Publications by authors named "Georgios Maroulakos"

13 Publications

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Accuracy of anterior denture tooth arrangements of CAD-CAM complete removable dental prostheses made with a tooth mold template.

J Prosthet Dent 2021 Jul 27. Epub 2021 Jul 27.

Private practice, Athens, Greece.

Statement Of Problem: Research evaluating the accuracy of anterior tooth mold templates to computer-aided design and computer-aided manufacture (CAD-CAM) fabricated complete removable dental prostheses (CRDPs) is limited.

Purpose: The purpose of this in vitro study was to investigate the accuracy of the anterior denture tooth arrangement on CAD-CAM complete removable dental prostheses made with the anterior tooth mold template.

Material And Methods: A maxillary and mandibular edentulous model was mounted on a semiadjustable articulator to simulate a patient's maxillary arch. Definitive impressions and jaw relation records were made as per the manufacturer's protocol. A maxillary and mandibular anatomic measuring device was completely seated onto the edentulous models, centered on the edentulous model midline, and horizontally positioned parallel to the mandibular ridge. A medium-size anterior tooth mold template sticker was attached on the anatomic measuring device to identify the maxillary dental midline and incisal edge position and was sent to the manufacturer as the proposed tooth arrangement reference for the definitive complete removable dental prostheses. A total of 10 milled complete removable dental prostheses were generated for 2 groups by using 2 different tooth arrangement techniques. One group (n=5) used the monobloc milling technique without bonding of denture teeth, while the other group (n=5) used the bonding system for denture teeth on the milled denture base. For comparison, a camera mounted on a tripod was used for photographic documentation. Reference markers placed on the edentulous model were used to orient and measure the difference of 4 aspects of the anterior tooth arrangement: average incisal edge position, intercanine distance, midline, and clinical crown length of the left central incisor. The difference values between the tooth mold template and definitive complete removable dental prostheses were statistically analyzed by multivariate ANOVA (α=.05) and 1-sample t tests (adjusted α=.0125).

Results: Overall, statistically significant differences were found between the tooth mold template (control) and definitive complete removable dental prostheses at all measuring aspects except for the midline of the midline of the milled arrangement technique (P<.0125). In terms of the midline value, the value of the milled group did not show a significant difference compared with tooth mold template (-0.19 mm). However, the value of the bonded group indicated a significant difference of midline (0.44 mm toward to the left of the tooth mold template midline). When the complete removable dental prosthesis milled denture tooth and complete removable dental prosthesis bonded denture tooth techniques were compared, there was no difference in the tested variables between the milled and the bonded groups (P>.0125).

Conclusions: The tooth mold template did not represent an accurate position for definitive complete removable dental prostheses for either the milled or bonded techniques. The largest differences were found at the average incisal edge of the anterior teeth and the intercanine distance for both groups. However, there was overall no clinical difference between the 2 groups (milled and bonded) of CAD-CAM complete removable dental prostheses.
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http://dx.doi.org/10.1016/j.prosdent.2021.06.039DOI Listing
July 2021

Dental Reshaping Using the Composite Resin Injection Technique After Dental Trauma and Orthodontic Treatment.

J Dent Child (Chic) 2021 May;88(2):144-147

Dr. Angelopoulou is a clinical instructor, Department of Pediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece;, Email:

Severe dental trauma can often result in tooth loss at an early age. Orthodontic space closure and reshaping of the teeth are a conservative treatment approach. The purpose of this paper is to present a fast and predictable way to reshape teeth using the composite resin injection technique. A 10-year-old female presented for orthodontic treatment with a Class II malocclusion, lateral open bite and loss of the permanent maxillary left central incisor due to trauma. The treatment plan involved mesialization of the maxillary left teeth and reshaping of the maxillary left canine and lateral incisor to the shape of the lateral and the central incisor, respectively. At the end of the orthodontic treatment, an impression was made and a transparent silicone index was fabricated based on the diagnostic wax-up. Through the index, flow composite resin was injected at the site to form the direct composite resin restorations.
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May 2021

Assessing the Effect of Low Calorie Soda Beverages on Primary Tooth Enamel: An Study.

J Clin Pediatr Dent 2019 ;43(3):190-195

The purpose of this study was to evaluate the effect of low calorie soda beverages on the enamel of primary teeth. : Fifty enamel slabs were prepared from twenty primary extracted teeth and were equally divided into five groups: a) 0.9% NaCl (Control), b) Coca-Cola Classic (Sucrose), c) Diet Coke (Aspartame), d) Zevia Cola (Erythritol), e) Coca-Cola Life (Stevia). Each specimen was exposed to the beverage for a total of sixty minutes. Enamel surface roughness was measured before and after the exposures using a LEXT OLS4000 3D Laser Measuring Microscope. All tested sodas resulted to a statistically significant change on the surface roughness of the enamel (p =.000). However, this effect did not differ significantly between the different treatment groups (p =.103). Both regular soda and low calorie soda containing different commercial sweeteners appear to have an effect on the surface morphology of primary tooth enamel. Thus, it is important to discourage the intake of any type of soda as part of the dietary advice provided in the dental office.
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http://dx.doi.org/10.17796/1053-4625-43.3.8DOI Listing
August 2019

Effect of cement type on the clinical performance and complications of zirconia and lithium disilicate tooth-supported crowns: A systematic review. Report of the Committee on Research in Fixed Prosthodontics of the American Academy of Fixed Prosthodontics.

J Prosthet Dent 2019 May 15;121(5):754-765. Epub 2019 Mar 15.

Clinical Professor, Department of Restorative Sciences, Texas A&M University College of Dentistry, Dallas, Texas.

Statement Of Problem: Zirconia and lithium disilicate have been commonly used as materials for tooth-supported complete-coverage restorations. Adhesive and conventional cements have been suggested for cementation of these restorations. However, evidence on the effect of cement type on the clinical outcomes of teeth restored with zirconia or lithium disilicate restorations is unclear.

Purpose: The purpose of this systematic review was to evaluate the clinical outcomes of teeth restored with zirconia or lithium disilicate restorations when adhesive or conventional cements are used.

Material And Methods: This systematic review adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered at the international prospective register of systematic reviews (PROSPERO) (CRD42018096493). An electronic search was performed in 2 databases (MEDLINE-PubMed and Cochrane Central), and a manual search, from January 2008 through January 2018. The primary clinical question was framed according to the Problem/Patient/Population, Intervention/Indicator, Comparison, Outcome (PICO) approach. The following question was the primary clinical question: "For patients requiring a single tooth-supported complete-coverage ceramic restoration, does adhesive cementation, as compared with conventional cementation, improve the clinical performance and limit the complications of this restoration?" The search included articles published in peer-reviewed journals in English and was limited to randomized clinical trials and prospective and retrospective clinical studies.

Results: Seventeen clinical studies met the eligibility criteria and were included for qualitative analysis. Included studies had 1280 participants who received 2436 zirconia and lithium disilicate crowns. The survival rates for adhesively cemented zirconia crowns ranged from 83.3% to 100%, whereas those reported for conventionally cemented zirconia crowns ranged from 82.0% to 100%. Survival rates for adhesively cemented lithium disilicate crowns ranged from 83.5% to 100%, whereas the survival rate reported for conventionally cemented lithium disilicate crowns was 98.5%. Commonly reported clinical complications included fracture of the veneering ceramic, crown fracture, and loss of crown retention. The mean follow-up time ranged from 25.5 months to 121.2 months. The studies that were assessed for risk of bias showed poor quality of evidence.

Conclusions: Based on the available evidence and within the limitations of this systematic review, zirconia and lithium disilicate tooth-supported crowns exhibited comparable survival rates and complication patterns after adhesive or conventional cementation.
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http://dx.doi.org/10.1016/j.prosdent.2018.10.011DOI Listing
May 2019

Effect of airborne-particle abrasion on 3-dimensional surface roughness and characteristic failure load of fiber-reinforced posts.

J Prosthet Dent 2019 Mar 13;121(3):461-469. Epub 2018 Dec 13.

Associate Professor and Director, Graduate Prosthodontics, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wis.

Statement Of Problem: Debonding is the most common complication of fiber-reinforced posts (FRPs). Airborne-particle abrasion (APA) has been suggested to increase resin cement adhesion to the surface of FRPs. However, which abrasion protocol is the most favorable is unclear.

Purpose: The purpose of this in vitro study was to compare the surface roughness and characteristic failure load of three FRP systems following different APA protocols.

Material And Methods: A total of 150 posts from 3 manufacturers (glass FRP, quartz FRP, and zirconia-enriched glass FRP) were randomly assigned to different surface treatments (NT: no treatment-control; E0: cleaned with 96% ethanol solution; E2: APA for 2 seconds/mm-ethanol cleaned, E5: APA for 5 seconds/mm-ethanol cleaned; and E10: APA for 10 seconds/mm-ethanol cleaned) forming 15 groups in total. APA was performed with 50-μm aluminum oxide. Each post was observed under a 3-dimensional (3D) laser microscope, and average 3D surface roughness (Sa) was measured. Failure was induced with a universal testing machine. Two specimens per group were evaluated under the same microscope to evaluate failure patterns. Surface roughness data were analyzed with the Welch ANOVA (α=.05), followed by the post hoc Games-Howell test. Failure load differences were determined by 2-parameter Weibull statistics and likelihood ratio contour plots (95% confidence bounds).

Results: Statistically significant differences were found in the mean surface roughness among the groups (Welch ANOVA, P<.001). APA resulted in a significant surface roughness increase in all tested post systems. No surface roughness difference was found between surface treatments E2, E5, and E10 in any tested post systems. Weibull statistics and likelihood contour plots revealed a significant decrease in the characteristic failure load for glass FRP after surface treatment E2 (88.7 N) compared with the control (95.3 N). Quartz FRP showed a significant decrease in the characteristic failure load after surface treatment E5 (103.6 N) compared with the control (108.9 N). Zirconia-enriched glass FRP showed no significant decrease in the characteristic failure load after any of the tested surface treatments. Qualitative morphological changes and failure pattern differences were observed among the tested post systems after the different surface treatments.

Conclusions: APA significantly increased surface roughness in all post systems. APA effects on characteristic failure load were dependent on the material used.
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http://dx.doi.org/10.1016/j.prosdent.2018.07.007DOI Listing
March 2019

Retrofitting a foundation restoration to an existing ceramic crown after endodontic treatment: A dental technique.

J Prosthet Dent 2018 Nov 28;120(5):651-653. Epub 2018 Jun 28.

Assistant Professor, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wis.

This article describes the fabrication of a foundation restoration after endodontic treatment using a preexisting ceramic prosthesis and polytetrafluoroethylene (PTFE) tape as a barrier. This technique presents a solution if the prosthesis and marginal integrity are to be maintained.
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http://dx.doi.org/10.1016/j.prosdent.2018.01.013DOI Listing
November 2018

Impending total airway collapse involving a maxillary removable partial denture: A clinical report.

J Prosthet Dent 2018 Nov 25;120(5):642-644. Epub 2018 May 25.

Assistant Professor of Anesthesiology, Division of Pediatric and Adult Cardiothoracic Anesthesiology, Medical College of Wisconsin, Milwaukee, Wis.

This article presents a rare incident of a bilateral maxillary removable partial denture as an airway foreign body. The removable partial denture and the surrounding soft tissue irritation caused partial obstruction of the airway. Impending airway collapse was avoided after successful removal of the foreign body. Removing a removable dental prostheses at night, not only to prevent soft tissue pathology but also to avoid ingestion or aspiration of the prosthesis, must be emphasized.
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http://dx.doi.org/10.1016/j.prosdent.2018.01.017DOI Listing
November 2018

Analysis of flexural strength and contact pressure after simulated chairside adjustment of pressed lithium disilicate glass-ceramic.

J Prosthet Dent 2018 Sep 30;120(3):439-446. Epub 2018 Apr 30.

Professor and Director, Graduate Dental Biomaterials, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wis.

Statement Of Problem: Research evaluating load-to-failure of pressed lithium disilicate glass-ceramic (LDGC) with a clinically validated test after adjustment and repair procedures is scarce.

Purpose: The purpose of this in vitro study was to investigate the effect of the simulated chairside adjustment of the intaglio surface of monolithic pressed LDGC and procedures intended to repair damage.

Material And Methods: A total of 423 IPS e.max Press (Ivoclar Vivadent AG) disks (15 mm diameter, 1 mm height) were used in the study. The material was tested by using an equibiaxial loading arrangement (n≥30/group) and a contact pressure test (n≥20/group). Specimens were assigned to 1 of 14 groups. One-half was assigned to the equibiaxial load test and the other half underwent contact pressure testing. Testing was performed in 2 parts, before glazing and after glazing. Before-glazing specimens were devested and entered in the test protocol, while after-glazing specimens were devested and glazed before entering the test protocol. Equibiaxial flexure test specimens were placed on a ring-on-ring apparatus and loaded until failure. Contact pressure specimens were cemented to epoxy resin blocks with a resin cement and loaded with a 50-mm diameter hemisphere until failure. Tests were performed on a universal testing machine with a crosshead speed of 0.5 mm/min. Weibull statistics and likelihood ratio contour plots determined intergroup differences (95% confidence bounds).

Results: Before glazing, the equibiaxial flexural strength test and the Weibull and likelihood ratio contour plots demonstrated a significantly higher failure strength for 1EC (188 MPa) than that of the damaged and/or repaired groups. Glazing following diamond-adjustment (1EGG) was the most beneficial post-damage procedure (176 MPa). Regarding the contact pressure test, the Weibull and likelihood ratio contour plots revealed no significant difference between the 1PC (98 MPa) and 1PGG (98 MPa) groups. Diamond-adjustment, without glazing (1EG and 1PG), resulted in the next-to-lowest equibiaxial flexure strength and the lowest contact pressure. After glazing, the strength of all the groups, when subjected to glazing following devesting, increased in comparison with corresponding groups in the before-glazing part of the study.

Conclusions: A glazing treatment improved the mechanical properties of diamond-adjusted IPS e.max Press disks when evaluated by equibiaxial flexure and contact pressure tests.
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http://dx.doi.org/10.1016/j.prosdent.2017.12.025DOI Listing
September 2018

The Post-endodontic Adhesive Interface: Theoretical Perspectives and Potential Flaws.

J Endod 2018 Mar 3;44(3):363-371. Epub 2018 Jan 3.

Department of Restorative Sciences, Texas A&M University College of Dentistry, Dallas, Texas.

Introduction: The aim of this review was to analyze the potential of successful bonds of endodontic posts to radicular dentin as well as the limitations of the post-endodontic adhesive interface.

Methods: The MEDLINE/PubMed and Web of Science electronic databases were searched. The search was augmented by a manual search of the pertinent bibliographies.

Results: The post-endodontic adhesive interface finds application in the endodontic cohesive units. Many techniques and materials exist to improve the bond between endodontic posts and resin-based materials as well as between resin-based materials and radicular dentin. Different techniques used for the adhesion of metallic and fiber-reinforced posts are discussed and critically analyzed.

Conclusions: Although adhesive cementation of endodontic posts is popular, a long-term predictable bond may be compromised because of procedures related to the endodontic treatment and/or the adhesive cementation procedures. Microleakage and degradation phenomena may further jeopardize the post-endodontic adhesive interface.
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http://dx.doi.org/10.1016/j.joen.2017.11.007DOI Listing
March 2018

Prosthetic rehabilitation following lateral resection of the mandible with a long cantilever implant-supported fixed prosthesis: A 3-year clinical report.

J Prosthet Dent 2017 Nov 29;118(5):678-685. Epub 2017 Apr 29.

Lecturer, Department of Prosthodontics, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece.

This clinical report describes the prosthetic management of the surgical reconstruction of a patient after mandibular resection. Complete oral rehabilitation was achieved with a maxillary complete denture and a mandibular implant-supported fixed prosthesis with a custom titanium framework and a long unilateral cantilever.
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http://dx.doi.org/10.1016/j.prosdent.2017.01.019DOI Listing
November 2017

Complete mouth rehabilitation and gastroesophageal reflux disease: Conventional and contemporary treatment approaches.

J Prosthet Dent 2017 Jan 7;117(1):1-7. Epub 2016 Aug 7.

Professor, Graduate Prosthodontics, Department of Restorative Sciences, Texas A&M University, Baylor College of Dentistry, Dallas, Texas.

This report describes the diagnosis and prosthodontic management of 2 patients with a history of chronic gastroesophageal reflux disease and worn dentition. Different treatment approaches were used for oral rehabilitation. Use of conventional and contemporary restorative materials resulted in functional and esthetic prosthodontic rehabilitation with a favorable prognosis.
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http://dx.doi.org/10.1016/j.prosdent.2016.05.014DOI Listing
January 2017

Acrylic resin guide for locating the abutment screw access channel of cement-retained implant prostheses.

J Prosthet Dent 2016 May 13;115(5):560-3. Epub 2016 Jan 13.

Assistant Professor, Department of Restorative Dentistry, Oregon Health Sciences University School of Dentistry, Portland, Ore.

Abutment screw loosening represents a common and challenging technical complication of cement-retained implant prostheses. This article describes the fabrication of a simple and accurate poly(methyl methacrylate) guide for identifying the location and angulation of the abutment screw access channel of a cement-retained implant prosthesis with a loosened abutment screw.
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http://dx.doi.org/10.1016/j.prosdent.2015.11.015DOI Listing
May 2016

Fracture resistance of compromised endodontically treated teeth restored with bonded post and cores: An in vitro study.

J Prosthet Dent 2015 Sep 2;114(3):390-7. Epub 2015 Jun 2.

Associate Professor, Department of Restorative Sciences, Texas A&M University, Baylor College of Dentistry, Dallas, Texas.

Statement Of Problem: It is unclear which post and core system performs best when bonded to severely compromised endodontically treated teeth.

Purpose: The purpose of this study was to investigate the fracture resistance and mode of failure of severely compromised teeth restored with 3 different adhesively bonded post and core systems.

Material And Methods: Thirty extracted endodontically treated maxillary anterior teeth were randomly divided into 3 groups, CPC, gold cast post and core; TPC, titanium prefabricated post/composite resin core; and FPC, quartz fiber reinforced post/composite resin core. All posts were adhesively cemented. All cores resembled a central incisor preparation with no remaining tooth structure above the finish line. Cast gold crowns were fabricated and cemented adhesively. The specimens were aged with thermocycling and cyclic loading. Two specimens per group were randomly selected for micro-computed tomographic imaging before and after aging. Failure was induced with a universal testing machine. The mode of failure was characterized by the interface separation. Data were analyzed with 1-way ANOVA (α=.05) followed by post hoc tests (Bonferroni).

Results: A statistically significant difference was found among the 3 groups (P=.002). CPC was significantly different than TPC (P=.008) or FPC (P=.003). The primary mode of failure for CPC and TPC was root fracture, and for FPC post debonding.

Conclusions: Severely compromised endodontically treated teeth restored with bonded gold cast post and cores showed significantly higher fracture resistance.
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http://dx.doi.org/10.1016/j.prosdent.2015.03.017DOI Listing
September 2015
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