Prosthesis, Volume 7, Issue 4 (August 2025) – 30 articles

Approximately 185,000 people in the United states experience limb loss each year. There is a need for an intuitive neural interface that can offer high-fidelity control signals to optimize the advanced functionality of prosthetic devices. Regenerative peripheral nerve interface (RPNI) is a pioneering advancement in neuroengineering that combines surgical techniques with biocompatible materials to create an interface for individuals with limb loss. RPNIs are surgically constructed from autologous muscle grafts that are neurotized by the residual peripheral nerves of an individual with limb loss. RPNIs amplify neural signals and demonstrate long term stability. In this narrative review, the terms “Regenerative Peripheral Nerve Interface (RPNI)” and “RPNI surgery” are used interchangeably to refer to the same surgical and biological construct. This narrative review specifically focuses on RPNIs as a targeted approach to enhance prosthetic control through surgically created nerve–muscle interfaces. This area of research offers a promising solution to overcome the limitations of existing prosthetic control systems and could help improve the quality of life for people suffering from limb loss. It allows for multi-channel control and bidirectional communication, while enhancing the functionality of prosthetics through improved sensory feedback. RPNI surgery holds significant promise for improving the quality of life for individuals with limb loss by providing a more intuitive and responsive prosthetic experience. Full article

Background/Objectives: Maxillofacial silicone prostheses’ long-term color stability remains a challenge. This study aimed to evaluate and compare the color stability of conventional and digital maxillofacial silicone elastomers mixed with nano-sized antimicrobial additives (ZnO nanoparticles and chlorhexidine salt-CHX) at various concentrations over a 10-week period. Methods: A total of nine groups (n = 10) of maxillofacial silicone elastomers were prepared. These included a control group (no additives), conventionally pigmented silicone, digitally pigmented silicone (Spectromatch system), and silicone mixed with ZnO or CHX at 1%, 3%, and 5% by weight. Specimens were fabricated in steel molds and cured at 100 °C for 1 h. Color measurements were performed at baseline and after 1, 4, 6, and 10 weeks using a Minolta Chroma Meter (CIELAB system, ΔE₀₀ formula). Data were analyzed using two-way ANOVA and Tukey HSD post hoc tests (α = 0.05). Results: Color changes (ΔE₀₀) ranged from 0.74 to 2.83 across all groups. The conventional pigmented silicone group showed the highest color difference (ΔE₀₀ = 2.83), while the lowest was observed in the ZnO 1% group (ΔE₀₀ = 0.74). Digital silicone and all antimicrobial-modified groups exhibited acceptable color stability (ΔE₀₀ < 3.1). Time significantly affected color difference, with the largest change occurring during the first four weeks (p < 0.05), followed by stabilization. Regression analysis confirmed high color stability over time for all groups except the conventional pigmented group. Conclusions: This is one of the first studies to directly compare digital and conventional pigmentation methods combined with nano-antimicrobials in maxillofacial silicones. Maxillofacial silicone elastomers mixed with up to 5% ZnO or CHX maintained acceptable color stability over 10 weeks. Digital pigmentation is similar to conventional methods. The incorporation of nano-antimicrobials offers significant microbial resistance and improved color retention. Full article

Objectives: Digitalization has revolutionized dentistry, introducing advanced technological tools that improve diagnostic accuracy and access to healthcare. This study aims to examine the effects of integrating digital technologies into the dental field, analyzing the associated benefits and risks, with particular paid attention to the therapeutic relationship and decision-making autonomy. Materials and Methods: A literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library, complemented by Google Scholar for non-indexed studies. The selection criteria included peer-reviewed studies published in English between 2014 and 2024, focusing on digital dentistry, artificial intelligence, and medical ethics. This is a narrative review. Elements of PRISMA guidelines were applied to enhance transparency in reporting. Results: The analysis highlighted that although digital technologies and AI offer significant benefits, such as more accurate diagnoses and personalized treatments, there are associated risks, including the loss of empathy in the dentist–patient relationship, the risk of overdiagnosis, and the possibility of bias in the data. Conclusions: The balance between technological innovation and the centrality of the dentist is crucial. A human and ethical approach to digital medicine is essential to ensure that technologies improve patient care without compromising the therapeutic relationship. To preserve the quality of dental care, it is necessary to integrate digital technologies in a way that supports, rather than replaces, the therapeutic relationship. Full article

Background/Objectives: This study aimed to assess the long-term clinical performance of full-arch fixed restorations made of fiber-reinforced composite (FRC) supported by four ultra-short implants (4.0 × 5.0 mm) in patients with edentulous, atrophic mandibles. Methods: Ten patients were treated at Sapienza University of Rome and monitored over a 10-year period. Each case involved the placement of four plateau-design implants with a pure conometric connection and a calcium phosphate-treated surface. The final prostheses were fabricated using CAD/CAM-milled Trinia^® fiber-reinforced composite frameworks. Clinical parameters included implant and prosthesis survival, marginal bone level (MBL), peri-implant probing depth (PPD), and patient-reported outcome measures (PROMs). Results: Implant and prosthesis survival reached 100% over the 10-year follow-up. MBL data showed a minor bone gain of approximately 0.11 mm per 5 years (p < 0.0001). PPD remained stable under 3 mm, with a minimal increase of 0.16 mm over the same period (p < 0.0001). PROMs reflected sustained high patient satisfaction. No technical complications, such as chipping or framework fracture, were observed. Conclusions: Rehabilitation of the edentulous mandible with ultra-short implants and metal-free FRC prostheses proved to be a minimally invasive and long-lasting treatment option. The 10-year follow-up confirmed excellent implant and prosthetic outcomes, favorable peri-implant tissue health, and strong patient satisfaction. Nonetheless, further studies with larger sample sizes are needed to confirm these encouraging results and strengthen the clinical evidence. Full article

Background/Objectives: Dental practitioners widely use dental implants to treat traumatic cases. Titanium implants are currently the most popular choice among dental practitioners and surgeons. The discovery of newer polymeric materials is also influencing the interest of dental professionals in alternative options. A comparative study between existing titanium implants and newer polymeric materials can enhance professionals’ ability to select the most suitable implant for a patient’s treatment. This study aimed to investigate material property advantages of high-performance thermoplastic biopolymers such as PEEK and PEKK, as compared to the time-tested titanium implants, and to find the most suitable and economically fit implant material. Methods: Three distinct implant material properties were assigned—PEEK, PEKK, and commercially pure titanium (CP Ti-55)—to dental implants measuring 5.5 mm by 9 mm, along with two distinct titanium (TI6AL4V) abutments. Twelve three-dimensional (3D) models of bone blocks, representing the mandibular right molar area with Osseo-integrated implants were created. The implant, abutment, and screw were assumed to be linear; elastic, isotropic, and orthotropic properties were attributed to the cancellous and cortical bone. Twelve model sets underwent a three-dimensional finite element analysis to evaluate von Mises stress and total deformation under 250 N vertical and oblique (30 degree) loads on the top surface of each abutment. Results: The study revealed that the time-tested titanium implant outperforms PEEK and PEKK in terms of marginal bone preservation, while PEEK outperforms PEKK. Conclusions: This study will assist dental practitioners in selecting implants from a variety of available materials and will aid researchers in their future research. Full article

Background/Objective: The most effective strategy for addressing users’ prosthetic needs is a comprehensive clinical assessment that provides a holistic understanding of the individual’s symptoms, health, function, and environmental barriers and facilitators. A standardized evaluation form would provide guidance for a structured approach to comprehensive clinical assessments of people with LLA. The objective of this study was to determine a list of relevant elements to be included in prosthetic evaluation for adults with lower limb amputation. Methods: Three independent focus group discussions were conducted with prosthetists (n = 15), prosthesis users (n = 11), and decision makers (n = 4) to identify all relevant elements that should be included in the clinical assessment of prosthetic services. The final content was then determined using the Delphi technique, with 35 panelists (18 prosthetists and decision makers, and 17 prosthesis users) voting in each round. Results: A total of 91 elements were identified through the focus group, of which 78 were included through the Delphi process. The identified elements are mostly related to the physical health of the prosthesis user (e.g., mobility, pain, and medical information), while others address personal or psychosocial aspects (e.g., activities of daily living, goals, and motivation) or technical aspects (prosthesis-related). Conclusions: Through a Delphi consensus, a list of relevant elements to be included in a prosthetic evaluation was generated. These results will inform the development of a standardized clinical prosthetic assessment form. This form has the potential to improve the quality of clinical evaluations, guide interventions, and enhance the well-being of prosthetic users. Full article

Background/Objectives: The present study aimed to evaluate the oral health and patient satisfaction of flexible and non-metal clasp dentures (NMCD) compared to removable partial dentures (RPD) using a systematic review. Methods: The PICOS framework of this review was as follows: Do rehabilitations involving flexible dentures or NMCD have a similar success rate to those using RPD? Thus, the PICOS approach involves the following topics: (P) Population/Problem: partial edentulous adult patients; (I) Intervention: patients rehabilitated with flexible dentures or NMCD; (C) Comparison: patients rehabilitated with standard RPD; (O) Outcome: clinical parameters such as oral health, masticatory function, and patient satisfaction; and (S) Study Type: clinical trials and observational studies (cohort, case–control, and cross-sectional). No language restrictions were applied to the studies. The search strategy consisted of the following keywords in different databases: ((flexible) OR (nonmetal) OR (non-metal) OR (thermoplastic)) AND (denture). Only clinical trials and observational studies (cohort, case–control, and cross-sectional studies) from the last 15 years were included, and no language restrictions were applied. Studies that did not describe the denture material were excluded. Results: Of the 2197 potentially relevant records, 14 studies were included in the present review. Two studies reported retrospective results, while twelve reported a prospective evaluation. Considering the thermoplastic materials, five studies evaluated polyester, five polyamides, three polyacetals, and only one study evaluated polyetheretherketone (PEEK). Flexible dentures and NMCD demonstrated similar periodontal status and bone levels on abutment teeth to RPD after up to 12 months. Flexible dentures exhibited a higher degree of redness of the mucosa after 12 months. One study showed a lower maximum bite force for flexible dentures compared to RPD. No study has performed a clinical evaluation of mastication and chewing ability. Conclusions: Despite increased short-term patient satisfaction for flexible dentures and NMCD, there is weak evidence to support a similar clinical performance of flexible dentures and NMCD to RPD. Full article

Background/Objectives: Additive manufacturing (AM) technology has emerged as an innovative approach in dentistry. Recently, manufacturers have developed permanent resins engineered explicitly for the fabrication of definitive prostheses using AM techniques. This systematic review evaluated the mechanical and physical properties of 3D-printed permanent resins in comparison to milled resins and hybrid ceramics for the fabrication of indirect dental restorations. Methods: Three electronic databases—Scopus, Web of Science, and PubMed—were searched for English-language articles. Two independent researchers conducted study selection, data extraction, quality assessment, and the evaluation of the certainty of evidence. In vitro studies assessing the mechanical and physical properties of the permanent resins were included in this review. Results: A total of 1779 articles were identified through electronic databases. Following full-text screening and eligibility assessment, 13 studies published between 2023 and 2024 were included in this qualitative review. The investigated outcomes included physical properties (surface roughness, color changes, water sorption/solubility) and mechanical properties (flexural strength, elastic modulus, microhardness). Conclusions: Three-dimensionally printed permanent resins show promising potential for fabricating indirect dental restorations. However, the current evidence regarding their mechanical and physical properties remain limited and inconsistent, mainly due to variability in study methodologies. Full article

Background: The use of lower limb prosthesis can impact all aspects of daily life, activities and participation. Various studies have compared the microprocessor-controlled knee (MPK) to the non-microprocessor-controlled knee (NMPK) using a variety of different outcome measures, but results are inconsistent and raise the question of which type of knee is most effective. Therefore, we aimed to assess the effect of MPKs compared to NMPKs across all classified ICF domains in adult prosthesis users. Methods: Participants performed baseline measurements with the NMPK (T0). One week later, they started a four-to-six-week trial period with the MPK. Afterward, measurements were repeated with the MPK (T1). Functional tests (6MWT, TUG-test and activity monitor) and questionnaires (ABC, SQUASH, USER-P and PEQ) were used. For statistical analyses, paired t-tests, Wilcoxon signed-rank tests and Chi² test were applied. The Benjamini–Hochberg procedure was applied to correct for multiple testing. Results: Twenty-five participants were included. Using an MPK compared to an NMPK significantly resulted in improvements in balance and walking confidence, safety, walking distance and self-reported walking ability, as well as a decrease in number of stumbles and falls. Additionally, participants using an MPK were significantly more satisfied with their participation, experienced fewer restrictions, reported greater satisfaction with the appearance and utility of the MPK, experienced less social burden and reported better well-being, compared to using an NMPK. Conclusions: Using an MPK instead of an NMPK can lead to significant improvements in all classified ICF domains, such as improved walking ability, confidence and satisfaction and reduced fall risk. Full article

Background: Accuracy of optical impressions—defined by the intraoral scanner (IOS)’s trueness and precision per International Organization for Standardization (ISO) standards—is influenced by both operator- and patient-related factors. Thus, this in vitro study aimed to (1) evaluate how scanning distance affects the accuracy of three different intraoral scanners (IOSs), and (2) identify the optimal scanning distance for each scanner. Methods: A maxillary arch model was obtained using polyvinyl siloxane impression material and poured with Type IV stone (Octa-rock royal^®, Kulzer, Germany). Using three different types of IOSs—the trios 3 shape (TRIOS ^® cart, 3Shape, Copenhagen, Denmark); the Helios 500 (Eighteeth ^®, Changzhou, China); and the Heron (3Disc ^®, Herndon, VA 20170, USA)—ten scans were performed with each of the IOSs with five predetermined distances: 0 mm, 2.5 mm, 5 mm, 7.5 mm, and 10 mm. Spacers of varying heights were designed using Meshmixer version 3.5 (Autodesk, Inc., Mill Valley, CA, USA) and three-dimensional printed with the Form 2 printer (Formlabs, Somerville, MA, USA). The scanned data was processed using Geomagic Control X (Version 16.0.2.16496, 3D Systems, Wilsonville, OR, USA). Statistical analyses were performed using R Statistical Software (version 4.2.2), with significance set at α = 0.05. Results: Scanning distance significantly influenced scan accuracy for all three scanners. The 3Disc scanner (3Disc, Herndon, VA, USA) demonstrated the highest accuracy at a 7.5 mm distance, while both the Helios 500 (Eighteeth, Changzhou, China) and Trios 3 (3Shape, Copenhagen, Denmark) scanners achieved their best accuracy at a 5 mm distance, as indicated by the lowest root mean square (RMS) values (p < 0.05). Conclusions: To conclude, each IOS has an optimal scanning distance for best accuracy. Trios 3 (3Shape, Copenhagen, Denmark) outperformed the others in both trueness and precision. Future studies should examine these effects under full-arch and clinical conditions. Full article

Objective: Several studies have compared the accuracy of digital scans and conventional impressions for post space capture. However, only a few have specifically investigated the precision of intraoral scanners in measuring post spaces of varied lengths. This study aimed to evaluate the accuracy of various intraoral scanning techniques in capturing long and short post spaces. Material and Methods: This study grouped samples into eight categories based on four techniques and two post space depths (7 and 11 mm). After tooth preparation, root canal treatment, and post space preparation, laboratory scans were performed using Duralay. Intraoral scans were obtained directly and indirectly with the Trios fourth generation scanner using the Duralay and PVS techniques. The accuracies, in terms of trueness, and precisions were compared after ten repetitions for each group using the Kruskal–Wallis or Mann–Whitney U tests. Results: The Duralay Intraoral Scan groups demonstrated a high consistency, while the Direct Intraoral Scan groups showed moderate consistency. Variability was higher for the Duralay Lab Scan and PVS Intraoral Scan groups for short post spaces. Conclusions: The capture technique significantly affected the accuracies of the post space measurements. The techniques also demonstrated varying consistency and precision. These findings provide critical insights to guide their selections for clinical and research applications. Clinical Significance: This study is one of the few to compare the accuracy of intraoral scanners for the capture of both short and long post spaces. It addresses a key gap in current dental research and offers practical guidance for clinicians and researchers in selecting appropriate scanning techniques for various clinical scenarios. The findings have the potential to enhance the accuracy and reliability of post space measurements and improve patient outcomes. Full article

Objectives: Our goal was to assess the role of leaflet geometry on the structural deterioration of bioprosthetic aortic valves (BAVs) in a closed configuration. Methods: With a Fung-type orthotropic model, finite element modeling was used to create ten cases with parabolic, circular and spline leaflet curvatures and six leaflet angles. Results: A circular circumferential curvature led to lower von Mises and compressive stresses in both the coaptation and load-bearing areas, reduced tensile stresses in the coaptation regions, and increased tensile stresses in the load-bearing areas. A parabolic radial curvature reduced von Mises stresses in the coaptation, as well as the load-bearing regions, reduced compressive stresses in the coaptation, and reduced tensile stresses in the load-bearing regions, leading to a slight increase in the minimized tensile stress in the coaptation regions (1.794 vs. 1.765 MPa) and the minimized compressive stress in the load-bearing regions (0.772 vs. 0.768 MPa). Within a range of downward inclination of the leaflets, all stresses in the coaptation regions decreased. A parabolic circumferential curvature, a linear radial curvature, and, for most cases, upward leaflet inclinations were associated with larger contact pressures between the leaflets. Conclusions: A parabolic radial curvature and downward leaflet inclination likely lead to the longer durability of BAVs. Full article

Background. Digital dentistry continues to evolve, offering improved accuracy, efficiency, and patient experience across various prosthodontic procedures. Many previous reviews have focused on digital applications in prosthodontics. But the use of a fully digital workflow for full-arch implant-supported prostheses in edentulous patients remains an emerging and underexplored area in the literature. Objective. This article presents a comprehensive methodological review of the digital workflow in full-arch implant-supported rehabilitation. It follows a structured literature exploration and synthesizes relevant technological processes from patient assessment to prosthetic delivery. Methods. The relevant literature was retrieved from the PubMed database on 20 June 2024, to identify the most recent and relevant studies. A total of 22 articles met the eligibility criteria and were included in the review. The majority included case and technical reports. Results. The review illustrates the integration and application of digital tools in implant dentistry, including cone-beam computed tomography (CBCT) exposure, intraoral scanning, digital smile design, virtual patients, guided surgery, and digital scanning. The key findings demonstrate multiple advantages of a fully digital workflow, such as reduced treatment time and cost, increased patient satisfaction, and improved interdisciplinary communication. Conclusions. Despite these benefits, limitations persist due to the low level of evidence, technological challenges, and the lack of standardized protocols. Further randomized controlled trials and long-term clinical evaluations are essential to validate the effectiveness and feasibility of a fully digital workflow for full-arch implant-supported rehabilitation. Full article

Background/Objectives: Dental cavity preparation is a critical procedure in restorative dentistry that involves the removal of decayed tissue while preserving a healthy tooth structure. Excessive stress during tooth preparation leads to enamel cracking, dentin damage, and long term compressive pulp health. This study employed finite element analysis (FEA) to investigate the stress distribution in dental structures during cavity preparation using round diamond burs of varying diameters and depths of cut (DOC). Methods: A three-dimensional human maxillary first molar was generated from computed tomography (CT) scan data using 3D Slicer, Fusion 360, and ANSYS Space Claim 2024 R-2. Finite element analysis (FEA) was conducted using ANSYS Workbench 2024. Round diamond burs with diameters of 1, 2, and 3 mm were modeled. Cutting simulations were performed for DOC of 1 mm and 2 mm. The burs were treated as rigid bodies, whereas the dental structures were modeled as deformable bodies using the Cowper–Symonds model. Results: The simulations revealed that larger bur diameters and deeper cuts led to higher stress magnitudes, particularly in the enamel and dentin. The maximum von Mises stress was reached at 136.98 MPa, and dentin 140.33 MPa. Smaller burs (≤2 mm) and lower depths of cut (≤1 mm) produced lower stress values and were optimal for minimizing dental structural damage. Pulpal stress remained low but showed an increasing trend with increased DOC and bur size. Conclusions: This study provides clinically relevant guidance for reducing mechanical damage during cavity preparation by recommending the use of smaller burs and controlled cutting depths. The originality of this study lies in its integration of CT-based anatomy with dynamic FEA modeling, enabling a realistic simulation of tool–tissue interaction in dentistry. These insights can inform bur selection, cutting protocols, and future experimental validations. Full article

Background/Objectives: the precise application of torque during prosthetic screw tightening is essential to the long-term success and mechanical stability of implant-supported restorations. This study aimed to evaluate the influence of practitioner experience, glove material, screwdriver length, and hand moisture on the maximum torque value (MTV) generated during manual tightening. Methods: thirty participants, comprising 10 experienced professors and 20 senior dental students, performed tightening tasks under six hand conditions (nitrile gloves, latex gloves, and bare hands, each in dry and wet environments) using two screwdriver lengths (21 mm and 27 mm). The torque values were measured using a calibrated digital torque meter, and the results were analyzed using a linear mixed model. Results: professors applied significantly higher torque than students (16.92 Ncm vs. 15.03 Ncm; p = 0.008). Nitrile gloves yielded the highest torque (17.11 Ncm), surpassing bare hands significantly (p = 0.003). No statistically significant differences were found for screwdriver length (p = 0.12) or hand moisture (p = 0.11). Conclusions: these findings underscore the importance of clinical proficiency and glove material in torque delivery, providing evidence-based insights to enhance procedural reliability and training standards in implant prosthodontics. Full article

Background/Objectives: The projected rise in limb amputations highlights the need for advancements in prosthetic technology. Current transtibial prosthetic designs primarily focus on sagittal plane kinematics but often neglect both the ankle kinematics and kinetics in the coronal plane, and the metatarsophalangeal joint, which play critical roles in gait stability and efficiency. This study aims to evaluate the combined effects of compliance in the coronal plane and a flexible toe joint on prosthetic gait using non-amputated participants as a model. Methods: We conducted gait trials on ten non-amputated individuals in the presence and absence of compliance in the coronal plane and toe compliance, using a previously developed three-degree-of-freedom (DOF) prosthetic foot with a prosthetic simulator. We recorded and analyzed sagittal and coronal kinematic data, ground reaction forces, and electromyographic signals from muscles involved in the control of gait. Results: The addition of compliance in the coronal plane and toe compliance had significant kinematic and muscular effects. Notably, this compliance combination reduced peak pelvis obliquity by 27%, preserved the swing stance/ratio, and decreased gluteus medius’ activation by 34% on the non-prosthetic side, compared to the laterally rigid version of the prosthesis without toe compliance. Conclusions: The results underscore the importance of integrating compliance in the coronal plane and toe compliance in prosthetic feet designs as they show potential in improving gait metrics related to mediolateral movements and balance, while also decreasing muscle activation. Still, these findings remain to be validated in people with transtibial amputations. Full article

Background/Objectives: The aim of this systematic review was to identify the role of orthodontics in patients undergoing tumor-ablative surgery, in collaboration with maxillofacial prosthodontic rehabilitation in a multidisciplinary fashion. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024582050). The focused question was constructed using the PICO (participant, intervention, comparison, and outcome) approach. A three-stage search was performed in PubMed, Scopus, and Web of Science using Medical Subject Heading (MeSH) terms. To assess the risk of bias, the National Institute of Health (NIH) “Quality Assessment Tool for case series/reports” was used. All data was synthesized qualitatively, according to the Synthesis Without Meta-analysis (SWiM) reporting guideline. Results: The initial search yielded 624 articles, of which 22 met the inclusion criteria after screening and eligibility assessment, with most being single-patient case reports and one case series involving 12 patients. The included studies primarily involved tumors in the mandible (64.5%) and maxilla (32.3%). Orthodontic treatment was initiated at various time points, ranging from one month pre-surgery to 19 years post-surgery, primarily utilizing fixed appliances (77.8%). In some studies, orthodontic appliances were used to enhance the stability of maxillofacial prostheses. The results of this study indicate that orthodontic treatment may facilitate prosthetic rehabilitation by improving conditions prior to prosthetic intervention and increasing the retention of the obturator prosthesis. Conclusions: Orthodontic treatment can enhance maxillofacial prosthetic rehabilitation after tumor-ablative surgery by optimizing jaw growth, improving occlusion, and facilitating prosthetic retention or space creation. Further research is needed to establish treatment guidelines. Orthodontic miniscrews may improve temporary prosthesis retention before final implant placement, when indicated. Full article

Background/Objectives: Partial maxillectomy frequently results in severe impairments of oral functions, such as difficulties in chewing, speech, swallowing, and facial appearance. Immediate prosthetic rehabilitation is challenging because soft tissue healing is typically required before impression taking. This study aimed to (1) develop a comprehensive digital workflow for fabricating immediate obturator prostheses using preoperative data and (2) assess their early clinical effectiveness in restoring oral functions after surgery. Methods: In this prospective clinical study, 20 patients undergoing partial maxillectomy from January 2023 to January 2025 were enrolled. A digital workflow combining cone-beam computed tomography (CBCT), intraoral scanning, CAD/CAM design, and 3D metal printing was implemented. Obturator prostheses were digitally designed preoperatively and inserted immediately post-resection. Functional outcomes were postoperatively evaluated after one month using the Obturator Functioning Scale (OFS), which measures functional, speech, esthetic, and psychosocial aspects. Results: The digitally fabricated immediate obturator prostheses were successfully placed intraoperatively in all patients. Most participants reported mild to moderate difficulties, with speech-related issues being the most common, while esthetic concerns were minimal. Masticatory function was satisfactorily restored in 75% of cases, and 60% of patients experienced minimal fluid leakage during swallowing. No significant differences were found between genders. Patients with larger defects tended to report greater functional challenges. Conclusions: The digitally planned immediate obturator prosthesis provides a practical and effective solution for early rehabilitation following partial maxillectomy. This digital workflow reduces patient discomfort, restores key oral functions, and facilitates psychosocial recovery. Full article

Background/Objectives: Autopolymerizing poly (methyl methacrylate) (PMMA) resin is widely used in provisional restorations; however, its inadequate mechanical properties represent a significant limitation. This study aimed to develop electrospun fibers with chemically reduced graphene oxide (rGO) and to evaluate the effect of fiber reinforcement on the mechanical and physical properties of a commercially available PMMA resin. Methods: Electrospinning was employed to produce nanofibers containing 0.02 wt% and 0.05 wt% rGO within a PMMA matrix. Fiber characterization was performed using SEM-EDS, XRD, TGA/DTG, and FTIR. Following characterization, the fibers were blended into PMMA resin at 1%, 2.5%, and 5% (by weight). The resulting fiber-reinforced composites were tested for flexural strength, elastic modulus, surface roughness, and Vickers microhardness. Results: The addition of 1% and 2.5% PMMA/rGO-0.02 fibers and 1% PMMA/rGO-0.05 fibers significantly improved the flexural strength of PMMA compared with the control group (p < 0.05). A statistically significant increase in elastic modulus was observed only in the group containing 1% PMMA/rGO-0.02 fibers (p < 0.05). However, there were no significant differences in surface roughness or microhardness between the control and experimental groups (p > 0.05). Conclusions: Incorporating electrospun PMMA-rGO fibers into PMMA resin enhances flexural properties at low concentrations without altering surface characteristics. These findings suggest that such fiber-reinforced systems hold promises for improving the mechanical performance and functional longevity of provisional dental restorations under clinical conditions. Full article

Objectives: This systematic review aimed to evaluate the cost, production time, clinical performance, and patient satisfaction of 3D printing workflows in prosthodontics compared to conventional and subtractive methods. Methods: Following PRISMA guidelines, a systematic search of electronic databases was performed to identify studies published between 2015 and 2025 that directly compared digital additive workflows with analogue or subtractive workflows. Studies were eligible if they included prosthodontic treatments such as dentures, crowns, or implant-supported prostheses and reported at least one relevant outcome. The primary outcomes were cost, time efficiency, clinical accuracy (e.g., marginal adaptation, fit), and patient satisfaction. Included studies were methodologically evaluated using MINORS scale and the risk of bias was assessed using ROBINS-I and RoB 2 tools. Results: Seven studies met the inclusion criteria. Overall, 3D printing workflows demonstrated reduced production time and cost in comparison to conventional or subtractive methods. Clinical outcomes were generally comparable or superior, particularly regarding adaptation and fit. Patient satisfaction was favourable in most studies, although reporting varied. Long-term follow-up was limited, which constrains the interpretation of sustained clinical performance. Conclusions: These findings suggest that 3D printing can serve as an efficient and cost-effective alternative in prosthodontic fabrication, with clinical results comparable to those already established. Further research is needed to assess long-term clinical performance and cost-effectiveness in various clinical scenarios. Full article

Background: Digital dental photography is increasingly essential for documentation and smile design. This study aimed to compare the linear measurement accuracy of various smartphones and a Digital Single-Lens Reflex (DSLR) camera against digital models obtained by intraoral and desktop scanners. Methods: Tooth height and width from six different casts were measured and compared using images acquired with a Canon EOS 250D DSLR, six smartphone models (iPhone 13, iPhone 15, Samsung Galaxy S22 Ultra, Samsung Galaxy S23 Ultra, Samsung Galaxy S24, and Vivo T2), and digital scans obtained from the Helios 500 intraoral scanner and the Ceramill Map 600 desktop scanner. All image measurements were performed using ImageJ software (National Institutes of Health, Bethesda, MD, USA), and statistical analysis was conducted using one-way analysis of variance (ANOVA) with Tukey’s post hoc test (α = 0.05). Results: The results showed no significant differences in measurements across most imaging methods (p > 0.05), except for the Vivo T2, which showed a significant deviation (p < 0.05). The other smartphones produced measurements comparable to those of the DSLR, even at distances as close as 16 cm. Conclusions: These findings preliminary support the clinical use of smartphones for accurate dental documentation and two-dimensional smile design, including the posterior areas, and challenge the previously recommended 24 cm minimum distance for mobile dental photography (MDP). This provides clinicians with a simplified and accessible alternative for high-accuracy dental imaging, advancing the everyday use of MDP in clinical practice. Full article

Background/Objectives: Guided implant surgery relies on the use of surgical templates to direct osteotomy drills, but guide design may influence irrigation efficiency, hence bone overheating, a critical factor in preventing thermal necrosis. This ex vivo study compared temperature changes when drilling using two guide designs: a closed-frame (occlusive structure) and an open-frame (non-occlusive design), evaluating their clinical relevance in mitigating overheating. Methods: Sixteen pig ribs were scanned, and implant osteotomies were planned via a guided surgery software. Two 3D-printed resin templates, one with a closed-frame design and one with an open-frame design, were tested (8 ribs per group, 24 implants per group). Drilling was performed sequentially (diameter of 1.9 mm, 3.25 mm, and 4.1 mm) at 800 rpm, while bone temperatures were recorded at depths of 3 mm and 10 mm using K-type thermo§s. Results: Significantly higher temperature rises were observed with the closed-frame guide. Drilling depth had also a significant influence, with higher temperatures at 3 mm than 10 mm (p < 0.001), suggesting that cortical bone density may amplify frictional heat. No significant effect of drill diameter was detected. Conclusions: Within the limitations of this ex vivo model, the open-frame design kept the maximal temperature rise about 0.67 °C lower than the closed-frame guide (1.22 °C vs. 0.55 °C), i.e., a 2.2-fold relative reduction was observed during the most demanding drilling step. This suggests a more efficient cooling capacity, especially in dense cortical bone, which offers a potential benefit for minimizing thermal risk in guided implant procedures. Full article

Purpose: The aim of this study was to compare the effect of rotary (air-driven, electric-driven) and oscillating (piezoelectric ultrasonic) handpieces on the quality of crown preparation, marginal integrity, and internal adaptation of monolithic zirconia crowns. Materials and Methods: Seventy-two standardized premolar preparations were performed using the air-driven handpiece with a guide pin-ended tapered fissure diamond bur on a modified dental surveyor. The finishing process utilized three handpiece types (n = 24/group) with fine/superfine diamond burs under controlled force with a fixed number of rotations and controlled advancement time. Marginal/internal adaptation was evaluated via the triple-scan technique; defects (marginal, axial, and occlusal) were quantified based on predefined criteria through the inspection of the Standard Tessellation Language (STL) file. Results: One-way ANOVA with Tukey HSD and Kruskal–Wallis with Dunn–Bonferroni tests were utilized. The marginal gap showed no significant differences (p > 0.05, η² = 0.04). The electric handpiece outperformed the ultrasonic (p = 0.023, η² = 0.105) in internal adaptation, while the air-driven showed no differences (p > 0.05). The ultrasonic handpiece produced fewer marginal defects than the air-driven (p = 0.039, ε² = 0.132), but more axial defects (median 9 vs. 6, p = 0.014, ε² = 0.168) than the electric handpiece and occlusal defects (5 vs. 3, 4 p = 0.007, p = 0.015, ε² = 0.227) than rotary handpieces. The air-driven handpiece exhibited comparable defect numbers to the electric handpiece without statistical significance (p > 0.05). Conclusions: Handpiece selection had a small effect on marginal adaptation but more pronounced effects on overall defect formations and internal adaptation. The ultrasonic handpiece’s decreased marginal defects but variable axial/occlusal results reveal technological constraints, whereas rotary handpieces’ consistency reflects their operator-dependent nature. Full article

Background: The increasing adoption of digital workflows in implant dentistry necessitates rigorous assessment of intraoral scanning, particularly for complex full-arch rehabilitations like All-on-Four prostheses, where posterior implant angulation may impact the accuracy of optical data acquisition. Objectives: This in vitro study aimed to assess the accuracy of digital intraoral scanners in scanning All-on-Four implant models with different posterior implant angulations. Methods: Two epoxy resin All-on-Four implant models were fabricated with two posterior implant angulations (30-degree and 45-degree). Both models were digitized to obtain control datasets using a Smart Optics reference scanner (REF). Four intraoral scanners were comparatively assessed: Cerec Omnicam AC (OMN), Trios 4 (TRI), Cerec Primescan AC (PRI), and Medit i700 (MED), with nine scans per each scanner (n = 9). All STL files were exported and analyzed using Geomagic Control X with root mean square (RMS) values computed for trueness and precision assessments. Results: The comparison between IOS types in terms of trueness revealed that with 30° angulation, the MED group showed the statistically significant least deviation (p = 402). With 45° angulation, both PRI and OMN scanners showed the statistically significant highest deviation values (p = 0.047 and 0.007, respectively). MED again showed the statistically significant least deviation (p = 402). For precision evaluation in 30° angulation models, PRI and OMN scanners showed the statistically significant least deviation values (p = 402 and <0.001, respectively). While, in 45° angulation models, no statistically significant inter-scanner differences were observed. Conclusions: While MED, PRI, and OMN scanners demonstrated clinical validity for 30° angled posterior implants, only the MED system achieved sufficient accuracy for 45° tilt. These findings emphasize the critical relationship between scanner selection and extreme implant angulations in full-arch digital workflows. Full article

Background: Patients awaiting total hip arthroplasty (THA), particularly those with hip osteoarthritis (OA), face an elevated risk of osteoporosis due to age and gender-related factors. Osteoporosis, indicated by low bone mineral density (BMD), can affect implant osteointegration, long-term stability, and increase the likelihood of periprosthetic fractures. Despite these risks, osteoporosis is often underdiagnosed and undertreated in THA candidates. While several studies have addressed this issue in Northern populations, data on Southern European cohorts, particularly Italian patients, remain limited. This study aims to evaluate the prevalence of osteoporosis and vitamin D deficiency, as well as the rates of related treatments, in patients with hip osteoarthritis scheduled for THA. Methods: This single-center, retrospective study was conducted at Policlinico Universitario di TorVergata, Italy, involving 66 hip OA patients (35 men, 31 women; mean age 67.5 years). BMD was assessed at the femoral neck, total femur, and lumbar spine via DEXA, alongside vitamin D and PTH levels. Demographic data, ongoing anti-osteoporotic therapies, Harris Hip Score (HHS), and handgrip strength were recorded. Statistical analysis included t-tests and Pearson’s correlation. Osteoporosis was defined per WHO criteria, with significance set at p < 0.05. Results: In this study of 66 patients with hip osteoarthritis (35 men, 31 women; mean age 67.5 years), women exhibited significantly lower bone mineral density (BMD) at the total femur (−0.98 ± 1.42 vs. −0.08 ± 1.04; p < 0.05) and lumbar spine (−0.66 ± 1.74 vs. 0.67 ± 1.59; p < 0.05) compared to men. Handgrip strength was also significantly reduced in females (17.1 ± 8.2 kg) versus males (27.3 ± 10.3 kg; p < 0.05). Vitamin D levels were below 30 ng/mL in 89.4% of patients, and 63.6% had levels below 20 ng/mL; PTH levels were elevated (>65 pg/mL) in 54.5% of cases, indicating frequent secondary hyperparathyroidism. Only 9 patients were receiving vitamin D supplementation and none were on anti-osteoporotic treatment. Conclusions: These findings highlight the frequent coexistence of low BMD, vitamin D deficiency, and reduced muscle strength in THA candidates, suggesting a pattern of musculoskeletal vulnerability that warrants clinical attention. Full article

Introduction: Pediatric prosthetic knee joints must be appropriately scaled from adult designs to ensure proper gait biomechanics. However, direct dimensional scaling without considering the biomechanical implications may lead to functional discrepancies. This study aimed to evaluate whether using a linear scaling factor can effectively adapt a knee for pediatric use. The study assessed whether such an approach yields a viable pediatric prosthetic knee joint by applying a fixed scaling factor and analyzing the resultant knee geometry. Methods: The linear scaling factor was determined based on the pylon tube diameter, a key constraint in compact pediatric knee design. Given a pediatric pylon diameter of 22 mm, the length of the tibial link was set to 22 mm, yielding a scaling factor of 0.6875 when compared to the adult-sized knee. This scaling factor was used to determine the dimensions of the pediatric four-bar (scaled) knee joint. Static geometric analysis was conducted using GeoGebra^® to model the lower-body segment lengths. The knee joint’s performance was evaluated based on stance and swing phase parameters. These metrics were compared between the scaled knee and a commercial pediatric knee. Results: The geometric analysis revealed that while using the linear scaling factor maintained proportional relationships, certain biomechanical parameters deviated from the expected pediatric norms. The scaled knee achieved a toe clearance of 13.5 mm compared to 19.7 mm in the commercial design and demonstrated a swing-phase heel clearance of 11.6 mm versus 13.3 mm, maintaining negative x/y ratios at heel contact and showing significant stability in push-off moments, while the stance flexion angle remained within an acceptable range. The heel contact and push-off ratios (x/y) were found to be comparable, with the scaled model achieving values of −1.21 and −0.59, respectively. The stance flexion angle measured 10.6°, closely aligning with the commercial reference. Conclusions: Using a linear scaling factor provides a straightforward method for adapting adult prosthetic knee designs to pediatric use. However, deviations in key biomechanical parameters indicate that further experimental study may be required to validate the applicability of the scaled knee joint for pediatric users. Future work should explore dynamic simulations and experimental validations to refine the design further and ensure optimal gait performance. Full article

Transcatheter aortic valve replacement (TAVR) is now established as a safe and effective treatment for severe aortic stenosis across all surgical risk categories. Nevertheless, periprocedural conduction disturbances—including new-onset left bundle branch block (LBBB), right bundle branch block (RBBB), and other intraventricular blocks—remain among the most frequent complications, often resulting in permanent pacemaker (PPM) implantation and impacting left ventricular remodeling. A review was conducted using the PubMed/MEDLINE database. Relevant clinical trials, observational studies, and meta-analyses addressing post-TAVR LBBB were included and analysed with a focus on frequency, risk factors, and association with adverse outcomes. We describe the incidence of post-TAVR conduction disturbances and identify key predictors: pre-existing RBBB, membranous septum length, valve oversizing, implantation depth, infra-annular leaflet extension, compression ratio, and valve type/generation. New-onset LBBB is a frequent complication after TAVR and may negatively affect patient outcomes. Accurate risk stratification and standardised post-procedural monitoring protocols are essential. Further prospective studies are needed to better define management strategies for patients developing LBBB after TAVR. Full article

Background: Dental implants enhance masticatory efficiency in edentulous patients, yet discrepancies exist between objective assessments and patient perceptions. This study evaluated masticatory efficiency before and after implant rehabilitation using the two-color mixing test (Hue-Check Gum^®) and Viewgum^® software Version 1.4. 32-bit, correlating objective data with patient-reported outcomes. Methods: In a prospective study of 30 patients receiving implant-supported prostheses, masticatory efficiency was assessed objectively (VOH values via Viewgum^®) and subjectively (10 cm VAS). Statistical analysis included Shapiro–Wilk, paired t-tests (VAS), and Wilcoxon tests (VOH). Correlation and regression analyses examined subjective–objective relationships. Results: Significant improvements occurred post-rehabilitation. VAS scores rose from 3.46 (95% CI: 2.54–4.39) to 7.29 (6.55–8.02; p < 0.001). VOH values decreased from 0.462 (0.426–0.497) to 0.438 (0.403–0.473; p = 0.001), confirming better chewing performance. No correlation was found between VAS and VOH, pre- (p > 0.346) or post-treatment (p > 0.980). Conclusion: Implant rehabilitation improves masticatory function objectively and subjectively. However, the lack of correlation underscores the need for dual assessment in clinical practice. Future studies should explore factors influencing satisfaction and performance to optimize outcomes. Full article

Background: Soft liners offer a cushioning effect that aids in the healing of inflamed mucosa and allocates the relevant load in the support area of prostheses, enhancing their fit and stability. This study looks at how strontium-infused phosphate bioactive glass affects a heat-cured acrylic-based soft liner, focusing on the surface hardness and the surface roughness of the material. Methods: One hundred soft liner specimens were produced, with fifty specimens being designated for surface hardness testing and fifty specimens for surface roughness testing. PBG*Sr was incorporated into the soft liner at the concentrations of 1 wt.%, 3 wt.%, 5 wt.%, and 7 wt.%. Surface hardness and surface roughness were evaluated with a digital durometer for Shore A hardness and a profilometer, respectively. Fourier transform infrared spectroscopy analysis and field emission scanning electron microscopy were employed. Results: The Shapiro–Wilk test demonstrated that the data adhered to a normal distribution, as the p-values were not statistically significant. Subsequently, for statistical analyses following the one-way ANOVA, Dunnett’s T3 post hoc test was employed for surface hardness, while Tukey’s post hoc test was used for surface roughness. The lowest hardness value was documented in the 7 wt.% subgroup (29.040 ± 0.070), followed by the 5 wt.% subgroup (30.97 ± 0.231), and the control (40.880 ± 0.473) had the highest hardness mean value. The 7 wt.% subgroup displayed the lowest value of Ra recorded, 0.489 ± 0.077 μm, while the control subgroup showed the highest, 1.994 ± 0.168 μm. FTIR analysis suggested that the domination of physical interactions according to the analyses with the FESEM led to improved surface morphology for the 7 wt.% PBG*Sr specimens. Conclusions: The 7 wt.% PBG*Sr specimens exhibited the lowest surface hardness, suitable for soft lining material, and improved the surface morphology of acrylic soft liners compared with the control and other concentrations. Full article

Background: Aesthetic dentistry increasingly demands minimally invasive, predictable, and patient-centered solutions. Digital technologies and AI-driven planning tools are now integral to interdisciplinary treatments. Aim: To evaluate, by means of a 16-item questionnaire, patients’ perceptions of smile aesthetics and oral function before and after receiving clear aligner therapy followed by minimally invasive ceramic veneers, using digital planning and Smile Creator software. Materials and Methods: Five adult patients underwent digital smile design, clear aligner therapy, and feldspathic veneer placement. Pre- and post-treatment perceptions of smile aesthetics and function were assessed using a structured questionnaire. AI-based simulation tools (2D and 4 K TruSmile video previews) were incorporated. Paired t-tests were used to compare outcomes before and after treatment. Results: Mean pre-treatment scores were 4.8 for smile aesthetics and 6.6 for function. Post-treatment scores significantly improved to 9.8 (p = 0.001) and 9.4 (p = 0.002), respectively. Patients rated AI-generated smile previews more favorably than 2D designs and acknowledged the value of digital tools in understanding and accepting treatment. Conclusions: The integration of digital and AI-based tools in aesthetic dentistry enhances patient communication, improves predictability, and enables minimally invasive treatment. Patient satisfaction was high, underscoring the effectiveness of the combined orthodontic and prosthetic approach. Full article