Abstracts from the 1st International Online Conference on Prosthesis ^†

1. Dental Restorative Materials in Prosthodontics

1.1. Economic and Environmental Evaluation of 3D Printing in Restorative Dentistry: A Scoping Review

Maria Gabriela Packaeser de Souza ¹, Amanda Maria de Oliveira Dal Piva ², Cornelis Johanness Kleverlaan ² and João Paulo Mendes Tribst ¹

¹ 

Department of Reconstructive Oral Care, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, 1081 LA, The Netherlands

² 

Department of Dental Materials, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, 1081 LA, The Netherlands

Introduction: Despite increasing adoption, there is limited comprehensive analysis of the economic and environmental implications of 3D printing in restorative dentistry. This review aims to systematically explore existing literature on the cost-efficiency, material utilization, production timelines, and material waste of additive 3D printing methods versus conventional manufacturing techniques for dental restorations.

Methods: Adhering to PRISMA-ScR standards, a systematic search was conducted in March 2025 across the PubMed, Embase, and Scopus databases. The included studies evaluated material costs, labor, equipment, and production duration for pressed and 3D printing techniques used in fabricating crowns, bridges, and dentures for permanent purposes. Data were extracted and analyzed independently, focusing on economic viability, material waste, environmental impact, and clinical outcomes.

Results: Out of 185 identified records, 9 studies met the inclusion criteria, encompassing in vitro experiments, clinical trials, retrospective analyses, and economic comparisons. The findings indicate that 3D printing generally incurs lower material and upfront costs, with reduced waste production compared to conventional methods. Although conventional manufacturing approaches offer superior precision and faster production for single restorations, 3D printing provides greater cost benefits and environmental sustainability, especially when producing multiple units. Clinical performance metrics, including patient satisfaction and retention, are comparable among the methods, with conventional methods being slightly superior in accuracy.

Conclusions: 3D printing is the most cost-effective alternative for large-scale or provisional dental restorations. However, traditional manufacturing methods are preferred when high precision and strength are required.

1.2. Cast-Gold vs. Fiber Post-and-Core in Restoring Severely Compromised Mandibular Molars: A 3D-Finite Element Analysis

Konstantinos Krommydas ¹, Athina Niakou ², Athanasios Stratos ², Konstantinos Michalakis ^3,4 and Alexander Tsouknidas ^4,5

¹ 

Laboratory of Biomaterials and Computational Mechanics, Department of Mechanical Engineering, University of Western Macedonia, Kozani, Greece

² 

Department of Prosthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

³ 

Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118, USA

⁴ 

Boston University Center for Multiscale and Translational Mechanobiology, Boston, MA 02118, USA

⁵ 

Laboratory for Applied Biomechanics, Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118, USA

Introduction: Posts and cores are frequently used to enhance retention and mechanical performance in teeth with compromised coronal structure. Common strategies include gold-cast post-and-cores and prefabricated fiber-reinforced-composite (FRC) posts with composite resin cores. The elastic modulus of post materials influences stress distribution in root dentin. While some studies support high-modulus dowels, others advocate for materials with a modulus of elasticity closer to dentin. This study compared the biomechanical behavior of cast-gold vs. FRC posts with composite cores using finite element analysis (FEA).

Methods: Two 3D models of a mandibular first molar were generated from micro-CT scans: (A) an intact molar (control) and (B) a structurally compromised molar restored with either (1) a cast-gold post-and-core or (2) an FRC post and composite core, both restored with lithium disilicate crowns. FEA was performed on a fully dentate mandibular model, including bilateral occlusal contacts. Regular masticatory forces were applied, and stress distribution was evaluated. Major principal stresses were calculated for dentin (anisotropic behavior), while for the surrounding structures (isotropic behavior), the mvM analysis was applied. Validation was performed against experimental data.

Results: Both restored models showed maximum stress values in the crown and dentin similar to the control model. However, stress distribution differed significantly. Critical stress zones included the crown–core, core–dentin, and core–post interfaces and post preparation cavities. FRC posts and cores exhibited lower stresses, especially in the cervical dentin, more closely replicating a natural tooth’s biomechanics. Cast-gold cores showed nearly double the stresses near the core–post interface and presented higher stresses within the dentin’s post preparation cavities. Stress and strain patterns in soft tissues (e.g., PDL) were similar across models.

Conclusions: While both systems restored biomechanical performance, FRC posts yielded a more favorable stress profile, particularly in critical areas of dentin, better resembling natural tooth behavior. Cast-gold systems demonstrated higher stress concentrations in critical areas.

1.3. Compressive Strength, Flexural Strength, Surface Microhardness, Wettability, and Bacterial Inhibition of Acrylic Bone Cements Modified with Silver-Doped CNTs

Tamer M. Hamdy

• Restorative and Dental Materials Department, Oral and Dental Research Institute, National Research Centre (NRC), El Bohouth St., 12622 Dokki, Giza, Egypt

Background: Acrylic bone cement is widely used in orthopedics and dentistry for primary bone fixation. However, its limited mechanical strength and poor biological interface pose clinical challenges. To enhance their properties, carbon nanotubes (CNTs) and silver nanoparticles (Ag) have been explored. CNTs are known to reinforce polymers, while Ag nanoparticles provide antimicrobial benefits. Combining both may yield a synergistic effect, improving mechanical strength and antibacterial performance. Objective: This study evaluates the effect of incorporating 0.05 wt% silver-doped carbon nanotubes (Ag-doped CNTs) into acrylic bone cement. Key properties assessed include compressive strength, flexural strength, surface microhardness, wettability, and antibacterial activity against Staphylococcus aureus. Methods: A control group was prepared using traditional acrylic powder mixed with monomer liquid. In the modified group, 0.05 wt% Ag-doped CNTs were added to the acrylic powder before mixing. Compressive strength, flexural strength, surface microhardness, and wettability were tested. Antibacterial activity was evaluated using an agar diffusion test against S. aureus to test the inhibition zone. Independent-sample t-tests (p 0.05) were used to compare results between groups. Results: The modified acrylic cement exhibited significantly higher compressive strength (91 MPa), flexural strength (73 MPa), and surface microhardness (39.1 VHN), and improved wettability (contact angle: 92.2°) compared to the control group, which recorded values of 72.3 MPa, 54.3 MPa, 21.1 VHN, and 107.9°, respectively. Additionally, the modified cement demonstrated a larger inhibition zone diameter against S. aureus (12.6 mm) than the control (9.1 mm) (p 0.05). Conclusions: Incorporating 0.05 wt% Ag-doped CNTs into acrylic bone cement significantly improves its mechanical and antibacterial properties. This modification holds strong potential for clinical applications in both orthopedics and dentistry, offering enhanced strength, better surface characteristics, and effective bacterial inhibition compared to traditional formulations.

1.4. Incorporation of Nanoparticles into the Thermal Behavior of Polycarbonate Resin: A Systematic Review

S.C. Ahila

• Department of Prosthodontics, SRM Dental College, Ramapuram, SRM Institute of Science and Technology, Chennai, Pincode-600089, India

Background: Nanoparticles are used for preventing oral diseases, fabricating prostheses, and for dental implantation. They are also used for delivering drugs for oral application; preventing and treating oral diseases, including oral cancer; and maintaining the health of oral tissues to a greater extent.

Purpose: To systemically analyze the thermal behavior of nanoparticle-incorporated polycarbonate resin.

Materials and Methods. Online databases like Google Scholar, PubMed, PubMed Central, Scopus, Cochrane, and Science Direct were searched using the key terms polycarbonate resin OR nanoparticles, polycarbonate resin AND nanoparticles, and polycarbonate resin NOT nanoparticles from 1 January 2010 to 31 December 2024. The inclusion criteria were in vitro studies with full-text articles in the English language, and the exclusion criteria were clinical research, randomized clinical trials, animal studies, articles with only abstracts available, and literature reviews.

Results. After applying the inclusion and exclusion criteria, 22 original articles were thoroughly analyzed, and 11 studies were selected for a systematic review. Thermal properties like glass transition temperature and decomposition of polycarbonate and nanoparticle composites were affected by nanoparticles such as Silica, Titanium, Zinc, and Zirconium at various percentages.

Conclusions. Thermal properties like glass transition temperature, light transmission, and decomposition rate decreased, while the storage modulus and flame retardancy increased with the increasing percentage of Silica, Titanium, Zinc, and Zirconium nanoparticles.

1.5. Less Is More: The Impact of Minimally Invasive Posterior Restorations

Yosra Gassara and Rim Kallala

• Department of Fixed Prosthodontics Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia

Introduction:

Minimally invasive posterior restorations (MIPRs) aim to preserve tooth structure while ensuring optimal function and esthetics. Adhesively bonded restorations, such as onlays, overlays, and endocrowns, provide conservative alternatives to full crowns. The clinical performance of these restorations depends largely on appropriate material selection, preparation design, and bonding procedures.

Methods:

This work presents four clinical situations illustrating different applications of MIPRs: a lithium disilicate endocrown, a zirconia endocrown, a disilicate onlay, and a zirconia overlay. Each case was analyzed regarding indication, preparation strategy, CAD/CAM fabrication, and adhesive luting protocol. Special attention was given to margin management, Immediate Dentin Sealing (IDS), and occlusal integration.

Results:

Clinical observations revealed satisfactory marginal adaptation, occlusal harmony, and esthetic integration in all four cases. Lithium disilicate restorations provided excellent translucency and enamel bonding potential, while zirconia offered enhanced fracture resistance in high-stress situations. IDS improved bonding reliability and reduced postoperative sensitivity. No complications were observed during follow-up.

Conclusions:

The clinical outcomes from these four cases support the reliability of MIPRs as conservative and durable treatment options for posterior teeth. The choice between disilicate and zirconia should be guided by the amount of residual tooth structure, esthetic expectations, and functional demands. Mastery of adhesive techniques remains essential for long-term success.

1.6. Minimally Invasive Management of Traumatized Maxillary Incisors

Fabio Andretti ¹, Silvia Rojas-Rueda ², Gerardo Guzman-Perez ³, Franciele Floriani ⁴, Kelvin I. Afrashtehfar ^5,6 and Carlos A. Jurado ^1,7

¹ 

Division of Operative Dentistry, Department of General Dentistry, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN 38103, USA

² 

Division of Dental Biomaterials, Department of Clinical and Community Sciences, The University of Alabama at Birmingham School of Dentistry, Birmingham, AL, USA

³ 

Department of Periodontology, Centro Educativo Multidisciplinario en Rehabilitacion Oral (CEMRO), Morelia, Mexico

⁴ 

Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA

⁵ 

Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern 3010, Switzerland

⁶ 

Private Practice, Dubai, United Arab Emirates

⁷ 

School of Dental Medicine, Ponce Health Sciences University, Ponce, PR 00732, USA

Minimally invasive management of traumatized maxillary central incisors is crucial for preserving tooth structure, function, and esthetics. This approach is supported by current evidence on traumatic dental injuries (TDIs). A recent literature review, which spanned from 2010 to 2025 and utilized databases like Google Scholar and PubMed, focused on identifying and analyzing conservative techniques for maxillary incisor fractures. This comprehensive search also included a manual review of references from selected articles to ensure no relevant information was missed. To illustrate this conservative philosophy, a compelling case report is presented. The patient, who suffered a traumatic injury to a maxillary central incisor, was successfully treated using a multi-step, minimally invasive protocol. The treatment began with the strategic placement of a fiber-reinforced-composite post and core, which provided foundational support without the need for excessive tooth removal. This was followed by a carefully planned preparation for a lithium disilicate layered-zirconia crown. This choice of material and technique ensured the preservation of the patient’s remaining sound tooth structure, a key principle of the treatment. The outcome of this approach was the successful restoration of both function and esthetics. By prioritizing a conservative strategy, the treatment not only achieved structural integrity and esthetic harmony but also secured a favorable long-term prognosis for the tooth. This case serves as a powerful example that traumatic injuries to maxillary central incisors can be managed effectively with minimally invasive strategies, ensuring excellent long-term functional and esthetic outcomes while prioritizing the preservation of the natural tooth.

1.7. Non-Invasive Therapy for Disc Displacement with Reduction and Myalgia: A Case Report

Neada Hysenaj and Vergjini Mulo

• Prosthodontic Department, Faculty of Dental Medicine, University of Medicine, 1005, Albania

Introduction. Disc displacement with reduction (DDwR) and myalgia are among the most common temporomandibular disorders, frequently affecting young adults. While conservative therapy is considered the first-line approach, the evidence on long-term outcomes is still limited. Case Presentation. A 22-year-old female had a 7-month history of left-sided TMJ clicking, deviation to the left during opening, and 2 months of bilateral masticatory pain, which was worsened by mastication. During clinical examination, reproducible left TMJ clicking and tenderness of the masseter and temporal muscles were observed. Based on DC/TMD Axis 1, a DDwR with myalgia diagnosis was made. Intervention and Results: A full maxillary stabilization splint was constructed and delivered together with patient education, dietary adjustments, and guided mandibular exercises. At baseline, pain intensity was VAS 6/10 with a maximum unassisted mouth opening of 41 mm and reproducible joint clicking. After 2 weeks, the patient reported a decrease in pain, VAS 2/10, mouth opening was 44 mm, and joint sounds were absent. After 1 year, the patient was asymptomatic (VAS 0/10) with stable function, preserved mouth opening, and completion of daily activities without limitations. Clinical Relevance and Conclusions: This case shows that multi-directional non-invasive therapy can result in complete and long-term remission of DDwR with myalgia. It emphasizes the need for careful diagnosis, through standardized instruments such as DC/TMD, and the need for personalized treatment to ensure durable clinical success.

1.8. Occlusal Splint Thickness in the Treatment of Temporomandibular Disorders: Review of Current Evidence

Neada Hysenaj, Edlira Mulo, Vergjini Mulo and Edit Xhajanka

• Prosthodontic Department, Faculty of Dental Medicine, University of Medicine, Tirana, 1005, Albania

Introduction. Occlusal splints are oral appliances that have been designed to relieve temporomandibular symptoms. The thickness of occlusal splints for optimal efficacy is still controversial. Methods. An electronic search in Medline, Scopus, and Web of Science databases was conducted, using the following keywords up to January 2025:

(“occlusal splint” OR “stabilization splint” OR “bite splint”) AND (“vertical dimension” OR “thickness” OR “occlusal height”) AND (“temporomandibular disorder” OR “TMD” OR “disc displacement” OR “myofascial pain”).

All titles and abstracts were screened.

Studies comparing different thicknesses of occlusal splints were included. Results. Eight studies met the inclusion criteria, including five randomized controlled trials, one retrospective study, and two finite element analyses. A mixed quality-level of the studies was found. Based on current evidence, although limited, the following results could be deduced: Occlusal splints with moderate thickness, 3 mm, are recommended for those cases that involve both muscular and joint components, particularly when masticatory muscle pain is the primary complaint. Occlusal splints with minimal thickness, 2 mm, may be appropriate in internal derangements in the early stage, though evidence is low. Thicker splints, ≥4 mm, may be appropriate for DDwoR and in cases with crepitus. Occlusal splints of ≤2 mm and >6 mm were associated with symptoms such as reduced functional outcomes or comfort. Conclusions. In most cases, occlusal splints with thicknesses of 3–5 mm seem to be optimal for most TMD cases; however, personalized treatment based on the respective diagnosis is recommended. The decision on splint thickness should be based on evidence according to the severity of the diagnosis, but also patient-centered, to achieve comfort, the compliance of the patient, and oral-structure preservation. Further high-quality RCTs are needed to have evidence-based guidelines and to achieve consistent results.

1.9. Posterior Mini-Invasive Restorations: The Dilemma of Material Choice

Rim Kallala and Yosra Gassara

• Department of Fixed Prostheses, Faculty of Dental Medicine, University of Monastir, Monastir, 5000, Tunisia

Introduction: Minimally invasive dentistry prioritizes preserving tooth structure while restoring function and esthetics. For posterior restorations, choosing among various ceramic and hybrid ceramic materials presents a significant dilemma. The present work discusses the critical factors influencing the selection of these indirect materials, highlighting their properties, indications, and the challenges in optimizing clinical outcomes.

Methods: The material classes considered include feldspathic porcelain, leucite-reinforced ceramics, lithium disilicate, zirconia (monolithic and layered), and resin–ceramic hybrid materials. Evaluation criteria encompass mechanical properties (flexural strength, fracture toughness, wear resistance), esthetics, bondability, biocompatibility, and their ability to facilitate conservative tooth preparation. Clinical scenarios and patient-specific factors like occlusal load, esthetic demands, and opposing dentition are also addressed.

Results: For posterior mini-invasive restorations, lithium disilicate is a common choice, offering excellent esthetics and good mechanical properties for inlays, onlays, and crowns. Zirconia, particularly in monolithic forms, is preferred for high-occlusal-load situations due to its superior strength, though esthetics may vary with opacity. Newer translucent zirconias balance esthetics and strength. Resin–ceramic hybrid materials combine polymer resilience with ceramic wear resistance, offering shock absorption and ease of repair for specific minimally invasive applications. The dilemma often involves balancing strength, esthetics, and conservative preparation, as material properties directly influence required preparation dimensions. Patient factors like bruxism or limited interocclusal space further complicate the decision.

Conclusions: Selecting indirect ceramic or hybrid ceramic materials for posterior minimally invasive restorations in prosthodontics is a complex decision. While lithium disilicate and zirconia offer robust options for strength and esthetics, resin–ceramic hybrids provide unique advantages. The ultimate choice hinges on a thorough clinical assessment, aiming to resolve this material dilemma for optimal long-term success of conservative restorations.

1.10. Prosthetic Rehabilitation of Velopharyngeal Insufficiency in a Patient with Locally Advanced Carcinoma Oropharynx: A Case Report

Jyothi Venkat Sainath ¹, Akhileshwar Namani ², Vinayak Munirathnam ³ and Karthik Rishi ⁴

¹ 

Department of Maxillofacial Prosthodontics, Sri Shankara Cancer Hospital and Research Centre, Bangalore 560004, India

² 

Department of Molecular Oncology, Sri Shankara Cancer Hospital and Research Centre, Sri Shankara National Centre for Cancer Prevention and Research, Sri Shankara Cancer Foundation, Bangalore 560004, India

³ 

Department of Medical Oncology, Sri Shankara Cancer Hospital and Research Centre, Bangalore 560004, India

⁴ 

Department of Radiation Oncology, Sri Shankara Cancer Hospital and Research Centre, Bangalore 560004, India

Introduction:

Oropharyngeal carcinoma and its treatment can cause structural and functional loss of the soft palate, leading to velopharyngeal insufficiency (VPI) with hypernasality, nasal regurgitation, and impaired speech. When surgical reconstruction is not feasible, prosthetic rehabilitation with a velopharyngeal obturator, supported by speech therapy, offers an effective alternative.

Methods:

A 50-year-old male presented with a 2-month history of dysphagia, voice change, and slurred speech. Clinical and radiological evaluation revealed an ulceroproliferative lesion involving the soft palate, right tonsillar fossa, and pharyngeal wall with cervical lymphadenopathy. Biopsy confirmed moderately differentiated squamous cell carcinoma. Following treatment, he developed loss of the uvula and posterior soft palate, resulting in incomplete velopharyngeal closure. A customized velopharyngeal obturator was fabricated to restore soft palate function. Concurrently, a structured speech therapy program was initiated to correct compensatory articulation, enhance intraoral pressure, and improve airflow control.

Results:

The obturator provided immediate improvement in oro-nasal separation, reducing hypernasality and nasal regurgitation during swallowing. With adjunctive speech therapy, the patient achieved consistent oral articulatory placement and improved intelligibility. Rehabilitation also enhanced swallowing and contributed to psychosocial confidence.

Conclusions:

This case demonstrates the importance of prosthetic rehabilitation for patients with VPI after oral cancer treatment. A velopharyngeal obturator, combined with targeted speech therapy, represents a minimally invasive and cost-effective approach to restore soft palatal closure, improve speech and swallowing, and enhance quality of life.

1.11. What Is the Effect of Brushing and Immersion in Hygiene Solutions on the Roughness of 3D-Printed Resins for Base and Teeth Dentures?

Beatriz de Camargo Poker, Ana Paula Macedo, Viviane de Cássia Oliveira, Adriana Barbosa Ribeiro, Vinicius Sabedra, Mariane Gonçalves and Cláudia Helena Lovato da Silva

• Department of Dental Materials and Prosthetics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14.040-904, Brazil

Printed digital and conventional complete dentures require appropriate hygiene materials and methods to prevent the formation of biofilm, tartar, stains, inflammation, and odor. However, some hygiene materials can affect resin properties, such as surface roughness, which, when increased, can favor biofilm adhesion and development. In the literature, it has been reported that roughness values ≤ 0.2 µm are considered clinically acceptable; however, studies evaluating the effects of hygiene protocols on the roughness of printed resins are scarce. So this study compared the roughness of 3D-printed resins for denture bases (3DB) and teeth (3DT) to conventional resins for base (CB) and teeth (CT), after hygiene protocol use. Ten specimens of each material were subjected to brushing and immersion in water (EA, control), 0.25% sodium hypochlorite (EHS), or 0.15% triclosan (ET). Roughness was measured after obtaining the specimens (T0) and after simulating daily 6 min brushing and daily 20 min immersion for 1 (T1) and 3 years (T3), using a confocal laser microscope (µm). Data were analyzed using Generalized Estimating Equations (GEEs) and Wald tests with Bonferroni adjustment (α = 0.05). Roughness was influenced by the following interaction: resin × hygiene protocol × time (p = 0.012). In T1, the average roughness (Sa—µm) of the 3DB (EA: 0.239; EHS: 0.258; and ET: 0.265) and 3DT (EA: 0.211; EHS: 0.202; ET: 0.248) resins was considered unacceptable. In T3, the roughness of the 3DB (EA: 0.183; EHS: 0.161; ET: 0.199) and 3DI (EA: 0.181; EHS: 0.173; ET: 0.188) resins decreased, possibly due to the removal of superficial layers of resin through brushing, exposing inner layers with less roughness. Conventional-resin roughness remains within acceptable limits regardless of hygiene protocol. Compared to conventional resins, printing resins should be indicated for short-term situations, when associated with the proposed hygiene protocols. Hygiene protocols can be recommended for both conventional resins during the periods studied.

2. Digital Technologies and Artificial Intelligence in Prosthodontics

2.1. “12-Month Clinical Evaluation of an Innovative Digital Index for the Follow-Up of Edentulous Patients”

Annamaria Mastrosimone, Gennaro Ruggiero, Vito Cirillo, Giulia de Durante, Ruben Maria Paino, Roberto Sorrentino and Fernando Zarone

• Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples 80131, Italy

Aim

Nowadays, digital technologies have deeply changed prosthetic paradigms, and dentists are increasingly providing dental treatments with a full digital workflow. This study aimed to assess whether edentulous patients, who were trained by a dental hygienist about hygienic maintenance, show a different plaque retention at the intaglio surface of full dentures (FD) compared to untrained patients. Additionally, the study aimed to introduce a new digital index for the denture hygiene evaluation.

Materials and Methods

Thirty edentulous patients were enrolled by dentists of the Scientific Unit of Digital Dentistry, directed by Prof. Fernando Zarone, and were randomly divided into two groups: trained (TG) or control group (CG). TG received practical demonstrations on home hygiene procedures, while CG received only written instructions following the American College of Prosthodontists’ guidelines. At baseline and 1-year follow-up, a plaque detector was used in the FD intaglio, then a photographic documentation and an intraoral scan of the FD were performed. Scan data was analyzed by MeshLab software to calculate the “Zarone Index,” detecting the percentage of denture surface covered with plaque.

Results

Power analysis confirmed the study’s statistical validity. Normality and homogeneity of variance tests were performed. The Welch test showed statistically significant differences (p 0.001) between the “Trained Baseline” and “Trained Follow-up” groups, as well as between the “Trained Follow-up” and “Control Follow-up” groups. No significant differences between the “Control Follow-up” and “Control Baseline” groups were evidenced.

Conclusions

Trained patients demonstrated both statistically and clinically significant improvements in prosthesis care and home hygiene. These findings highlight the importance of a collaborative approach involving the dentist, hygienist and patient in order to improve the treatment outcomes. These preliminary results will be extended with a longer-term follow-up.

2.2. Effect of Clinical Experience on Acquisition Time and Chairside CAD Design Accuracy: An In Vitro Study

Clarissa Esposito, Gennaro Ruggiero, Annamaria Mastrosimone, Vito Cirillo, Giulia De Durante, Ruben Maria Paino, Roberto Sorrentino and Fernando Zarone

• Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples 80131, Italy

Aim

This in vitro study aimed to assess the influence of clinical experience on two key aspects of the digital chairside workflow: intraoral scanning efficiency and the morphological accuracy of CAD-designed prosthetic crowns, by comparing three operator groups with different levels of experience.

Materials and Methods

Thirty dental operators were divided into three homogeneous groups: ten sixth-year dental students (S), ten general practitioners (O), and ten prosthodontic specialists with advanced clinical expertise (P). The reference model featured the lower-left second premolar, prepared with a horizontal finish line and supragingival margin. Each operator performed three digital scans of the model following a standardized scanning strategy, and completed a CAD design of a crown on the prepared tooth. Digital impressions were acquired using the Primescan intraoral scanner (Dentsply Sirona), and designs were created with CEREC 5.3 software. Scan time was manually measured with a stopwatch. Three expert prosthodontists independently assessed the CAD crown quality using a Visual Analogue Scale (VAS).

Results

Mean scan times were group S = 231.80 s; group O = 174.40 s; and group P = 70.00 s. Mean VAS scores were S = 7.60; O = 9.00; and P = 9.60. The Shapiro–Wilk test indicated a non-normal distribution (p > 0.005). The Kruskal–Wallis test revealed significant differences between students and prosthodontists in both scan time (p = 0.002) and CAD quality (p = 0.012). No significant differences emerged between students and general practitioners, nor between practitioners and prosthodontists.

Conclusions

Despite all operators producing clinically acceptable results, a positive correlation was found between clinical experience and performance in terms of scanning efficiency and CAD design quality.

2.3. Evaluating Artificial Surface Bridging in Intraoral Scans: A Comparative In Vitro Study of Six IO Scanners

Vincenzo Vallefuoco, Gennaro Ruggiero, Annamaria Mastrosimone, Vito Cirillo, Giulia de Durante, Ruben Maria Paino, Roberto Sorrentino and Fernando Zarone

• Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, 80131, Italy

Aim: The aim of this study is to quantify the artificial surface bridging area between non-contiguous tooth surfaces using multiple scans from six different intraoral scanner devices.

Materials and Methods: A typodont master model with an onlay preparation on the maxillary left first molar (tooth 26) was scanned using a laboratory-grade scanner. To obtain controlled interproximal gaps, an artificial digital separation was created between the prepared surface of tooth 26 and the adjacent second molar (tooth 27). Interdental distances of 100 µm, 300 µm, 500 µm, and 700 µm were digitally modeled, generating six different intraoral scanners: 3Shape TRIOS, Dentsply Sirona Primescan, iTero Element, Carestream CS 3800, Medit i900, and SIRIOS. Each model was scanned ten times, producing four different STL files, which were then 3D-printed using polyurethane resin. The resulting STL files were analyzed using MeshLab software for metrological evaluation. Bridging surface areas were measured and analyzed using descriptive statistics and post hoc tests.

Results: The statistical results showed that, at 100 µm, the mean ranged from 4.35 to 5.60 mm²; at 300 µm, from 1.57 to 5.11 mm²; at 500 µm, from 2.00 to 4.75 mm²; and at 700 µm, from 2.03 to 4.35 mm². The Friedman test revealed statistically significant differences among the experimental groups. Post hoc Bonferroni tests confirmed significant differences between the analyzed intraoral scanners at interproximal distances of 0.1, 0.3, 0.5, and 0.7 mm.

Conclusions: Bridging artifacts were present at all tested distances within the study limits. The outcomes at 0.7 mm showed values that could be regarded as potentially suitable for clinical use.

2.4. A Full Digital Workflow for Immediate Removable Denture Fabrication and Overdenture Rehabilitation in Elderly Patients: A Proof of Concept for Maxilla and Mandible

Corina Marilena Cristache ¹ and Cristian Corneliu Butnarasu ²

¹ 

Department of Dental Techniques, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania

² 

Megagen Dental Laboratory, 38 Delea Noua Street, 030925 Bucharest, Romania

Elderly patients often present with multiple co-morbidities and reduced mobility, making frequent dental visits challenging. Many have insufficient residual bone for fixed implant prostheses, while limited manual dexterity or cognitive decline may compromise oral hygiene. Financial limitations can also preclude multiple implant placements. In such cases, an implant-supported overdenture offers an optimal balance between function, aesthetics, and cost. Digital technologies now allow streamlined treatment with fewer appointments, greater accuracy, and improved comfort. This proof-of-concept protocol integrates a full digital workflow for extractions and immediate delivery of a digitally designed, 3D-printed removable denture, followed by immediate implant placement and fabrication of the definitive overdenture with minimal clinical sessions.

Methods: The protocol was applied to maxillary and mandibular edentulous cases. Preoperative data included intraoral scanning, CBCT, facial scanning, and virtual patient integration. Digital planning in Exocad DentalCAD software involved virtual articulator use for occlusal plane modeling, digital smile design, extraction simulation, implant positioning, and denture design. Removable dentures were 3D-printed in biocompatible resin and delivered immediately after extractions. Where indicated, implants (four in the maxilla, two in the mandible) were placed in the same session using sleeveless guided surgery planned in R2Gate software, and the dentures were adapted as interim prostheses. Definitive overdentures were fabricated conventionally in fewer appointments. Patient-reported outcomes were measured on a Visual Analog Scale (VAS).

Results: The workflow enabled accurate pre-surgical planning, immediate prosthesis delivery, and efficient transition to the final overdenture. In both arches, immediate dentures provided satisfactory aesthetics and function during healing. Patient satisfaction was high, especially due to reduced treatment time and minimal visits.

Conclusions: This protocol is a feasible, predictable, and time-efficient approach for elderly patients, reducing discomfort and enhancing treatment acceptance. Validation in larger cohorts is recommended.

2.5. A Revolution in Dentistry: AI-Powered 3D Scanning and Printing System for Custom Prosthetics, Implants, and Orthodontics Using Palano-Enhanced Implants

Mariam Tarek Shawkat

• College of Applied Health Sciences, 6th October Technological University, Cairo, Egypt

This research introduces a transformative breakthrough in dental medicine through the development of an integrated system that combines artificial intelligence, 3D printing, and sustainable nanotechnology. The system is built on three key pillars: first, high-precision digital scanning, which captures highly detailed and accurate images of oral and dental structures; second, AI-driven algorithms, which analyze and process these data to design fully customized prosthetics, implants, and orthodontic devices tailored to the unique needs of each patient; and third, 3D printing with eco-friendly nano-enhanced materials, ensuring superior quality, durability, and biocompatibility.

The proposed system stands out by significantly reducing diagnostic and manufacturing time compared to conventional methods, while also lowering costs and promoting environmental sustainability through the use of advanced materials that minimize medical waste and ecological impact. Furthermore, this innovation enhances the patient experience by offering highly personalized and rapid treatment solutions, ultimately improving clinical outcomes and patient satisfaction.

This study aspires to redefine the future of dental prosthetics and digital dentistry by providing a comprehensive scientific model aligned with the Fourth Industrial Revolution and the Sustainable Development Vision 2030. By bridging advanced technology and medicine, the research contributes not only to advancing oral healthcare but also to supporting global sustainability efforts, thereby creating a positive impact on both human health and the environment.

2.6. Clinical Application of Photogrammetry in Mandibular Full-Arch Immediate Implant Rehabilitation: A Case Report

Nesrine Slimene ¹, Ghada Bouslama ², Hajer Zidani ², Najla Taktak ², Izdihar Bouzaabia ², Narjes Hassen ² and Souha Boudegga ²

¹ 

Department of Removable Partial Prosthodontics, Dental Clinic, Monastir, 5019, Tunisia

² 

Department of Dental Medicine, Farhat Hached University Hospital, Sousse, 4000, Tunisia

Introduction:

Full-arch implant rehabilitations require precise transfer of implant positions to achieve passive fit and ensure long-term prosthetic success. In edentulous cases requiring the extraction of all remaining teeth, immediate loading protocols are often preferred to minimize functional impairment and patient discomfort. Conventional impression techniques may introduce distortions, particularly in extensive rehabilitations. Photogrammetry offers a highly precise and efficient method for capturing three-dimensional implant positions, eliminating the inaccuracies and auxiliary aids often associated with conventional and digital impression workflows. This report illustrates the clinical application of photogrammetry in an immediate mandibular full-arch implant rehabilitation.

Materials and Methods:

A 64-year-old patient with severely compromised mandibular dentition due to advanced periodontal disease and generalized tooth mobility underwent extraction of all remaining mandibular teeth. Six implants were simultaneously placed following a conventional surgical protocol. Immediately post-implantation, implant positions were recorded using a photogrammetry system. Scan bodies were connected, and multiple images were captured from various angles to generate a digital three-dimensional map of implant locations. The photogrammetric dataset was merged with intraoral scans of the soft tissues and occlusion to design a CAD/CAM screw-retained provisional prosthesis, which was delivered under immediate loading conditions.

Results:

The provisional prosthesis exhibited an excellent passive fit, confirmed clinically and radiographically. The patient reported immediate improvement in masticatory efficiency, comfort, and esthetics. Following mandibular rehabilitation, maxillary prosthetic treatment was performed using a delayed-loading protocol to achieve optimal occlusal balance and esthetic integration.

Discussion and Conclusions:

This case demonstrates that photogrammetry can significantly enhance the accuracy and efficiency of immediate full-arch implant rehabilitation. The method reduces impression-related distortions, eliminates errors from conventional impressions and reduces patient discomfort. Photogrammetry represents a valuable adjunct to contemporary digital implantology protocols, particularly in cases involving immediate loading.

2.7. Comparative In Vitro Study of the Marginal Fit of 3D-Printed Nanocomposite Crowns with Horizontal and Vertical Preparation Geometries

Giulia de Durante, Gennaro Ruggiero, Annamaria Mastrosimone, Vito Cirillo, Ruben Maria Paino, Roberto Sorrentino and Fernando Zarone

• Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples 80131, Italy

Aim:

This study aimed to evaluate the marginal adaptation of 3D-printed crowns with either horizontal or vertical margin preparations, scanned with an IOS (3 Shape), showing an accuracy of 5 µm, at standardized environmental conditions.

Methods:

Two maxillary first premolar abutments were designed using CAD software, one with a horizontal preparation (Ho) and the other with a vertical preparation (Ve). Both abutments had a 5-degree angle of TOC (total occlusal convergence); they were 3D-printed in resin and then mounted on a reference typodont. Ten crowns were fabricated for each preparation geometry using the DFAB 3D printer (DFAB CHAIRSIDE, Thiene, Italy). Cementation was simulated with polyether impression material, and then the crowns were scanned with an industrial metrological device (Atos Core 80; GOM GmbH, Germany). Finally, the scans were analyzed using dedicated software (Geomagic Control X, Raindrop Inc., USA) to assess the marginal fit. Descriptive statistics (95% confidence interval) were calculated, and an independent-samples t-test was performed at a significance level of α = 0.05 to compare differences between groups.

Results:

Mean marginal fit values for both preparation geometries were below the clinically acceptable threshold of 120 µm, with Ho at 76.83 µm and Ve at 84.37 µm. No statistically significant difference was found between the two groups (Ho p = 0.58; Ve p = 0.83).

Conclusions:

Nanocomposite crowns fabricated via 3D printing showed mean marginal discrepancies within clinically acceptable limits for both vertical and horizontal preparation geometries, with no significant difference between the two.

2.8. Digital Implant–Prosthetic Protocol for Maxillary Lateral Incisor Agenesis: A 4-Year Clinical Assessment of Soft Tissue Integration and Biomaterial Compatibility

Ruben Maria Paino, Gennaro Ruggiero, Annamaria Mastrosimone, Vito Cirillo, Giulia de Durante, Roberto Sorrentino and Fernando Zarone

• Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, 80131, Italy

Aim

This prospective clinical protocol aimed to assess the four-year survival and success rates of single implant-supported monolithic zirconia crowns, fabricated through a fully digital workflow, in the prosthetic rehabilitation of patients presenting with unilateral or bilateral congenital absence of the maxillary lateral incisors. The study also analyzed biological and technical variables affecting clinical outcomes, including patient-reported satisfaction.

Methods

A total of 22 patients with mono- or bilateral agenesis of the maxillary lateral incisors were enrolled, receiving 30 narrow-diameter implants. Corresponding screw-retained monolithic cubiczirconia (5Y-TZP) crowns with internal connections were digitally manufactured and delivered. Clinical performance was objectively evaluated using the Functional Implant Prosthodontic Score (FIPS), while subjective patient satisfaction was measured using a Visual Analog Scale (VAS). Survival and success analyses were performed using descriptive statistics and the Kaplan–Meier method.

Results

At the four-year follow-up, the mean FIPS (Functional Implant Prosthodontic Score) was 9.2, and the mean VAS (Visual Analog Scale) score for patient satisfaction was 8.7. Cumulative survival and success rates were 100% and 93.3%, respectively, according to Kaplan–Meier estimates.

Conclusions

The use of a fully digital implant–prosthetic protocol represents a reliable and effective short-term solution for the functional and esthetic rehabilitation of maxillary lateral incisor agenesis. Nonetheless, further longitudinal studies are warranted to confirm the long-term predictability of this approach.

2.9. DTX Studio Integrated with Exocad for Precise Esthetic Crown Lengthening and Veneers

Zhouyu Ding

• WeiKang Dental Clinic Company, Yuyao, Ningbo, 315400, China

Background

The precise orchestration of crown lengthening and veneers in the esthetic zone remains a cardinal challenge in multidisciplinary oral rehabilitation. Traditional empiricism-based approaches inherently carry risks of unpredictable esthetic outcomes due to reliance on subjective estimation. To address this, a digital workflow integrating DTX Studio and Exocad was developed, enabling closed-loop precision control from diagnosis to prosthetic design.

Integration with Digital Workflow Elements

1.

Multimodal Data-Driven Assessment

CBCT, intraoral scans, and facial topography were integrated to construct a patient-specific digital model for comprehensive assessment.

2.

Virtual Planning for Biological Width Preservation

Exocad’s morphology simulation reverse-engineers ideal gingival positions, quantifying gingival trimming with 0.1 mm accuracy. For example, if a veneer margin requires placement 1 mm apical to the existing gingiva, the digital workflow calculates a 3 mm total adjustment (1 mm gingival recontouring + 2 mm biological width), guided by the dual-positioning guide plate.

3.

Surgical Guidance via 3D-Printed Precision

The dual-positioning guide plate, designed in DTX Studio using CBCT-derived bone segmentation, enforces precise bone reduction trajectories. Its primary cortical registration and secondary soft tissue matching ensure the surgical margin is maintained at the calculated 2 mm from the bone, minimizing risks of biological width violation

4.

Post-Surgical Prosthetic Optimization

iTero scans post-healing capture final gingival topography, allowing Exocad to refine veneer emergence profiles, contributing to the 40% treatment duration reduction by eliminating iterative adjustments for biological width-related complications.

Result:

Surgical error was minimized to 0.3 mm (70% reduction vs. traditional methods), as validated by the digital workflow’s closed-loop control from CBCT segmentation to prosthetic design. Preoperative smile visualization via the multimodal model enhances patient understanding of how biological width preservation influences final pink–white esthetic harmony.

Conclusions:

The DTX-Exocad platform revolutionizes traditional workflows through data-driven decision-making and real-time workflow control, delivering quantifiable precision for complex rehabilitations. This technological convergence epitomizes evidence-based digital dentistry, where seamless workflows redefine clinical excellence.

2.10. Evaluation of Dental Students’ Perception and Appreciation of 3D Augmented Reality Systems in Education: An Experimental Study

Vito Cirillo, Annamaria Mastrosimone, Gennaro Ruggiero, Giulia de Durante, Ruben Maria Paino, Clarissa Esposito, Roberto Sorrentino and Fernando Zarone

• Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples 80131, Italy

Abstract:

Digital technologies have become an integral part of daily life, offering increasingly sophisticated tools across many professional sectors. With the growing integration of artificial intelligence and digital realities (AR, VR, MR), even specialized fields such as dentistry are beginning to benefit from these advancements. In particular, augmented reality now allows for the simultaneous visualization of intraoperative information and the remote sharing of clinical procedures.

Aim:

This study aimed to evaluate dental students’ perception and appreciation of a 3D augmented reality system (Falko) used in an educational context, comparing 3D and 2D visualizations. The null hypothesis stated that no statistically significant difference would be found between the two modalities.

Methods:

During a standard clinical teaching session, thirty dental students from various academic years were divided into two groups. One group used the 3D system via head-mounted displays and VR glasses, while the other used 2D displays via smartphones or clinic monitors. The session was delivered both in the clinical environment and remotely. At the end of the session, participants completed a questionnaire via Google Forms, consisting of six VAS-scale questions evaluating key aspects of the system’s educational usefulness.

Results:

Students reported a highly positive experience, with increased engagement and attention noted across both groups. Due to the non-normal distribution, Student’s t-test was not applicable. Instead, the Mann–Whitney test revealed a statistically significant difference for the 3D group.

Conclusions:

The null hypothesis was rejected, confirming that the 3D visualization mode was significantly more appreciated than the 2D one. Despite the encouraging findings, the innovative nature of this study and the limited sample size, further research with a larger sample size is needed to validate these results.

2.11. Sustainable 3D Printing: Optimizing Waste Reduction and Recycling

Roldan Castro Hernandez, David Gangitano Atilio and Alberto Moreno Pelluz

• Department of Dentistry, Faculty of Medicine, Campus Cartagen, University San Antonio of Murcia, City Cartagena, Murcia, 30310, Spain

Introduction: The accuracy and efficiency of dental-model fabrication has experienced significant progress in recent years. However, environmental concerns, such as the use of petrochemical by-products, overproduction of plastic and waste management, have led to the development of new materials that can lessen these environmental challenges and contribute to a better ecological transition. Objective: To analyze cutting-edge technology in 3D printing techniques applied to the fabrication of dental models, with a particular focus on sustainable practices. Methods: This systematic review was conducted according to PRISMA guidelines. A comprehensive literature search was conducted using the electronic academic databases PubMed, Web of Science, and Scopus. The search strategy incorporated specific keywords and MeSH terms relevant to sustainable dental 3D printing. Scientific articles reviewed and published between 2020 and 2025 were considered. Studies written in English, German and Spanish were included in the selection process. Results: A total of five in vitro studies met the inclusion criteria and contain sufficient information for this review. All studies are in vitro and are peer-reviewed articles from the years 2023–2024. The materials investigated in these studies were polylactic acid (PLA), recycled PLA, recycled resins and soy-based resins. The studies employed either fused filament fabrication (FFF) or vat polymerization technology (VAT) as the main 3D printing techniques. Each study addressed sustainability as a central theme. Conclusions: The results of this systematic review show the potential of 3D dental models in the adoption of more sustainable materials, such as biodegradable and/or recyclable polymers, but this approach is relatively novel in the dental sector. The performance of these innovative materials has improved in terms of dimensional accuracy, efficiency and clinical application. Materials such as polylactic acid (PLA) and fused filament fabrication (FFF) are set to play a key role in the advancement of environmentally friendly dental manufacturing.

3. Innovations and Challenges in Dental Implants

3.1. Evaluating the Effects of Mechanical and Electrical Stimuli on Osteoblast Mineralization in Dynamic Cell Cultures

Yash Desai, Abdulkareem Al Otaibi, Choi Jae, Alexandros Tsouknidas, Jacob Miszuk and Michalakis Konstantinos

• Department of Restorative Sciences/Biomaterials, Boston University GSDM, Boston, Massachusetts—02118, USA

Introduction:

Functional xenografts are gaining momentum in tissue engineering because of their ability to replicate the complex microenvironment of native bone, where osteoblast function is influenced by mechanical loading and endogenous piezoelectric potentials generated by collagen. Poly-l-lactic acid (PLLA) scaffolds incorporating piezoelectric ceramics such as barium titanate (BaTiO₃) represent a promising approach to reproduce these cues. By converting applied stress into localized electrical signals at the cell–material interface, these scaffolds may activate osteogenic pathways. Characterizing their mechanical and physicochemical properties is therefore essential for assessing their translational potential.

Methods:

PLLA scaffolds (8–10 wt%) with 10 wt% BaTiO₃ were fabricated using thermally induced phase separation and freeze-drying. Morphological evaluation was performed with SEM, while BaTiO₃ dispersion was quantified using ImageJ analysis. Mechanical testing under uniaxial compression provided Young’s modulus values. Osteoblast viability was assessed with MTT assays, and confocal microscopy was employed to observe mineralization.

Results:

SEM confirmed interconnected pores with uniform distribution, with 10 wt% PLLA scaffolds achieving optimal porosity (85.3 ± 2.1%). ImageJ analysis demonstrated homogeneous BaTiO₃ distribution, with 92.4 ± 3.7% surface coverage. Mechanical characterization revealed a Young’s modulus of 1.47 ± 0.12 GPa for 10 wt% PLLA scaffolds, a value closely approximating trabecular bone. Biological assays indicated high osteoblast viability (>95%) across groups. Confocal microscopy revealed early mineralization in BaTiO₃-containing scaffolds, suggesting enhanced osteogenic activity.

Conclusions:

The PLLA–BaTiO₃ composite scaffolds exhibit favorable porosity, mechanical resilience, and cytocompatibility, supporting their application in bone regeneration. The combination of homogeneous BaTiO₃ dispersion and bone-mimetic mechanical properties underscores their potential as piezoelectric scaffolds for dental and orthopedic use. Future studies will focus on validating these findings under dynamic bioreactor conditions and conducting statistical comparisons of osteogenic outcomes.

3.2. Innovative Ag–CaP–ZrO₂ Coatings on Ti6Al4V: A Multifunctional Strategy to Improve the Durability of Dental Implants

Mohamed Aissi, Azzedine Er-ramly and Nadia Merzouk

• Laboratory of Dental Biomaterials and Nanotechnology Research, Faculty of Dental Medicine, Mohammed V University, Rabat 10100, Morocco

Introduction:

The titanium alloy Ti6Al4V is widely applied in dental implantology due to its high mechanical strength and biocompatibility. However, its biologically inert surface limits osteointegration and provides insufficient protection against bacterial adhesion, which may compromise long-term clinical outcomes. Developing multifunctional coatings is therefore essential to overcoming these limitations.

Methods:

A composite coating composed of calcium phosphate (CaP) and silver (Ag), reinforced with zirconium oxide (ZrO₂), was deposited on Ti6Al4V substrates using an immersion technique. Morphological and structural characteristics were assessed by SEM/EDS and XRD. Electrochemical performance was evaluated in artificial saliva using electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization. Antibacterial activity against Staphylococcus aureus and cytocompatibility with MG-63 osteoblast-like cells after 72 h of culture were also investigated.

Results:

The coatings exhibited a homogeneous and stable morphology. Electrochemical analyses showed a marked improvement in corrosion resistance, with a polarization resistance (Rp) of 861,652 Ω·cm² for Ti6Al4V–CaP/Ag, Zr compared to 492,253 Ω·cm² for bare Ti6Al4V and 232,086 Ω·cm² for CaP-only coatings. Silver incorporation reduced bacterial adhesion by approximately 75–80%, while cell viability remained above 80%, confirming the absence of cytotoxic effects.

Conclusions:

Ag–CaP–ZrO₂ coatings combined bioactivity, antibacterial activity, and superior corrosion resistance. These multifunctional surfaces represent an innovative and effective approach to enhancing osteointegration and improving the long-term clinical performance of dental implants.

3.3. Microbiological Study Using Phase-Contrast Microscopy for the Disinfection of Complete Dentures Anchored to Ball-Attachment Implants

Saverio Ceraulo ¹, Antonio Barbarisi ¹, Paolo Caccianiga ², Zhong Hao Hu ¹, Giulia Caccianiga ³ and Gianluigi Caccianiga ⁴

¹ 

Department of Medicine and Surgery, University of Milano-Bicocca, Monza, 20100, Italy

² 

Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, Milan, 20122, Italy

³ 

Centro Odontoiatrico Caccianiga, via Costantino Simoncini, 20, 24122 Bergamo BG, Italy

⁴ 

Department of Translational Medicine, University of Ferrara, Ferrara, 44121, Italy

Introduction: The microbial environment surrounding implant-supported overdentures plays a crucial role in the long-term success of rehabilitation, as inadequate disinfection can favor the growth of pathogenic species that jeopardize peri-implant health. The aim of this study is to analyze the effectiveness of a disinfection protocol for complete dentures anchored to ball attachments with respect to the peri-implant health of osseointegrated implants.

Methods: Thirty patients were randomly divided into two groups. All thirty patients had compatible flora (absence of spirochetes/Treponema denticola) at phase-contrast microscopy sampling. This was due to the modified oral hygiene protocol (sonic toothbrush and oral irrigator twice daily). The use of the irrigator was discontinued for all thirty patients. Group A disinfected their dentures with EC Ster daily, while Group B did not use EC Ster.

Peri-implant flora was re-examined with phase-contrast microscopy every month for 6 months.

Results: Patients in Group A maintained compatible flora at all samplings, but patients in Group B did not (at 1 month, 2/15 patients developed incompatible flora; at 2 months, 5/15; at 3 months, 8/15; at 4 months, 10/15; at 5 months, 15/15; and at 6 months, 15/15). Peri-implant parameters were stable and constant in group A, but they slowly worsened in group B (plaque index, bleeding on probing, peri-implant probing).

Conclusions: EC Ster maintains an environment unfavorable to the development of spirochetes (Treponema denticola), promoting greater stability in the peri-implant compartment.

3.4. The Effect of Surface Modifications on the Biocompatibility of PEEK Dental Implant Material

Sherine Philip, Nikolaos Poulis and Raya Karaganeva

• Queens Dental Sciences Centre, University of Greater Manchester, Bolton, BL4 7AH, United Kingdom

Introduction: Polyetheretherketone (PEEK) is considered an alternative to titanium for dental implants due to its favourable properties. However, its bio-inert and hydrophobic surface limits osseointegration. This study investigated the effects of sandblasting and gold sputter coating on the cell viability of fibroblasts in contact with PEEK.

Methods: Eighty PEEK discs (8 mm diameter × 2 mm height; PEEK Bio Solution) were divided into four groups: untreated (C), sandblasted (SB), gold sputter-coated for 30 s (G30), and sputter-coated following sandblasting (SBG30). The specimens were sandblasted with 50 µm alumina particles at 0.25 MPa pressure for 10 s (Duostar, BEGO). A gold sputter coater (Agar Scientific Ltd., Stansted) was used at 30 mA for 30 s against the G30 and SBG30 groups. Surface roughness (Sa and Ra) was assessed by optical profilometry (Profilm3D^®, Filmetric) and analysed using MANOVA. Cell viability was evaluated using L929 fibroblasts via MTT assay at 2 and 7 days, analysed by two-way ANOVA. A pilot qualitative assessment was utilised to further examine cell proliferation.

Results: Sandblasting significantly influenced roughness (p 0.001) with SBG30 showing the highest values (Sa = 1.398 ± 0.920 µm; Ra = 0.663 ± 0.185 µm), while C showed the lowest (Sa = 0.386 ± 0.476 µm; Ra = 0.180 ± 0.050 µm). Cell viability significantly increased over time for all surface treatments (p 0.001, η² = 0.896), with SB showing the lowest values at 2 days (26.55 ± 9.53%), but the highest values at 7 days (136.04 ± 26.74%). These results with a pilot microscopy assessment revealed enhanced proliferation, suggesting a correlation between roughness and cell attachment. There was no interaction effect between the surface modification and the time (p 0.076, η² = 0.129).

Conclusions: Sandblasting, with or without gold coating, enhanced PEEK’s roughness into the optimal Sa and Ra, which was found to be associated with favourable fibroblast proliferation. These findings highlight sandblasting as an effective surface modification to improve the biological performance of PEEK in dental implant applications. In contrast, gold sputter coating on its own did not show any significant effects on cell viability.

3.5. Internal Sinus Elevation with Osseodensification and i-PRF Sticky Bone Graft: A Case Report

Mohammed Samir

• Department of Oral Medicine, Periodontology and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt

Background:

Posterior maxillary rehabilitation is often complicated by sinus pneumatization and reduced residual ridge height. Traditionally, multiple adjacent implant placements in such situations require an open lateral sinus elevation. Minimally invasive internal sinus lift techniques, particularly when combined with biologically active grafts, offer a promising alternative. This case highlights the novelty of performing closed sinus elevation at multiple adjacent sites in a subantral Class 3 case, supported by the use of platelet-rich fibrin (PRF)-based sticky bone to enhance osteogenesis.

Case Description:

A 43-year-old female patient (ASA I) presented with multiple missing posterior teeth in the right maxillary arch, impairing mastication. CBCT revealed sinus pneumatization with reduced alveolar bone height, classifying the case as subantral Class 3. Internal sinus elevation was performed using osseodensification burs. Sticky bone was prepared by combining autologous PRF with a xenograft (Bio-Oss, Geistlich Pharma, Switzerland) using a centrifugation protocol (2700 rpm for 12 min). Three implants (4.0 × 10 mm) were simultaneously placed at the first premolar, second premolar, and first molar sites.

Results:

Sinus membrane elevations of 3.58 mm, 4.45 mm, and 6.69 mm were achieved. Implants demonstrated primary stability of 30–40 Ncm and ISQ values of 62–74. Post-operative CBCT confirmed complete bony housing along the full implant length, indicating substantial bone gain and increased peri-implant bone density. After 3 months, osseointegration was achieved, and a cement-retained zirconia fixed partial denture was delivered.

Conclusions:

Closed sinus elevation across multiple adjacent implant sites in a subantral Class 3 case, combined with PRF-enriched sticky bone, enabled predictable vertical bone gain and complete implant housing without the need for open sinus augmentation. The incorporation of growth factor-rich PRF enhanced the osteogenic potential of the sinus membrane, supporting rapid healing and successful implant integration. This approach demonstrates a minimally invasive and biologically favorable strategy for managing posterior maxillary edentulism with reduced ridge height.

3.6. Metal–Organic Frameworks (MOFs) in Dental Research

Selçuk Demir

• Department of Chemistry, Faculty of Arts and Sciences, Recep Tayyip Erdogan University, Rize, 53100, Turkey (Türkiye)

Metal–organic frameworks (MOFs) are a class of porous and highly ordered crystalline materials composed of metal ions or clusters coordinated with organic linkers. MOFs possess a high surface area, porosity, chemical and thermal stability, and the ability to be tailored using both organic and inorganic units. MOFs also exhibit antibacterial, biodegradable, and biocompatible properties depending on the metal and organic linker used. Due to these properties of MOFs, they are utilized in a wide range of applications, such as the storage of energy-related gases like hydrogen, the adsorption of chemicals, the detection of different molecules, the delivery of drugs, etc. Because of their high drug-loading capacity and slow-release processes, the drug delivery properties of MOFs are very crucial in biomedicine. Additionally, the physicochemical and mechanical properties of MOFs may also help improve the quality of the desired materials. Despite their extensive biomedical applications of MOFs, their potential in dentistry remains largely unexplored. In fact, MOFs are particularly relevant for dental research. For example, MOFs could be very useful in preparing dental composites or coatings for implants. The organic linkers of MOFs can be modified to introduce specific groups, such as methacrylate, which is useful for dental composites. Antibacterial coatings for implants are also possible. Herein, I aim to introduce the potential of MOFs to the field of dental research. This presentation will address detailed information about the synthesis, characterization, and application areas of MOFs, and then explore the application of MOFs as emerging, innovative materials in dental research. Consequently, this overview highlights both the opportunities and challenges of employing MOFs in restorative and implant dentistry, pointing towards future directions for research and clinical translation.

3.7. Patent-Based Socket-Shield Technique Utilizing Bone Trephine: A Case Series

Haseeb H. AlDary

• Independent Researcher, Private practice, Dr. Haseeb’s dental clinic, Amman, P.O. Box 1543, 11953, Jordan

Introduction:

Post-extraction bone remodeling, often accompanied by buccal bone loss, presents a challenge in implant dentistry, potentially complicating implant placement and compromising esthetic outcomes. The socket-shield technique (SST) preserves the buccal root fragment to mitigate these changes; however, conventional SST is technique-sensitive, time-consuming, and carries risks such as root injury or shield displacement. A guided trephine-based technique was developed to enhance accuracy and predictability in shield preparation.

Methods:

This case series reports on three patients with nonrestorable maxillary anterior teeth treated in a private practice. Surgical guides were digitally designed and fabricated to direct trephine burs, as described in a patented approach (WO 2024/038478 A1; USPTO No. 509030716). The guided trephine was used to prepare and preserve a precise buccal root segment to maintain periodontal and alveolar integrity. Immediate implants were placed in the palatal socket, and restorations were completed following a standard delayed protocol. Clinical and radiographic follow-up after loading demonstrated stable outcomes at 12 months (Case 1), 6 months (Case 2), and 3 months (Case 3). Long-term data are not yet available.

Results:

All cases showed successful preservation of buccal root fragments, with reduced operative time and improved surgical control based on the author’s clinical experience. Radiographs and clinical assessments demonstrated stable peri-implant bone levels, maintained ridge contours, and indicated satisfactory esthetic outcomes. No complications, such as shield mobility or adjacent root damage, were reported.

Conclusions:

The guided trephine-based socket-shield technique may offer advantages over conventional SST in terms of precision, reproducibility, and reduced chair time. However, the present report is limited by the inclusion of only three cases with very short follow-up periods. Although early results appear to be stable both functionally and esthetically, the technique requires validation through larger, well-controlled studies to confirm its reliability and efficiency, thereby supporting wider adoption by clinicians.

3.8. Prosthetic Management in Patients with Sjögren’s Syndrome: Challenges, Biomaterials, and Pharmacological Considerations

Barbarita Sánchez-Peña ¹, Carlos Domínguez Vargas ² and Samantha Jonnue Ramírez-Flores ³

¹ 

Faculty of Dentistry, Universidad Michoacana de San Nicolás de Hidalgo (UMSNH), Morelia, 58010, Mexico

² 

University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, 44340, Mexico

³ 

University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, 44430, Mexico

Introduction. Sjögren’s syndrome (SS) is a chronic autoimmune disorder characterized by lymphocytic infiltration of exocrine glands, leading to profound hyposalivation, xerostomia, and mucosal fragility. These pathophysiological changes pose significant challenges to prosthetic rehabilitation, including poor prosthesis retention, mucosal trauma, and increased susceptibility to infections.

Methods. We conducted a narrative review using PubMed, Scopus, and Web of Science, including clinical studies, systematic reviews, and case series (minimum 6-month follow-up), published in English between 2000 and 2024. Studies were selected based on their focus on prosthetic strategies—both tissue-supported and implant-supported—in SS patients. Exclusion criteria included animal studies and those not directly addressing prosthetic or pharmacological considerations.

Results:

Tissue-supported prostheses are often compromised by poor lubrication and mucosal ulceration, limiting their long-term use. In contrast, implant-supported prostheses, such as overdentures or fixed-implant restorations, demonstrate superior performance in retention, patient comfort, and masticatory function. Digital technologies (e.g., CAD/CAM and 3D printing) improve adaptation and reduce surface roughness. Polished, low-porosity acrylic resins reduce microbial colonization, and bioactive coatings (antifungal, antimicrobial) are emerging as adjunctive options. However, current evidence is largely derived from case series and observational studies, underscoring the need for controlled trials.

Conclusions:

An integrated, multidisciplinary approach is essential. Besides careful prosthetic planning and biomaterial selection, pharmacological interventions (sialogogues, antifungals, remineralizing agents) are critical for managing xerostomia and its consequences. Long-term follow-up protocols, including periodic relining, hygiene reinforcement, and management of peri-implant health, are crucial for implant longevity. Future research should explore implant survival rates in SS, biomaterial innovations with mucosa-friendly interfaces, and personalized protocols for maintenance and oral microbiome modulation. Prosthetic success in SS hinges on precision, prevention, and collaboration.

3.9. Psychosomatic Bruxism and Dental Implant Complications

Barbarita Sánchez-Peña ¹, Carlos Domínguez Vargas ², Paloma Marylí Prado-López ² and Daniela Alejandra Torres-Rodríguez ³

¹ 

Faculty of Dentistry, Universidad Michoacana de San Nicolás de Hidalgo (UMSNH), Morelia, 58010, Mexico

² 

University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, 44430, Mexico

³ 

La Salle University, Morelia, 58880, Mexico

Introduction: Bruxism is increasingly recognized as a psychosomatic condition mediated by stress, anxiety, and sleep disturbances, generating sustained non-physiological occlusal forces that compromise the stability and longevity of dental implants. This narrative review with integrated pilot data synthesizes the causal pathway linking psychological factors to bruxism and its impact on implant outcomes, advocating for an interdisciplinary model of prevention and management.

Methods: A narrative review was conducted using PubMed, Scopus, and Cochrane Library (2000–2025) with keywords including bruxism, dental implants, psychosomatic, stress, anxiety, sleep, biomechanics, implant failure, digital dentistry, artificial intelligence, and interdisciplinary management. Peer-reviewed clinical studies, case series, and technical reports were analyzed. Inclusion criteria were studies addressing psychosomatic or biomechanical aspects of bruxism in relation to implants; exclusion criteria were non-peer-reviewed or non-clinical reports. Pilot data from 15 patients with bruxism and implant-supported restorations (12-month follow-up) were reviewed, integrating psychological assessment, dental examination, and sleep medicine evaluation. Digital tools, including finite element analysis and AI-based occlusal monitoring, were considered.

Results: Evidence shows a strong association between psychosocial stress, anxiety disorders, and sleep disturbances with bruxism. Mechanical complications (screw loosening, veneer and framework fractures) and biological complications (peri-implant bone loss, implant failure) were identified. Early studies indicate that intraoral force sensors, AI-based scan analysis, and polysomnography enable the early detection of overload and prosthetic compromise. Interdisciplinary interventions—occlusal splints, cognitive-behavioral therapy, stress reduction, and sleep medicine—reduce complications. Studies remain small and heterogeneous; consistent trends support the association between psychosocial stressors, bruxism, and implant outcomes.

Conclusions: Psychological determinants threaten implant survival via biomechanical overload. Proactive management requires interdisciplinary collaboration. The proposed model—integrating dentists, psychologists, and sleep medicine physicians, supported by digital monitoring—represents not only a clinical recommendation but also a research agenda. Future randomized trials and validation of AI tools are essential to strengthen evidence and improve long-term outcomes.

3.10. Structural, Mechanical, and Biological Characterization of Polycaprolactone (PCL) Scaffolds for Dynamic Cell Cultures, Toward Dental Applications

Abdulkareem Alotaibi, Yash Desai, Jae Choi, Alexander Tsouknidas, Jacob Miszuk and Konstantinos Michalakis

• Department of Restorative Sciences & Biomaterials, Boston University, Boston, Massachusetts 02118, USA

Introduction

Alveolar bone loss after tooth extraction is a challenge for predictable implant placement. Bone grafting is widely used but limited by resorption, availability, and donor site morbidity. Bio-mimetic scaffolds with engineered structural, mechanical, and biological properties offer alternatives by supporting cell adhesion, proliferation, and tissue formation. Polycaprolactone (PCL), a biodegradable polymer with established biocompatibility, is widely applied in tissue engineering. This study examined the effect of PCL concentration on scaffold properties relevant to alveolar bone regeneration.

Methodology

Scaffolds were fabricated using Thermally Induced Phase Separation (TIPS) with PCL dissolved in a THF/water solvent at 8%, 9%, and 10% (w/w). Mechanical properties were assessed by compression testing at 1 mm/min and 25 °C. Morphology was examined by Scanning Electron Microscopy (SEM), and porosity was measured with AccuPyc II. Biological performance was evaluated by MTT assay, where cells were incubated with MTT solution for 3 h at 37 °C before absorbance at 590 nm. Confocal microscopy was performed with MC3T3-E1 pre-osteoblast cells stained with Texas Red™-X Phalloidin (591 nm) and DAPI.

Results

The 9% PCL scaffold demonstrated the most consistent mechanical behavior, with a modulus ranging from 2.81 to 3.40 MPa. Statistical analysis (ANOVA, p 0.05) confirmed that the 9% PCL group had a significantly higher modulus than both 8% and 10%, while no significant difference was observed between 8% and 10%. SEM analysis revealed interconnected pore structures with porosity ranging from 84% to 87%, supporting tissue ingrowth. The MTT assay confirmed good cell viability across all groups, with the 9% PCL group nearly matching the control. Cytotoxicity remained low (0.31–8.50%), with the 9% showing the lowest value and the 8% group the highest. Confocal microscopy, after seeding 100,000 cells (MC3T3-E1) per scaffold, showed strong cell attachment and penetration, indicating effective scaffold–cell interaction.

Conclusions

The 9% PCL scaffold demonstrated optimal mechanical stability and biological performance, making it a promising candidate for alveolar bone regeneration. Nevertheless, in vivo validation is required to confirm translational potential.

3.11. Systematic Review of CAD/CAM-Fabricated Customized Healing Abutments and Their Effect on Soft Tissue Esthetics

Inesa Stonkutė ¹, Miglė Miškinytė ² and Justina Stučinskaitė-Maračinskienė ²

¹ 

Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2 LT-50161, Kaunas, Lithuania

² 

Department of Maxillofacial Surgery, Medical Academy, Hospital of Lithuanian University of Health Sciences, Eiveniu 2, LT-50161 Kaunas, Lithuania

Introduction:

Immediate implant placement provides clear clinical benefits, including reduced treatment time and preservation of alveolar bone structure. Despite these advantages, achieving predictable and esthetic soft tissue outcomes remains a consistent challenge. Customized healing abutments (CHAs), fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM), are intended to better support peri-implant soft tissue compared to standard stock components. Although initial findings are encouraging, the available evidence remains limited and inconsistent across studies. This systematic review aims to assess soft tissue esthetic outcomes associated with CAD/CAM-fabricated CHAs following immediate implant placement.

Methods:

A systematic search was conducted in PubMed, Springer Nature Link, and Wiley Online Library following PRISMA guidelines. Studies published in English within the past five years assessing soft tissue esthetic outcomes of CAD/CAM CHAs after immediate implant placement were included. Out of 145 articles screened, 5 met the inclusion criteria.

Results:

All five studies reported improved peri-implant soft tissue esthetics with CAD/CAM CHAs. High Pink Esthetic scores were consistently observed, with Elgendi et al. reporting a mean score of 9.64 ± 0.50 and full papilla fill at 12 months using PEEK CHAs. Increases in mucosal thickness and keratinized tissue width were statistically significant in multiple studies (p 0.05). Long-term data from Akin and Chapple demonstrated preserved emergence profiles and no mucosal recession over 8 years in 115 posterior implants, indicating durable soft tissue outcomes. Buccal volume loss was significantly reduced (−4.76% ± 5.29%, p = 0.043) and overall dimensional stability was maintained, with minimal soft tissue changes reported across studies. While sample sizes and methodologies varied, all studies demonstrated favorable esthetic outcomes with CHAs compared to conventional approaches.

Conclusions:

CAD/CAM-fabricated CHAs improve soft tissue esthetics in immediate implant placement by preserving volume, enhancing contours, and maintaining emergence profiles. Despite promising results, further standardized, long-term clinical trials are needed to validate these outcomes.

3.12. Targeted Delivery of miR-210 Rosuvastatin in the Treatment of Periodontitis

Jialing Sun ¹, Yihua Song ² and Jiawen Zhang ²

¹ 

Faculty of Medicine, Nantong University, Nantong, Jiangsu Province, 226019, China

² 

Department of Stomatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, 226007, China

Differentiation of PDLSCs and the development of periodontal disease are closely connected with the stimulation of inflammatory factors. The cardiovascular system, immune system, and skeletal system can all be affected by rosuvastatin, which is a selective inhibitor of 3-hydroxy-3-methylglutarate monoacyl coenzyme reductase. The NF-κB signaling pathway can regulate stem cells’ differentiation ability and inhibit the secretion of inflammatory factors by stem cells, as confirmed by existing studies. Our research found that in the inflammatory microenvironment of periodontitis, rosuvastatin sustained release by the RS-PC scaffold can effectively up-regulate the expression of miR-210, target and bind to p65, inhibit the inflammatory response regulated by the NF-κB signaling pathway, and promote osteogenic differentiation. The purpose of this project is to clarify the impact of miR-210 on the function of the PDLSCs in periodontitis conditions and its possible pathway in the PDLSCs. It became apparent that rosuvastatin targets the NF-κB signaling pathway, which controls miR-210, suppresses the release of inflammatory factors, and promotes osteogenic differentiation. The rosuvastatin in the RS-PC scaffold has been tested in animal experiments to investigate its sustained-release, anti-inflammatory, and alveolar bone repair abilities. The research findings offer a theoretical basis for investigating the mechanism behind periodontitis’ occurrence and treatment methods.

3.13. The Importance of Design and Restorative Materials in Implant Prosthetics for Reducing the Risk of Peri-Implant Bone Loss

Oriol Cantó Navés

• Department of Dentistry, Univesitat Internacional de Catalunya (UIC), Barcelona, 08195 Sant Cugat del Vallès (Barcelona), Spain

The success of an implantological rehabilitation is determined by multiple surgical factors (implant position, implant distribution, number of implants, implant size, bone and gingival regeneration…), patients’ personal factors (general health, oral hygiene, hereditary factors, previous periodontitis, smoking, bruxism…), and prosthetic factors (restorative materials and prosthesis design).

It is on this last point that we are going to focus because, despite being of vital importance, it is the least publicized and explained. Among the different intervention points in the design of prosthesis, such as the emergence profiles, spaces to facilitate hygiene, design of the pontics, length and shape of the transepithelial abutments…, there are some that affect edentulous mandibular patients: mandibular flexion, weight of the prosthesis, impact against the antagonist, and the importance of the design of the prosthesis and the restorative material.

It is well known that there is a flexion, a deformation of the mandible when the person opens the mouth and/or protrudes, but what is not well known is the problems it causes to the prosthesis and the implants if a correct design and a good choice of the restorative material are not made. Among the most common problems are: fracture of the prosthesis, loosening of the screws, pain and/or dysfunction during opening or protrusion, peri-implant bone loss and loss of the implants.

By means of photographs, radiographs and numerous references, we will review the existing problems and provide different solutions, both in terms of design and restorative materials, to reduce the risk of prosthesis and/or implant failure in these edentulous mandibular patients.