challenge for the treatment with full crowns following digital impressions is the location of the prospective restoration margin related to the distance to the gingiva. However, the overall accuracy for all abutment teeth was very high; thus, the factors tested are unlikely to have a strong clinical impact.

Background: The aim of this study was to collect long-term restorative and endodontic outcomes of endodontically treated teeth (ETT). Methods: 298 teeth were included in the study and were recalled up to 18 years with a media of 10.2 years. At baseline, 198 sample teeth (66.44%) showed symptoms and 164 (55%) had periapical radiolucency. The most frequently used obturation techniques were warm gutta-percha in 80% of cases, and by carrier in 20%. A total of 192 ETT were restored by direct resin composite restorations, and 106 posts were luted. Moreover, 75 (25.16%) direct restorations remained as final restorations, 137 single crowns (45.97%), 42 (14.09%) partial adhesive crowns, and 42 (14.09%) abutments of fixed bridges were the final treatments. Descriptive and inferential statistics were performed (α = 0.05). A Cox regression model was made. Results: results showed success for 92.6% of ETT up to 18 years, 2.68% (8 ETT) showed irreversible failures, and 14 (4.69%) reversible complications. Four ETT (1.34%) failed because of root fracture and the other four (1.34%) because of endodontic complications. Eight ETT (2.69%) showed non-irreversible periodontal complications and the other six (2.01%) prosthodontic complications. Accordingly, with Kaplan–Meier analysis, the survival rate after 18 years was 97.3% (Interval of Confidence (IC) 95.1–98.3). The presence of a short or long (at least 1 mm related to radiographic apex) quality endodontic filling displayed a statistically significant higher risk of complication (hazard ratio (HR) = 17.00 (IC 5.68–56.84). Furthermore, a clinically detectable not precise coronal margins predicts the presence of any clinical complication with a hazard ratio almost seven times higher than endodontically treated teeth with a proper margin (HR = 6.89 (IC 2.03–23.38)), while the presence of lucency at the baseline did not affect the risk of complication (HR = 0.575 (IC 0.205–1.61)). The presence of post, tooth position in the arch, and the type of it did not show a high-risk rate (HR = 1.85, 1.98, and 2.24, respectively). Conclusions: a correct filling (at the apex) of root canals combined with proper coronal margins allow obtaining a long-term high success rate in teeth with a periapical lesion at the baseline. The use of a post or not, when its placement is related to the residual amount of the crown, does not change the final outcome of the ETT.

Supporting teeth preservation at the restoration of dentition defects with the help of fixed porcelain fused metal dentures is considered one of the most important issues of prosthodontics. Margin line preparation strategies are still disputable nowadays. In most cases preparation is confined to the ledge creation. Its function is to provide a smooth transition of orthopedic restoration to a tooth root and prevent the traumatization of marginal paradontium. These issues are gaining a momentum when the possibility of manufacturing fixed prosthesis with the use of partially or completely ruined teeth with the preserved root as a support appears. Since the opportunities of thermal method for gingiva retraction and marginal line formation around the supporting teeth are not studied enough in modern scientific sources, our research aims to define the mastication efficiency state in patients of sample groups after the fixation of dentures on the supporting teeth prepared for prosthesis with the help of diathermocoagulation and mechanical retraction. The authors of the article have determined the mastication efficiency in the patients with the restored tooth crown. Altogether 54 patients of two sample groups aged from 20 to 60 years and above with completely ruined tooth crowns were examined. Their soft tissues around the supporting teeth were prepared for the fixed prosthesis manufacturing. The first sample group involved 29 patients that made up 53.7% of general studied population. Their supporting teeth gingiva margins were retracted with the help of diathermocoagulation while preparing them for the fixed dentures. While the gingiva margins of the patients of the second sample group, consisting of 25 people (46.3% of general studied population), were retracted with the help of cotton Ultrapak cord, produced by Ultradent (the USA). It is offered in several size options. Mastication efficiency state after prosthesis was determined with the help of mastication test (Ukrainian Utility Patent # 94841). In this case, mastication index was the main diagnostic tool. It was received with the help of computer analysis of digital samples in software “Adobe Photoshop Extended”. The analysis of the dynamics of mastication test indices of the patients of sample group 1 delivered typical results. In a week after the fixation of fixed porcelain fused metal dentures, the reduction of the mean value of mastication test index by 0.2 was fixed. The verification of these changes according to the statistical significance showed positive result (at p = 0.0004). At the same time, the verification of the changes, occurred during the period from the 7th to the 30th day after the fixation of dentures in patients of sample group 1, with the help of Wilcoxon test showed that at p = 0.9 the reduction of the mean value to 5.148 had no statistical significance. While the dynamics of mastication test changes in sample group 2 looked as follows. The reduction of the mean values of mastication test index from 5.184 to 5.112 was observed. So, the spread between the values received before the retraction and in seven days after crown fixation made up 0.072. The conducted statistical verification of these changes (at p = 0.01) proved their statistical significance. In contrast, the collation of the indices received after seven days of denture fixation and in 30-days period after it (from 5.112 to 5.132) at p = 0.961 demonstrated changes at the level of statistical error. According to the received research results, prosthesis with the fixed porcelain fused metal dentures promotes patients’ mastication efficiency restoration. That is traced in the reduction of the mastication test index values received after the 7th day of crown fixation in both sample groups. It should be noted here, that statistically significant difference between the indices of the patients of sample group 1 and 2 was not found. On the 30th day of denture fixation, mastication efficiency indices remained almost the same.

Periodontal health plays an important role in the longevity of prosthodontic restorations. The issues of comparative assessment of prosthetic constructions are complicated and not fully understood. The aim of this article is to review and present the current knowledge regarding the various technical, clinical, and molecular aspects of different prosthetic biomaterials and highlight the interactions between periodontal health and prosthetic restorations. Articles on periodontal health and fixed dental prostheses were searched using the keywords “zirconium”, “CAD/CAM”, “dental ceramics”, “metal–ceramics”, “margin fit”, “crown”, “fixed dental prostheses”, “periodontium”, and “margin gap” in PubMed/Medline, Scopus, Google Scholar, and Science Direct. Further search criteria included being published in English, and between January 1981 and September 2021. Then, relevant articles were selected, included, and critically analyzed in this review. The margin of discrepancy results in the enhanced accumulation of dental biofilm, microleakage, hypersensitivity, margin discoloration, increased gingival crevicular fluid flow (GCF), recurrent caries, pulp infection and, lastly, periodontal lesion and bone loss, which can lead to the failure of prosthetic treatment. Before starting prosthetic treatment, the condition of the periodontal tissues should be assessed for their oral hygiene status, and gingival and periodontal conditions. Zirconium-based restorations made from computer-aided design and computer-aided manufacturing (CAD/CAM) technology provide better results, in terms of marginal fit, inflammation reduction, maintenance, and the restoration of periodontal health and oral hygiene, compared to constructions made by conventional methods, and from other alloys. Compared to subgingival margins, supragingival margins offer better oral hygiene, which can be maintained and does not lead to secondary caries or periodontal disease.

ABSTRACT Planning and executing the restorative rehabilitation of a severely worn dentition is probably one of the most intellectually and technically demanding tasks faced by the restorative dentist. This article describes the rehabilitation of a 55-year-old male patient with severe loss of tooth structure. The maxillary arch was restored using fixed restorations and the mandibular arch using the integration of fixed and removable prosthodontics. The integration of fixed and removable prosthodontics in a partially dentate patient poses a challenge as well as an opportunity for the use of a partial overdenture.

Prosthodontic and periodontal correlation on teeth In the daily dental practice 3 fundamental/empiric/clinical parameters have a role to establish the clinical success of prosthodontic treatment: function, aesthetic and longevity of the restorations. But, from a scientific point of view, how do we rate the success of the restorations? When analyzing the existing literature, it can be noted that many authors focus their attention on the precision of the margin, to pursuit a small gap between the abutment and the crown, and to achieve the clinical success. Christensen et al.1 and Mc Lean & Von Fraunhofer2 investigated the margins’ clinical acceptability by dentists and asked to measure the gap between the abutment and the crown to a number of practitioners: it was shown that a clinician can clinically appreciate a gap not lower than 120 microns using a sharp explorer. This result may end in a not sure and sufficient seal between the crown and abutment, and consequently leakage at the margins. This finding is not in agreement with the existing data coming from an in vitro study in which the acceptable marginal gap is lower than 50 microns3 Sorensen3 reported that small defects less or equal then 0,050 mm were associated with significantly less fluid flow and bone loss than defects exceeding this value. Martignoni4-5 reported that there are variable definitions regarding what constitutes a margin that cab ne clinically acceptable, and there is no definite threshold for the maximum marginal discrepancy that is clinically acceptable. Many authors accept the criteria established by McLean and Von Fraunhofer2, they completed a 5-year examination of 1000 restorations and concluded that 120 microns should be considered the maximum marginal gap. The adaptation, the precision and the quality of the restoration margin can be of greater significance in terms of gingival health, than the position of the margin6. According to Lang et al. 7 following the placement of restorations with overhanging margins, a subgingival flora was detected which closely resembled that of chronic periodontitis. Following the placement of the restorations with clinically perfect margins, a microflora characteristic for gingival health or initial gingivitis was observed. In patients with suitable oral hygiene, tooth-supported and implant-supported crowns with intra-sulcular margins were not predisposed to unfavorable gingival and microbial responses8. Even among patients receiving regular preventive dental care, subgingival margins are associated with unfavorable periodontal reactions9. Ercoli and Caton10, in a systematic review, describe how placement of restoration margins within the junctional epithelium and supracrestal connective tissue attachment can be associated with gingival inflammation and, potentially, recession or periodontal pocket. The presence of fixed prostheses finish line within the gingival sulcus or wearing of partial, removable dental prostheses does not cause gingivitis if the patients are complaint with self-performed plaque control and periodic maintenance. Procedures adopted for the fabrication of dental restorations and fixed prostheses have the potential to cause traumatic loss of the periodontal supporting tissue. They concluded that restoration margins located within the gingival sulcus do not cause gingivitis if the patients are complaint with self-performed plaque control and periodic maintenance. Tooth-supported and/or tooth-retained restorations and their design, fabrication, delivery, and materials, have often been associated with plaque retention and loss of attachment. Restoration margins placed within the junctional epithelium and supracrestal connective tissue attachment can be associated with inflammation and, potentially, recession. Factors related to the presence, design, fabrication, delivery and materials of tooth-supported prostheses seem to influence the periodontium, generally related to localized increase in plaque accumulation and, less often, to traumatic and allergic reactions to dental materials10. Jansson showd that the influence of a marginal overhang on pocket depth and radiographic attachment decrease with increasing loss of periodontal attachment in periodontitis-prone patients, and the effect on pocket depth of a marginal overhang may act synergistically, potentiating the effect of poor oral hygiene11. Subgingival restorations with their apical borders still located subgingivally after periodontal treatment should be regarded as a risk factor in the progression of periodontitis12. Consequently, placement of the restoration margin supragingivally is recommended, especially in periodontitis-prone patients with an insufficient plaque control12. Dental restorations may be suggested as a risk indicator for periodontal disease and tooth loss. Routine SPT (Supportive Periodontal Therapy) was found to be associated with decrease in the prevalence of deep PPD over time, and it is of the utmost importance in maintaining periodontal health, especially adjacent to teeth with restorations. Finally, these findings may support the treatment of caries lesions and faulty restorations as part of a comprehensive cause-related therapy and should be followed by a regular maintenance program13. The relationship between dental restorations and periodontal status has been examined for some time. Research has shown that overhanging dental restorations and subgingival margin placement play an important role providing an ecologic niche for periodontal pathogens14. An overhanging dental restoration is primarily found in the class II restoration, since access for interdental finishing and polishing of the restoration, and cleansing is often difficult in these areas, even for patients with good oral hygiene. Many studies have shown that there is more periodontal attachment loss and inflammation associated with teeth with overhangs than those without. Presences of overhangs may cause an increase in plaque formation15-21 and a shift in the microbial composition from healthy flora to one characteristic of periodontal disease14. The location of the gingival margin of a restoration is directly related to the health status of the adjacent periodontium8. Numerous studies8-12-25 have shown that subgingival margins are associated with more plaque, more severe gingival inflammation and deeper periodontal pockets than supragingival ones. In a 26-year prospective cohort study, Schatzle et al. 25 followed middle class Scandinavian men for a period of 26 years. Gingival index, and attachment level were compared between those who did and those who did not have restorative margins greater than 1mm from the gingival margin. After 10 years, the cumulative mean loss of attachment was 0.5 mm more for the group with subgingival margins. This was statistically significant. At each examination during 26 years of the study, the degree of inflammation in the gingival tissue adjacent to subgingival restorations was much greater than in the gingiva adjacent to supragingival margins. This is the first study to document a time sequence between the placement of subgingival margins and periodontal attachment loss, confirming that the subgingival placement of margins is detrimental to gingival and periodontal health. Plaque at apical margin of a subgingival restoration will cause periodontal inflammation that may in turn destroy connective tissue and bone approximately, 1-2 mm away from inflamed area14. Determination of the distance between the restorative margin and the alveolar crest is often done with bitewing radiographs; however, it is important to remember that a radiograph is a 2-dimensional representation of 3-dimensional anatomy and structure. Thus, clinical assessment and judgment are important adjuncts in determining if, and how much, bone should be removed to maintain adequate room for the dento-gingival supra crestal connective tissue height attachment14. Although surface textures of restorative materials differ in their capacity to retain plaque26, all of them can be adequately maintained if they are correctly polished and accessible to patient care27. This includes underside of pontics. Composite resins are difficult to finish interproximally and may be more likely to show marginal defects than other materials28. As a result, they are more likely to harbor bacterial plaque29. Intra-subject comparisons of unilateral direct compositive “veneers” showed a statistically significant increase in plaque and gingival indices adjacent to the composites, 5-6 years after placement28. In addition, when a diastema is closed with composite, the restorations are often overcontoured in the cervical-interproximal area, leading to increased plaque retention28. As more plaque is retained, this could pose a significant problem for a patient with moderate to poor oral hygiene14. For that, in absence of more specific prosthodontic parameters to evaluate the integration of crowns in to the periodontal environment, another way to determine the success and health of the restoration is to use the periodontal parameters such as: PPD (Periodontal Probing Depth) that is the measurement of the periodontal sulcus/pocket between the gingival margin and the bottom of the sulcus/pocket; REC (Recession) is the apical migration of the gingival margin measured with the distance between the gingival margin and the CEJ (Cement-Enamel Junction); PI (Plaque Index) the index records the presence of supragingival plaque; BOP (Bleeding On Probing) the presence or not of bleeding on surfaces of the teeth during the probing. The aim of this study/thesis was to propose a clinical procedure to evaluate single unit restorations and their relations with periodontal tissues by a new clinical score: the FIT ( Functional Index for Teeth). FIT, that is a novel index for the assessment of the prosthetic results of lithium disilicate crowns, based on seven restorative-periodontal parameters, that evaluate crowns placed on natural abutments, and want to be a reliable and objective instrument in assessing single partial crown success and periodontal outcome as perceived by patients and dentists.

Cracked teeth have long presented a diagnostic challenge. Previous investigators have considered possible predictive factors, many of which revolve around the tooth’s restorative characteristics. Few have investigated the restorative status of teeth with cracks extending into the pulp chamber. The purpose of this investigation was to determine the prevalence of the different types of restorations present in intrapulpally cracked teeth and determine any other restorative factors that may aid in predicting the presence or extent of an intrapulpal crack. Intrapulpally cracked molars requiring endodontic therapy at the VCU Graduate Endodontic Practice were included in this study. For each tooth, the type of restorative material present and surfaces involved were recorded. The Restoration Volume Proportion (RVP) was calculated to accurately quantify the size of the restoration present. Pulpal and periapical diagnoses, and intrapulpal crack classification were also recorded. Chi squared analysis and logistic regression were used to determine any significant associations. This study included 43 teeth. The study population was 65% female and the average age was 56. Of the various restoration types evaluated, 73% of teeth presented with amalgams, 12% with composites. Class I restorations were 61% of the sample. The most frequently occurring restoration size by volume was a “small” restoration. The most commonly involved teeth were the maxillary 1st molar and mandibular 2nd molar. A significant association was found between restoration size and crack classification suggesting that teeth with larger restorations had a higher incidence of coronal cracks while those with smaller restorations had a higher incidence of radicular cracks. Restoration classification and pulpal walls involved were also significantly associated suggesting that Class II restorations were most frequently associated with cracks involving a single pulpal wall while Class I restorations were evenly associated with one and two wall cracks. Other significant associations were found between tooth type and pulpal walls involved and between restoration surfaces and pulpal wall classification. This study found several significant associations between restoration characteristics and intrapulpal cracks. Further research may continue to reveal how a tooth’s restorative status may influence its risk for the presence of an intrapulpal crack.

One of the most critical aspects of successful crown and bridgework is temporary restorations. Failure of temporary restoratins often affects the patient's confidence and mau result in unscheduled appointments for repair. This study compared the the fracture toughness of two materials commonly used to fabricate provisional restorations, namely Coldpac, a polymethyl methacrylate and Protemp 3 Garant, a bis-acryl composite. It also compard the fracture toughness of the two materials when reinforced with stainless steel wire, glass fibers and polythylene fibers.

The study uses a qualitative comparative case study design to study the adoption, implementation and integration of restorative justice in education (RJE) in public high schools as a remedy to the growing school-to-prison pipeline. Such zero-tolerance, exclusionary policies that dominate schools today adopt punitive tactics towards handling matters of conflict and justice within schools. The retributive approach is gaining harsh criticism as it disproportionately impacts minority youth and criminalizes student behavior. RJE along with other Social Emotional Learning (SEL) approaches is gaining traction within schools as a means of humanizing school environments and emphasizing a student centered perspective. Drawing on human service organizational theoretical frameworks, namely institutional entrepreneurship, innovation implementation, ambiguity-conflict model of policy implementation and diffusion of innovation, this study seeks to expand knowledge on RJE by providing a more critical examination of whether RJE has moved from a more marginal status towards becoming mainstream or standardized practices at schools. The study has a particular focus on the partnerships with community-based organizations (CBOs) many high schools form in order to carry out this work.

The study adopts a two-phased purposively sampled approach conducted over a period of a year. The primary mode of data collection comprised of conducting face-to-face semi-structured interviews with program managers of CBOs (n=10), central district personnel (n=3), which constitutes the first phase, and multiple school personnel across four high schools (n=60), which constitutes the second phase. Using the AtlasTi software, verbatim transcripts of audio-recorded interviews were analyzed using an inductive and deductive coding scheme. Additional sources such as school discipline data, observations, contract documents and other media sources were examined for data triangulation purposes.

The findings highlight the critical role played by CBOs to bring about RJE adoption at both the policy level as well as the local schools. However post RJE reform at the policy level, the role and the agency of the CBOs have diminished as evidenced in my findings. Despite the RJE seed being planted by CBOs at schools, the principals make the ultimate adoption decisions about catalyzing RJE reform within schools. Successful implementation of RJE within schools includes three main factors: leadership, effective communication on RJE programming and invigorating a positive school culture. Schools which diffuse and institutionalize RJE as a part of SEL compared to schools that integrate RJE as a part of discipline are more likely to be contributing to the care ethos and nurturing healthy school cultures. However, such a contribution has not redefined the notion of policing and justice within schools, as the study finds traces of the retributive approach still operational within these schools.

Using the various organizational theoretical frameworks I argue that there are five critical aspects that have come in the way of RJE reform dole out. Firstly, there is a discrepancy in RJE policy vis a vis practice because the CPS Central District Office is using coercive tactics and mandating the use of RJE within schools, which has resulted in resistance to RJE. Secondly, precarity of school-CBO partnerships are playing out largely because of resource dependency issues of CBOs who have lost their ability to effect change beyond adoption. Thirdly, findings highlight the constant state of urban flux in operation at these schools such as drastic leadership changes, staff attrition, neighborhood gentrification amongst others, which has made embedding RJE into the fabric of schools very challenging. Principals have emerged as being very crucial to the RJE change process, since they are contending with both policy level actors as well as CBOs to continue to inspire their own personnel to implement and institutionalize RJE reform. Finally, especially at the local school level personnel appear to be more misinformed about the key components of RJE, thus training efforts need to be reoriented with fidelity and quality control in mind. Thereby, RJE has definitely moved away from the margins but it is still not the mainstream practice at schools. RJE has failed to upkeep its promise and potential especially towards marginalized, communities of color.

Greater district engagement, continued CBO agency as well as sustained programmatic endeavors spearheaded by principals at the local school level are important for RJE to pose as a true alternative to punitive sanctions rather than being coopted by the retributive approach. Therefore, my study pushes the field of human service delivery, in that instead of focusing on the outcomes of RJE, per se, it looks at the process of and challenges in implementing this innovation, providing insight into improving contracting relations between partners and questions the sustainability of reform efforts within urban environments.

Digital technology is advancing rapidly in dentistry. Computers are making what were previously manual tasks easier, faster, cheaper and more predictable. Layered manufacturing processes can produce complex shapes at affordable prices with little or no waste. The challenge for the dental materials research community is to mach the new technology with materials that are suitable for use in dentistry. This can potentially take dental materials research in a totally different direction. The new generation of ceramic materials presents interesting options, both in terms of material selection and in terms of fabrication techniques. A closer understanding of the dynamics of the materials with respect to design of the restoration and the intended use is required to enable these restorations to perform productively.

This chapter explores a range of justice mechanisms that present as alternatives to courtrooms and jails. It discusses a number of ‘othered’ alternatives. A rich thread of Schabas’s work itself engages with such alternatives, and this chapter references this thread. When it comes to alternatives to criminal trials, truth commissions and public inquiries emerge as among the most obvious candidates. In this regard, then, they find themselves at the center of peripheralized modalities of post-conflict justice. This chapter looks well beyond this center so as to recover the value of the margins, the edges, within the periphery. It thereby addresses traditional cleansing ceremonies, community service, civil actions in national courts, restitution, qualified amnesties, and the gacaca in Rwanda. It also examines how, because of perceived inadequacies in victim integration, the Rome Statute framework sought to incorporate restorative approaches to justice (including victim participation in criminal proceedings and entitlements to reparations).

Prosthodontics comprises most of the routine restorative treatments that practitioners perform on a daily basis. Much restorative work re¬sults from the impact of caries and periodontal disease. However, the prevalence of toothwear is dramatically increasing and can be expected to form a more prominent feature of the modern practitioner’s work¬load. There is a considerable theory base in prosthodontics, covering all aspects of fixed and removable treatments, both conventional and contemporary. Although the individual management of teeth can be tricky, a challenge many new practitioners struggle with is treatment planning on a patient level. Treatment planning is rarely black and white, with considerable variations in opinion among clinicians, even for more simple cases. The staging of treatment planning is fairly consistent across the profession (e.g. relief of pain first, then investigatory phase, etc.), but in complex cases, a second opinion may be warranted. Not only is treatment plan¬ning a difficult skill, but so is the execution. It takes practice to become adept at the variety of clinical skills in prosthodontics and the staging of treatment, but this makes for a rewarding and fascinating discipline. Modern dentistry has a much greater focus on minimal invasive treat-ment, relying on dentine bonding and adhesive dentistry to limit the need for aggressive preparations of teeth and protect the vitality of the pulp. Moreover, the progression in digital dentistry is exponential, with newer production methods and clinical techniques becoming increasingly accurate and ever more accessible. As such, the modern practitioner needs to have a good understanding of both conventional concepts and modern alternatives in order to be able to apply the material and tech¬nique of choice to achieve an optimal outcome. The questions in the chapter aim to cover a wide range of topics, testing conventional concepts in both fixed and removable prostho¬dontics, whilst touching on contemporary materials and production methods. It is hoped that the reader will be challenged and the more difficult questions will promote wider reading. Key topics include: ● Diagnosis and treatment planning ● Occlusion ● Toothwear ● Complete dentures ● Removable dentures (including denture design principles) ● Direct restorations ● Crown and bridge ● Implant restorations ● Laboratory processes ● Digital dentistry.