Search Results (222)

This study evaluated the effect of saliva contamination at different stages of application of an acetone-based universal adhesive on dentin bond strength. Seventy-two caries-free third molars were assigned to six groups (n = 12) according to contamination step. Specimens underwent shear bond strength testing. To determine the SBS, each bonded specimen was subjected to an SBS test in a universal testing machine (Shimadzu Autograph AGS-X; Shimadzu Corp., Kyoto, Japan) equipped for operating at a crosshead speed of 1 mm/min. Data were analyzed using one-way analysis of variance (ANOVA) followed by Tamhane’s T2 test for post hoc multiple comparisons with p ˂ 0.05 as the significance level. Saliva contamination significantly affected dentin bond strength (p < 0.001). The highest bond strength was observed in the post-polymerization contamination group with adhesive reapplication (12.32 MPa), whereas the lowest values were recorded when contamination occurred after the initial adhesive application (6.37 MPa). Overall, contamination prior to polymerization resulted in reduced bond strength, while reapplication of adhesive after polymerization improved bonding performance. Within the limitations of this in vitro study, salivary contamination adversely influences the dentin bonding effectiveness of acetone-based universal adhesives, particularly when it occurs before curing. However, adhesive reapplication following post-polymerization contamination may partially compensate for this effect. Full article

(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

The objective of this in vitro study was to investigate the effects of dentin pretreatment protocols and thermocycling on the shear bond strength (SBS) of a self-adhesive resin cement (Maxcem elite chroma) on dentin. A total of 168 extracted human third molars were randomly divided into four main groups according to dentin pretreatment: no treatment, 10% polyacrylic acid, Optibond universal, and Scotchbond universal plus. Half of these were subjected to thermocycling (5000 cycles; 5–55 °C). Composite resin rods were bonded using the self-adhesive resin cement, and SBS was measured with a universal testing machine. Two-way ANOVA showed that dentin pretreatment and thermocycling significantly affected SBS, with significant interaction between factors (p < 0.001). The highest SBS was observed in the Optibond universal group (18.71 ± 0.43 MPa), while the lowest SBS occurred in the 10% polyacrylic acid-treated group after thermocycling (2.69 ± 0.39 MPa). Thermocycling significantly reduced SBS in all groups. These results indicate that pretreatment with a compatible universal adhesive improves bond durability, whereas 10% polyacrylic acid pretreatment adversely affects bonding performance. Full article

Background: Post-extraction alveolar ridge is an important factor affecting dental implant restoration. Among myriads of bone grafting materials, dentinal grafts are gaining faster popularity among clinicians. Unlike conventional xenografts derived from animal sources, these autogenous materials may offer advantages in terms of biocompatibility and cost. Objective: This article aims to compare their performance with other commonly used materials, like xenografts, or natural blood clots and to examine whether they could maintain bone quality and quantity during socket healing with better properties than the rest of the graft materials in terms of implants success rate. Methods: This search was conducted in multiple medical databases (PubMed/MEDLINE, Scopus, Cochrane Library, Embase, and Google Scholar) for studies published between 2015 and 2025. This search focused exclusively on randomized controlled trials. The study quality was assigned by using the Cochrane Risk of Bias 2 tool, performing statistical pooling of results using random-effects meta-analysis when appropriate. Results: Eight randomized controlled trials involving 249 patients and 281 bone graft sites were selected according to inclusion and exclusion criteria. Dentinal grafts produced significant increase in formation of new bone compared to xenografts (12.4% greater, 95% CI: 6.8–18.0%, p < 0.001). The grafts also resorbed more completely, leaving less foreign material behind (8.6% less residual material, p < 0.001). Importantly, implants placed in bone preserved with dentinal grafts showed comparable stability and success rates to those in bone treated with xenografts. When compared to allowing sockets to heal naturally, dentinal grafts dramatically reduced bone loss by 60–70% horizontally and 65–75% vertically. Remarkably only minor complications were observed (2.2%), with no serious adverse events across all studies. Conclusions: Our analysis indicates that dentinal grafts represent a viable and potentially superior alternative to conventional xenografts for not only preserving alveolar bone after tooth extraction but also in any existing bone defects. The evidence particularly supports using partially demineralized preparations. These materials demonstrate excellent biocompatibility, produce good bone quality, and offer cost advantages. Full article

The aim was to evaluate the interface zone between glass hybrid (GH), high-viscosity (HV), and resin-modified (RM) glass-ionomer cements (GIC) and sound (SD) and artificially created caries-affected (ACAD) primary dentin. Occlusal cavities were prepared in 120 extracted primary molars and randomly assigned to SD or ACAD. Samples were restored with GH (Equia Forte HT-EF), HV-GIC (Equia Fill-E; Ketac Molar-KM), or RM-GIC (Fuji-II LC-FII; Photac Fill-PF) and exposed to thermal aging. Microleakage (methylene-blue) was analyzed using an optical digital microscope. The interface between dental tissues and restorative materials was analyzed using a scanning electron (SE) microscope. SE microphotographs were manually annotated for intimate contact and cracks/gaps at the material-enamel/dentin interface and analyzed using a custom Python-based algorithm to quantify the respective percentages. No microleakage was noted only in the SD group for EF (50%), FII (42%), and E (33%). All materials showed higher microleakage in ACAD than SD (p < 0.05). No continuous intimate contact between restorative material and dental tissues was observed along the entire interface. The mean proportion of intimate contact between the material and SD was EF (76%) > KM (55%) > E (38%) > FII (7%) > PF (4%), and EF (32%) > KM (24%) > E (16%) > FII (15%) > PF (0%) for ACAD (p < 0.05). Caries-induced demineralization affects the quality of the material–dentin interface. GH are likely to provide better sealing compared to the previous generations of GI materials. Full article

A three-dimensional finite element analysis (FEA) was performed to evaluate stress accumulation and distribution in endodontically treated immature and mature mandibular molars restored with endocrowns. Three tooth models representing different stages of root development (Cvek 2, Cvek 3, and mature) were generated from cone-beam computed tomography data. Endocrowns were fabricated using lithium disilicate (LDS) and resin nanoceramic (RNC). In immature teeth, two apexification strategies were simulated: a 3 mm mineral trioxide aggregate (MTA) apical plug followed by gutta-percha obturation, and complete canal obturation with MTA. All models were subjected to axial (600 N) and oblique (200 N) loading. A total of 20 finite element models were analysed. Endocrown material and loading direction were the main factors affecting von Mises stress distribution, whereas root development stage and apexification technique showed limited influence. LDS resulted in reduced stress transmission to the residual dentin, despite higher stress accumulation within the restoration itself. In the LDS groups, von Mises stress values in the root dentin ranged from 35.24 to 35.96 MPa under oblique and from 42.93 to 44.45 MPa under axial loading, while the RNC group exhibited higher values (39.36–40.40 MPa and 51.59–53.66 MPa, respectively). These findings indicate that endocrown restoration after apexification is a reliable treatment option for immature mandibular molars with extensive structural loss, with LDS demonstrating more favorable biomechanical behavior. Full article

Objectives: This study evaluated the effect of three root canal filling material (RCFM) removal techniques—mechanical, thermo-mechanical, and chemico-mechanical—on the micro push-out bond strength of fiber posts to root dentin in endodontically treated teeth. Materials and Methods: Forty-five single-rooted human premolars were endodontically treated and randomly allocated into three groups (n = 15) according to the RCFM removal technique used during post-space preparation: mechanical, thermo-mechanical, or chemico-mechanical. Fiber posts were luted using a dual-cure resin cement. Roots were embedded in resin and sectioned into coronal, middle, and apical thirds. Micro push-out bond strength was measured using a universal testing machine. Failure modes were examined under a stereomicroscope and validated using scanning electron microscopy. Statistical analysis used two-way ANOVA and Chi-square tests (α = 0.05). Results: Both the thermo-mechanical and mechanical groups showed significantly higher bond strength values than the chemico-mechanical group (p < 0.001). Across all groups, the coronal third recorded the highest bond strength, while the apical third presented the lowest values (p < 0.001). Adhesive failure at the dentin–cement interface was the most frequent failure mode. Conclusions: The gutta-percha removal technique and the root canal region significantly influence fiber-post bond strength. Solvent-based chemico-mechanical methods may adversely affect adhesion quality. Clinical Relevance: Thermo-mechanical and mechanical removal techniques may provide more reliable post retention during retreatment procedures, improving adhesion and reducing the risk of post debonding in daily practice. Full article

Background: X-linked hypophosphatemic rickets (XLH) is a rare hereditary disorder characterized by renal phosphate wasting and impaired bone mineralization. Oral manifestations such as spontaneous periapical lesions and dental abscesses in the absence of caries or trauma may precede systemic features in XLH due to underlying dentin hypomineralization and enamel–dentin junction defects, and could serve as early diagnostic indicators. Case Report: We report on the case of a 4-year-old boy referred to our pediatric dental unit with recurrent intraoral fistulas persisting over the past year. Clinical examinations and an orthopantomogram revealed extensive root resorption and periapical pathology affecting multiple primary molars without evident caries or trauma. Laboratory investigations showed hypophosphatemia, elevated renal phosphate loss, and raised inflammatory markers (CRP (C-reactive protein) and granulocytes). Genetic testing of the child and his mother confirmed a diagnosis of X-linked hypophosphatemic rickets. Management: Due to behavioral challenges, treatment proceeded with difficulty over multiple visits. Endodontic treatment was initiated using a formalin–resorcinol technique; however, several primary molars developed progressive necrosis and required extraction. Orthodontic space maintainers were placed to preserve arch integrity and support future eruption. The patient remains under follow-up and is currently awaiting Burosumab therapy. Despite systemic management, spontaneous necroses of the primary molars persist, highlighting the refractory nature of dental involvement in XLH. Conclusions: This case underscores the pivotal role of pediatric dentists in recognizing systemic diseases through oral findings and demonstrates the challenges of managing XLH-related dental pathology, even under targeted systemic therapy. Early interdisciplinary collaboration is essential to optimize both dental and systemic outcomes in affected children. Full article

Background: Pediatric syrups are frequently prescribed but may pose a risk to dental enamel due to their acidity and viscosity. Aim: To evaluate the erosive potential of commonly prescribed pediatric syrups on enamel from primary and permanent human teeth under ex vivo conditions. Design: Enamel–dentin blocks from sound primary and permanent teeth were assigned to nine groups (eight syrups and one control). Samples were immersed in their respective solutions four times daily for a 6-day exposure period. Mineral loss (ΔF) was assessed via Quantitative Light-Induced Fluorescence (QLF), surface roughness via profilometry, and morphological changes via scanning electron microscopy (SEM). Syrup pH and viscosity were also measured. Results: Significant ΔF changes were found only for dextromethorphan on primary enamel (p = 0.0054). No significant enamel loss was observed by profilometry. Surface roughness increased significantly with glycerin, distilled water, and azithromycin. Syrups showed a wide pH range (3.92–8.44) and varied viscosity, with ibuprofen and glycerin being the most viscous. Conclusions: Most pediatric syrups did not cause significant enamel demineralization or loss under short-term ex vivo exposure. However, increased surface roughness suggests that specific formulations may affect enamel texture, underscoring the need for preventive care in frequent users. Full article

Minimally invasive treatment is increasingly successful in managing carious lesions in primary teeth, owing to the regenerative capacity of the dental pulp and the possibility to influence the pulp–dentin complex. Chemo-mechanical caries excavation (CME) with Brix 3000, a papain-based enzymatic agent, allows selective removal of infected dentin while preserving affected dentin for potential remineralization. Fluorescence-aided caries excavation (FACE) enables visualization of porphyrins produced by cariogenic microorganisms, guiding selective dentin removal. In this study, 42 children aged 4–7 years with ICDAS II code 05–06 lesions in primary molars were treated, and the correlation between fluorescence intensity and cariogenic microbial load was evaluated. CME was performed using Brix 3000, and residual dentin was categorized by fluorescence as red, red with pale-pink areas, pale-pink, or non-fluorescent. Microbiological samples were collected pre- and post-excavation, cultured under standardized laboratory conditions, and quantitatively analyzed. Results showed that higher fluorescence intensity corresponded to increased presence of S. mutans (ρ = 0.945, p < 0.001), while other species were present in lower quantities. CME with Brix 3000 significantly reduced microbial load, and fluorescence reliably indicated areas requiring removal. These findings demonstrate that combining FACE with Brix 3000 allows precise, minimally invasive caries removal in primary teeth, providing an objective method to guide tissue-preserving excavation while effectively controlling cariogenic microorganisms. Full article

Aim: This in vitro study aimed to evaluate the marginal and internal fit of three monolithic CAD/CAM zirconia ceramics with different Y-TZP contents, prepared with chamfer and rounded shoulder finish lines. Methods. Sixty monolithic zirconia crowns were fabricated and divided into three groups (n = 20) based on their yttria content: (1) multilayer zirconia consisting of a dentin layer of 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) and an incisal layer of 5 mol% partially stabilized zirconia (5Y-PSZ), (2) shade-gradient zirconia fully composed of 3Y-TZP, and (3) shade-gradient zirconia containing 4 mol% partially stabilized zirconia (4Y-PSZ). Each group was further divided into two finish line configurations (chamfer and rounded shoulder). Marginal and internal gaps were measured using the silicone replica technique under a stereomicroscope by a single operator. Data were analyzed using three-way ANOVA followed by Tukey’s post hoc test (α = 0.05). Marginal and internal gaps were assessed using the silicone replica technique under a stereomicroscope by a single operator. Statistical analysis was performed with three-way ANOVA and Tukey’s post hoc test (p < 0.05). Results: The occlusal region exhibited the largest gap values, while the axial region showed the smallest across all groups. Mean marginal and internal gaps were 33.79 µm for chamfer and 43.37 µm for rounded shoulder finish lines. Zirconia with higher Y-TZP content demonstrated significantly greater gap values than those with lower percentages (p < 0.05). Significant interactions were found among finish line design, material type, and measurement region (p < 0.05), with rounded shoulder margins showing larger gaps (p = 0.001). Conclusions: Y-TZP content significantly affects marginal and internal adaptation, with higher percentages associated with increased gap values. Both finish line types produced clinically acceptable fits, although chamfer margins provided superior adaptation. Full article

Oral diseases pose a significant global public health challenge, affecting 3.5 billion people and surpassing the prevalence of major noncommunicable diseases. There is a growing burden of oral diseases, including dental caries, periodontal diseases, and dentine hypersensitivity (DH) from several countries in Southeast Asia including Malaysia, the Philippines, Vietnam, Thailand, Indonesia, and Taiwan. The impact of oral diseases on quality of life and their association with systemic health emphasize the need for preventive strategies and early interventions. The objectives of the Oral Health Steering Committee were to gain insights and a comprehensive picture of the oral disease burden in the Southeast Asian region including Malaysia, the Philippines, Vietnam, Thailand, Indonesia, and Taiwan, to highlight the importance of early prevention of oral health diseases, as well as the importance of identifying early symptoms of oral discomfort associated with oral diseases and to examine the correlation between oral diseases and systemic health. The committee included nine experts from the region with significant expertise in dental health. A steering committee of nine dental experts from seven Southeast Asian countries reviewed evidence on the burden of oral diseases, the prevention of oral discomfort in early diagnosis and its impact on systemic health. The association between oral health and systemic health was discussed by the group. The committee highlighted that there is a need for comprehensive public health strategies, including population-level preventive measures, professional evaluations, and awareness programs to improve oral health outcomes and reduce treatment costs. The role in interprofessional collaboration between dental professionals and medical professionals in achieving early identification of oral diseases and increases referrals to dental professionals at early stages of diseases was highlighted. These insights stress the importance of early diagnosis, prevention and targeted interventions to mitigate the impact of oral health issues and improve overall public health outcomes in the region. Full article

Background/Aim: Immature permanent teeth with necrotic pulps present thin dentinal walls and open apices, making them highly susceptible to cervical fractures even after apexification. This study aimed to compare stress distribution patterns produced by different coronal base materials following mineral trioxide aggregate (MTA) apexification using three-dimensional finite element analysis (FEA). Materials and Methods: A CBCT-based model of a maxillary immature incisor was reconstructed and modified to simulate six restorative scenarios: control (sound tooth), MTA + conventional glass ionomer cement (GIC), MTA + resin-modified glass ionomer cement (RMGIC), MTA + bulk-fill flowable composite, MTA + conventional composite resin, and MTA + flowable composite resin. A 100 N oblique load (45°) was applied, and von Mises stress, displacement, and periodontal ligament strain were analyzed. Inter-model comparisons were performed using one-way ANOVA with Tukey post hoc tests (p < 0.05). Results: All models exhibited maximum stress concentration in the cervical third of the root. Bulk-fill flowable composite and RMGIC generated lower cervical stress and more homogeneous distribution compared with GIC or conventional composite resin. Conventional composite resin produced the highest stress concentration due to its higher stiffness. Derived biomechanical metrics confirmed statistically significant differences between groups (p < 0.05). Conclusions: The coronal base material strongly affects the biomechanical behavior of immature incisors restored after MTA apexification. Selecting low-modulus, stress-dissipating materials such as bulk-fill flowable composites or RMGICs may minimize cervical stress and potentially reduce fracture risk. These computational findings warrant validation through in vitro and clinical studies. Full article

Background/Objectives: Adhesion to caries-affected dentin remains challenging due to its altered structure and composition. Remineralizing agents have been proposed to strengthen this substrate and improve bonding. This study evaluated the effect of three remineralization treatments, CPP-ACP, self-assembling peptide P11-4, and silver diamine fluoride (SDF), on the microtensile bond strength (μTBS) of universal adhesive systems applied to caries-affected dentin, using both etch-and-rinse and self-etch strategies. Methods: Seventy human molars were sectioned and artificially demineralized to simulate caries-affected dentin. Samples were divided into ten groups: four untreated and six treated with CPP-ACP (MI Paste™), P11-4 (Curodont™ Protect), or SDF (Riva Star™). Universal adhesives were applied via etch-and-rinse or self-etch mode, followed by composite restoration. Microtensile bond strength was measured using a universal testing machine, and results were statistically analyzed with ANOVA and t-tests (p < 0.05). Results: Untreated caries-affected dentin showed significantly lower μTBS than sound dentin (C3: 18.3 ± 5.4 MPa vs. C1: 41.3 ± 2.7 MPa). Remineralization agents improved μTBS considerably. CPP-ACP achieved the highest recovery (S1: 31.8 ± 2.6 MPa; S2: 29.2 ± 4.6 MPa), nearing sound dentin levels. P11-4 yielded moderate gains (S3: 24.4 ± 6.5 MPa; S4: 24.1 ± 4.7 MPa), while SDF provided the lowest, yet significant, improvements (S5: 23.7 ± 7.5 MPa; S6: 21.3 ± 5.3 MPa). Etch-and-rinse generally produced higher μTBS than self-etch, but differences were not statistically significant (p > 0.05). Conclusions: Pre-treatment of caries-affected dentin with CPP-ACP, P11-4, or SDF enhances universal adhesive bond strength, with CPP-ACP showing the most pronounced effect. Remineralization protocols represent a valuable adjunct in restorative procedures involving compromised dentin. Full article

Dilated Composite Odontoma also known as Dens invaginatus, “dens in dente”, or “tooth within tooth” is a rare dental anomaly resulting from enamel organ infolding during tooth development, often leading to complications like caries and pulp infection. With a prevalence of 7.45%, it commonly affects upper lateral incisors, predominantly as a Type I morphology. Mesiodens, a supernumerary tooth in the anterior maxillary midline, occurs in 89.7% of single cases and 10.3% of bilateral cases. The coexistence of dens invaginatus in a mesiodens is extremely rare, posing diagnostic and treatment challenges. This report presents a unique case of dentin invagination in a mesiodens. Full article