Dentistry Journal

21 pages, 5307 KB

Open AccessArticle

Clinical Applications of Orthodontic Mini-Implants in Orthodontic and Esthetic Practice: A Case Series Exploring Biomechanical Versatility

by Teodora Consuela Bungău, Ada Radu and Gabriela Ciavoi

Dent. J. 2026, 14(3), 132; https://doi.org/10.3390/dj14030132 - 25 Feb 2026

Abstract

Background/Objectives: Orthodontic mini-implants have become indispensable in modern orthodontics due to their ability to provide absolute anchorage, independent of patient compliance. Our research aims to illustrate the versatility of mini-implants in addressing diverse biomechanical challenges across different planes of tooth movement (sagittal, transverse, [...] Read more.

Background/Objectives: Orthodontic mini-implants have become indispensable in modern orthodontics due to their ability to provide absolute anchorage, independent of patient compliance. Our research aims to illustrate the versatility of mini-implants in addressing diverse biomechanical challenges across different planes of tooth movement (sagittal, transverse, and vertical) based on a retrospective clinical analysis. Methods: A retrospective analysis of orthodontic treatments performed with mini-implants (Dual Top and JS systems) was conducted, focusing on predefined biomechanical objectives and outcomes. The analysis encompassed distinct biomechanical applications, including incisor retraction and space closure using sequential direct and indirect anchorage; transverse and vertical correction of adult open bite through mini-implant–assisted rapid palatal expansion (MARPE) and molar intrusion; deep bite correction via simultaneous upper and lower incisor intrusion; and unilateral molar distalization using palatal skeletal anchorage. Results: Mini-implants provided stable, reproducible anchorage in all cases, enabling complex three-dimensional tooth movements with minimal side effects. Sequential reuse of the same mini-implants for both indirect and direct anchorage reduced treatment invasiveness and enhanced anchorage efficiency. Combined skeletal expansion and posterior intrusion allowed improved transverse and vertical control in adult open-bite presentations. Pure incisor intrusion was achieved without molar extrusion or incisor proclination, while unilateral molar distalization was effectively managed using palatal skeletal anchorage. Across all cases, mini-implants enhanced treatment efficiency, reduced the need for auxiliary appliances, and ensured predictable outcomes. Conclusions: Orthodontic mini-implants represent a highly versatile and minimally invasive anchorage system adaptable to a broad range of biomechanical situations. Their ability to provide stable, reusable, and site-specific anchorage supports efficient correction of complex malocclusions and reinforces their pivotal role in contemporary orthodontic practice. Full article

(This article belongs to the Special Issue Esthetic Dentistry: Current Perspectives and Future Prospects)

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15 pages, 2006 KB

Open AccessArticle

Herbal and Alcohol-Free Mouthwashes as Chlorhexidine Alternatives for Preventing Enamel Demineralization in Orthodontic Patients: An In Vitro Study

by Nyema A. Abualsaud, Shahad T. Alameer, Lama M. Alshamrani, Abdulaziz S. Alamri, Naif N. Almasoud, Suliman Y. Shahin, Mohammed M. Gad, Osama A. Alsulaiman, Abdulrahman A. Balhaddad and Ahmed A. Alsulaiman

Dent. J. 2026, 14(3), 131; https://doi.org/10.3390/dj14030131 - 25 Feb 2026

Abstract

Background/Objectives: Chlorhexidine (CHX) and alcoholic (A+) mouthwashes are associated with adverse oral effects. Therefore, this study compared the efficacies of non-alcoholic mouthwashes, including fluoride (A−) and herbal (Hr) rinses, for preventing bacterial accumulation and enamel demineralization around metal brackets (MBs), ceramic brackets (CBs), [...] Read more.

Background/Objectives: Chlorhexidine (CHX) and alcoholic (A+) mouthwashes are associated with adverse oral effects. Therefore, this study compared the efficacies of non-alcoholic mouthwashes, including fluoride (A−) and herbal (Hr) rinses, for preventing bacterial accumulation and enamel demineralization around metal brackets (MBs), ceramic brackets (CBs), and resin composite attachments (RCAs). Methods: Following the exposure to CHX, A+, A−, and Hr rinses for 1 min, the growth of Streptococcus mutans on MB, CB, and RCA was assessed using colony-forming units and scanning electron microscopy (SEM). Controls included attachments without intervention. In another setting, enamel with bonded attachments was exposed to mouthwashes for 1 min and subjected to cariogenic demineralization for 24 h. Enamel’s Vickers microhardness was measured before and after the demineralization challenge. Data were analyzed using paired t-tests and one-/two-way ANOVA with Tukey’s tests. Results: CHX mouthwash demonstrated superior antimicrobial efficacy against S. mutans biofilms across all orthodontic attachments (p < 0.05). On metallic brackets, CHX (0 ± 0 log₁₀) and A− (1.7 ± 0.4 log₁₀) significantly (p < 0.001) outperformed controls (6.9 ± 0.1 log₁₀), Hr (6.08 ± 0.2 log₁₀), and A+ (6.2 ± 0.6 log₁₀). Similar patterns emerged for ceramic brackets, with CHX (0 ± 0 log10) and A− (1.4 ± 0 log10) superior to controls (6.6 ± 0.4 log₁₀). On resin composite attachments, CHX (2.9 ± 0.05 log₁₀) and Hr (3.4 ± 0.08 log₁₀) exceeded controls (5.4 ± 0.09 log₁₀) in inhibiting the biofilm growth (p < 0.05). Enamel microhardness reduction was significantly influenced by attachment type (p < 0.0001) and mouthwash type (p = 0.0063), with significant interaction between variables (p = 0.0052). Conclusions: CHX and A− mouthwashes effectively inhibited S. mutans biofilms on orthodontic attachments, while attachment type and mouthwash significantly influenced enamel microhardness reduction. Full article

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15 pages, 589 KB

Open AccessReview

Clear Aligner Therapy and Marginal Edge Design: Clinical and Laboratory Evidence on Periodontal and Biological Outcomes—A Scoping Review

by Emilia (Prodea) Rusu, Ana-Petra Lazăr, Bianca Luminița Erhan, Eugen Bud, Mariana Păcurar and Luminița Lazăr

Dent. J. 2026, 14(3), 130; https://doi.org/10.3390/dj14030130 - 24 Feb 2026

Abstract

Background: Clear aligner (CA) therapy has been increasingly adopted as an alternative to fixed orthodontic appliances. However, evidence regarding its periodontal effects, including gingival inflammation, biofilm composition, and the potential role of aligner marginal edge design, remains insufficiently mapped. The objective of this [...] Read more.

Background: Clear aligner (CA) therapy has been increasingly adopted as an alternative to fixed orthodontic appliances. However, evidence regarding its periodontal effects, including gingival inflammation, biofilm composition, and the potential role of aligner marginal edge design, remains insufficiently mapped. The objective of this scoping review was to map and synthesize available clinical and laboratory evidence on periodontal and biological outcomes associated with CA therapy, with particular attention to the potential influence of aligner marginal edge design. Methods: This scoping review followed PRISMA-ScR and the Population–Concept–Context (PCC) framework. PubMed, Scopus, and Web of Science were searched from 1 January 2015 to 24 October 2025. A total of 1587 records were identified; after deduplication, 770 unique records were screened by title and abstract, followed by full-text assessment of potentially eligible articles. Twenty-five primary studies published between 2020 and 2025 met eligibility criteria and were included in the review. Results: The final synthesis comprised clinical investigations, laboratory studies, and case reports. Clinical periodontal indices and inflammatory biomarkers were assessed using heterogeneous protocols and timepoints. Only three studies specifically addressed aligner marginal edge design; one directly compared margin configurations, reporting differences in local gingival response, with substantial diversity in study design precluding quantitative synthesis. Conclusions: Available evidence on periodontal outcomes during CA therapy is methodologically heterogeneous. Investigations of aligner marginal edge design remain scarce. Standardized assessment protocols and targeted clinical studies are needed to establish the periodontal relevance of trimline configurations. Full article

(This article belongs to the Special Issue Orthodontics and New Technologies: 2nd Edition)

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Graphical abstract

14 pages, 4950 KB

Open AccessCase Report

Extranodal NK/T-Cell Lymphoma, Nasal Type, Presenting as an Isolated Oral Manifestation

by Andrea Kanizsai, Ágnes Bán, László Kereskai and Árpád Szomor

Dent. J. 2026, 14(2), 129; https://doi.org/10.3390/dj14020129 - 23 Feb 2026

Abstract

Background/Objectives: Extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT), is a rare and extremely aggressive subtype of non-Hodgkin lymphoma that most frequently involves the nasal cavity and upper aerodigestive tract. Primary isolated oral manifestation is exceptionally uncommon and may mimic odontogenic or infectious diseases, [...] Read more.

Background/Objectives: Extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT), is a rare and extremely aggressive subtype of non-Hodgkin lymphoma that most frequently involves the nasal cavity and upper aerodigestive tract. Primary isolated oral manifestation is exceptionally uncommon and may mimic odontogenic or infectious diseases, delaying diagnosis. We report a case of ENKTCL-NT presenting initially as a destructive oral lesion without sinonasal involvement at diagnosis. Methods: A 32-year-old man with progressive palatal ulceration underwent clinical and imaging assessment (panoramic radiography and staging ^18F-FDG PET–CT) and repeated biopsies. Diagnosis was established using histopathology (H&E), immunohistochemistry (T-cell markers and cytotoxic profile), EBV detection by EBER in situ hybridization, and T-cell receptor gamma (TCRG) gene rearrangement analysis. Results: The lesion presented as a hemorrhagic, ulcerative palatal destruction covered by pseudomembranous exudate and was complicated by fungal infection, periostitis, and severe dental inflammatory foci, contributing to diagnostic delay. Histopathological examination revealed extensive necrosis with a dense atypical lymphoid infiltrate; angiocentric and angiodestructive growth was identified in one biopsy specimen. Tumor cells expressed T-cell markers (CD2, CD3, CD5, CD7; heterogeneous) and cytotoxic markers (TIA-1) and showed CD30 and CD56 positivity, with EBV positivity confirmed by EBER in situ hybridization. Molecular analysis demonstrated monoclonal TCRG rearrangement, and Ki-67 indicated high proliferative activity. Initial PET–CT demonstrated an intensely FDG-avid, locally invasive lesion without distant organ involvement. The patient was treated with L-asparaginase-based SMILE chemotherapy followed by radiotherapy (50 Gy), achieving marked initial clinical improvement and partial metabolic response; however, systemic relapse subsequently occurred with refractory disease despite salvage therapy and immunotherapy. Conclusions: This case highlights the substantial diagnostic challenge posed by isolated oral extranodal NK/T-cell lymphoma, nasal type, which may closely mimic benign inflammatory or infectious conditions and lead to significant diagnostic delay. Persistent, progressive, or therapy-resistant oral ulcerations should prompt early consideration of hematologic malignancy. Timely biopsy with comprehensive immunophenotyping, EBV testing, and close multidisciplinary collaboration are essential for accurate diagnosis and may contribute to earlier diagnosis and improved patient outcomes in these rare and atypical presentations. Full article

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13 pages, 1092 KB

Open AccessArticle

International Perspectives on Digital and Generative AI Adoption and Governance in Undergraduate Dental Education: A Cross-Sectional Survey

by Isabel C. Olegário, Niamh Coffey, Akhilanand Chaurasia and Albert Leung

Dent. J. 2026, 14(2), 128; https://doi.org/10.3390/dj14020128 - 23 Feb 2026

Abstract

Background/Objectives: Digital technologies and generative artificial intelligence (AI) are increasingly used in undergraduate dental education, yet international variations in adoption and governance remain insufficiently described. This study aimed to characterise cross-national patterns of educational software use, perceived importance for curriculum delivery, and institutional [...] Read more.

Background/Objectives: Digital technologies and generative artificial intelligence (AI) are increasingly used in undergraduate dental education, yet international variations in adoption and governance remain insufficiently described. This study aimed to characterise cross-national patterns of educational software use, perceived importance for curriculum delivery, and institutional readiness for AI governance. Methods: A cross-sectional online survey of educators and academic administrators involved in undergraduate dental education captured institutional software use across teaching delivery, learning management, assessment, clinical record systems, imaging, simulation, digital workflows, and generative AI. Results: A total of 97 respondents from 38 countries completed the survey, with most institutions delivering both undergraduate and postgraduate dental education (66.0%). Videoconferencing platforms were widely adopted. LMS provision varied, with Google Classroom, Moodle, and Blackboard most frequently reported. Paper-based clinical records remained in use in 32% of institutions. Among digital PMS/EDR platforms, axiUm, Salud/Titanium, and Carestream Dental were the most prevalent. Adoption of simulation software, CAD/CAM systems, and 3D printing was inconsistent. LMS and videoconferencing were most often rated as essential, whereas simulation, scanners, CAD/CAM, and 3D printing were generally considered useful but not essential. Generative AI use was commonly reported, while formal institutional guidance and policies were frequently absent. Conclusions: Although digital integration in undergraduate dental education is widespread, its distribution is uneven across different regions and technology domains. The combination of rapid generative AI uptake and limited governance highlights an urgent need for institution-level guidance, staff development, and strategic investment to support responsible and equitable integration. Full article

(This article belongs to the Special Issue Dental Education: Innovation and Challenge)

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14 pages, 6635 KB

Open AccessArticle

Human and Artificial Intelligence (AI) Analysis of Patient Experiences of Periodontal Graft Surgery

by William W. N. Mak, Timothy Budden, Sushil Kaur and Maurice J. Meade

Dent. J. 2026, 14(2), 127; https://doi.org/10.3390/dj14020127 - 23 Feb 2026

Abstract

Background/Objectives: The prominent role the internet plays in being a source of dental information prompts qualitative evaluation of relevant online content. This study aimed to explore patients’ experience regarding periodontal graft surgery communicated through the social media platform YouTube. Methods: An [...] Read more.

Background/Objectives: The prominent role the internet plays in being a source of dental information prompts qualitative evaluation of relevant online content. This study aimed to explore patients’ experience regarding periodontal graft surgery communicated through the social media platform YouTube. Methods: An initial YouTube search using the term “gum surgery experience” retrieved 40 videos. Graft surgery was the most frequently discussed procedure, and 19 relevant videos were included in the qualitative analysis. Video content was analysed using a combined human-centered and artificial intelligence (AI)–assisted approach. AI-supported analysis of viewer comments was conducted using ChatGPT-4 and Gemini-1.5 Pro. Themes generated by human and AI analyses were compared. Results: Nine key themes were identified from the 19 videos that satisfied selection criteria. Most themes were similar between human and AI analyses, with six overlapping and three unique. The most frequently coded theme was post-operative recovery (n = 177), with pain, work absence, eating difficulties, and disrupted oral hygiene commonly reported. Patient-clinician relationships were frequently highlighted, with mixed experiences regarding communication and trust. Positive experiences were reported more frequently than negative. Comment analysis revealed varied audience engagement and sentiments, emphasizing concerns about pain, recovery, and procedural anxiety. Conclusions: Key themes related to patient experiences were identified, notably concerns regarding post-operative recovery and patient-clinician relationships. Challenges in finding information prior to having surgeries motivated patients to provide support and advice on YouTube, emphasizing the need for patient-centered resources and effective patient-clinician communication. Integrating human and AI methods in qualitative analysis was efficient and insightful, with AI supplementing but not substituting human research. Full article

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16 pages, 1778 KB

Open AccessArticle

Caries Risk Assessment and Management in Europe: The Multi-Country Observational CARMEN Study

by José Frias-Bulhosa, Agnieszka Mielczarek, Nikolai Sharkov, Maria Gaveli, Ana Luísa Costa, Alberto Ogalla, Pierre-Marie Voisin, Sylvain Levet and Jean-Noel Vergnes

Dent. J. 2026, 14(2), 126; https://doi.org/10.3390/dj14020126 - 23 Feb 2026

Abstract

Background: This observational ambispective longitudinal international study explored dentists’ practices and patient records concerning dental caries risk management across four European countries (Bulgaria, Greece, Poland and Portugal). Methods: Dentist volunteers recruited patients needing caries risk management, either through preventive or curative measures, from [...] Read more.

Background: This observational ambispective longitudinal international study explored dentists’ practices and patient records concerning dental caries risk management across four European countries (Bulgaria, Greece, Poland and Portugal). Methods: Dentist volunteers recruited patients needing caries risk management, either through preventive or curative measures, from their regular practice. Analyses focused on assessing dentists’ practices in caries risk assessment and management, along with gathering information on patient and dentist characteristics, oral health assessments, and caries risk evaluation. Results: A total of 51 dentists recruited 1008 patients. Across the countries studied, caries risk assessment and management methods varied, with fewer than 15% of dentists using standardized tools. Primary assessment methods included oral examinations and medical interviews, while nutritional and fluoride intake assessments were less common, and salivary or microbiological tests were rare. There was an inverse association between the risk of dental caries and patients’ socioeconomic status. Specific university training on caries risk showed a positive correlation with adherence to recommendations. Conclusions: Our findings emphasize the importance of clinicians adapting their approaches to individual patient needs in caries risk assessment and management. However, the wide array of available risk assessment tools presents a challenge, underscoring the necessity of integrating biopsychosocial models into dental practice to effectively deliver personalized care. Full article

(This article belongs to the Special Issue Updates and Highlights in Cariology)

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14 pages, 2574 KB

Open AccessArticle

Anti-Inflammatory Effects on Periodontal Tissue and Antibacterial Effects on Oral Bacteria of Chlorogenic Acid

by Yuya Suzuki, Kosuke Maruyama, Masato Mikami and Soh Sato

Dent. J. 2026, 14(2), 125; https://doi.org/10.3390/dj14020125 - 22 Feb 2026

Abstract

Objectives: Combining mechanical plaque control, the physical removal of oral biofilm, with chemical plaque control, the use of agents to inhibit biofilm formation, is effective in preventing periodontal disease. Chlorogenic acid (CGA) found in coffee beans has medicinal effects, such as anti-inflammatory [...] Read more.

Objectives: Combining mechanical plaque control, the physical removal of oral biofilm, with chemical plaque control, the use of agents to inhibit biofilm formation, is effective in preventing periodontal disease. Chlorogenic acid (CGA) found in coffee beans has medicinal effects, such as anti-inflammatory and antibacterial properties. Periodontal pathogens are difficult to reach in certain areas with traditional self-care tools, such as toothbrushes. Additionally, the viscous biofilm is difficult to remove using mechanical plaque control alone. Therefore, this study aimed to evaluate the efficacy of CGA in chemical plaque control. Methods: The mRNA and protein expression of inflammatory cytokines in lipopolysaccharide (LPS)-stimulated human gingival fibroblasts (HGFs) and human periodontal ligament fibroblasts (HPDLs) in the presence of CGA were analyzed using reverse transcription-qPCR and enzyme-linked immunosorbent assay. Additionally, the proliferation levels of oral bacteria in the presence of CGA were evaluated. Results: CGA suppressed mRNA and protein expression levels of the inflammatory cytokines, interleukin (IL)-1β and IL-8, in HGFs and HPDLs stimulated with Porphyromonas gingivalis LPS. Furthermore, CGA inhibited bacterial proliferation of Streptococcus mutans, Aggregatibacter actinomycetemcomitans, P. gingivalis, and Fusobacterium nucleatum. Conclusions: This study demonstrated that CGA exhibits anti-inflammatory effects on gingiva and periodontal ligaments, and antibacterial effects against oral bacteria. These results indicate the potential application of CGA in chemical plaque control and suggest its use in preventing periodontal disease progression. Full article

(This article belongs to the Section Oral Hygiene, Periodontology and Peri-implant Diseases)

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13 pages, 890 KB

Open AccessArticle

Effects of At-Home Bleaching on Color Stability and Surface Roughness of Single-Shade, ORMOCER-Based, and Conventional Resin Composites

by Colwin Yee, Hassan Ziada and Neamat Hassan Abubakr

Dent. J. 2026, 14(2), 124; https://doi.org/10.3390/dj14020124 - 22 Feb 2026

Abstract

Background/Objectives: This study evaluated the effects of at-home bleaching on color stability (ΔE) and surface roughness (Ra) of a single-shade nanohybrid composite, an ORMOCER-based composite, and a conventional nanohybrid resin composite, acknowledging that bleaching represents only one of several clinical ageing challenges. [...] Read more.

Background/Objectives: This study evaluated the effects of at-home bleaching on color stability (ΔE) and surface roughness (Ra) of a single-shade nanohybrid composite, an ORMOCER-based composite, and a conventional nanohybrid resin composite, acknowledging that bleaching represents only one of several clinical ageing challenges. Methods: One hundred and five extracted, non-carious human molars received standardized Class I restorations and were randomly allocated to five groups (n = 21): an ORMOCER-based composite (Admira Fusion), a single-shade composite (Omnichroma), Omnichroma bonded with an alternative universal adhesive, and two conventional nanohybrid composites (Filtek Supreme Ultra and Harmonize). Baseline and experimental color (CIELAB, ΔE) were measured with a spectrophotometer, and surface roughness (Ra) was measured using a 3D optical profilometer. Specimens underwent five bleaching cycles using 22% carbamide peroxide, with each cycle consisting of 8 h of bleaching followed by 16 h of storage in artificial saliva at 37 °C. Measurements were taken at baseline and after each cycle. The data were analyzed using a repeated-measures ANOVA, with bleaching cycle as the within-subject factor, the effect sizes reported as partial eta-squared (ηp²), and the statistical significance set at α = 0.05. Results: All restorative materials exhibited progressive color change with repeated bleaching, and ΔE values exceeded established clinical acceptability thresholds across materials. The extent of color change varied among materials. None of the evaluated materials maintained clinically acceptable color stability following repeated bleaching cycles. The single-shade composite (Omnichroma) demonstrated the greatest magnitude of color change, particularly when bonded with Scotchbond Universal Bond. Admira Fusion and Filtek Supreme Ultra had lower ΔE values but still exceeded acceptability thresholds. Surface roughness generally decreased following bleaching, with statistically significant reductions in Ra observed for multiple materials. Admira Fusion and Omnichroma bonded with Tokuyama Universal Bond showed minimal surface alteration. Conclusions: All restorative materials demonstrated clinically unacceptable color changes following bleaching, indicating limited esthetic stability under bleaching conditions. ORMOCER-based composites showed comparatively greater resistance to surface roughness alterations. Full article

(This article belongs to the Special Issue Dental Materials Design and Application)

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11 pages, 1179 KB

Open AccessArticle

Clinical Outcomes of Bovine Bone Xenografts Following Sequestrectomy in Advanced Medication-Related Osteonecrosis of the Jaw

by Raluca Maracineanu, Ciprian Roi, Marilena Dinuti, Alexandra Roi, Florin Urtila, Anca Tudor, Ivona Mihaela Hum and Serban Talpos-Niculescu

Dent. J. 2026, 14(2), 123; https://doi.org/10.3390/dj14020123 - 21 Feb 2026

Abstract

Background/Objectives: Bisphosphonates, a class of drugs that are widely used in the treatment of neoplastic diseases, can lead to the development of medication-related osteonecrosis of the jaw (MRONJ). This condition is challenging to manage due to the high incidence of postoperative complications: [...] Read more.

Background/Objectives: Bisphosphonates, a class of drugs that are widely used in the treatment of neoplastic diseases, can lead to the development of medication-related osteonecrosis of the jaw (MRONJ). This condition is challenging to manage due to the high incidence of postoperative complications: superinfections, local wound dehiscence, or fractures in pathological bone. The aim of this study is to evaluate the therapeutic role of bovine-derived xenografts in the management of MRONJ. Methods: This retrospective observational study evaluates the clinical outcomes of patients with confirmed stage II or III MRONJ, after surgical treatment with Bio-Oss application. All patients had received zoledronic acid therapy, which was discontinued for a minimum of four months prior to surgical intervention. The surgical protocol included local debridement, sequestrectomy, and grafting of the residual defect with a bone substitute, followed by periodic clinical evaluations and monitoring of local healing with a follow-up period of up to one year. Results: Of the total number of patients treated according to this surgical protocol, 85.71% achieved favorable healing without complications at 8 weeks. Cases with poor local healing results were more likely to have prolonged zoledronic acid administration. Conclusions: Within the limits of this retrospective observational study, the use of bovine-derived xenografts following sequestrectomy in stage II–III MRONJ was associated with satisfactory local healing in several cases. However, considering the limited sample size and lack of a comparator group, these findings should be interpreted cautiously. To better understand the connection between the length of antiresorptive therapy, surgical management techniques, and postoperative outcomes, more prospective, multicenter trials with bigger patient cohorts are needed. Full article

(This article belongs to the Section Oral and Maxillofacial Surgery)

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21 pages, 5262 KB

Open AccessCase Report

Root Resective Procedures: A Case Series of Tooth Hemisection and Bicuspidization with Prosthetic Rehabilitation in Contemporary Dental Practice

by Sofia Sokratous, Andreas Krokidis and Nikolaos P. Kerezoudis

Dent. J. 2026, 14(2), 122; https://doi.org/10.3390/dj14020122 - 20 Feb 2026

Abstract

Background/Objective: Root resective procedures are well established tooth-preserving techniques used when pathology is confined to one root of a multirooted tooth or in the furcation area. Although in recent years implant therapy has become a standard approach in many cases, the rising [...] Read more.

Background/Objective: Root resective procedures are well established tooth-preserving techniques used when pathology is confined to one root of a multirooted tooth or in the furcation area. Although in recent years implant therapy has become a standard approach in many cases, the rising incidence of peri-implantitis has renewed interest in classical conservative treatment alternatives, such as hemisection, root resection and bicuspidization. The aim of this study is to present clinical cases in which hemisection and bicuspidization were performed to maintain compromised molars in function and achieve long-term outcomes. Methods: This retrospective case series study was conducted in a private dental practice and included three patients treated between 2009 and 2017. The presented cases involved molar teeth exhibiting a vertical fracture or extensive subgingival carries in one root while the remaining root(s) demonstrated favourable periodontal, endodontic and restorative prognosis. An interdisciplinary approach was followed in each case, involving comprehensive clinical and radiographic evaluation including cone beam computed tomography when indicated. The clinical treatment included an endodontic approach (primary treatment or retreatment if required) followed by hemisection or bicuspidization and placement of a permanent prosthetic rehabilitation with full-coverage restoration designed to optimize proper load distribution. Clinical and radiographic follow-up examination was done up to six years in case one, after six months in case two and up to six years in case three. Results: The teeth remained in function through their respective follow-up periods. Clinical and radiographic assessments, according to predefined success criteria, demonstrated periodontal stability (probing depth ≤ 4 mm), no evidence of secondary caries or root fracture, absence of clinical symptoms, normal tooth mobility and masticatory function, absence or reduction in periradicular radiolucency, and stable bone levels. Conclusions: Resective techniques require an interdisciplinary approach, namely, careful case selection, lege artis endodontic treatment, precise surgical technique, and appropriate prosthetic rehabilitation, in order to provide predictable and long-term outcomes. Within the limitations of this case series, resective techniques appeared to be a reliable and predictable alternative to extraction and implant placement in carefully selected clinical cases. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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14 pages, 666 KB

Open AccessArticle

Early Clinical Outcomes of Full-Arch Rehabilitations with Immediately Loaded Implants with Buccal Dehiscence Treated with Horizontal Augmentation: A 1-Year Retrospective Case Series

by Alfonso Acerra, Mario Caggiano, Angelo Aliberti, Michele Langone and Francesco Giordano

Dent. J. 2026, 14(2), 121; https://doi.org/10.3390/dj14020121 - 19 Feb 2026

Abstract

Background: Buccal bone dehiscence is a frequent finding during implant placement and often requires horizontal bone augmentation. When combined with immediate loading protocols, concerns remain regarding early implant stability and failure risk. This retrospective case series aimed to describe the early clinical [...] Read more.

Background: Buccal bone dehiscence is a frequent finding during implant placement and often requires horizontal bone augmentation. When combined with immediate loading protocols, concerns remain regarding early implant stability and failure risk. This retrospective case series aimed to describe the early clinical outcomes of immediately loaded implants placed in sites with buccal dehiscence treated by horizontal bone augmentation and restored with full-arch screw-retained prostheses. Methods: Fifty-nine consecutive edentulous patients were rehabilitated with immediately loaded cross-arch implant-supported prostheses. A total of 253 implants were placed, including 148 implants presenting buccal dehiscence and treated with horizontal bone augmentation using particulate grafting materials with or without autogenous bone and a resorbable collagen membrane. Clinical outcomes were assessed over a 1-year follow-up period. Implant survival and biological complications were recorded. Descriptive statistics were applied. An exploratory event-based comparison between augmented and non-augmented implants was performed using Fisher’s exact test, and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: At 1 year, no patients were lost to follow-up. Two implant failures occurred, both in augmented sites (2/148; 1.35%), while no failures were observed among non-augmented implants (0/105). The exploratory comparison did not show a statistically significant difference in failure rates between groups (p = 0.51). The estimated RR for implant failure associated with horizontal augmentation was 3.56 (95% CI: 0.17–73.34). Two biological complications (one peri-implantitis and one peri-implant mucositis) were recorded, both involving augmented implants. Conclusions: Within the limitations of this retrospective case series, immediately loaded implants placed in sites with buccal dehiscence and treated with horizontal bone augmentation demonstrated high early survival rates and a low incidence of biological complications. These findings are descriptive and exploratory and should be interpreted as hypothesis-generating. Further prospective controlled studies with longer follow-up are needed to confirm these observations. Full article

(This article belongs to the Special Issue Contemporary Dentistry: Classical and Modern Approaches)

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20 pages, 18996 KB

Open AccessArticle

Comparative Evaluation of Conventional and Digital Workflow Impressions for Implant-Supported Restorations

by Cristian Abad-Coronel, David Ruiz, Miguel Ángel Quelal, Diana Estrada, Nancy Mena Córdova and Paulina Aliaga

Dent. J. 2026, 14(2), 120; https://doi.org/10.3390/dj14020120 - 18 Feb 2026

Abstract

Background: Digital technologies, particularly CAD/CAM workflows, have transformed implant prosthodontics by improving the accuracy and efficiency of impression procedures, facilitating clinician–laboratory communication, and supporting the preservation of peri-implant tissues. Objective: To compare the three-dimensional accuracy (trueness) and passive fit of five conventional and [...] Read more.

Background: Digital technologies, particularly CAD/CAM workflows, have transformed implant prosthodontics by improving the accuracy and efficiency of impression procedures, facilitating clinician–laboratory communication, and supporting the preservation of peri-implant tissues. Objective: To compare the three-dimensional accuracy (trueness) and passive fit of five conventional and digital impression techniques for fixed prostheses supported by two implants. Methods: An in vitro experimental study was conducted using a partially edentulous maxillary model with two implants supporting a three-unit zirconia bridge. Five impression workflows were evaluated: conventional techniques (open-tray and closed-tray, splinted and non-splinted) and digital impressions using plastic and titanium scan bodies. Three-dimensional accuracy was assessed by digital superimposition analysis, and passive fit was evaluated by marginal gap measurements using digital microscopy and ImageJ (version 1.54r) software. Statistical analyses were performed using exploratory ANOVA with Welch’s correction and Games–Howell post hoc tests (p < 0.05), complemented by effect size analysis. Results: Three-dimensional superimposition analysis revealed that digital impression workflows and the splinted conventional open-tray technique exhibited the highest trueness, with minimal spatial deviations relative to the reference model, together with the lowest marginal gap values (<1 µm). The non-splinted open-tray technique presented higher discrepancies (7.37 ± 0.94 µm), although all techniques remained within clinically acceptable tolerance ranges (60–150 µm). Conclusions: Under controlled in vitro conditions, both digital impression techniques and conventional splinted protocols achieve high three-dimensional accuracy and clinically acceptable passive fit for multi-implant-supported fixed prostheses. Digital workflows represent a predictable and efficient alternative, while conventional splinted impressions remain a reliable option depending on clinical and technological considerations. Full article

(This article belongs to the Section Dental Implantology)

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20 pages, 2262 KB

Open AccessReview

Toward a Functional and Conceptual Framework for Adhesive Materials: The Role of Etching Technique

by Miguel Angel Muñoz and Issis Luque-Martinez

Dent. J. 2026, 14(2), 119; https://doi.org/10.3390/dj14020119 - 18 Feb 2026

Abstract

Background/Objectives: The classification of adhesive systems has historically relied on the type of etching agent and the sequence of application steps, distinguishing etch-and-rinse and self-etch categories. However, these models do not encompass the versatility introduced by universal adhesives or other emerging polymeric [...] Read more.

Background/Objectives: The classification of adhesive systems has historically relied on the type of etching agent and the sequence of application steps, distinguishing etch-and-rinse and self-etch categories. However, these models do not encompass the versatility introduced by universal adhesives or other emerging polymeric materials. This review aimed to integrate etching technique as a defining parameter within adhesive classification, linking material composition, bonding strategy, and clinical execution into a coherent functional framework. Methods: A structured narrative review of experimental, translational, and clinical studies published between 2010 and 2025 was conducted using PubMed and Scopus. Literature addressing adhesive categories, etching strategies, etching techniques, and smear layer characteristics was critically synthesized to identify functional relationships relevant to bonding performance and clinical decision-making. Results: The proposed taxonomy classifies materials as conventional, universal, touch-cure primers, self-adhesive/universal, and glass ionomer cements. Bonding strategies are organized as etch-and-rinse, self-etch, pre-etched, and unassisted, while etching techniques are defined as selective or nonselective families encompassing five clinically defined techniques. Incorporating etching technique clarifies the role of smear layer density, the acidity of adhesive materials, and functional monomer reactivity in demineralization and bonding. This structure enhances the understanding and teaching of adhesive concepts and supports evidence-based clinical selection of materials and techniques. Conclusions: Integrating etching technique into adhesive classification provides a functional and dynamic framework that unifies material, strategy, and technique. This taxonomy facilitates clinical decision-making and can evolve with future adhesive formulations. Further independent, long-term studies are warranted to validate the proposed combinations of materials and etching procedures. Full article

(This article belongs to the Special Issue Feature Papers in Restorative Dentistry, Endodontology and Traumatology)

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13 pages, 2522 KB

Open AccessArticle

Prevalence of Pre-Eruptive Intracoronal Resorption (PEIR) and Proposal of a Novel Classification: Retrospective Study with the Aid of Cone Beam Computed Tomography (CBCT)

by Emmanuel Mazinis, Konstantinos Ioannidis, Shanon Patel, Vassilis Karagiannis and Christos Gogos

Dent. J. 2026, 14(2), 118; https://doi.org/10.3390/dj14020118 - 17 Feb 2026

Abstract

Background/Objectives: Pre-eruptive intracoronal resorption (PEIR) in impacted or unerupted teeth often remains undiagnosed. The aim of this study was to investigate the prevalence of PEIR with the aid of cone beam computed tomography (CBCT) and propose a new three-dimensional (3D) classification for [...] Read more.

Background/Objectives: Pre-eruptive intracoronal resorption (PEIR) in impacted or unerupted teeth often remains undiagnosed. The aim of this study was to investigate the prevalence of PEIR with the aid of cone beam computed tomography (CBCT) and propose a new three-dimensional (3D) classification for the analysis of the lesions. Methods: A total of 164 unerupted teeth diagnosed in CBCT scans, derived from an equivalent number of patients, were examined for the presence of PEIR, tooth type, angulation and position. A novel 3D classification system was proposed and all PEIR lesions were further classified. The classification system was used to stage PEIR lesions according to their extend from the enamel level apically, the circumferential spread and their proximity to the pulp chamber. Descriptive statistics were used to assess the prevalence and type of resorption. The association between PEIR, demographics, tooth type, position and angulation were studied. The estimation of the multivariate relationship between PEIR, patient’s demographics and tooth characteristics was conducted with the multiple binary logistic regression model. Results: The prevalence of PEIR was 33.5%, affecting mostly maxillary canines, and maxillary and mandibular molars. The prevalence of PEIR in ages over 45 years was significantly higher (p < 0.001). The presence of PEIR was significantly associated with buccal position (p = 0.002) and buccal angulation (p = 0.016) of the tooth. Conclusions: Due to the high prevalence of PEIR, CBCT may improve detection and 3D characterization when imaging is already clinically indicated, and influence treatment planning in selected cases. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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14 pages, 1814 KB

Open AccessArticle

Gap Formation at Luting Interfaces of CAD/CAM Ceramic and Composite Partial Crowns Assessed by OCT

by Nadia Oberück, Dennis Palsa, Tobias Meißner, Marco Pellino, Rainer Haak, Ellen Schulz-Kornas and Dirk Ziebolz

Dent. J. 2026, 14(2), 116; https://doi.org/10.3390/dj14020116 - 17 Feb 2026

Abstract

(1) Background/Objectives: Gap formation contributes to the clinical failure of partial crowns. Therefore, it was analyzed at the interfaces between restoration, luting material, and tooth in partial crowns made of lithium disilicate ceramic (LS2) and nanohybrid composite (RBC) after thermomechanical loading (TCML) [...] Read more.

(1) Background/Objectives: Gap formation contributes to the clinical failure of partial crowns. Therefore, it was analyzed at the interfaces between restoration, luting material, and tooth in partial crowns made of lithium disilicate ceramic (LS2) and nanohybrid composite (RBC) after thermomechanical loading (TCML) using optical coherence tomography (OCT). (2) Materials and Methods: Sixteen human mandibular molars were restored with CAD/CAM partial crowns made of LS2 (IPS e.max^® CAD) or RBC (Tetric^® CAD) using adhesive cementation (Variolink^® Esthetic DC). The restorations were imaged by OCT (1550 nm, 28 kHz) at t0 = 24 h, t1 = 90 days of water, t2 = after TCML with 480,000 loading cycles, and t3 = TCML with 1,200,000 loading cycles. Gap lengths (%) at interface 1 (partial crown-luting material) and interface 2 (luting material–enamel/dentin) were quantified. Groupwise and pairwise comparison of OCT parameters was conducted using the Mann–Whitney U, Friedman, and Conover–Iman tests with Bonferroni correction (α = 0.05). (3) Results: At interface 1, LS2 showed a larger median gap length than RBC (ceramic = 48.4%; composite = 5.2%, p < 0.01). At interface 2, the largest median gap length for LS2 was measured at the dentin (ceramic = 59.7%; composite = 52.5%), while for RBC, the enamel was more affected (ceramic = 26.2%; composite = 36.9%). (4) Conclusions: OCT enables reliable gap detection in partial crowns under functional loading and is therefore suitable for monitoring adhesive interface integrity. Under in vitro conditions, both materials demonstrated stable adhesive performance without debonding, while material-dependent differences in gap formation and distribution were observed. Full article

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17 pages, 2170 KB

Open AccessArticle

Comparative Evaluation of Commercial Bulk-Fill Resin-Based Composites: Flexural Properties, Roughness, Water Sorption and Solubility, and Color Stability

by Khalid S. Almulhim, Sarah M. Alghamdi, Raghad S. Alqahtani, Jood K. Alsahiem, Afnan O. Al-Zain, Mohammed M. Gad and Abdulrahman A. Balhaddad

Dent. J. 2026, 14(2), 117; https://doi.org/10.3390/dj14020117 - 14 Feb 2026

Abstract

Background/Objectives: Bulk-fill (BF) resin-based composites (RBCs) have become increasingly popular due to their efficient placement. However, there is a lack of comprehensive performance comparisons among commercially available BF RBCs. In standardized curing conditions, this study aimed to compare the mechanical performance, water [...] Read more.

Background/Objectives: Bulk-fill (BF) resin-based composites (RBCs) have become increasingly popular due to their efficient placement. However, there is a lack of comprehensive performance comparisons among commercially available BF RBCs. In standardized curing conditions, this study aimed to compare the mechanical performance, water sorption and solubility, surface roughness, and color stability of commercially available BF RBCs with different consistencies (flowable and packable). Methods: Ten BF RBCs, along with a conventional RBC (control), were evaluated. Flexural strength and elastic modulus were measured using a three-point bending test. Water sorption and solubility were assessed after 28-day water storage. Color (ΔE₀₀) and surface roughness (ΔRa) changes were measured after 28-day immersion in water, Pepsi, or coffee. One-way ANOVA and Tukey’s tests analyzed the data. Results: 3M Flow, Shofu Bulk, and Ivoclar Flow revealed lower strength (p < 0.001) compared to 3M Bulk (132.17 ± 12.54 MPa) and the control (124.56 ± 15.60 MPa). Shofu Bulk (24.68 ± 12.55 µg/mm³) and Ivoclar Flow (27.11 ± 6.27 µg/mm³) were the least affected by water sorption. While Shofu Bulk (13.98 ± 11.39 µg/mm³), Ivoclar Flow (20.28 ± 6.64 µg/mm³), and SDR (20.84 ± 9.74 µg/mm³) exhibited the lowest solubility (p < 0.01). After water and Pepsi immersion, FGM Bulk showed a significant color change compared to 3M Bulk and Ivoclar Bulk (p < 0.05). Following coffee immersion, Shofu Bulk (17.38 ± 1.82) revealed significant color changes (p < 0.001). Increased surface roughness was observed in 3M Bulk and Ivoclar Bulk after water immersion, Shofu Bulk after Pepsi immersion, and FGM Bulk after coffee immersion. Conclusions: BF RBCs exhibit notable variability in their intrinsic properties. 3M Bulk and Control showed the highest strength, while Shofu Bulk had significant color changes. Full article

(This article belongs to the Section Dental Materials)

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19 pages, 509 KB

Open AccessArticle

Assessment of Language Barriers Between Dental Students and Patients in Riyadh, Saudi Arabia—A Mixed Methods Study

by Sanjeev B. Khanagar, Samar Alanazi, Razan Alotaibi, Hebah Alenazi and Lujain Altalhi

Dent. J. 2026, 14(2), 115; https://doi.org/10.3390/dj14020115 - 14 Feb 2026

Abstract

Background: Language serves as a significant barrier to accessing dental services. Dental treatment options are often complex and involve terminology that is unfamiliar to most patients. In some cases, dental students may use technical terms that patients do not understand, leading to [...] Read more.

Background: Language serves as a significant barrier to accessing dental services. Dental treatment options are often complex and involve terminology that is unfamiliar to most patients. In some cases, dental students may use technical terms that patients do not understand, leading to confusion and misunderstandings. Therefore, this study aimed to assess the language barriers faced by dental students and patients in Riyadh, Saudi Arabia. Methods: A mixed-methods research design was employed to evaluate language barriers between dental students and patients, as it provides an in-depth understanding and generates information beyond mere numerical data. The study was conducted from 1 September 2024, to 30 August 2025, in Riyadh, Saudi Arabia. Data collection primarily involved conducting interviews with focus group members using a comprehensive topic guide consisting of predetermined questions. Results: Forty dental students and forty patients agreed to participate in this study. The students encountered significant difficulty explaining terms such as crown lengthening (72.5%) and periodontitis (67.5%), while patients reported limited understanding of interim removable dental prosthesis (65%) and fixed dental prosthesis (60%). Comparative analysis indicated that sixth-year students reported significantly more difficulty explaining “crown lengthening” and “prefabricated post and core” compared to fifth-year students. It was also observed that patients’ educational level had a significant impact on their understanding of terms such as “interim dental prosthesis” and “removable dental prosthesis.” Qualitative analysis revealed patients’ partial understanding or misinterpretation of dental terminologies. Conclusions: Our findings indicate that language discordance, even among speakers of the same native language, can hinder effective communication, particularly when technical vocabulary is involved. Students may struggle to explain procedures in a manner that patients can easily understand. This can lead to incomplete patient comprehension and potential non-compliance with treatment recommendations. Hence, we recommend incorporating Arabic dental terminologies alongside English into the curriculum, developing bilingual glossaries, and using visual aids when communicating with patients. Full article

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18 pages, 792 KB

Open AccessReview

CBCT in Evaluation of Root Canal Preparation—A Scoping Review

by Andreia Vidal, Ana Moura Teles, Miguel Cardoso, Maria Bartolomeu and Rita Noites

Dent. J. 2026, 14(2), 114; https://doi.org/10.3390/dj14020114 - 14 Feb 2026

Abstract

Cone-beam computed tomography (CBCT) is widely utilized in endodontics for evaluating root canal shaping outcomes, offering critical three-dimensional imaging capabilities. This study aims to assess the differences in apical and root canal preparation across various instrumentation techniques using CBCT. A systematic search of [...] Read more.

Cone-beam computed tomography (CBCT) is widely utilized in endodontics for evaluating root canal shaping outcomes, offering critical three-dimensional imaging capabilities. This study aims to assess the differences in apical and root canal preparation across various instrumentation techniques using CBCT. A systematic search of the Medline database (via PubMed) and Web of Science was performed up to 12 April 2025, yielding a total of 70 studies, with 45 full-text articles assessed for eligibility; 28 were included in the review. Studies showed great heterogeneity in experimental design, anatomical variables, and outcome measurements. The results indicate that rotary instruments, such as ProTaper Next^® and XP-Endo Shaper^®, were reported more frequently or showed favorable shaping trends in individual studies. Although rotary systems often appeared advantageous, conclusions were limited by study design variability and a lack of correlation with clinical outcomes. The evidence highlights the need for standardized methodologies and further research, especially on manual techniques. CBCT remains a valuable research tool despite inherent spatial resolution limitations. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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